After experiencing an acute stroke, patients come to the 20-bed Oxfordshire Stroke Rehabilitation Unit at Abingdon Community Hospital as part of their care pathway. They normally stay at the service, run by Oxford Health NHS Foundation Trust, for around four weeks before they’re discharged home or to other locations in the community.
Follow-up rehab is usually provided by the county’s community therapy service, but with the Covid-19 pandemic in March came a national focus on patients being discharged from hospital, and rehab services were put on the backburner.
“At the same time, two of our allied health professionals were shielding, and couldn’t work face-to-face, and we had patients discharged without being followed up,” says Emma Garratt, clinical lead physiotherapist and interim ward manager at Oxfordshire Stroke Rehab Unit.
The team decided to set up its own follow-up service, aiming to provide advice and support, and ongoing rehab. They have since followed up almost 80 patients who have been discharged from the service.
Garratt says they have seen some ‘brilliant’ success stories so far, with patients who have made great progress, including getting back to driving and work.
“Covid forced a lot of services to innovate and look at how they work. This was an idea one week and put into action the next. We thought, ‘We have staff who can’t work on the ward, and patients who need support, so let’s find a way to do that’.”
The follow-up starts with a phone call, then remains either telephone follow-ups or transfers to video calls. Garratt says there’s an effort to move on to video calls for as many patients as possible, although for some this isn’t feasible.
“For some patients, it’s been more about advice and support, acting as a signposting service, answering queries that have cropped up, that they’re not sure who else to ask.
“For other patients, it’s been very much a rehab-focused process, with one or two sessions a week to progress their exercise programmes, mobility and independence” she says.
“It very much feels like the service meets a need, and it does different things for different people.”
Now, Garratt feels the programme is at a point where it needs evaluating, and the team is collecting patient data with the aim of measuring its impact. Staff are also collecting feedback from patients, which Garratt says has been ‘overwhelmingly positive’. A patient discharged home during lockdown said: ‘The remote sessions have given me exactly what I need, and I feel that I am making steady and good progress towards my aim of a very good recovery to a pre-stroke situation’.
There isn’t a specialist community neurological rehab service in Oxfordshire, so before the pandemic, patients leaving the stroke rehab unit would be followed up by a generic community service that doesn’t necessarily specialise in stroke.
The new service allows patients to be followed up by clinicians who normally work in the rehab unit, and who are familiar with the patient pathway, the service and its staff. This allows good continuity of care, Garratt says.
Garratt, who also has a good knowledge of the patients, has been having weekly meetings with the therapists working in the follow-up service, giving them advice where needed.
“Continuous care is really valuable for patients. It helps them feel like they’re not being passed from one group of people to another, and that the whole process isn’t starting again. Ideally, we would like the process of people moving through the stroke pathway to feel quite seamless for them, even if we’re juggling things behind the scenes,” she says.
“Simple things, like a therapist having access to a patient’s admission notes and having direct links with that service, helps with this. The programme isn’t currently using any extra resources, it’s simply making use of staff who are shielding, who otherwise would have been at home or redeployed.”
They’ve had a locum filling in for this on the ward, Garratt says, but otherwise, the service hasn’t had any additional funding. In order to run the service long term there would need to be extra resources, which Garratt is currently looking into, as staff will be needed on the ward to maintain quality of care.
One challenge with community services is the time-consuming nature of travel, Garratt says. There is potentially a group of patients that could be supported through such a remote service, and this may free up capacity for face-to-face community teams to meet other patient’s needs.
“Being optimistic, I’d like to think this is longer term than the virus, as it’s meeting a patient need. A lot of research shows us that, when patients leave in-patient services they feel ‘abandoned’ and like they ‘drop off a cliff’.
“They feel unsupported – often because community support post-discharge is lacking, due to insufficient resources.
“We’re seeing that this project helps bridge that gap a bit. There is definitely a cohort of patients who need face-to-face input as well, so it doesn’t solve everything, but having someone to talk to proactively, to get advice from, and guide ongoing recovery, is helping our patients with the transition from hospital to home” Garratt says.
Breathe Care creating ‘new generation’ of ABI support
The provider is creating an initial two new independent living developments, with more planned
A care provider is creating a new generation of independent living accommodation to maximise the recovery potential and future opportunities of people living with acquired brain injuries (ABI).
Breathe Care is set to open two new developments in the coming months – comprising a total of 17 one and two-bedroom apartments – to help bring new and much-needed choice in ABI provision.
Both developments, in Wellingborough, will have an integrated multi-disciplinary team (MDT) on site around the clock, which clinicians specialising in neurotrauma and ABI rehabilitation.
And plans are already underway for Breathe Care to expand its accommodation and care provision further across the country. Kettering has been identified as the next location, with hopes to bring 14 apartments to the town by the end of 2022, followed by a move into adjoining counties.
Breathe Care has shaped its ABI model based on the expertise of its leadership team, bringing together years of experience spanning brain injury rehabilitation and care, commercial development, supported living and architecture and design.
Its new developments – flagship project, St Heliers, and Edwards Chambers – build on its experience of operating independent living apartments in specialist mental health care across Northamptonshire for over a decade.
“We did a lot of research into what the current offering for long term living with slow stream rehabilitation in ABI looks like in this area and realised that we could make a really big difference,” says Stephen Crouch, founder and chief executive of Breathe Care.
“A lot of the client group is aged between 20 and 30, but the choice is often living in an HMO or care home with older people. Independent living apartments, done at a high standard, can bring huge benefits to this group in particular. Our projects are very specialist and answer an exact need.
“Not only are they beautiful apartments, but they can help to reduce anxiety and anger through clients having their own space and privacy, while having the support there 24/7 as and when they need it.”
The combination of living space designed for the exact requirements of its residents, coupled with a specialist MDT on site that includes specially-trained support staff, is already helping Breathe Care and its model to stand out from the competition, says Stephen.
“Because our team is there around the clock, and the clinicians or Amanda are there, we are creating a new level of support. We can introduce new or better processes for these people as soon as they are needed, which will lead to better outcomes,” he says.
While the focus is on getting everything ready for a January launch for St Heliers, Breathe Care is also turning its attention to future plans and replicating its model elsewhere in the country.
“For now, the main thing is getting the care team established at Wellingborough. This style of independent living accommodation is badly needed,” says Stephen.
How the power of football is increasing brain injury support
The partnership between Liverpool County FA and The Brain Charity is helping to raise both awareness and funds for survivors
A new partnership is harnessing the power of football to help increase support for people living with brain injuries and other neurological conditions.
Liverpool County FA is working alongside The Brain Charity to raise both funds and awareness around the impact brain illness or injury can have on individuals and families. It is also supporting the frontline work of the charity in delivering support across Merseyside and, increasingly, the wider UK.
The two-year partnership is building on the love of football to help engage people, and hopes it can particularly target men, who can be a hard to reach group who are reluctant to seek support.
In another strand of the initiative, Liverpool County FA will work alongside its new charity partner to help grassroots football clubs and leagues to be more dementia-friendly, and learn how to recognise early warning signs and offer support.
It will also help to raise awareness of the growing links between football and neurodegenerative illness – building further on the work of the FA nationally with its guidance around high-force heading in training to help grassroots players understand the risks.
Daniel Green, CEO of Liverpool County FA, says the partnership will offer support to brain injury survivors in a host of ways.
“We hope it will be quite diverse. As well as the financial support we can hopefully give to The Brain Charity, we are looking at areas which could potentially include employment and volunteering and how we can work together, be it through support around education, coaching and CPD qualifications, for some of the their clients,” he says.
“If we can use football to tackle some of the social isolation they may have been experiencing and rebuild their confidence, then then we believe we’ve got a real role to play locally.
“Football can cater for all demographics, male and female, young and old, but we know the male population can be particularly hard to reach. Football is still quite a male dominated game, and while this goes more broadly than just neurological issues, men don’t tend to talk very openly, or will maybe be more flippant, in talking about what troubles them.
“The Brain Charity have identified a real target audience that they want to work with, and to potentially use the power of football to get to those individuals to feel more comfortable talking about and identifying what those issues may be.”
Another key aspect of the partnership focuses on the high-profile issue of dementia in football, with Liverpool County FA working with The Brain Charity to raise awareness of the signs and impact of the illness.
“There is the wider issue and ongoing work around dementia linked to football, and back in July the FA issued their updated guidance for amateur and youth football, both male and female. So this is something we are raising awareness of, and how to spot those early signs of dementia too,” says Daniel.
“This could be among people who have had a career in football, or they may not have done, but it’s about how we can all work together to spot those symptoms, and identify the actions that friends, family and people’s wider networks can take to support people from recognising the signs through to managing the symptoms.
“And also, one of the big challenges The Brain Charity have identified is, it’s one thing that clients receive the medical support and advice that they need, but it’s another thing to look at their own physical wellbeing alongside that.
“We’re keen to use the facilities at our disposal to link the two elements. So an individual may receive some counselling through The Brain Charity, and we’ll then help facilitate a walking football session, or something of that nature, so that they’re getting not only the medical advice that they need, but also that physical wellbeing piece for them.
“We can provide that safe environment whereby they can talk openly, to try and find that normality again for them and rebuild that confidence. We’re also keen to work with our local clubs to see how we can work together to reintegrate people back into a football environment, but in a manner that is sensitive to some of the challenges they may face – but that’s in its early stages.”
Nanette Mellor, CEO of The Brain Charity, said: “We can’t wait to get to work delivering a programme of physical activities, awareness campaigns, fundraising appeals and volunteering opportunities in partnership with their staff and wider grassroots network.
“Liverpool County FA’s key value of ‘Football for All’ matches our own wholehearted commitment to fighting for an inclusive society.
“We are excited to improve the health and wellbeing of people with neurological conditions across Merseyside, with their support.”
Daniel adds: “Through discussions very early on with The Brain Charity there’s a lot that we need to try and get to grips of, but there’s also a lot of opportunities as well.
“We hope that through the two-year partnership we will be able to put in place the service provision and structures so that when the two years come to an end, the work will be able to continue, so we can continue to support people with neurological conditions for the long term.”
UK City of Culture uses music to support people with dementia
The UK’s City of Culture is seizing the power of music to increase its support for people in the community living with dementia.
Coventry University is working with The Orchestra of the Swan to bring classical music to the city and use this to aid those living with the neurodegenerative condition.
The Orchestra of the Swan is a British chamber orchestra and will be the university’s, as well as the city’s, orchestra-in-residence for the UK City of Culture year, which began in May 2021.
As well as hosting a number of concerts at prominent venues across the city, including its Drapers’ Hall and iconic Cathedral, the orchestra will also help to train Coventry University students in music therapy for people with dementia.
Once trained, the students will then volunteer with the orchestra’s client care homes, as part of a joint outreach project to help increase the levels of provision for those with dementia.
Dr Geoff Willcocks, Coventry University’s director of arts, culture and heritage, said: “We have many great musical groups in Coventry, but we really lack a professional orchestra.
“In a small way, for the City of Culture year, Coventry University is filling that gap, and we are thrilled to be working with our long-term partners The Orchestra of the Swan to make this happen.
“Music is one of the most powerful ways in which we can connect with our memories and our past.
“The dementia music therapy that our students will be undertaking over the next year will help many people who live with dementia. I hope that this will be the start of a legacy program that sees our students helping older generations live better and more fulfilled lives.”
The Orchestra of the Swan is based at the Stratford Play House in Stratford-upon-Avon and has a history of helping people through outreach work.
Debbie Jagla, managing director, Orchestra of the Swan, said: “Since 2014, The Swan has delivered hundreds of workshops in care homes, dementia and wellbeing cafés benefitting over 10,000 people living with dementia in Warwickshire, Worcestershire, Gloucestershire, Herefordshire and Birmingham.
“The benefits are extensive, with improvement in cognition including memory and attention, whilst reducing agitation, anxiety and depression.
“We are thrilled to be working with Coventry University students to pass on our knowledge and open up more opportunities for students to engage with the Warwickshire community.
“Having the chance to perform regularly in the newly-refurbished Drapers’ Hall is icing on the cake, and we look forward to sharing our cross-genre approach with the Coventry community.”
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