Cardiac and Pulmonary Rehabilitation

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in for 2020-2025’

16th December 2019

1 Who’s Who?

Emma Freya Redrup Crossland Patient Clinical Pathway Pulmonary Representatives Development Nicola Simpson Rehabilitation Manager – Leeds Lindsay Springall Cardiac Lead - LCH CCG Commissioning Rehabilitation Lead for Long-Term Lead - LCH Caroline Stocks Conditions – Leeds Jane Slough Head of Service CCG Lead Nurse for for Respiratory, Respiratory Cardiac, CIVAS, TB Charlotte Coles Diane Burke Conditions- LTHT Head of Long-Term and HHIT- LCH Commissioning Conditions – Public Lead for Health Respiratory – Leeds Hanna Kaye Bryan Power Katherine CCG Advanced Health Clinical Lead for Hickman Improvement Cardio-vascular Clinical Lead for Specialist – Public Disease– Leeds Respiratory – Leeds Health CCG CCG

CCG – Clinical Commissioning Group LCH – Leeds Community Healthcare *House Keeping LTHT – Leeds Teaching Hospitals Trust Agenda

Timing Item Lead 8.30 -9.00am Arrival and Refreshments

9.00 -9.20am Welcome and Introductions Bryan Power/ including the objectives for the day, and setting the local and national Katherine Hickman context 9.20 -9.45am Overview - Cardiac Rehabilitation Service Nicola Simpson Current position 9.45 -10.10am Overview - Pulmonary Rehabilitation Service Emma Crossland Current position

10.10 -10.30am What is the need? Review of Leeds Public Health Data, Diane Burke/ Hanna National Evidence and Best Practice Kaye 10.30 -10.45am Refreshment Break

10.45 -12.10pm Group Work Freya Redrup

12.10 -12.25pm Closing and Next Steps Bryan Power/ Katherine Hickman Objectives for the Day

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for 2020-2025’

• To review the local and national context for cardiac and pulmonary rehabilitation. • To understand the current offer of cardiac and pulmonary rehabilitation in Leeds. • To share national evidence and best practice for cardiac and pulmonary rehabilitation. • To begin designing our vision for cardiac and pulmonary rehabilitation in Leeds. • To prioritise opportunities for enabling this vision.

Outcomes for the Day

To take the initial steps towards co-designing cardiac and pulmonary rehabilitation services in Leeds for 2020-2025, and to progress outputs from the day, utilising existing working groups we have in place.

Respiratory CVD Steering Steering Group Group

Pathways Post Acute Working Working Group Group National Context

The NHS Long Term Plan 2019 • Access and Uptake varies across o Nationally 52% take up the offer of cardiac rehab – ambition: 80% by 2028 o Nationally 13% of patients with COPD are offered Pulmonary Rehab – ambition: not yet defined • Joint Programmes • Personalised Care

• Digital Tools Scaling up and improving By expanding pulmonary marketing of cardiac rehabilitation rehabilitation services over • Mental Health to be amongst the best in Europe 10 years, 500,000 will prevent up to 23,000 exacerbations can be

• Lifestyle Changes premature deaths and 50,000 prevented and 80,000 England • Deprivation acute admissions over 10 years admissions avoided.

• Medicines 230 premature deaths and 500 5,000 exacerbations can be acute admissions over 10 years prevented and 800

And more… (wider context) Leeds admissions avoided. NHS England (January, 2019): The NHS Long Term Plan. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan- version-1.2.pdf National Context NHS LTP Implementation Five Year Framework 2019 Framework 2019 • National Service Specs – CVD; • Encouraged to test the use of prevention, diagnosis and technology to increase referrals and management uptake to Cardiac rehab (national monies from 2021/22). • CVD Prevention Audit 2021/22

• NHSE will provide targeted funding for a number of sites in 2020/21 and 2021/22 to expand pulmonary Commissioning Guide rehabilitation services and test new models of care for breathlessness • Rehabilitation as prevention or early management in patients with either intervention cardiac or respiratory disease. • Person-centred approach

QOF 2019/20 • Partnership working

NHS England (April 2016). Commissioning Guide for Rehabilitation. • New Indicators – Pulmonary https://www.england.nhs.uk/wp-content/uploads/2016/04/rehabilitation-comms-guid-16-17.pdf Rehabilitation

National Context

Patient Expectations of Good Principles of Good Rehabilitation Rehabilitation Services Services

• Knowledge and access • Optimise physical, mental and social • Focus on my needs wellbeing • Recognise carers • Improved experiences and outcomes • Instil hope, support ambition and balance • Self-care and self-management risk • Clear, meaningful and measured goals • Individualised, goal-based approach • Support to reach my potential • Early and ongoing assessment • Self-referral • Self-management (Personalised Care – PCSP) • Single point of contact • New and established interventions • Support for people important to me • Integrated multi-agency pathways • Information on my progress • Leadership and accountability • Best practice

NHS England (June 2015): Rehabilitation is everyone’s business: principles and expectations for good adult rehabilitation. https://www.networks.nhs.uk/nhs-networks/clinical-commissioning-community/documents/principles-and-expectations Local Context

• Based on The NHS Long Term Plan – expanding our access, uptake and offer of cardiac/ pulmonary rehabilitation in Leeds is a priority commissioning intention for 2020 and beyond.

• Current waiting times/ workforce/ uptake (presentations to follow)

• ICS Pulmonary Rehabilitation Opportunity

Heart Age Check NHS Smoke Free Lung Health Check NHS Health Check Leeds Assisted Local Context Living Pharmacists Change4Life Leeds Citizens Leeds Heart MyMHealth Advice Leeds Heart Watch Failure Service Adult Social (LTHT) MyCOPD Care (Leeds Cardiology (Leeds City Leeds Mental City Council) Service (LTHT) Council) Wellbeing Service (LCH) One You Leeds Community Breathe Easy MindWell Cardiac Groups (BLF) Leeds Weight Cardiac Service (LCH) Rehabilitation Management Self- (LCH) Management Cardiac and Pulmonary Leeds CCG (LCH) Pharmacists Pulmonary Rehabilitation Exercise The LEEDS Programme Leeds Blood Leeds City Programme (Active Leeds) Pressure Wise Council (LCH) (Public Health/ Leeds Community Carers Leeds CCG/LCH) Respiratory Respiratory Community Community Service (LCH) Virtual Ward Learning Falls Service (LCH) Disabilities (LCH) Team (LYPFT) Social Annual Review Prescribing CCSP Approach (GP Age UK Surgeries)

Cardiac Rehabilitation

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for 2020-2025’

Nicola Simpson (Cardiac Rehabilitation Lead – LCH)

11 Service Model/ Pathway

Cardiac Rehabilitation Service 12 Service Model/ Pathway

CRITERIA • Recent heart attack • Elective coronary stenting • Coronary Artery Bypass Grafting • Valve replacement • Heart failure STAFFING • Band 7 Clinical Lead Physiotherapist • Pre & Post Assessment needs 1 Cardiac Nurse 1 Clinical Support Worker 1 BACPR Instructor • Class Needs 1 to 5 ratio of the above

Cardiac Rehabilitation Service 13 Service Model/ Pathway DURATIONS • This is a 6 week programme. • All of the above classes are provided twice a week. • The exercise component is for 60 minutes, with a warm up and cool down at either side. • Once a week there is up to an hour education session.

VENUS • John Smeaton Leisure Centre LS15 • Leisure Centre LS12 • Leisure Centre LS5 • Leisure Centre LS16 • Middleton Leisure Centre LS10

We are currently not NACR Certified as we do not input the NACR patient questionnaires. We have had some IG problems in the past and also we want the questionnaires to sync with S1 and the templates we use with our patients.

Cardiac Rehabilitation Service 14 Service Model/ Pathway

• Patients referred to the Physiotherapy service are not suitable for the regular class for various reasons. • These patients are assessed at home and given a programme or assessed in the gym setting and seen as one to one or in small group sessions.

Cardiac Rehabilitation Service Patient Profiles

• The service currently deals with older patient groups, which are becoming more complex as medical interventions and medications improve. • Average age of 70 years • Increase in younger patient referral some of working age • Males = 538 • Females = 196 • Decreased representation of females in class but maybe due to misdiagnosis and especially females from an ethnic background

Cardiac Rehabilitation Service 16 Patient Profiles

Cardiac Rehabilitation Service 17 Patient Profiles

DIAGNOSIS NUMBERS

MI 1083

CABG 266

PCI 148

VALVE 102

HEART FAILURE 464

Cardiac Rehabilitation Service 18 Activity and Outcomes

• Increased patient referrals • Increased attendance and completion rates • Incremental Shuttle Walk test, waist measurement, blood pressure, oxygen saturations, pulse rate and rhythm, blood sugars if diabetic, • Patient Activation Measure PAM and goal setting PHQ2/9, and GAD2/7 – psychological screening tool • Completion Rate = 72%

Cardiac Rehabilitation Service 19 Leeds Provision

Before we move on to the challenges within the service I would just like to say how fortunate we are in Leeds to be able to provide a fantastic service for our patients, which is well received by our patients and the fantastic feedback we get from them.

Cardiac Rehabilitation Service 20 Challenges

• Increased overall referral rates into the service year on year. • No increase in Cardiac Rehab class provision. Not enough capacity. • Increasing complex patient needs. • Increasing older population • Staffing provision not adequate • No increase in AHP and AHP support and provision • No lower functioning groups • No certification of services. • No Digital options • Younger working age patients • More ethnic minority patients being referred who need interpreters • Patients facing financial difficulty limiting them in additional costs for activities post rehab • Patients being diagnosed with conditions that we do not accept as a criteria at the moment E.g. TAVI and valve repairs Cardiac Rehabilitation Service 21 Opportunities

• To include all cardiac conditions • Groups and activities that are not disease specific to address what matters to the patient • A holistic lifestyle practitioner and AHP led appointment, once the patient is stable with their signs & symptoms and their medications. To address any needs the patient may have (see check list) • More venues and classes for the traditional rehab programme. • More choice for the patients who do not want the above. • More in-depth appointment to go over the PAM, a patient choice check list and Dartmouth Co-op to set individual appropriate goals. Using health coaching and motivational interviewing. • To work with our partners in the UK who are also working towards better community rehab for all patients such as CSP, Age UK, BHF, BLF, and to link with the NHS long term plan. Cardiac Rehabilitation Service 22 Opportunities

• More of the lower functioning groups linking with falls and respiratory. • Mental health assessment by an OT or other professional • To link with social prescribing • A consistent confidence coach • A man with a van for transport of patients • A volunteer/buddy service • Hand held individual patient records to link with HELM • NACR certification • Digital options with loan facilities • Social media and patient forums • Improved website for patients to link them to activities and venues 3,6 & 12 month follow ups to help patients stay on track longer term, and check on their goals. Having systems in place to be able to measure outcomes during these follow ups.

Cardiac Rehabilitation Service 23 Opportunities (Staff)

• To continue to attend study days and conferences • Regular audits and evaluations to improve the services • Band 4 rehab practitioners • Mental health and wellbeing checks for staff • Rebrand with new uniforms • Regular health coaching updates and peer support • Access to evidence based research • Peer forums • Peer shadowing in other areas/specialities for the overall picture

Cardiac Rehabilitation Service 24 Patient Feedback

Medical and fitness support The professionalism Building confidence at a critical time. Friendly and friendliness of support and encouragement. and belief. all staff. Monitoring and medical advise following treatment giving more confidence to recover problems on my Understanding Friendly and helpful – very Building confidence in own. individual supportive and encouraging exercising. Meeting new needs. making people feel included and people. Enjoying life more. at ease. The continuous support throughout the whole experience. Always some Really enjoyed it! Well organised and friendly there to give advice and all Good fun and good team helping you to get fit. staff extra caring. to be able to push Confidence in what yourself and feel exercise I can do. safe. Information on The classes have been excellent in food, medication. Excellent team, enjoyed every way I can think of. Friendly, Friendly staff. every minute and I professional staff with lots of patience and offering a great level of knowledge Friendly, helpful, wouldn’t have progressed so well about anything related to my encouraging, condition. Simply brilliant, I’ve enjoyed without you! professional. it all and it has encouraged me to join a gym and continue the good work, safe in the knowledge that I know how Cardiac Rehabilitation Service to exercise safely. Thanks to everyone! 25 Cardiac Rehabilitation Service 26

Pulmonary Rehabilitation

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for 2020-2025’

Emma Crossland (Pulmonary Rehabilitation Lead – LCH)

27 Service Model/ Pathway

• Pulmonary rehabilitation service is part of the Community Respiratory Service. • 4 venues across the city- 3 running at present due to staffing- Woodhouse Health Centre, Middleton Elderly Aid community centre and Gipton Old Fire Station. (4th venue Armley Leisure Centre) • All programs are rolling programs allowing for better patient flow • Patients can be referred by any HCP, via the integrated COPD service email address- referral forms found on Leeds Health Pathways (as per all other respiratory team referrals) • Patients attend a pre course assessment –physio and nurse specialist assess the patient then they attend an 8 week course of exercise and education, twice a week. Education forms part of the program once a week. • The Leeds course is not currently RCP accredited • NACAP PR audit in progress- current result run charts suggest areas to improve inc- lack of consistency in individualised exercise plans given out; inconsistency of meeting MCID in walk tests compared to other services. Wait times comparable with national average.

Pulmonary Rehabilitation Service 28 Service Model/ Pathway

Referral criteria 1. Patients who consider themselves disabled by breathlessness MRC Grade 3 or above 2. Patients with MRC 2 who are functionally disabled by their condition 3. Patients who have been discharged for hospital following exacerbation of COPD 4. Patients with chronic progressive lung conditions (such as bronchiectasis, interstitial lung disease, chronic asthma, and chest wall disease) 5. Pre and post thoracic surgery patients including lung transplant patients

Staffing Band 7 physiotherapist clinical lead Pre assessment requires- x1 physiotherapist , x1 respiratory nurse specialist, x1 clinical support worker PR class requires- x1 physiotherapist, x1 clinical support worker Post assessment (completion) requires x1 physiotherapist x1 clinical support worker

Pulmonary Rehabilitation Service 29

Service Model/ Pathway

Wait times (average across city) –October 2018-september 2019 Referral to pre assessment: 90 days Referral to first class: 26 days

Current pre assessment slot availability (end November 2019) • Woodhouse- 7 weeks • Middleton- 9 weeks • Gipton OFS- 9 weeks

Pulmonary Rehabilitation Service 30 Patient Profiles

• Average age of patient- 69 • Gender – 51% female, 49% male • Ethnicity- African 2 Any other Asian background 2 Any other Black background 1 Any other ethnic group 7 Any other White background 17 Bangladeshi 1 British 736 Caribbean 3 Indian 9 Irish 6 Not known 91 Not stated 17 Pakistani 5 White and Asian 1 White and Black Caribbean 3

Pulmonary Rehabilitation Service 31 Activity and Outcomes

Completion rates (10/18-09/19)

Pulmonary Rehabilitation Service 32 Activity and Outcomes Referral numbers-2742 ( October 2016-September 2019) Primary care -46% Secondary care-39% Internal referrals- 13% Other- 2%

Geography of referrals (Primary care only) Armley- 10% Woodsley,Holt Park,Yeadon- 15% - 10% - 9% Beeston- 5% - 16% Middleton - 10% - 2% Morley- 7% Kippax- 6% Chapeltown- 10%

Attendance data (10/18 to 09/19) DNA rates- 2.92% Overall Attendance- 30% not interested after referral; 37% lost at pre assessment or during course; 33% complete course

Pulmonary Rehabilitation Service 33 Activity and Outcomes

Clinical Outcome measures 2018-2019

6MWT- 34% average improvement ISWT/ESWT- 79% average improvement 30 second STS test- 23% average improvement Dynamic grip strength- 8% average improvement

Pulmonary Rehabilitation Service 34 Patient Feedback

‘advice and knowledge about various lung/heart conditions and medications. Excellent exercise programme which gives you the motivation to want to do more and after the programme has finished. ‘ ‘Been great to have the advice of professionals. A great course, I'm very grateful, many thanks. Very friendly too. ‘ ‘Excellent course, well run by a very friendly team.’ ‘The Doctors need to be more proactive in promoting groups’ ‘Maybe change some of the exercises over the 9 week period so people don't get bored.’ ‘I would recommend to anyone who needs it.’ ‘All staff are excellent, it was full of useful information. I would highly recommend it. I enjoy the exercises. ‘ ‘Better parking.’ ‘Knowledgeable, professional physios and nurses. Most helpful. Give you confidence and a sense of community’ ‘Allow more weeks on the course. The PAM form makes no sense at all.’

Pulmonary Rehabilitation Service 35 Challenges and Opportunities

Challenges • Long waiting times from referral to assessment due to demand outweighing current capacity • Staffing numbers do not allow for any more venues or classes to run. • Patients are often referred without discussion and consent so drop out at point of referral can be high. • Lack of understanding of PR from referrers- lack of time for engagement work from PR team for whole city. • Difficulty to slot in ‘rapid access’ patients such as exacerbating COPD patients, or ILD patients requiring faster access as assessment slots are booked weeks in advance.

Pulmonary Rehabilitation Service 36 Challenges and Opportunities Opportunities • Opt in letter recently introduced ensures patients are motivated to attend • Improved integration with physio in ILD clinics in LGI- patients assessed there and put straight into PR class- reduces duplication and wait times. • Need to increase amount of pre assessment slots. (time and staffing) • Referral into ‘PR’ at point of diagnosis- PR prescription that the patient takes and calls to ‘opt in’- potentially not for standard ‘PR’ but more ‘expert patient program’ style- could be done in GP surgeries. • Re-referrals into service offered ‘alternative’ program- may not require standard PR program • Working with social prescribing teams for more ‘functional/interest’ style part of program • Functional classes for ‘palliative’/low function patients- run by OT and exercise instructor or band 4 NHS staff? • Need a plan for regular primary care engagement • Development of rapid access into PR classes-open up pre assessment slots ? How- ? Team to do in LTHT- links with COPD bundle. • Development of individualised PR booklets for patients they fill in at class and are in charge of-develop some ‘ownership’-aid completion and continuation of exercise

Pulmonary Rehabilitation Service 37

Thank you

Any questions?

38

Cardiac and Pulmonary Rehabilitation

What is the need? Review of Leeds Public Health Data and National Evidence and Best Practice

Diane Burke & Hanna Kaye Public Health,

What is the need?

. Leeds has a GP registered population of 916,418, and a resident population of 789,194

. There are over 191,000 people in Leeds who live in areas that are ranked amongst the most deprived 10% nationally

. 10 year life expectancy gap between the most deprived and most affluent areas

. Conditions associated with service provision have been analysed to understand the prevalence and new incidences for 2018/19

. All data within this document has been extracted from the Leeds Data Model, and representative as at the end of March 2019. Diagnoses are identified from both primary and secondary care data sets

Public Health COPD

• Prevalence of diagnosed COPD in Leeds at the end of March 2019 was 2.4%. Approximately 22, 274 people, 18,856 people diagnosed in primary care, and an additional 3,418 in secondary care.

• Expected prevalence for Leeds is 2.8%. Suggesting a gap of approximate 5, 476 people which needs to be taken into account for planning future service provision

• Of those with COPD, 3% (664) have Serious Mental Illness, and 0.4% (97) have a Learning Disability

• 4,667 (21%) received diagnosis in 2018/19

• LS25/LS26 has the highest number of people with COPD (2,272) compared to all PCN’s, while Middleton and has the highest prevalence (4.4%)

Public Health

COPD Prevalence

Total and 2018/19 counts of COPD diagnoses by PCN

Gender, Age and COPD

• COPD is slightly higher in females (51.6%) compared to males (48.4%) • The age band with the highest proportion with COPD is 70-74 (16.8%) for both females and males.

• 2018/19 diagnoses increased in younger age bands up to and including band 60-64

Ethnicity • Ethnicity data shows 75% of those diagnosed are from a white background • But must be viewed with caution as 25% of people are recorded as Not Known/Not Stated or ethnicity is missing from the data, therefore this doesn’t represent a complete picture. Deprivation 31% of people with COPD live within the most deprived 10% areas nationally Just over half (50.8%) live within deciles 1-3. Pulmonary Rehabilitation & Eligibility • 16,096 people diagnosed have an MRC scale coded • 48% have an MRC 3+ recorded • Presuming the offered is based on eligible people – 35.5% have been recorded as offered the programme (ever). • 61.3% of those to have been offered pulmonary rehab have declined rehabilitation • 28% have a recorded code for attending pulmonary rehab. Public Health Cardiac • For the purpose of data extraction – a cardiac condition is defined by a diagnosis of Myocardial Infarction (MI), Heart Failure (HF) or has had Heart Bypass/valve surgery (secondary care recorded procedure). • Only the last 5 years of secondary care procedure data has been available to supplement this definition. • Prevalence of cardiac cohort in Leeds at the end of March 2019 was 2.5%, 22,650 people. • Of those with cardiac condition, 2% (460) have SMI, and 0.5% (106) have LD. • 3,486 (15.4%) had a diagnosis recorded in 2018/19

Public Health Cardiac Cohort Prevalence

Public Health Total and 2018/19 counts of Cardiac diagnoses by PCN

Public Health Age, Gender and Cardiac • Cardiac conditions is higher in males (60.9%) compared to females (39.1%). • 80-84 (15.3%) is the highest proportion age group overall

• However, the highest proportion age band for males and females differs, with age bands 70- 74 in males and 90+ in females.

Public Health Ethnicity • Again, as with COPD ethnicity data shows 75% of those diagnosed are from a white background • But must be viewed with caution as 20% of people are recorded as Not Known/Not Stated or ethnicity is missing from the data, therefore this doesn’t represent a complete picture.

Deprivation 21.4% live within an LSOA in the most deprived 10% areas nationally. There is variation across all other deciles with higher proportions in less deprived areas. Cardiac Rehabilitation

• In the cardiac cohort, only 6.6% (1478) have a primary care recorded code indicating a cardiac rehab referral or offer.

• 7.5% (111) of those to have been offered cardiac rehab have declined, with 24.9% (368) having a recorded code for attending cardiac rehab.

Public Health Cardiac Rehabilitation National Audit

• We know these programmes are evidence based and demonstrates a positive impact on cardiovascular mortality, improved quality of life and reduced hospital readmissions • However, uptake isn't as it should be and the barriers to why need to be explored • The National Audit Cardiac Rehabilitation (NACR) 2018 report based on submitted data has made the following key recommendations for programme delivery:

- Recruit more female patients and programmes are better tailored to the needs of female patients - Carry out a comprehensive CR assessment prior to, and on completion of, CR - Offer facilitated home-based modes of CR delivery for all CVD patients, including those with heart failure - Ensure programmes are working to certification standards and aim to secure certified status for the delivery of CR

Public Health Pulmonary Rehabilitation National Audit

National COPD Audit 2018 made the following recommendations for programme provision: • Offer to all eligible patients across range of severity of exercise limitation (MRC breathlessness grades 2–5). • Improve written information about its benefits for patients and patients and referrers, to improve uptake • Ensure adequate, long-term funding frameworks that will allow an appropriate skill mix. • Ensure that services are offered supervised treatment for eligible patients due to other chronic respiratory diseases. • PR programmes should review their programme structure (frequency and duration) and content to ensure that they are providing treatment in line with BTS quality standards • Review of discharge processes to ensure each patient receives a written, individualised plan for ongoing exercise and maintenance when they finish rehabilitation Public Health ‘Breathlessness’ A symptom based model

• Most evidence based on the provision of a joint service for CHD and COPD patients due to the symptom overlap and patient cohort similarities • Cardiac rehab often attracts a heterogeneous population younger with high exercise tolerance - where as COPD and CHF older frail patients who both experience ‘breathlessness’ • Exercise is a component that most benefit from but not always the most important – needs to sit alongside wider wellbeing education including anxiety • Leeds have piloted this approach • Leicester have implemented this model – embedded a holistic approach for people with shared symptoms • A feasibility trial proposed with a view to influence routine delivery • It’s the ambition in the LTP Public Health An assessment based model of rehabilitation • Scotland developed their 2020 vision to be: ‘CR should aim to provide each patient with an Individualised Programme of Care that is tailored to their specific needs. The rehabilitation outcomes should cover a wide range of options addressing all appropriate risk factor behavioural changes, which can be delivered across multi-agency providers and underpinned by the BACPR Standards.’ • As a result they have updated their National Clinical Guideline for Cardiac Rehabilitation published by Scottish Intercollegiate Guidelines Network (SIGN) in 2017. • The guideline for delivery places emphasis on: - An assessment to build an individualised care plan - Assess motivation and confidence to achieve what is important to them - Then based on need, offer a wide range of options to aid recovery and support in managing the health condition

Public Health Personalised Care – could this be the future for Leeds? • Could this approach be a consideration for Leeds?

• Building on the successful Collaborative Care and Support Planning (CCSP)/Better Conversation approach

• Could this be expanded wider to management of cardiac/pulmonary patients?

• Holistic assessment

• Patient Activation Measure

• Development of individualised goals

• Offer of menu based flexible model of rehabilitation options

Public Health Digital & Web Based Models • A menu based model should offer where and how to attend rehabilitation • Centre vs home based programmes – evidence suggests equally effective and that choice should be offered • There is a growing evidence base for web/app based interventions for chronic conditions • This can provide new opportunities to increase uptake • Currently use myCOPD in Leeds • Leicester building web based programme based on the SPACE Manual for PR – but uptake was low. • Activate your Heart/myHEART/The Heart Manual • Evidence base is emerging • Digital literacy needs to be considered when implementing such approaches

Public Health Cardiac/Pulmonary Rehabilitation Is it time for a change?

• The impact rehabilitation can bring is evidence based and we need to increase uptake • Is the delivery model of two separate programme achieving the best outcomes? • This workshop gives us an opportunity to explore innovative and flexible models for future commissioning • It should be a holistic and individualised approach - people with the same diagnosis have very different abilities and needs based on wide number of determinants • Research suggests avoid disease centred approaches - but translation into practice can be challenging • An assessment based model could help to achieve this approach and tailor interventions using the provision we already have in the city • A flexible menu based programme is likely to accommodate the needs of different ages, ethnicities, diseases and symptoms.

Public Health Thank you

Any questions? Group Work

Timing Task Duration 10.50am – 11am Task 1 – Understanding the Patient Perspective 10 minutes

11.00am - 11.20am Task 2 – Generating Ideas 20 minutes

11.20am – 11.50am Task 3 – Prioritising Ideas 30 minutes

11.50am – 12.10pm Task 4 – Feeding Back 20 minutes (5 minutes per group)

Table Facilitator Red Charlotte Coles

Yellow Jane Slough

Green Diane Burke

Blue Caroline Stocks Task 1 (10 minutes)

THINK FEEL Ms Ms Stephens Coates

DO SAY

Mr Mr Jones Winters

Task 1 – Understanding the Patient Perspective Task 2 (20 minutes)

Task 2 – Generating Ideas Task 3 (30 minutes)

‘Long-term

vision’

‘Quick

Wins’ IMPACT

FEASIBILITY Task 3 – Prioritising Ideas Task 4 (20 minutes)

• 5 minutes – each table • Overview of patient scenario • Overview of ideas – including how they address the needs of patient scenario • Overview of prioritisation of ideas – including explanations of why ideas are high/low impact vs. high/low feasibility Next Steps and Closing

‘Co-designing a vision for Cardiac and Pulmonary Rehabilitation in Leeds for 2020-2025’

January 2020 February – June 2020 16th December December 2019 Project Planning 2019 Summarise key /agreement of Work commences priorities with commissioning Hold Workshop outcomes from workshop pathways/post plans developed if acute groups required

Patient & Staff Engagement

[email protected] Thank you

Any questions? Please complete evaluation form