How are you meeting the NICE Quality Standards on 45 Minutes of Therapy and Seven Day Working? A South Devon Perspectiv

1. How are you meeting the NICE Quality Standards on 45 Minutes of Therapy and Seven Day Working? A South Devon Perspective Kathryn Bamforth Clinical Specialist Physiotherapist Newton Abbot Hospital Torbay and Southern Devon Care Trust

2. NICE Quality Standard No. 7 (2010) Torbay and Southern Devon Care Trust Patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it. • Patients with stroke are offered a minimum of 45 minutes of each active therapy that is required, for a minimum of 5 days a week, at a level that enables the patient to meet their rehabilitation goals for as long as they are continuing to benefit from the therapy and are able to tolerate it.

3. The 45 minute debate Torbay and Southern Devon Care Trust • Why 45 minutes? • Dose : response effect in motor rehabilitation (Kwakkel et al, 2004; RCP Guidelines for Stroke – Physiotherapy, 2008) • Intensity of required SLT input remains unclear (Cochrane review, 2010) • What is the ideal dose?? Why would you not receive 45 minutes of therapy?

4. Optimising Practice Opportunity Torbay and Southern Devon Care Trust • Restructured PT and OT staffing levels • Created 3 Band III Rehabilitation Support Workers working flexibly to include Sat & Sun • Included qualified staff from the ward and community team on a weekend rota to work Saturday mornings (1:12)

5. Data Collection Torbay and Southern Devon Care Trust • National Project • Admission to assessment time • LOS • Discharge destination • Patient, carer and staff satisfaction

6. Results Torbay and Southern Devon Care Trust • Admission to assessment time • 2008: 80% within 24 hours • 2010: 100% within 24 hours • LOS • 2008: 21 days • 2010: 19 days • Discharge destination: No change

7. Patient Satisfaction Torbay and Southern Devon Care Trust In your opinion, were there enough therapists on duty to care for you in hospital?

8. Satisfaction (Cont’d…) Torbay and Southern Devon Care Trust Carer: • Appreciated weekend service particularly access to physiotherapy Staff: • Increased confidence to progress treatment plans in a more timely fashion • Friday discharges • 100% agreement to continue current service

9. Local work Capacity and Demand exercise “units” of 45 minutes Time and motion study of therapists’ time Torbay and Southern Devon Care Trust

10. Next Steps Torbay and Southern Devon Care Trust Complete Capacity and Demand exercise – efficiency across the week Group work Extend RSW role to offer SLT support Repeat audit process

11. Conclusion Torbay and Southern Devon Care Trust 45 minutes more of a guideline than a prescription? Therapy is highly individual Patient-led rather than service-led Challenge to services: to be able to offer each patient what is needed.

12. Torbay and Southern Devon Care Trust “I’m such a good lover because I practice on my own” Woody Allen “Everything is practice” Pele