Understanding what is already happening in your hospital is an important starting point. All hospitals will be investing in various rehabilitation services. It is useful to carry out a Scoping Exercise at the outset to understand what is already happening and what you can therefore add locally. The links you make through this process will be invaluable collaborators going forward.
New or re-designed services need to align with your trusts strategic planning process. Business cases will have a greater chance of success if they align with key strategic objectives. It is also important to consider how new services will work with, and enhance the impact of, existing services.
Public Health Teams are well placed in inform your business cases. It is important to engage them early to ensure what you are planning fits with past, current and future initiatives.
The CCG health and wellbeing boards can also help you understand the current landscape, particularly in community care, and how planned services can best compliment and align with each other.
Once you have decided how your physical activity service can meet Trust aims and objectives, it can be useful to articulate what you plan to do and what you need to make it happen. An example from the Active Hospitals pilot site is available to download.
There are desirable components of a consultant led service which are transferrable across multiple interventions. We have given some examples of those active ingredients we have found most useful.
When you have carried out your scoping exercise, you will have made many important links across the trust. These links will enable you to share learning, improve communication, improve data collection and share governance and training opportunities. A community of practice model may be useful to adopt as things develop. The NHS collaboration platform is a useful tool to enable collaboration across the community of practice.
Electronic, searchable documentation of physical activity levels of inpatients and outpatients is extremely useful as a baseline measure. The conversation involved in documenting this information raises the profile of physical activity in both patient and staff minds. Understanding physical activity level and functional level as a marker of frailty is useful. Establishing a way of documenting this in patient records is important as a starting point. Working towards compulsory documentation on admission should be the ultimate aim.
All new services should be supported by projected outcome data. Establishing achievable outcomes and a way of collecting this data is important. Try our data collection tool as a useful starting point. Consistency of data collection across pathways builds a profile across the trust which is vital as a measure of activity.
Consistency of training across the trust is important to ensure consistency of messaging. The ability to train staff on a large scale through a variety of training methods is an attractive active ingredient of a consultant led physical activity service.
Linking with the CCG health and wellbeing board early will enable you to integrate your active components into the community to ensure consistency of delivery across primary and secondary care
The Social Prescribing agenda is currently poorly defined nationally and there is substantial local variation in delivery. Engaging with the CCG to understand local development is important. Aspects of the Active Hospital Pilot that could help CCG’s to deliver on the social prescribing agenda could include:
- Training link workers in Active Conversations to improve the quality of brief intervention.
- Provide link workers with interactive maps of local resources
- Support link workers with CPD and QIP/audit and a community of practice which should be integrated with secondary care.
There are useful ways in which the Active Hospital Team can integrate with primary care networks. Here are some examples of interventions you might like to consider:
- Training for over 75’s nursing teams and use of community interactive maps
- Training for GPs and over 75’s nurses to better understand the relationship between frailty and physical activity.
- Support GP practices with audits and QIP’s to ensure that those identified through the electronic frailty index are supported effectively.
- Integrated discharge planning for high risk patients to support physical activity in the community
- Promotion of Moving Medicine as a consultation tool for all health care professionals
Scoping Document Of Current National Service Provision Of Exercise Rehabilitation In Multiple Morbidities