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Over 100,000 people are affected by a neurological condition in
Wales.
There are a large number of neurological conditions,
including:
- conditions that emerge from a traumatic incident
- conditions that can be lived with for decades, such as multiple sclerosis – MS
- conditions where there is a high prevalence such as Parkinson’s disease, with 1 in 500 affected.
- and rarer conditions with a lower prevalence such as Wilson’s disease with 1 in 30,000 affected.
For the majority of neurological conditions, physiotherapy can offer:
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the prospect of maintaining and improving mobility and
independence, for example, in people with spina bifida
– slowing the speed of a progressive condition
- or the prospect of rehabilitation and a return of function – for example incases of stroke or head injury.
Physiotherapy services cover a range of specialities, from neonatal care right through to palliative end of life care.
They uses physical modalities or treatments, exercise, moving and handling, to advise, assess, treat and enable people to manage their condition.
They can make a huge difference to quality of life, yet too many people are either not able to access services or receive only short term rehabilitation.
The Assembly Cross Party Group for Neurological Conditions has recently undertaken a review of Neurophysiotherapy services in Wales - and as Cross Party Group Chair I launched its resulting Inquiry into physiotherapy services for people living with neurological conditions in February at the Physiotherapy Department in Ysbyty Glan Clwyd, Bodelwyddan.
It was instructive and a pleasure to meet patients and Neurophysiotherapists there – and to discuss the issues highlighted with Betsi Cadwaladr University Health Board’s Head of Therapies, Iain Mitchell.
It is almost a decade since I first met Iain Mitchell to discuss his pioneering self-referral model, something I subsequently championed.
I therefore welcome the fact that the first recommendation in the Neurophysiotherapy report relates to this – and will say more about this later.
The inquiry found that although there is evidence of good practice within physiotherapy services, availability of specialist Neurophysiotherapy services across Wales is inconsistent.
Having taken evidence from people who have neurological conditions, the Chartered Society of Physiotherapy and Local Health Boards, the Neurophysiotherapy report suggests that the Welsh Government should establish a working group to take forward 12 key recommendations.
This report makes serious and well informed recommendations which I now hope will be given full and proper consideration by both the Welsh Government and our Health Boards.
As a contributor to the report, who has Parkinson’s, stated - people with Neurological conditions need access to specialist physiotherapy as soon as possible after diagnosis - but some services miss this, and she therefore calls for “more physiotherapists with specific neurological experience and knowledge”.
The inquiry concluded that most of the 100,000 people living with a neurological condition in Wales could benefit from physiotherapy or from self managed exercise classes with the right support.
There are networks of talented physiotherapists across Wales, who, with the right training, support from specialists, and by working through multidisciplinary teams, could make a positive impact to the lives of people living with neurological conditions.
Philippa Ford, Policy Officer for the Chartered Society of Physiotherapy in Wales said,
“The recommendations will provide a focus for the Health Boards to examine current services and address some of the challenges. The setting up of a working group (if Welsh Government agrees to this suggestion) will provide an opportunity for physiotherapy services to learn from each other and share innovative practice."
And the Chair of the Wales Neurological Alliance, Joseph Carter, added:
“Physiotherapy can make a real difference to people living with neurological conditions, but there are still barriers in accessing it. We are calling on the Welsh Government to consider our report and deliver the services that our service users need.”
It is in the context that the Cross Party Group on Neurological Conditions would like the Welsh Government to establish a working group to take forward the following 12 recommendations:
The report recommends:
That Local Health Boards expand self-referral so that anyone with a neurological condition who would benefit from physiotherapy can self-refer to local physiotherapy services.
Self-referral is popular with patients. It is a patient-centred
approach that increases ease of use, convenience, portability,
patient influence, choice, engagement and involvement in care,
and promotes self-management.
The pilots in other parts of the UK showed that people who self-refer to physiotherapy take fewer days off work and are about half as likely to be off work for onemonth, compared with those referred to physiotherapy by a GP.
Self-referral to physiotherapy is efficient for other healthcare
providers too, reducing costs, time and resources. Patients often see a GP several times before being referred to physiotherapy, by which time their condition may be more longstanding and difficult to resolve.
In May 2012 Abertawe Bro Morgannwg University Health
Board confirmed that in the short time self referral has been in operation for musculoskeletal physiotherapy, the clinic has resulted in a reduction in waiting lists and an increase in the number of patients seen.
This specific service model has been expanded to neurological conditions in Scotland to improve the lives of service users there.
Where trialled, self-referral has not led to an increase in demand for physiotherapy, apart from in physiotherapy services that have a history of under-referral. A proportion of people who would normally have seen their GP first simply opt for a more direct route to solve their problem.
The report recommends that Local Health Boards establish regular neurological multi-disciplinary teams so that service users can access physiotherapy and other support. These teams must have access to appropriate rehabilitation facilities including the ability to refer to inpatient beds.
Across Wales there are emerging examples of best practice
to bring together physiotherapists, occupational therapists, speech and language therapists and other clinicians into conditions specific or neurological clinics.
Three multi-disciplinary teams involving a range of
Health and Social Care professionals established across North Wales, have demonstrated benefits for both people living with
motor neurone disease and the professionals providing care
services for such a complex progressive degenerative disease.
The report recommendsan expansion in the number of clinical specialist neuro-physiotherapy roles so that every Local Health Board (LHB) has a specialist neuro-physiotherapist for Aquired Brain Injury, Multiple Sclerosis, Parkinson’s disease, neuro muscular disease (NMD), spinal cord injury and stroke - and specialist neuro-physiotherapists to provide support for rarer conditions such as spina bifida or Huntingdon’s disease.
The report recommendsthat Local Health Boards organise specific neurological skills rehabilitation courses for generic physiotherapists in order to improve skills within the community and within hospitals.
The report recommendsthat Local Health Boards review access to all training across professions in order to maximise appropriate professional skills development within limited training budgets.
The report recommendsthat the Health and Social Care Committee considers whether the All Wales Medicines Strategies Group should appraise equipment and technology and question whether they are cost effective as part of the upcoming inquiry on access to medical technologies in Wales.
The report recommendsthat the Local Health Boards evaluate and standardise the use of specialist equipment for patients with complex needs so a common level of service can be expected when patients transfer closer to home, or to their own home, for continued rehabilitation.
The report recommendsthat the Welsh Government considers commissioning a review of hydrotherapy provision across Wales to ensure those people with neurological conditions who might benefit from hydrotherapy are able to access it, both as in-patients and out-patients.
The report recommendsthat the Welsh Government continues to work with Local Health Boards to fund an expansion of telemedicine and telecare technology across Wales.
The report recommendsthat Heads of Therapies promote the use of validated outcome measures so that physiotherapy for people living with neurological conditions is provided for the appropriate length of time that is commensurate to their needs.
The report recommendsthat the National Exercise Referral Scheme be expanded into all neurological conditions to support individuals to self-manage their condition.
And the report recommendsthat Local Health Boards review their specialist physiotherapy facilities to determine appropriate access for community use.
There are definitely some ‘quick-wins’ in relation to these recommendations – on specialist equipment, on training and support and on the expansion of services to meet patients across Wales, which could be incorporated into a new Delivery Plan.
It is encouraging that the Welsh Physiotherapy Leaders Advisory Group has been looking at the cross party Inquiry and considering action and response to the recommendations – and that they will be producing a report themselves.
After all, it is my understanding that no new money has gone into physiotherapy services since the paediatric neuromuscular post and paediatric palliative care/transitional posts in 2011.
A special thanks are due to the Chartered Society of Physiotherapy and all of the individual physiotherapists who assisted in the development into tis Cross Party Report into physiotherapy services for people living with neurological conditions.
The report’s findings are based on responses from service users, information from Local Health Boards and oral evidence from professionals.
They provide a legitimate basis for discussion and action.
The Cross-Party Group for Neurological Conditions would support further research undertaken by Local Health Boards or the Welsh Government to examine the issues raised further –
but above all we would welcome a commitment from the Minister that he will establish a working group to take forward the 12 recommendations.
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