Cardiac Rehabilitation Service… · coaching and motivational interviewing. • To work with our...

Cardiac and Pulmonary Rehabilitation

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for

2020-2025’

16th December 2019

1

Who’s Who?

Patient Representatives

Freya Redrup Clinical Pathway

Development Manager – Leeds

CCG Lindsay Springall

Commissioning Lead for Long-Term Conditions – Leeds

CCG

Charlotte Coles Commissioning

Lead for Respiratory – Leeds

CCG Katherine Hickman

Clinical Lead for Respiratory – Leeds

CCG

Bryan Power Clinical Lead for Cardio-vascular Disease– Leeds

CCG

Hanna Kaye Advanced Health

Improvement Specialist – Public

Health

Diane Burke Head of Long-Term Conditions – Public

Health

Nicola Simpson Cardiac

Rehabilitation Lead - LCH

Emma Crossland Pulmonary

Rehabilitation Lead - LCH

Jane Slough Lead Nurse for

Respiratory Conditions- LTHT

Caroline Stocks Head of Service for Respiratory,

Cardiac, CIVAS, TB and HHIT- LCH

CCG – Clinical Commissioning Group LCH – Leeds Community Healthcare LTHT – Leeds Teaching Hospitals Trust

*House Keeping

Agenda Timing Item Lead

8.30 -9.00am Arrival and Refreshments

9.00 -9.20am Welcome and Introductions including the objectives for the day, and setting the local and national

context

Bryan Power/

Katherine Hickman

9.20 -9.45am Overview - Cardiac Rehabilitation Service Current position

Nicola Simpson

9.45 -10.10am Overview - Pulmonary Rehabilitation Service Current position

Emma Crossland

10.10 -10.30am What is the need? Review of Leeds Public Health Data,

National Evidence and Best Practice

Diane Burke/ Hanna

Kaye

10.30 -10.45am Refreshment Break

10.45 -12.10pm Group Work Freya Redrup

12.10 -12.25pm Closing and Next Steps Bryan Power/

Katherine Hickman

Objectives for the Day

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for 2020-2025’

• To review the local and national context for cardiac and pulmonary rehabilitation.

• To understand the current offer of cardiac and pulmonary rehabilitation in Leeds.

• To share national evidence and best practice for cardiac and pulmonary rehabilitation.

• To begin designing our vision for cardiac and pulmonary rehabilitation in Leeds.

• To prioritise opportunities for enabling this vision.

Outcomes for the Day

To take the initial steps towards co-designing cardiac and pulmonary rehabilitation services in Leeds for 2020-2025, and to progress outputs from

the day, utilising existing working groups we have in place.

Respiratory

Steering Group

CVD Steering Group

Pathways Working Group

Post Acute Working Group

National Context The NHS Long Term Plan 2019

• Access and Uptake varies across England o Nationally 52% take up the offer of cardiac rehab – ambition: 80% by 2028 o Nationally 13% of patients with COPD are offered Pulmonary Rehab – ambition: not yet defined

• Joint Programmes • Personalised Care • Digital Tools • Mental Health • Lifestyle Changes • Deprivation • Medicines And more… (wider context) NHS England (January, 2019): The NHS Long Term Plan.

https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf

Scaling up and improving marketing of cardiac rehabilitation to be amongst the best in Europe

will prevent up to 23,000 premature deaths and 50,000

acute admissions over 10 years

230 premature deaths and 500 acute admissions over 10 years

By expanding pulmonary rehabilitation services over

10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided.

5,000 exacerbations can be prevented and 800

admissions avoided. Leed

s En

glan

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National Context

• New Indicators – Pulmonary Rehabilitation

Commissioning Guide

• Rehabilitation as prevention or early intervention

• Person-centred approach

• Partnership working

QOF 2019/20

Five Year Framework 2019

• National Service Specs – CVD; prevention, diagnosis and management

• CVD Prevention Audit 2021/22

NHS England (April 2016). Commissioning Guide for Rehabilitation. https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf

NHS LTP Implementation Framework 2019 • Encouraged to test the use of

technology to increase referrals and uptake to Cardiac rehab (national monies from 2021/22).

• NHSE will provide targeted funding for a number of sites in 2020/21 and 2021/22 to expand pulmonary rehabilitation services and test new models of care for breathlessness management in patients with either cardiac or respiratory disease.

https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf












National Context

Patient Expectations of Good Rehabilitation Services

• Knowledge and access

• Focus on my needs

• Improved experiences and outcomes

• Self-care and self-management

• Clear, meaningful and measured goals

• Support to reach my potential

• Self-referral

• Single point of contact

• Support for people important to me

• Information on my progress

Principles of Good Rehabilitation Services

• Optimise physical, mental and social wellbeing

• Recognise carers

• Instil hope, support ambition and balance risk

• Individualised, goal-based approach

• Early and ongoing assessment

• Self-management (Personalised Care – PCSP)

• New and established interventions

• Integrated multi-agency pathways

• Leadership and accountability

• Best practice

NHS England (June 2015): Rehabilitation is everyone’s business: principles and expectations for good adult rehabilitation. https://www.networks.nhs.uk/nhs-networks/clinical-commissioning-community/documents/principles-and-expectations

https://www.networks.nhs.uk/nhs-networks/clinical-commissioning-community/documents/principles-and-expectations












Local Context

• Based on The NHS Long Term Plan – expanding our access,

uptake and offer of cardiac/ pulmonary rehabilitation in Leeds is a priority commissioning intention for 2020 and beyond.

• Current waiting times/ workforce/ uptake (presentations to

follow)

• ICS Pulmonary Rehabilitation Opportunity

Local Context

Cardiac Rehabilitation

NHS Health Check

Heart Age Check

Weight Management

(LCH)

Annual Review CCSP

Approach (GP Surgeries)

Leeds Citizens Advice

Carers Leeds

Leeds Heart Watch

Community Falls Service

(LCH)

Pharmacists

Leeds Assisted Living

MindWell Leeds

Leeds Mental Wellbeing

Service (LCH)

NHS Smoke Free

One You Leeds

Change4Life

The LEEDS Programme

(LCH)

MyMHealth

Cardiology Service (LTHT)

Leeds Heart Failure Service

(LTHT)

Community Cardiac

Service (LCH)

Cardiac and Pulmonary

Exercise Programme

(Active Leeds)

Pulmonary Rehabilitation

Community Respiratory

Service (LCH) Respiratory

Virtual Ward (LCH)

Breathe Easy Groups (BLF)

MyCOPD (Leeds City

Council)

Adult Social Care (Leeds City Council)

Leeds Blood Pressure Wise (Public Health/

Leeds CCG/LCH)

Pharmacists

Self-Management

(LCH)

Social Prescribing

Lung Health Check

Community Learning

Disabilities Team (LYPFT)

Age UK

Leeds CCG

Leeds City Council



2020-2025’

Nicola Simpson

(Cardiac Rehabilitation Lead – LCH)

11

12

Service Model/ Pathway

Cardiac Rehabilitation Service

13


CRITERIA

• Recent heart attack

• Elective coronary stenting

• Coronary Artery Bypass Grafting

• Valve replacement

• Heart failure

STAFFING

• Band 7 Clinical Lead Physiotherapist

• Pre & Post Assessment needs 1 Cardiac Nurse

1 Clinical Support Worker

1 BACPR Instructor

• Class Needs 1 to 5 ratio of the above


14

Service Model/ Pathway DURATIONS • This is a 6 week programme. • All of the above classes are provided twice a week. • The exercise component is for 60 minutes, with a warm up and cool down at

either side. • Once a week there is up to an hour education session.

VENUS • John Smeaton Leisure Centre LS15 • Armley Leisure Centre LS12 • Kirkstall Leisure Centre LS5 • Holt Park Leisure Centre LS16 • Middleton Leisure Centre LS10

We are currently not NACR Certified as we do not input the NACR patient questionnaires. We have had some IG problems in the past and also we want the questionnaires to sync with S1 and the templates we use with our patients.



• Patients referred to the Physiotherapy service are not suitable for the regular class for various reasons.

• These patients are assessed at home and given a programme or assessed in the gym setting and seen as one to one or in small group sessions.


16

Patient Profiles

• The service currently deals with older patient groups, which are becoming more complex as medical interventions and medications improve.

• Average age of 70 years

• Increase in younger patient referral some of working age

• Males = 538

• Females = 196

• Decreased representation of females in class but maybe due to misdiagnosis and especially females from an ethnic background


17

Patient Profiles


18

Patient Profiles

DIAGNOSIS NUMBERS

MI 1083

CABG 266

PCI 148

VALVE 102

HEART FAILURE 464


19

Activity and Outcomes

• Increased patient referrals

• Increased attendance and completion rates

• Incremental Shuttle Walk test, waist measurement, blood pressure, oxygen saturations, pulse rate and rhythm, blood sugars if diabetic,

• Patient Activation Measure PAM and goal setting PHQ2/9, and GAD2/7 – psychological screening tool

• Completion Rate = 72%


20

Leeds Provision


Before we move on to the challenges within the service I would just like to say how fortunate we are in Leeds to be able to provide a fantastic service for our patients, which is well received by our patients and the fantastic feedback we get from them.

21

Challenges

• Increased overall referral rates into the service year on year. • No increase in Cardiac Rehab class provision. Not enough capacity. • Increasing complex patient needs. • Increasing older population • Staffing provision not adequate • No increase in AHP and AHP support and provision • No lower functioning groups • No certification of services. • No Digital options • Younger working age patients • More ethnic minority patients being referred who need interpreters • Patients facing financial difficulty limiting them in additional costs for

activities post rehab • Patients being diagnosed with conditions that we do not accept as a

criteria at the moment E.g. TAVI and valve repairs


22

Opportunities

• To include all cardiac conditions

• Groups and activities that are not disease specific to address what matters to the patient

• A holistic lifestyle practitioner and AHP led appointment, once the patient is stable with their signs & symptoms and their medications. To address any needs the patient may have (see check list)

• More venues and classes for the traditional rehab programme.

• More choice for the patients who do not want the above.

• More in-depth appointment to go over the PAM, a patient choice check list and Dartmouth Co-op to set individual appropriate goals. Using health coaching and motivational interviewing.

• To work with our partners in the UK who are also working towards better community rehab for all patients such as CSP, Age UK, BHF, BLF, and to link with the NHS long term plan.


23

Opportunities

• More of the lower functioning groups linking with falls and respiratory. • Mental health assessment by an OT or other professional • To link with social prescribing • A consistent confidence coach • A man with a van for transport of patients • A volunteer/buddy service • Hand held individual patient records to link with HELM • NACR certification • Digital options with loan facilities • Social media and patient forums • Improved website for patients to link them to activities and venues 3,6 &

12 month follow ups to help patients stay on track longer term, and check on their goals. Having systems in place to be able to measure outcomes during these follow ups.


24

Opportunities (Staff)

• To continue to attend study days and conferences

• Regular audits and evaluations to improve the services

• Band 4 rehab practitioners

• Mental health and wellbeing checks for staff

• Rebrand with new uniforms

• Regular health coaching updates and peer support

• Access to evidence based research

• Peer forums

• Peer shadowing in other areas/specialities for the overall picture


25

Patient Feedback

Building confidence and belief.

The professionalism and friendliness of

all staff.

Medical and fitness support at a critical time. Friendly

support and encouragement. Monitoring and medical

advise following treatment giving more confidence to recover problems on my

own. Friendly and helpful – very supportive and encouraging

making people feel included and at ease.

Building confidence in exercising. Meeting new

people. Enjoying life more.

The continuous support throughout the whole

experience. Always some there to give advice and all

staff extra caring.

The classes have been excellent in every way I can think of. Friendly,

professional staff with lots of patience and offering a great level of knowledge

about anything related to my condition. Simply brilliant, I’ve enjoyed it all and it has encouraged me to join a gym and continue the good work,

safe in the knowledge that I know how to exercise safely. Thanks to everyone!

Friendly, helpful, encouraging, professional.

Really enjoyed it! Good fun and good to be able to push yourself and feel

safe.

Well organised and friendly team helping you to get fit.

Excellent team, enjoyed every minute and I

wouldn’t have progressed so well

without you!

Confidence in what exercise I can do. Information on

food, medication. Friendly staff.

Understanding individual

needs.


26


Pulmonary Rehabilitation


2020-2025’

Emma Crossland

(Pulmonary Rehabilitation Lead – LCH)

27

28

Pulmonary Rehabilitation Service

Service Model/ Pathway • Pulmonary rehabilitation service is part of the Community Respiratory Service.

• 4 venues across the city- 3 running at present due to staffing- Woodhouse Health Centre, Middleton Elderly Aid community centre and Gipton Old Fire Station. (4th venue Armley Leisure Centre)

• All programs are rolling programs allowing for better patient flow

• Patients can be referred by any HCP, via the integrated COPD service email address- referral forms found on Leeds Health Pathways (as per all other respiratory team referrals)

• Patients attend a pre course assessment –physio and nurse specialist assess the patient then they attend an 8 week course of exercise and education, twice a week. Education forms part of the program once a week.

• The Leeds course is not currently RCP accredited

• NACAP PR audit in progress- current result run charts suggest areas to improve inc- lack of consistency in individualised exercise plans given out; inconsistency of meeting MCID in walk tests compared to other services. Wait times comparable with national average.

29



Referral criteria

1. Patients who consider themselves disabled by breathlessness MRC Grade 3 or above

2. Patients with MRC 2 who are functionally disabled by their condition

3. Patients who have been discharged for hospital following exacerbation of COPD

4. Patients with chronic progressive lung conditions (such as bronchiectasis, interstitial lung disease, chronic asthma, and chest wall disease)

5. Pre and post thoracic surgery patients including lung transplant patients

Staffing

Band 7 physiotherapist clinical lead

Pre assessment requires- x1 physiotherapist , x1 respiratory nurse specialist, x1 clinical support worker

PR class requires- x1 physiotherapist, x1 clinical support worker

Post assessment (completion) requires x1 physiotherapist x1 clinical support worker

30



Wait times (average across city) –October 2018-september 2019

Referral to pre assessment: 90 days

Referral to first class: 26 days

Current pre assessment slot availability (end November 2019)

• Woodhouse- 7 weeks

• Middleton- 9 weeks

• Gipton OFS- 9 weeks

31


Patient Profiles

• Average age of patient- 69

• Gender – 51% female, 49% male

• Ethnicity-

African 2

Any other Asian background 2

Any other Black background 1

Any other ethnic group 7

Any other White background 17

Bangladeshi 1

British 736

Caribbean 3

Indian 9

Irish 6

Not known 91

Not stated 17

Pakistani 5

White and Asian 1

White and Black Caribbean 3

32



Completion rates (10/18-09/19)

33


Activity and Outcomes Referral numbers-2742 ( October 2016-September 2019)

Primary care -46%

Secondary care-39%

Internal referrals- 13%

Other- 2%

Geography of referrals (Primary care only)

Armley- 10% Woodsley,Holt Park,Yeadon- 15%

Pudsey- 10% Meanwood- 9%

Beeston- 5% Seacroft- 16%

Middleton - 10% Wetherby- 2%

Morley- 7% Kippax- 6%

Chapeltown- 10%

Attendance data (10/18 to 09/19)

DNA rates- 2.92%

Overall Attendance- 30% not interested after referral; 37% lost at pre assessment or during course; 33% complete course

34



Clinical Outcome measures 2018-2019

6MWT- 34% average improvement

ISWT/ESWT- 79% average improvement

30 second STS test- 23% average improvement

Dynamic grip strength- 8% average improvement

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Patient Feedback

‘advice and knowledge about various lung/heart conditions and medications. Excellent exercise programme which gives you the motivation to want to do more and after the programme has finished. ‘ ‘Been great to have the advice of professionals. A great course, I'm very grateful, many thanks. Very friendly too. ‘ ‘Excellent course, well run by a very friendly team.’ ‘The Doctors need to be more proactive in promoting groups’ ‘Maybe change some of the exercises over the 9 week period so people don't get bored.’ ‘I would recommend to anyone who needs it.’ ‘All staff are excellent, it was full of useful information. I would highly recommend it. I enjoy the exercises. ‘ ‘Better parking.’ ‘Knowledgeable, professional physios and nurses. Most helpful. Give you confidence and a sense of community’ ‘Allow more weeks on the course. The PAM form makes no sense at all.’

36


Challenges and Opportunities

Challenges

• Long waiting times from referral to assessment due to demand outweighing current capacity

• Staffing numbers do not allow for any more venues or classes to run.

• Patients are often referred without discussion and consent so drop out at point of referral can be high.

• Lack of understanding of PR from referrers- lack of time for engagement work from PR team for whole city.

• Difficulty to slot in ‘rapid access’ patients such as exacerbating COPD patients, or ILD patients requiring faster access as assessment slots are booked weeks in advance.

37


Challenges and Opportunities Opportunities

• Opt in letter recently introduced ensures patients are motivated to attend

• Improved integration with physio in ILD clinics in LGI- patients assessed there and put straight into PR class- reduces duplication and wait times.

• Need to increase amount of pre assessment slots. (time and staffing)

• Referral into ‘PR’ at point of diagnosis- PR prescription that the patient takes and calls to ‘opt in’- potentially not for standard ‘PR’ but more ‘expert patient program’ style- could be done in GP surgeries.

• Re-referrals into service offered ‘alternative’ program- may not require standard PR program

• Working with social prescribing teams for more ‘functional/interest’ style part of program

• Functional classes for ‘palliative’/low function patients- run by OT and exercise instructor or band 4 NHS staff?

• Need a plan for regular primary care engagement

• Development of rapid access into PR classes-open up pre assessment slots ? How- ? Team to do in LTHT- links with COPD bundle.

• Development of individualised PR booklets for patients they fill in at class and are in charge of-develop some ‘ownership’-aid completion and continuation of exercise

38

Thank you

Any questions?

Cardiac and Pulmonary

Rehabilitation

What is the need? Review of Leeds Public Health Data

and National Evidence and Best Practice

Diane Burke & Hanna Kaye

Public Health, Leeds City Council

What is the need? Leeds has a GP registered population of

916,418, and a resident population of 789,194

There are over 191,000 people in Leeds who live in areas that are ranked amongst the most deprived 10% nationally

10 year life expectancy gap between the

most deprived and most affluent areas

Conditions associated with service provision have been analysed to understand the prevalence and new incidences for 2018/19

All data within this document has been

extracted from the Leeds Data Model, and representative as at the end of March 2019. Diagnoses are identified from both primary and secondary care data sets

Public Health

Public Health

• Prevalence of diagnosed COPD in Leeds at the end of March 2019 was 2.4%. Approximately 22, 274 people, 18,856 people diagnosed in primary care, and an additional 3,418 in secondary care.

• Expected prevalence for Leeds is 2.8%. Suggesting a gap of approximate 5, 476 people which needs to be taken into account for planning future service provision

• Of those with COPD, 3% (664) have Serious Mental Illness, and 0.4% (97) have a Learning Disability

• 4,667 (21%) received diagnosis in 2018/19

• LS25/LS26 has the highest number of people with COPD (2,272) compared to all PCN’s, while Middleton and Hunslet has the highest prevalence (4.4%)

COPD

COPD Prevalence

Total and 2018/19 counts of COPD diagnoses by PCN

Gender, Age and COPD

• COPD is slightly higher in females (51.6%) compared to males

(48.4%)

• The age band with the highest proportion with COPD is 70-74

(16.8%) for both females and males.

• 2018/19 diagnoses increased in

younger age bands up to and

including band 60-64

Ethnicity

• Ethnicity data shows 75% of those diagnosed are from a white

background

• But must be viewed with caution as 25% of people are

recorded as Not Known/Not Stated or ethnicity is missing from

the data, therefore this doesn’t represent a complete picture.

Deprivation

31% of people with

COPD live within the

most deprived 10% areas

nationally

Just over half (50.8%)

live within deciles 1-3.

Pulmonary Rehabilitation & Eligibility

• 16,096 people diagnosed have an MRC scale coded

• 48% have an MRC 3+ recorded

• Presuming the offered is based on eligible people –

35.5% have been recorded as offered the programme

(ever).

• 61.3% of those to have been offered pulmonary

rehab have declined rehabilitation

• 28% have a recorded code for attending pulmonary

rehab.

Public Health

Cardiac • For the purpose of data extraction – a cardiac condition is

defined by a diagnosis of Myocardial Infarction (MI), Heart

Failure (HF) or has had Heart Bypass/valve surgery (secondary

care recorded procedure).

• Only the last 5 years of secondary care procedure data has

been available to supplement this definition.

• Prevalence of cardiac cohort in Leeds at the end of March

2019 was 2.5%, 22,650 people.

• Of those with cardiac condition, 2% (460) have SMI, and 0.5%

(106) have LD.

• 3,486 (15.4%) had a diagnosis recorded in 2018/19

Public Health

Cardiac Cohort Prevalence

Public Health

Total and 2018/19 counts of Cardiac diagnoses by PCN

Public Health

Age, Gender and Cardiac • Cardiac conditions is higher in males (60.9%) compared to

females (39.1%).

• 80-84 (15.3%) is the highest proportion age group overall

• However, the

highest proportion

age band for males

and females differs,

with age bands 70-

74 in males and

90+ in females.

Public Health

Ethnicity

• Again, as with COPD ethnicity data shows 75% of those diagnosed are

from a white background

• But must be viewed with caution as 20% of people are recorded as Not

Known/Not Stated or ethnicity is missing from the data, therefore this

doesn’t represent a complete picture.

Deprivation

21.4% live within an LSOA in

the most deprived 10% areas

nationally.

There is variation across all

other deciles with higher

proportions in less deprived

areas.


• In the cardiac cohort, only 6.6% (1478) have a primary care

recorded code indicating a cardiac rehab referral or offer.

• 7.5% (111) of those to have been offered cardiac rehab have

declined, with 24.9% (368) having a recorded code for

attending cardiac rehab.

Public Health

Cardiac Rehabilitation National Audit

• We know these programmes are evidence based and demonstrates a positive

impact on cardiovascular mortality, improved quality of life and reduced hospital

readmissions

• However, uptake isn't as it should be and the barriers to why need to be explored

• The National Audit Cardiac Rehabilitation (NACR) 2018 report based on submitted

data has made the following key recommendations for programme delivery:

- Recruit more female patients and programmes are better tailored to the needs of female patients

- Carry out a comprehensive CR assessment prior to, and on completion of, CR

- Offer facilitated home-based modes of CR delivery for all CVD patients, including those with heart failure

- Ensure programmes are working to certification standards and aim to secure certified status for the delivery of CR

Public Health

Pulmonary Rehabilitation National Audit

National COPD Audit 2018 made the following recommendations for programme

provision:

• Offer to all eligible patients across range of severity of exercise limitation (MRC breathlessness grades 2–5).

• Improve written information about its benefits for patients and patients and referrers, to improve uptake

• Ensure adequate, long-term funding frameworks that will allow an appropriate skill mix.

• Ensure that services are offered supervised treatment for eligible patients due to other chronic respiratory diseases.

• PR programmes should review their programme structure (frequency and duration) and content to ensure that they are providing treatment in line with BTS quality standards

• Review of discharge processes to ensure each patient receives a written, individualised plan for ongoing exercise and maintenance when they finish rehabilitation

Public Health

‘Breathlessness’ A symptom based model

• Most evidence based on the provision of a joint service for CHD and COPD

patients due to the symptom overlap and patient cohort similarities

• Cardiac rehab often attracts a heterogeneous population younger with

high exercise tolerance - where as COPD and CHF older frail patients who

both experience ‘breathlessness’

• Exercise is a component that most benefit from but not always the most

important – needs to sit alongside wider wellbeing education including

anxiety

• Leeds have piloted this approach

• Leicester have implemented this model – embedded a holistic approach

for people with shared symptoms

• A feasibility trial proposed with a view to influence routine delivery

• It’s the ambition in the LTP

Public Health

An assessment based model of rehabilitation

• Scotland developed their 2020 vision to be:

‘CR should aim to provide each patient with an Individualised Programme of

Care that is tailored to their specific needs. The rehabilitation outcomes

should cover a wide range of options addressing all appropriate risk factor

behavioural changes, which can be delivered across multi-agency providers

and underpinned by the BACPR Standards.’

• As a result they have updated their National Clinical Guideline for Cardiac

Rehabilitation published by Scottish Intercollegiate Guidelines Network (SIGN) in

2017.

• The guideline for delivery places emphasis on:

- An assessment to build an individualised care plan

- Assess motivation and confidence to achieve what is important to them

- Then based on need, offer a wide range of options to aid recovery and

support in managing the health condition

Public Health

Personalised Care – could this be the future for Leeds?

Public Health

• Could this approach be a consideration for Leeds?

• Building on the successful Collaborative Care and Support Planning (CCSP)/Better Conversation approach

• Could this be expanded wider to management of cardiac/pulmonary patients?

• Holistic assessment

• Patient Activation Measure

• Development of individualised goals

• Offer of menu based flexible model of rehabilitation options

Digital & Web Based Models • A menu based model should offer where and how to attend

rehabilitation • Centre vs home based programmes – evidence suggests equally

effective and that choice should be offered • There is a growing evidence base for web/app based interventions

for chronic conditions • This can provide new opportunities to increase uptake • Currently use myCOPD in Leeds • Leicester building web based programme based on the SPACE

Manual for PR – but uptake was low. • Activate your Heart/myHEART/The Heart Manual • Evidence base is emerging • Digital literacy needs to be considered when implementing such

approaches

Public Health

Cardiac/Pulmonary Rehabilitation Is it time for a change?

• The impact rehabilitation can bring is evidence based and we need to increase

uptake

• Is the delivery model of two separate programme achieving the best outcomes?

• This workshop gives us an opportunity to explore innovative and flexible models

for future commissioning

• It should be a holistic and individualised approach - people with the same

diagnosis have very different abilities and needs based on wide number of

determinants

• Research suggests avoid disease centred approaches - but translation into practice

can be challenging

• An assessment based model could help to achieve this approach and tailor

interventions using the provision we already have in the city

• A flexible menu based programme is likely to accommodate the needs of different

ages, ethnicities, diseases and symptoms.

Public Health

Thank you

Any questions?

Group Work

Timing Task Duration

10.50am – 11am Task 1 – Understanding the Patient Perspective 10 minutes

11.00am - 11.20am Task 2 – Generating Ideas 20 minutes

11.20am – 11.50am Task 3 – Prioritising Ideas 30 minutes

11.50am – 12.10pm Task 4 – Feeding Back 20 minutes (5 minutes per group)

Table Facilitator

Red Charlotte Coles

Yellow Jane Slough

Green Diane Burke

Blue Caroline Stocks

Task 1 (10 minutes)

Ms Stephens

Mr Jones

Ms Coates

Mr Winters

THINK

DO SAY

FEEL

Task 1 – Understanding the Patient Perspective

Task 2 (20 minutes)

Task 2 – Generating Ideas

Task 3 (30 minutes)

FEASIBILITY

IMPA

CT

Task 3 – Prioritising Ideas

‘Long-term vision’

‘Quick Wins’

Task 4 (20 minutes)

• 5 minutes – each table

• Overview of patient scenario

• Overview of ideas – including how they address the needs of patient scenario

• Overview of prioritisation of ideas – including explanations of why ideas are high/low impact vs. high/low feasibility

16th December 2019

Hold Workshop

December 2019

Summarise key outcomes from

workshop

January 2020

Project Planning /agreement of priorities with pathways/post acute groups

February – June 2020

Work commences commissioning

plans developed if required

Patient & Staff Engagement

[email protected]

Next Steps and Closing ‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds

for 2020-2025’

Thank you

Any questions?

Please complete evaluation form

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