Allied Health Professions Awards for Innovation in Health Improvement and Improved Health Services 2005

First Prize Winners

Chat Pack Initiative
NHS Borders

Sarah Duncan
Ann Brown
Liz Hurst
Tricia Mitchell

This project grew out of some of the challenges faced in delivering services to children in rural and isolated communities. There was a growing need to deliver support to a number of children rural primary schools, particularly for Primary 1.
Traditional models of speech and language therapy (S&LT) delivery needed to be reviewed in line with the changing needs of children, parents and carers. Increasing parental involvement in the therapy process and addressing the high rates of non attendance were identified as key drivers.

Many parents of language disordered children reported that they did not know how to communicate with their children or felt that their children's difficulties were so complex they did not know where to start, so building partnerships with parents was a vital part in achieving success. Also, many parents felt powerless when it came to helping their children to develop speech and language skills and a collaborative approach the empowered parents and carers was needed.

Strengthening relationships between therapists and clients, improves understanding of the therapist's role and empowers parents to take responsibility for their child's speech and language development and this project was taken forward to assist parents and therapists in this. Chat Packs were developed as a means to include parents and carers as active participants in their child's speech and language development.

The Story Sack initiative (Griffiths 2000) is a concept many parents, nurseries and primary schools are familiar with which helps children develop literacy skills and an interest in books. They promote positive interaction of parent and child. This concept was adapted to formulate Chat Packs that enable therapists to support parents and teachers develop children's communication skills.
Parents/carers meet with the speech and language therapy team regularly to discuss how their children are progressing.

One of the main outcomes from this project has been facilitating parents and children working together as well as families feeling supported through a structured, but relaxed and informal, approach to supporting speech and language development.

Occupational Therapy Vocational Assessment and Support
NHS Lanarkshire

Lisa Greer

Evidence demonstrates that involvement in vocational activities has a positive effect on the rehabilitation of individuals experiencing mental health problems. UK surveys show that many in this client group want to work but the majority of people diagnosed with mental illness are not in employment, suggesting that they are still subject to the personal, service related and community related barriers to returning to work.

The aim of this project is to minimize or remove the barriers that prevent mental health service users from achieving their vocational goals.
It focused on four strands, firstly and primarily, to provide a clinical service of assessment and intervention to mental health service users who wanted to engage in work activity and required assistance to achieve this. Sharing assessment information with other agencies enabled them to provide more relevant and targeted support for individuals.
Secondly, to provide close liaison, information and education to mental health workers about vocational issues so that they could effectively support their clients to progress their vocational goals. This benefited both patients and mental health workers as the service provided a resource that brought a different clinical perspective to the issues facing this client group.
Thirdly, to develop and maintain links with community base vocational services, through joint working initiatives and provision of education about mental health issues. This approach enabled the sharing of information and expertise to better meet the needs of clients.
Finally, through audit and service user consultation, to identify gaps in service and make recommendations for further service development.

The project signposted service users to mainstream and specialist vocational services and involved partnership working with employment services, disability employment agencies, volunteer agencies and charities. A service user was employed to set up and maintain the database for auditing outcomes.
61% of people using the service in the first year have successfully engaged in the vocational activity of their choice or are using other services and activities to achieve their long term goals.

A significant outcome of this project was referral to the service of individuals with no prior mental health history. Invariably in paid employment, but with recent onset of minor mental health issues, they required more specialized mental health input than could be provided by the General Practitioner.
24% of referrals into the service were of this type and of these, 64% were able to either remain at work, return to work after a period of sick leave or achieve other vocational goals such as going to college.

This identified a gap in the service for those with minor mental health problems and showed that appropriate support in primary care can enable people to overcome difficulties with minimum impact on their working lives.

West Lothian Children's Equipment Pathway
NHS Lothian

Christine Owen
Nicky Seymour
Anne Sheriff

Working across Health Education and social work can prove challenging, however it does result in real benefits to children, parents, carers and staff as this project from West Lothian demonstrates.
Collaborative approaches between professionals to tackle such issues as duty of care and managing risk can break down professional barriers and improve patient care.
Establishing an interagency service that uses a common language and works towards a common outcome for children, their families and carers was the overarching aim. The team identified key strands of work within the service to achieve this.

Firstly, the team identified low risk equipment that could be issued by a wide variety of multi-agency professionals, for use in schools and without the need for follow up. This was to reduce waiting time for low risk equipment, particularly in relation to education equipment.

Secondly, the identification of high risk equipment that required assessment, follow up and monitoring including identifying those children with complex needs who require professionals to work closely together. This stream established better communication between professionals, less duplication of effort and a more streamlined and effective service provided to the child.

Thirdly, the introduction of a universal equipment documentation system for children throughout health, social work and education to support the sharing of information to avoid duplication of effort.

Implementation was facilitated by the appointment of an access officer within education necessitating a wider communication network for the provision of all equipment for children. This also assisted in establishing an agreed care pathway.

The project means to continue developing a medium risk equipment pathway along the same lines and the ultimate goal is that all children's equipment to be held in one setting

Joint Paediatric Assessment Service - Physiotherapy and Podiatry
NHS Forth Valley

Gordon McLay
Frank Gilroy
Claire Pickthall
Arlene Smillie

A joint approach was introduced between physiotherapy and podiatry with the aim of improving the service for lower limb function and foot orthoses to patients.

The joint clinic approach meant that a fuller range of biomechanical expertise was made available during clinic sessions, improving access to both areas of expertise for patients. By providing a one stop clinic, patients could see the right person for their specific needs.
There was a large uptake by patients needing both physiotherapy and podiatry services and the joint clinic approach led to a significant reduction in waiting times for foot orthoses and a more effective use of professional expertise and resource within the system.

The new clinics made a major impact on waiting times. This group of patients traditionally had a 20 week wait within the old model of service provision, awaiting the arrival of an external orthotic company, and the project aimed to reduce waiting time to about 8 weeks. The outcome was and actual reduction in waiting times to 2 - 3 weeks in most areas with an even greater reduction in some of the pilot areas.

Future developments include an analysis of non attendances and the development of a strategy to manage these e.g.: patient focused booking system. Evaluation has also identified the need for further awareness raising and education of the specific needs of this client group for medical practitioners.

Joint Approach to Assessment for Children with Motor Coordination Difficulties
NHS Lothian

Christine Owen
Caroline Wilson

Children with gross and fine motor problems as well as visual perceptual difficulties were historically seen by Occupational Therapy (OT) and Physiotherapy (PT) services working independently. Parents had identified that this built in delays and waiting times for not only assessment but also for treatment.

In order to address this, a joint assessment clinic with agreed referral pathways was established. The clinic introduced standardised tools for the assessment of coordination difficulties that led to quicker, holistic assessment and treatment planning.
The impact the clinic has had on patient care is to reduce waiting time for initial contact with OT/PT services as well as reducing the number of appointments for patients.
There has also been a reduction in the number of non attendees to PT and OT Out Patient departments with the joint clinic showing a rate 8% below the OT Out Patient department. The joint clinic has also led to a reduction in the amount of time out of school for children.

Future developments include extending the clinic to include dietetics to provide an information service to parents on the impact food and nutrition can have on children's behaviour

Involving Patients to inform the development of e-learning on diabetes and alcohol
NHS Greater Glasgow

Diane Smith
Fiona Clark
Liz Britton

This initiative grew from young people's dissatisfaction with existing education resources for younger people with diabetes.
Traditionally, there has been no formal involvement of young people with diabetes in the development of education and information resources. A series of focus groups with young diabetics identified that current advice and literature did not meet their information requirements as their needs included appropriate education and information on alcohol and diabetes that enabled young diabetics to make informed choices about their own alcohol consumption.

With user involvement at every stage, this project developed and brought about the introduction of an e-learning resource that supports young diabetics and in addition forms a community of learning.

Staff have also benefited from the project by gaining transferable skills in IT and by having the opportunity to work directly with Higher Education Institutions and software developers.

Prehabilitation
NHS Tayside

Lorraine Paterson
Patricia Baynes
Neil Bryson

This project demonstrates the use of an anticipatory approach to care in the management of chronic disease.
Improving the management of patients prior to surgery has an added value in that it improves physical function, reduces pain and where possible, enhances overall fitness for anaesthesia. In addition, it promotes self management of rehabilitation post surgery.

This project introduced patients to different types of exercise and the expected levels of exercise required post operatively to regain function. The aim was to reduce the need for long term Physiotherapy input post surgery, providing shorter and more effective interventions in the rehabilitation stage.
An additional aim was to streamline the discharge processes and reduce the length of stay in hospital.

Intervention pre operatively was targeted at those patients on the Orthopaedic waiting list awaiting total knee replacement surgery. This allowed for the promotion of exercise and self managed care post operatively that had a positive effect on patients, engendering mutual support.
Functional outcome measures used were both subjective and objective. The project evaluation is ongoing, including an audit of function during hospital stay, length of hospital stay and Out Patient PT follow up.

Patients are offered a review appointment at 3, 6 and 12 months post operation in order to monitor progress and any continuing individual rehabilitation needs.