APPENDIX 19
Memorandum by Priory Healthcare (H 45)
ALL FIGURES RELATE TO THE PERIOD OF JANUARY
2000 TO JANUARY 2001 AND REFER ONLY TO BUSINESS CARRIED OUT WITH
THE PUBLIC SECTOR
INTRODUCTION
1. Priory is part of Westminster Healthcare,
Europe's largest provider of specialist health services in the
independent sector. In addition to neurorehabilitation the company
provides psychiatric, forensic, Senior Living, learning disability
and diagnostic services spread among over 120 facilities across
the UK. The company is based in Leatherhead, Surrey and employs
over 10,000 people.
2. Priory Healthcare provides 123 beds for
people requiring rehabilitation for traumatic brain injury and
maintained an average daily occupancy across these units of 95.7
(88 per cent). Recent increased provision in the Southeast has
seen a directly proportional increase in purchasing. (See appendix
i)
3. Eighty eight public sector purchasers
across the UK purchased over £6.5 million worth of services
from the company's Brain Injury facilities last year. In most
cases this accounts for between 85 per cent and 95 per cent of
total revenues for brain injury services. The public sector uses
our services because of their specialist nature. Unsted Park Hospital
provides treatment for stroke patients who may by treated under
private medical insurance schemes. Other private patients are
treated with funding from compensation claims arising from their
injury. Our services are often selected as the most effective
treatment option (see appendix ii).
4. These beds are situated across the country
in a mix of dedicated brain injury units and as part of larger
specialist healthcare facilities. The four larger units at Lancashire,
Surrey and Sussex (2) are registered under the Registered Homes
Act. The two smaller units in East Sussex are registered with
the Local Authority.
5. In addition to the current provision
of brain injury services Priory aims to provide further specialist
services within several of Westminster's Senior Living Division
nursing homes to widen the availability of services and provide
more facilities close to local areas of need. These units will
be staffed over and above the usual provision for nursing homes
with qualified staff skilled and experienced in brain injury rehabilitation
to ensure that high standards of rehabilitation are achieved and
most cost effective services delivered.
RESOURCES, RECRUITMENT
AND TRAINING
1. Units are managed within the structure
of Priory, each facility has a Hospital Director or Unit Manager
responsible for the operation at unit level. Consultant Clinical
Neuro-psychologists and Consultants in Rehabilitation Medicine
provide clinical management.
2. Staffing varies depending on the size
and nature of the unit. Within the larger units rehabilitation
is provided by a team, the constitution of which, varies according
to the nature of the services provided. It normally includes a
medical consultant with a specialisation in rehabilitation medicine,
consultant clinical neuro-psychologists, senior nurses, physiotherapists,
occupational therapists, speech and language therapists and social
workers. At the Priory Ticehurst House there is a workshop technician
to look at work-related skills. The children's services at Highbank
Rehabilitation Centre employ a special needs teacher and play
specialist. Additional input from creative therapies, dietetics,
and pharmacy is provided as required.
3. The smaller residential units—Egerton
Road and The Vines—are run by a Unit Manager and staffed
by trained support workers. They receive regular input from Consultant
Clinical Neuropsychologists and from other disciplines as required.
4. The majority of the staff are directly
employed by the Company. Some Consultant posts, both medical and
psychological, are contracted from the NHS or through an individual
agreement with the Doctor concerned. General medical cover is
generally provided by a GP who will have a special interest in
neuro rehabilitation.
5. Postgraduate training for all qualified
staff is encouraged. This may be provided in house or via a range
of recognised training organisations and professional bodies.
Those include the Bobath Centre in London, NW3 and the national
Demonstration Centre for Rehabilitation at Derbyshire Royal Infirmary.
6. Recruitment of nursing staff into the
sector remains as problematic as it is in the NHS. Registered
Psychiatric Nurses and Registered Sick Children's Nurses are the
most difficult vacancies to fill. Therapy staff, such as occupational
therapists and physiotherapists, are easier to recruit with all
units staffed to 80 per cent-90 per cent of their budgeted levels.
7. The attraction of the independent sector
for clinical staff is the opportunity to influence clinical activity,
work in highly specialised areas, and with greater autonomy. Reduced
caseloads (in line with guidelines from professional bodies) enables
a higher quality service to be provided. As an example a Senior
II OT in a similar service in the NHS may have 35 or more patients
on their caseload whereas in the independent sector the ratio
is generally 1:5.
HOSPITAL AND
COMMUNITY
1. The company provides a mix of hospital
and community based services. The larger facilities provide post
acute rehabilitation where the patient is treated for a limited
period of time with a view to returning to the community or being
moved to a residential setting. This mix of service varies from
unit to unit and is largely borne out of local need and demand.
(See Fig ii). Patients live in residential settings and are encouraged
to gain independence through structured rehabilitation programmes.
Programmes are designed by a psychologist working with both the
patient and the rehabilitation team.
2. The two residential facilities provide
services where the emphasis is on integrating the patient into
the local area. In some cases this will result in discharge from
the unit into independent housing whilst in others the patient
will continue to need long term residential care.
3. There has been an increase in the demand
for "outreach" work. These are services that provide
a range of interventions in the community either in the patients'
own home or a dedicated facility in a local area. This demand
seems to be in keeping with the general change in philosophy in
the Health Care sector that champions' community based services
against institutional care.
4. Priory recognises the need to ensure
patients are returned to their home, community or to an appropriate
supportive setting as soon as reasonably possible. The rehabilitation
team works closely with the patient and their family and community
agencies to ensure the most effective solution for the patient's
difficulties. This in turn increases the throughput for the inpatient
facility and assists addressing the increasing demand on such
facilities.
5. Of the facilities owned by Priory three
currently provide outreach services with two providing a dedicated
outreach facility. The Priory Hospital Ticehurst also employs
Brain Injury Case Managers who have current caseload of 21 patients.
Most of these patients are funded through insurance claims and
are provided with bespoke packages of care.
COLLABORATION
1. Collaboration with statutory bodies and
the provision of seamless care can be a difficult issue. There
are pockets of good practice but by and large the working patterns
of Local and Health Authorities vary so considerably that seamless
service becomes difficult to provide. None of the facilities owned
by Priory enjoys a consistently successful relationship with the
public sector.
2. Services are generally purchased on an
"ad hoc" basis with little or no planning or discussion
with provider units as to the medium or long term arrangements
for patients. Purchasers generally use our services because of
the specialist skills our units possess.
3. The responsibility of public sector provider
units and services to collaborate with the independent sector
is not sufficiently clear and this can result in long delays,
poor quality of discharge planning and in some situations relapse
for the patient concerned. [8]
4. It often appears, anecdotally, that the
quality of discharge and follow up in the community is dependent
on the individual professional(s) involved. Where a collaborative
and professional relationship develops with local authority employees,
be it placement officers or social workers, then the process by
which patients are admitted and discharged is more efficient and
effective.
5. There is an untested hypothesis, among
some facilities, that independent providers enjoy the least favourable
relationship with their host Authority. Whereas purchasers from
further afield will work more collaboratively with the facility
and foster a more fruitful partnership.
6. Links with purchasers and other significant
parties are maintained through a system of case conferences and
family meetings, which are held on regular basis determined by
the patients' length of stay. Families are routinely involved
in the decision-making processes that relate to the care and treatment
of their family member.
7. The largest single hurdle to better collaboration
is communication. The apparent "spiders web" of communication
lines that exists in both the Local and Health Authorities does
not foster clear timely information. Moreover the failure of Health
and Local Authority departments to work in collaboration exacerbates
the problem for the independent provider who is often caught in
the cross fire between purchasers, community service providers
and the patient's family when trying to effectively settle a patient
in the community. Clear lines of accountability and identified
case managers for each patient within the public service sector
would begin to ease the problem.
8. Where there are clearly identified individuals
with properly defined roles the relationship between sectors improves
drastically and the patient gets a "better deal". Strengthening
and making mandatory the principles of "partnership"
would help enhance these relationships and lead to more efficient
health and social care network.
SUMMARY AND
CONCLUSION
1. The services provided by Priory for Brain
Injury rehabilitation are broad and geographically wide-ranging.
2. The services are provided in a mix of
hospital and community settings with an emphasis on meeting local
demand with high quality, flexible and cost-effective treatment
facilities.
3. The further development of Brain Injury
services is a key part of Westminster's strategic plan. This includes
the use of existing local resources to bring the services closer
to where they are required.
4. Over £6.5m is spent annually by
the Public sector on Brain Injury Services provided by Priory.
5. The company is changing to meet the growing
demand for outreach and community work and is developing services
that meet a range of complex needs associated with brain injury
neurorehabilitation and other services such as early onset dementia
and other degenerative neurological disorders.
6. Collaboration with the statutory sector
remains dependent upon the quality of the relationships developed
between individual professionals and services. This is not the
most effective approach and much work needs to be done on defining
the responsibility of those concerned with admitting and discharging
patients through the independent system.
] February 2001
ANNEX
I
SCOPE OF CURRENT PROVISION (NOT INCLUDING
NURSING HOMES). FIGURES RELATE TO THE PERIOD JANUARY 2000 TO JANUARY
2001
| Name of facility |
Number of beds | Average daily occupancy
| Number of discharges | Number of admissions
| Public sector purchasers | Per cent of total purchasers
|
| Highbank Rehabilitation Centre, Bury, Lancashire
| 52 | 43 | 19 |
28 | 38 | 91 per cent
|
| Unsted Park, Godalming, Surrey | 20
| 16.3 | 92 | 94
| 11 | 43 per cent |
| The Priory Hospital, Ticehurst, Wadhurst, Sussex
| 14 | 8.1 | 24
| 35 | 17 | 94 per cent
|
| The Priory Grange, Heathfield, Sussex | 10
| 8.8 | 0 | 1 |
7 | 93 per cent |
| The Vines, Crowborough, Sussex | 11
| 10 | 0 | 0 |
10 | 100 per cent |
| Egerton Road, Bexhill, Sussex | 10
| 9.5 | 2 | 2 |
5 | 84 per cent |
| TOTAL | 123 | 95.7
| 137 | 160 | 88
| |
Figure 1. Availability of Services.
ANNEX
II
TYPES OF SERVICE OFFERED. ONLY
| Facility | Services/Programmes
| Outreach Work |
| Highbank Rehabilitation Centre, Lancashire |
Post acute rehabilitation
Paediatric neurorehabilitation
Cognitive rehabilitation
Long-term care
| Largely through the cognitive rehabilitation service
|
| Unsted Park | Stroke rehabilitation
Traumatic brain injury including day and inpatient rehabilitation
Spinal injury
| None |
| The Priory Hospital, Ticehurst, Sussex |
Post acute rehabilitation
Cognitive rehabilitation
Challenging behaviour
Day patient rehabilitation
| Largely through employed case managers with support from the Consultant Clinical Neuropsychologists and other members of the team
|
| The Priory Grange, Sussex | Long-term care
| None |
| The Vines, Sussex | Long-term care
| None |
| Egerton Road, Sussex | Intermediate and long-term care
| Currently for one patient |
Figure 2. Range of Services provided.
8
It is worth noting that in Priory's experience, patients who are
discharged under Section 117 of the 1983 Mental Health Act are
better provided for as the responsibility of all concerned are
clearly laid down by law. A similar system for the discharge and
community management of brain injured and other similarly disabled
patients with complex needs would be a welcome tool for all concerned. Back
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