NWL Neuro-Rehabilitation Programme

Jess Henderson, Davina

Richardson, Susan Brown

May 2016

Who we are

We are a partnership organisation bringing together the academic and health

science communities across North West London. We are also the designated

Academic Health Science Network (AHSN) for the same area.

We’re here to deliver demonstrable improvements in health and wealth for the

people of North West London and beyond through collaboration and innovation.

Our partners in North West London

Our three strategic priorities

We’re focused on:

• enabling discovery of new ideas and innovations, and then facilitating the adoption and diffusion of

these across the NHS

• reducing variation and spreading best practice across healthcare

• strengthening synergy between the NHS and industry for the benefit of patients and to create wealth for

the local population, the NHS and the UK.

Neuro-rehabilitation – the problem

Complex pathway

Staff gave an average score of just over 2/5 about how well the

referral pathway worked

Too many variables in forms when units

surely all need to know the same

information Poor feedback from accepting

and declining units Reliance on paper based

communication when email would be much

quicker

Not a clear process. Each unit has their own

criteria/method of assessment and it is only

because our therapists have so much

experience that we can navigate through the

process/

Variable service, often no acknowledgement

of referral, info on likely assessment date or

likely wait for bed. At least level 1 units have

single form. It would be nice if all bedded

units had single form

A lot of paperwork and chasing

A proposed pilot

What is Badgernet?

A North West London pilot which aimed to:

• Improve the neuro-rehabilitation referral

pathway

• Collect information to improve the quality of

services and enable commissioners to

commission smartly

The pilot started in September, and has

included:

• 8 L1 neuro-rehabilitation units

• 7 L2b/ 3 neuro-rehabilitation units

• 8 referring hospitals

8 referring hospitals 15 neuro-rehab services were involved in the

pilot

Referrers Providers

Imperial College Healthcare Trust

• Charing Cross Hospital

• Hammersmith Hospital

• St Mary’s Hospital

Hillingdon Neuro-Rehabilitation Services:

• Alderbourne Unit

• Daniel Unit

London North West Healthcare NHS Trust

• Ealing Hospital

• Northwick Park Hospital

• Central Middlesex Hospital

Royal Free Neurological Rehabilitation Service

Chelsea and Westminster NHS Foundation Trust

• Chelsea and Westminster Hospital

• West Middlesex Hospital

Robertson Neurological Rehabilitation Service

Charing Cross Neuro-Rehabilitation Unit

Clayponds Hospital

Central London Community Health:

• Athlone Unit

8 x L1 Neuro-Rehabilitation Services across

London (not directly involved)

We agreed some new standards to work towards to accompany

the pilot

Consolidation of paperwork to

two referral forms:

• One for L2b/3 units

• Adherence to the L1

Consortium Form

Referral to assessment time for

L2b/3 units of 7 days. Baseline

of 8.04 days (UKROC data)

Referral to admission time for

L2b/3 units of 14 days (inc

weekend). Baseline of 17.37

days (UKROC data)

Saving of £741 per patient

What have we learned about our provision

of neuro-rehabilitation in NWL?

So what has been achieved?

For our 8 North West London CCGs we have recorded in the period 1st September- 31st March:

Referrals:

• 155 referrals made into L2b/L3 units

• 122 accepted

• 23 declined

• 10 open referrals

Admissions

• 72 L2b admissions

• 55 L3 admissions

Active waiting list

• 3 on the L1 active waiting list

• 12 on the L2b/3 active waiting list

We are also getting an understanding of patient needs and

whether services are sufficiently responsive

30%

52%

4%

4%

1% 7%

2%

Referral Reasons in NWL

Multiple reasons

Primarily complexphysical

Primarily cognitivebehavioral

Assessment of lowawareness state

Advice for appropriateplacement

Other

Not recorded

0

20

40

60

80

100

120

Average wait by referral reason

Number of Patients Average wait

One outlier of 206

days, and another

with an 81 day wait

The system allows for identification of savings

*The data does not include a small amount of forwarded referrals as they do not highlight actual service performance

0

2

4

6

8

10

12

14

16

18

20

NHS BrentCCG

NHS EalingCCG

NHS HarrowCCG

NHS WestLondon CCG

NHS CentralLondon CCG

NHSHammersmithand Fulham

CCG

NHS HounslowCCG

NHS HillingdonCCG

Average Referral to Admission by CCG

The overall average wait is

11.4 days, a reduction from

17.4 days for 127 patients.

This represents a saving of

£168k in 7 months (using

£220 cost for average bed

day)

We can see variation across

our CCGs, and it may give

an indication of a need to

review process or capacity

to understand the drivers for

this. The sample size

remains small so the data is

easily skewed by one outlier

How are our providers performing?

0

5

10

15

20

25

30

35

40

45

50

Charing Cross Neuro-Rehabilitation Unit (L2b)

Hillingdon RehabilitationService (L2b)

RNRU Homerton (L2b) Robertson NeurologicalRehabilitation Unit (L2b)

Royal Free NeurologicalRehabilitation Centre (L2b)

Athlone Rehabilitation Unit(L3)

Clayponds Hospital (L3)

Neuro-Rehab Units - Volumes and Waits

Number of patients Average referral to admission time

NR Unit 1 (L2b) NR Unit 2 (L2b) NR Unit 3 (L2b) NR Unit 4 (L2b) NR Unit 5 (L2b) NR Unit 6 (L3) NR Unit 7 (L3)

Staff have reported an improvement

General feedback is that that providers need to

complete their sections better.

Glitches have been addressed on an ongoing

basis.

There would be a benefit in having this available

pan London

As a system, there are still some user

training issues, but the overall

process for referring is quicker and

we don't have to wrestle with fax

machines.

Overall Benefits

Patients:

• Supporting faster access to neuro-rehabilitation services to accelerate recovery

• Better communication between services ensuring patients are accessing the right care, in the right location at the right time

• Allows for review of local services to ensure they are optimised

Clinical Staff:

• More transparency through the referral process, this means less time chasing paperwork and more time available to spend with patients

• An audit trail of actions taken regarding patients and referrals

• Education around available services for patients

• Beds are freed up in acute trusts for patients who need them

Commissioners:

• Access to non-identifiable data which was previously unavailable, allowing for greater visibility of provider and acute performance to enable smarter investment in services

• Savings generated through efficiencies

Neuro-Navigator Service

19

What patients told us

20

Lack of engagement with patients and families

Delays in accessing appropriate care

Feeling ‘lost’ and ‘abandoned’ on discharge from rehab

Don’t know what help they can get access to, and who to ask

So – how have I helped?

21

Close working with clinical teams in acute

- attendance at therapy MDTs allows earlier referral, advising on most appropriate referral, changing

pathway in response to changing needs of patients

Liaison with consultants /therapists from specialist rehabilitation units

- they get up-to-date information on patients and priorities for admission

- allows me to get information on local capacity

Family support as early as possible and through the pathway

- Link in transition between services

- Consistent point of contact

Benefits

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• To patients

• Getting people in the right place to meet their needs, at the right time

• To clinical staff

• Upskilling/ education about specialist and local rehab services

• Sustains good practice in appropriate referral

• Time – can chase referrals and save clinical time

• To the health system

• Appropriate use of specialist resource - through reduced inappropriate referrals

• Days saved in acute – estimate in first 8 months 165-180=GBP 45,000-50,000

Future challenges and

developments

23

• Continue to collect acute days saved /DToC data

• Qualitative feedback from service users – clinicians and patients

• Feedback information on use of services / gap analysis

Questions?