Embedding the INSPIRE strategy
Developing the toolbox.
Catherine Atkinson - AHP Consultant in neuro rehab/ occupational therapist BHSc MSc
Jacqueline Twelfree - Clinical Lead for neuro rehab/ physiotherapist BSc MSc
Homerton Healthcare
NHS Foundation Trust
I
N
S
P
I
RE
Improving
Neurology and
Stroke Services
Patient experience
Integration and
The INSPIRE strategy aims to ensure a population health approach to improve neurological care. Social and economic disadvantages often limit access to resources, opportunities, and care, leading to poorer health outcomes. Understanding our population will help us provide the right services in the right way.
Rehabilitation
The INSPIRE strategy aims to ensure a population health approach to improve neurological care. Social and economic disadvantages often limit access to resources, opportunities, and care, leading to poorer health outcomes. Understanding our population will help us provide the right services in the right way.
Population: 259,200 Hackney
8,600 City of
London
Age*: 20.3% <18yrs 68.4% 19-64yrs 9.5% 65yrs+
Hackney is 9th most deprived of London boroughs *77.9% reg. population living in the most deprived 30%
Hackney is the third most densely populated of all London's boroughs
Ethnicity: 46.7% White, 18.2% Black; 14.5% other; 9.9% Asian; 5% mixed; 5% NK. (NEL ICB Patient master index (PMI))
490 people with Acquired Brain Injuries
428
people with
Multiple
Sclerosis
Ethnicity: 46.7% White, 18.2% Black; 14.5% other; 9.9% Asian; 5% mixed; 5% NK. (NEL ICB Patient master index (PMI))
530
with
Parkinson's disease
1325
people had
a stroke
3830
neurology
referrals
neurology outpatients appmts
1325 people had a stroke
3830
neurology
referrals
3001
acute
discharges
per year*
days average
length of
stay*
6%
of HHFT A&E
attendances*
10 Homerton services with over >200 WTE staff
INSPIRE Aims:
Provide an overarching strategy for the development of stroke, neurology and neuro-rehab services in line with HHFT's 'Our Future Together' strategy and the NEL ICB strategy for stroke and neuro-rehab.
Provide an integrated and comprehensive approach to stroke, neurology and neuro-rehabilitation.
Support a transformational programme of work to implement the strategy.
Provide a strategic forum to discuss and action wider ICB and national stroke, neurology and neurorehab developments and progress actions across pathways.
Support stroke and neuro rehab training, workforce development, and research opportunities within HHFT and NEL.
To take a data driven, population health approach to ensure our services meet the needs of the population we serve.
Improving collaboration and communication
Delivering clinical expertise at the right time in the right place
Key Themes
Developing a ready and able workforce
Improving collaboration and communication
Developing seamless pathways of care
Developing a culture of research, innovation and improvement
Strengthening our partnerships and supporting the region
Developing the strategy
Stakeholders
Pathway mapping
Transformation board
Strategy launch
Patients and carers
HHFT Staff
Pathways for Patient with long term, congenital and hereditary condition
Communication plan
Monthly meeting, chaired by divisional directors
Online presence
Outpatient neurology
Neurology phone line
Diagnostics / investigations
Inpatient admission
Primary care and regional colleagues
Inpatient rehabilitation services
ANTS / RAAR
Acute Stroke unit
HTNRU (Level 2b)
RNRU (Level 1)
Key service leads and non clinical teams e.g. finance
Stakeholder engagement
Key service leads and non clinical teams e.g. finance
Charitable and voluntary services
Specialist HHT OP
Specialist injection therapy
Neuro orthotics
Other specialist OP
Vocal rehab level 1
neuro orthoptics
Augmented and alternative communication AAC
Specialist Neurology
Practitioners/ nurses
Epilepsy
Parkinson's Disease
MS
MND
Community health and rehabilitation services
Community palliative care and hospice
Support and governance for projects
Local award nomination
Adult social services Children and young people services Housing
DWP and benefits Community, Voluntary, and Social Enterprise Groups
= Two-way pathway
Workstreams and project delivery
Supported by:
INSPIRE Transformation board
QI
Informatics
Embedding the strategy: INSPIRE tool box
Data Dashboard in
development:
: Local Admission and activity data
: National neurology dashboard
: ICB population health data
Transformation Board
6 weekly, strong attendance
4 Active projects
3 in development
Coproduction: INSPIRE Community Voices
programme
6 workshops to co-produce
engagement options for individual
projects, transformation
Overview.
Stroke & neuro community Rehab Core Offer
•Response to ICB programme
Benchmarking NEL services
Optimising integrated
Stroke and neuro
provision (IIT / ACRT)
Focus on improving
access and intensity
Stroke listening event
MS & PD patient
experience, ACRT
forum
Parkinson's ACP Business Case
Neuro Injection Therapy Service
Peer Mentor Programme
Develop ACP role for Parkinsons across acute and community• Acute support• Complex community• Parkinsons UK audit Established new Consultant physio role to deliver:• Expanded adult focal spasticity service (botulinum toxin)• Hemiplegic shoulder pain service • Working with the Peer Connect team to establish peer mentor provision for• LTNC's (PD, MS, FND)• Stroke pathway
Established new Consultant physio role to deliver:
Expanded adult focal spasticity service (botulinum toxin)
Hemiplegic shoulder pain service
Sialorrhea service
Acute Neuro Pathway Project
Improving patient safety, experience and flow:
Understanding the challenges for specific patient groups (FND, SCI, Behaviours that challenge)
Addressing access to expertise
Developing agreed pathways for liaison neurologv
Pathway navigation
Reviewing and developing how service and pathway information is shared with colleagues, referrers and patients. Internet and intranet review
Community Neurology Clinics
Moving specialist services closer to the community.
PD service patient feedback [F2] INSPIRE listening event feedback
Evaluation feedback
Peer connect
mentorship
programme
questionnaire and
fellow engagement
Expectation set that all projects have patient experience embedded.
Evaluation, outcomes and next steps
Evaluation and Governance: through Trust quality board
presentations
6 month review of work completed, in action.
• Communication plan across acute, community and stakeholders Outcomes:
Project outcomes clearly reported through project updates
Impact analysis to be shared across the pathways and themes
Lived experience feedback and engagement
Data - reduction in unplanned care etc
"How things will look and feel better"
Functional outcomes for the strategy themes
Ripple effect mapping
Capturing the wider impacts and adaptive nature of this system approach to improving neurological and stroke services, patient experience and Rehabilitation.