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HomeLink Healthcare have been shortlisted for a Chief Allied Health Professionals Officers (CAHPO) award for their work in partnership with Lewisham Adult Therapy Team (LATT). The service saw the waiting list of 203 reduce by 85 percent to 30 in an 18 week period. Not only that, 69 percent of patients were seen within three days and improved patient outcomes were seen across the board.  

In October 2021 Allied Health Professional (AHP) Leads from the South East London joined forces with AHP Leads from HomeLink Healthcare to provide a collaborative approach to addressing the increasing demands on the community physiotherapy service for patients residing in the South East London regions of Lambeth, Southwark and Lewisham.  

The AHP Team drove innovation and change in the creation and implementation of a new pathway that addresses both the NHSE/I Long Term Plan and commitments to AHPs into Action. The results were increased physiotherapy capacity in the community; improved patient flow; and better patient outcomes and experience. 

The challenge 

The challenges identified by the AHP Team were as follows: 

• The LATT therapy leads reported an increase in demand from referrals for patients requiring community physiotherapy.  
• They cited workforce concerns preventing them from meeting their referral demands along with an increase in the use of agency staff thereby driving up costs and potentially reducing quality and effectiveness. 
• LATT were experiencing an increase in staff burn out, sickness and challenges balancing annual leave and staff training. 
• LATT reported a waiting list of 203 patients, with patients waiting more than six months for a therapy review. 
• Concerns were raised that patients were being admitted to hospital on account of not receiving timely physiotherapy support to maintain them safely in their own homes. 
• The patient experience was poor due to increased waiting times for therapy input. 

Aims, outcomes, and ways of working to overcome potential barriers 

Aims 

A set of SMART aims for the pathway were co-created to improve patient flow and physiotherapy capacity for patients living in the Lambeth, Southwark and  Lewisham localities. 

• Provide a responsive physiotherapy service that delivers efficient and effective  patient centred physiotherapy treatments to maintain them safely at home. 
• Reduce waiting list of community physiotherapy. Prior to the service, 203 patients were awaiting therapy. 
• Improve patient outcomes by increasing mobility and functional independence. There were no standard clinical outcomes in circulation. 

Outcomes 

• A shared vision of quality improvement across all pathways made it possible to mobilise the pathway in just 4 weeks.
• 69 percent* of patients were able to be seen within three days of (non-urgent) referral (*based on patient choice). 
• The waiting list was reduced by 85.2% to just 30 patients in just 18 weeks. 
• Positive outcomes in mBarthel and EQ-5D-5L measures.   
  • mBarthel increased from 76.5 to 87 
  • Self-reported health state (VAS) increased from 54.4 to 67.6 
  • Self-reported EQ-5D-5L figures improved in all dimensions (note a decreasing score is an improvement) 

• Quality improvement was delivered and measured with data regularly shared by the AHP Team to support wider MDT collaboration. These outcome measures are now adopted as standard within SEL.  
• As a result of shared learnings 4x as many patients are benefitting from the new pathway in South East London. 
• The service has spread across the System. From Lambeth and Southwark, the model has been reused in Lewisham, Bromley and Woolwich with learnings shared in other ICSs. 

How did we do this?

• AHPs worked collaboratively. Regular review meetings were held to ensure quality and safety. 
• An operational manual was co-produced with wider MDT to ensure effective and efficient governance. 
• We agreed patient specific outcome measures in order demonstrate quality improvements. 
• Wider system partners were involved in order to increase shared learning practices and collaboration to safely deliver 240 visits per week 

Transferable lessons learned:

• Workforce retention and recruitment strategies are essential to ensure longevity to new services. This pathway enabled a 66% increase in capacity for staffing which allowed teams to take annual leave and manage COVID-19 isolations whilst providing continuation of care to patients.  
• Involving Consultant bodies and wider system partners from the outset is essential to optimise referral and discharge processes. 
• Being comfortable having open and honest conversations with colleagues for the benefit of the patient has enabled improved outcomes. 
• Regular knowledge-sharing and reporting are vital for optimising patient outcomes. 
• Ensure the whole AHP/MDT team is involved in the journey, so the service is driven by those who deliver it. Recognising the value of different knowledge and skills that staff of all levels can add. 

Adeola Telesford, Highly Specialist Rehabilitation Occupational Therapist from Enabling Services, Lewisham and Greenwich NHS Trust commented:

“I am truly pleased with the professional relationship/rapport we have built because it has enhanced our regular verbal and written feedback on cases.

I am particularly pleased by the fact your service has been able to visit patients in a timely manner (within 24-48hours of receiving the referral) and to carry out pre-planned joint visits with me. Timely intervention, which I have found with a number of cases, made a significant positive impact on the SMART goals that were set for each patient.

It was refreshing if not amazing to see how the combined intervention of PT and OT input complimented each other. Your service input proves the validity in having PT and OT working alongside each other in a service of this nature when working towards a time frame of maximum 6 week interventions. I look forward to continued working with you”.