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# 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

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Improving

## Homerton Healthcare NHS Foundation Trust

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Neurology and

S

P

Stroke Services

Patient experience

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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

RE

Population: 259,200 Hackney

8,600 City of

London

490 people with Acquired Brain Injuries

Age*: 20.3% <18yrs 68.4% 19-64yrs 9.5% 65yrs+

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))



Hackney is 9th most deprived of London boroughs *77.9% reg. population living in the most deprived 30%

530

with

Parkinson's disease

Hackney is the third most densely populated of all London's boroughs

1325 people had a stroke

3830

neurology

referrals

Focal spasticity

Graham

Stroke Unit

RNRU outreach team

Wheelchair services

Acute wards and ANTS

Urology and other specialties

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INSPIRE

10.5k

neurology

outpatients

appmts

Community neuro rehab: ACRT / IIT

HTNRU

Orthotics

RNRU

Primary care services

Neuro navigation

3001 acute

discharges per year*

Specialist outpatient services

MS and PD practitioners

13 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.

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## Key Themes

Delivering clinical expertise at the right time in the right place

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Developing a ready and able workforce

• To take a data driven, population health approach to ensure our services meet the needs of the population we serve.

Improving collaboration and communication



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Developing seamless pathways of care

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Developing a culture of research, innovation and improvement

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Strengthening our partnerships and supporting the region

## Developing the strategy

## Stakeholders

• Patients and carers

• HHFT Staff

• Primary care and regional colleagues

• Charitable and voluntary services

## Pathway mapping

Pathways for Patient with long term, congenital and hereditary condition

Outpatient neurology

Neurology phone line

Diagnostics / investigations

Inpatient admission

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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

Adult social services Children and young people services Housing

DWP and benefits Community, Voluntary, and Social Enterprise Groups

## Transformation board

Monthly meeting, chaired by divisional directors

• Key service leads and non clinical teams e.g. finance

= Two-way pathway

• Support and governance for projects

## Strategy launch

• Communication plan

• Online presence

• Stakeholder engagement

- Local award nomination

## Workstreams and project delivery

Supported by:

• INSPIRE Transformation board

• QI

• Informatics

## Embedding the strategy: INSPIRE tool box

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Data Dashboard in

development:

: Local Admission and activity data

: National neurology dashboard

: ICB population health data

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## Transformation Board

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## Stroke & neuro community Rehab Core Offer

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6 weekly, strong attendance

4 Active projects

3 in development

•Response to ICB programme

Coproduction: INSPIRE Community Voices

Optimising integrated

Stroke and neuro

provision (IIT / ACRT)

Focus on improving

access and intensity

• Benchmarking NEL services

programme

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6 workshops to co-produce

engagement options for individual

projects, transformation

Overview.

Stroke listening event

MS & PD patient

experience, ACRT

forum

## Parkinson's ACP Business Case

• Develop ACP role for Parkinsons across acute and community

• Acute support

• Complex community

• Parkinsons UK audit

## Neuro Injection Therapy Service

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PD service patient

feedback

Established new Consultant physio role to deliver:

questionnaire and

fellow engagement

• Expanded adult focal spasticity service (botulinum toxin)

• Hemiplegic shoulder pain service

• Sialorrhea service

## Community Neurology Clinics

## Peer Mentor Programme

• Working with the Peer Connect team to establish peer mentor provision for LTNC's (PD, MS, FND)

• Stroke pathway

## Evaluation feedback

Understanding the challenges for specific patient groups (FND, SCI, Behaviours that challenge)

Addressing access to expertise

## Acute Neuro Pathway Project

Improving patient safety, experience and flow:

Developing agreed pathways for liaison neurologv

Peer connect

mentorship

programme

• Moving specialist services closer to the community.

improving access, patient experience, MDT collaboration.

• Neuro rehab

• MS

Reviewing and developing how service and pathway information is shared with colleagues, referrers and patients. Internet and intranet review

INSPIRE listening

event feedback

## Pathway navigation

PD complex care

Expectation set that all projects have patient experience embedded.

## Evaluation, outcomes and next steps

• Evaluation and Governance: through Trust quality board

presentations

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• 6 month review of work completed, in action.

• Communication plan across acute, community and stakeholders Outcomes:

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• 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.



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Contact:

catherine.atkinson1@nhs.net



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Jacqueline.twelftree@nhs.net

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https://www.homerton.nhs.uk/inspire

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