Frontline talks to a team of physios and social care providers working together to improve care workers’ skills and confidence.
Meeting the needs of a changing population involves considering how to use physiotherapy knowledge and skills for maximum impact.
The growing and ageing multimorbid population means the demand for health and social care is increasing, and this places ever more strain on physiotherapy services, particularly as more of the care is shifting into community settings. In England, the NHS Long Term Plan commits increased funding for primary care and community services to support this shift but increased resources alone won’t solve the monumental challenge of providing better, more accessible community physiotherapy. It is vital that, along with growing our services, we consider and re-evaluate how we can use our unique knowledge and skills for maximum impact.
One such area where a different approach to optimising physiotherapy expertise is being used is in adult social care services in Hertfordshire. Social care practitioners are frequently the backbone of our over-stretched system: keeping people well and at home, and supporting their quality of life and independence. However they don’t always necessarily possess the knowledge and skills that enable them to work in enabling and empowering ways with their clients. Anecdotally they report that they feel unconfident and become risk averse when it comes to keeping people mobile and implementing the principles of postural care that can prevent people from developing escalating healthcare needs.
Hertfordshire Care Providers Association (HCPA) recognised the benefits of giving social care practitioners the knowledge and skills to take a better informed and enabling approach to care, and approached Enlight Physiotherapy to provide an additional teaching module on its complex care pathway programme. HCPA is a non-profit membership organisation that sources and manages funds on behalf of the government, the local authority, the NHS and other local funding agencies for the provision of adult social care training courses and qualifications. It acts as a central hub for care providers across Hertfordshire to share best practice to raise the quality of care services in the county.
Carers who have already undertaken the HCPA’s ‘falls’ or ‘health champion’ courses can apply to undertake the physio support facilitator course, a level 3 gateway assured course. It gives them a better awareness of physiotherapy and physiotherapy approaches, equipping them with essential knowledge and enhanced skills in movement and physical management approaches and techniques in their care setting. The module was designed by Enlight director Suzy White, and her former business partner, Natalie Hilliard, a physiotherapist.
At the end of the formal teaching programme Ms White provides workplace assessments and ongoing regular supervision to the physio support facilitators, as well as virtual support via telephone and a WhatsApp group. Their ongoing support package also includes CSP associate membership, as Ms White says: ‘The physio support facilitators benefit hugely from membership of the CSP, as it not only gives them an ongoing community of support and CPD access, but also adds that much-needed credibility to their social care role.’
Theory into practice
Back in their care settings, those who have completed the course are able to work differently in two significant ways.
Firstly, by putting into practice the principles of enablement, therapeutic handling and posture management they are better able to support residents to be more physically active, prevent secondary consequences of immobility and apply a more developed sense of their personal scope. They are also confident in knowing when to escalate concerns to a registered physiotherapist for assessment.
Secondly, they are equipped to offer knowledgeable and skilled support to that registered physiotherapist.
Care homes engaging with the complex care pathway
training have seen a 11% reduction in A&E attendance
Ms White says: ‘Physiotherapists in community settings have always delegated tasks to social care practitioners and frequently spend significant time teaching and supporting competence where carer knowledge and understanding of physiotherapy practice is limited. With this model of training and support, carers are able to pick up much more quickly what to do and how. And, significantly, by applying the simple principles that they learn, they are able to work in more enabling ways and challenge traditional notions of risk.’
HCPA evidence indicated that, at the care homes who have engaged with the complex care pathway training, A&E attendances have reduced by 11 per cent compared with a 24 per cent increase from others.
The next step is to develop plans to broaden the data and information required to demonstrate patient, local and system level impact.
Jeanette Bussey, who underwent training with Ms White in the first cohort in 2017, believes the knowledge and skill she has acquired have revolutionised her approach to care and the culture in the residential home where she has worked for 11 years. Her increased confidence in her own practice led to her applying for and being appointed assistant manager of the home. She explains, ‘I’m well aware that, while I can’t do physiotherapy assessments or prescribe exercise programmes, I now have the knowledge to spot early signs of deterioration in a client that I can flag up to the appropriate health professional. With the right approach, our residents can actually improve rather than deteriorating or staying the same. Working in the care sector, we’re now being encouraged to adopt a positive risk-taking approach, and I feel more confident that I can do this safely now. I’m amazed – and so are my colleagues – at the impact this has had on our residents’ motivation and quality of life.’
View from the CSP
Claire Fordham, CSP professional adviser, says: ‘This innovative approach to support worker development in the social care sector shows the impact that physiotherapists can have system-wide. This programme of imparting our unique professional knowledge, skills and expertise to empower others to provide outstanding care, shows the true and far reaching power of physiotherapy.’
Since the complex care pathway training for carers, including the physio support facilitator training has been embedded in Jeanette’s residential home, she has seen improvements for residents and carers. The local community physiotherapy services have also noticed an impact, with reduction in the visits and an improvement in the relationship.
HCPA have won an industry award for this work
The project won a Value in Healthcare Award in 2017, taking the Workforce Efficiency category in the Health Service Journal-run annual industry awards scheme.
The judges said: ‘Our winners are an ambitious and passionate team who used evidence to identify the issue and built relationships with partners to create the solution, with clear positive impact on care homes and the overall health social care system.’
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