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Get Mobile – Stay Mobile. Patients Charter

Get mobile stay mobile Patient Standards

“In the United Kingdom every year 5,000 people with diabetes have an amputation – that’s 100 people every week”

GET MOBILE – STAY MOBILE

And Avoid:

LIMB LOSS, ULCERS AND PRESSURE SORES

Through Our Vital

NURSING, ORTHOTIC, PODIATRY, PROSTHETIC & THERAPY SERVICES

in England with the support of this

PATIENTS CHARTER

Developed Collaboratively and Iteratively under the aegis of the

Associate Parliamentary Limb Loss Group

In continuing consultation with key Stakeholders including

Age Concern; Arthritis Care; Assist UK; British Association of Occupational Therapists; British Association of Prosthetists and Orthotists; British Orthopaedic Foot and Ankle Society; British Polio Fellowship; British Society of Rehabilitation Medicine; Chartered Society of Physiotherapy; Diabetes UK; Disabled Living Foundation; Help The Aged; International Society for Prosthetics & Orthotics (UK); Joint Committee on Mobility for Disabled People; Leonard Cheshire; NHS Purchasing & Supplies Agency; Royal College of Nursing; Society of Chiropodists & Podiatrists.

July 2006 DRAFT

APLLG/SG/SM

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Foreword

Skilled, caring and vital multidisciplinary teams of Consultants, General Practitioners and Allied Healthcare Professionals (AHPs) combine and coalesce creatively and share resources to ensure timely and effective delivery of  NURSING, ORTHOTIC, PODIATRY, PROSTHETIC, THERAPY – SERVICES & EQUIPMENT (hereinafter referred to as Services) to enable Patients to avoid Limb Loss, Ulcers and Pressure Sores and to “GET MOBILE and STAY MOBILE”.

This Charter supports Government welcome policies and initiatives that require improvements in Commissioning, including:

  • “Tackling Hospital Waiting – the 18 week patient pathway”
  • The National Service Framework for Diabetes, which stresses the importance of effective services and strategies to manage diabetes, and the Diabetic Foot Guide implementing the NSF standards;
  • The Fair Access to Care Services (FACS) initiative, which aims to make eligibility for services dependent on needs and circumstances, not on where people live and where they first access services;
  • The National Service Framework for Older People, which details the Government’s expectations of the services that should be available to older people, and the manner of their delivery as part of the NHS Plan;
  • The National Service Framework for Disabled Children and Young People, to enable them and their families to live ordinary lives;
  • The National Service Framework for Long Term Conditions to transform NHS and Social Services support through easier and quicker access to independent living;.
  • Practice-based commissioning to give GPs, Trusts and Authorities the tools to influence and innovate local service developments.

This Charter applies to the delivery of Services in the full variety of settings, including NHS, Contractors to the NHS, and Voluntary sectors.

Patient Needs:

Services should meet all of the following 6Cs from the National and International Charter adopted by the Associate All Party Limb Loss Group:

  • Choice

Patients need to be able to choose from a variety of convenient high-quality providers, with clear and consistent information and advice to back that choice, with money following the patient, and AHPs free to meet patients’ expectations. Locations need to be convenient and accessible. Appointment times should meet the needs of an adult patient and any carer, or a child patient and his/her parents.

  • Comfort

Equipment must provide adequate support and comfort to enable the Patient to achieve optimal pain-free function and mobility

  • Capability

Equipment must be appropriate to each Patient’s requirements, safe, easily maintained and easy to use – instructions must be given which are suitable for and understandable to the patient – there should be a single point of contact for advice about maintenance/recreation/travel/safety etc;

  • Cosmesis

Where necessary for self-esteem, Equipment must be cosmetically acceptable commensurate with optimal function – needs for children and young people, at the early stages of developing a positive self-image, must be met.

  • Competence

All AHPs whether from the NHS, Contractors to the NHS, or the Voluntary sectors, must (be enabled to) have educational and career opportunities necessary to developing and sustaining their competencies and skills – generating mutually dignified and positive relationships with patients of all ages.

  • Caring

Caring is the Catalyst, whatever the age of the patient.

Equipment includes footwear and coverings, orthoses, crutches, prostheses, and other mobility and risk-reducing aids.

The needs of the individual Patient will change, or new assistive technologies will become available. Services should provide the Equipment (including a “second” if required for employment/independence/lifestyle) most appropriate for the individual Patient throughout each stage of his/her lifetime pathway.

It must be recognised that some apparent/assumed psychological problems (e.g. presumed inability to “cope”), may be due to not meeting one or more of the 6Cs, and that proposed psychological/counselling solutions or services could then be contra-indicated and absorb scarce resources.

Aims:

Despite the best endeavours of Staff current services may in certain aspects be found to be unsatisfactory because:

  • There are unexplained variations in all aspects of service provision, bearing little relation to underlying levels of need;
  • Quality of Services may owe more to custom and practice, rather than to a considered view of the contribution that Services could make to the overall needs of the population.

Co-working to drive up standards of care, Patients seek to help:

  • Provide the detailed data analysis that underpins sound commissioning
  • putting patients and service users first through more personalised care;
  • a focus on the whole of health and well-being, not only illness;
  • Give the individual – the patient, service user or client – more power to improve their care and drive the whole system
  • Improve both quality and equality
  • Address the needs of children as well as the adult population and their families and carers
  • Secure prompt referral for support where needed
  • Support new types of team working across organisational boundaries.

Best practices require the provision of adequate resources and continued professional development, to “provide the right care, at the right time, and to the right quality without unnecessary delays.”

Patient Pathways:

From GP or other referral to final delivery of equipment, including diagnostic tests and procedures and outpatient treatments, the patient pathway should not exceed 18 weeks.

Delivery will be in stages and the final outcome should include confirmation by the Patient that the 6Cs have been met, agreement of objectives, and validation of education of Patient and Carers.

“Pain-Stop” or emergency repairs should be offered on the same, or the day following, the day of request.

In support of the defined mechanism for Repairs & Maintenance, including regular reviews, Patients and Carers must keep the service informed of any relevant changes in their personal circumstances.

Opportunities for Commissioners:

Opportunities for Commissioners are to:

  • Look across organisational boundaries, achieve better co-ordination of care, and recognise total savings;
  • Ensure that reliable and relevant information is freely available to patients both generally and through User Groups;
  • Secure that the necessary range of high-quality Services is more and adequately resourced;
  • Improve prevention, treatment, rehabilitation and care, underpinned by holistic assessment of needs;
  • Reduce falls risks;
  • Reduce hospital bed occupancies; and
  • Enable increased capacity to be put to optimum use by treating people as efficiently as possible and responding to their needs and expectations.

Patients support Commissioning to involve the Patient (and the Carer) collaboratively in the design and delivery of Services to achieve and maintain health, independence and well-being.

They welcome the obligations on Strategic Health Authorities to align the continuing NHS health care criteria they have inherited and establish common criteria across each health economy.

Best Practices:

Sources for information about Best Practices may include:

  • Diabetic Foot Guide from the National Diabetic Support Team - NDST@prolog.uk.com
  • National Institute for Health and Clinical Excellence – www.nice.org.uk
  • Prosthetic and orthotic awards sponsored through the Douglas Bader Foundation and the Limbless Association
  • Prizes sponsored by Age Concern, British Limbless Ex-servicemen’s Association, British Polio Fellowship, Diabetes UK, Help the Aged and other key stakeholders
  • Websites such as that of Associate Parliamentary Limb Loss Group – www.apllg.org.uk
  • British Society of Rehabilitation Medicine and the International Society for Prosthetics and Orthotics (UK)
  • Rehabilitation Forum supporting clinical and cost-effective rehabilitation services
  • User Groups

Domains to which regard should be had, looking at services across healthcare organisations, include:

  • Putting service users first through more personalised care;
  • a focus on the whole of health and well-being, not only illness;
  • safety
  • care environment and amenities
  • clinical and cost effectiveness
  • governance
  • patient focus
  • accessible and responsive care
  • public health

Equal Opportunities and Access:

Patients are committed to supporting equal opportunities and access for all, irrespective of age, disability, gender, marital status, race, religion and belief, sexual orientation, transgender and working patterns, all with openness and transparency of process.

They agree that “effective care involves a partnership between patients and professionals and all decision making should be shared.”

Quality of Care and Assessment and Prescription:

The Patient assesses Quality of Care by its Effectiveness – the extent to which, and the quality with which his/her needs and informed expectations are met. Effectiveness requires Services to be organised and managed around Patient and Carer needs and to deliver maximum possible health and independence for both adult and child patients. AHPs should, subject to health and safety requirements, advise the Patient of the optimum solutions to his/her needs, through a process of Collaborative Realistic Attainable Goal-Setting, and such advice should not be compromised by resource constraints, realistic though immediate (not long-term) recognition of the latter must be.

Assessment by the Rehabilitation team and should result in a written Report of Assessment to the Patient (or for a Child the Parent/Carer), which should, with his/her consent, be circulated to all relevant parties.

If, because of lack of funding or pressure on resources, the most appropriate solution (see 6Cs) cannot be prescribed, the reasons should be fully documented in the written Report of Prescription and circulated to all concerned.

Continued Professional Development:

Delivering the workforce skills to meet Patient rights and needs requires sustained opportunities for Continued Professional Development, and clear career “stepping stones” for all professional staff. Undergraduate and Postgraduate studies and training need to be accessible regardless of distance both geographically and academically.

Workforce budgets must facilitate:

  • Involvement of AHPs in clinical/planning responsibilities and requisite post-graduate training leading to the appointments nationally of Consultant Practitioners
  • Opportunities for Technicians and Assistants to take Foundation Degrees, and thereafter achieve further qualifications.

Research & Development:

Consultation with Patients before budget commitment should ensure that Research Proposals and Development proposals, both Local and National, are intended to meet specific Patient needs. Worthwhile innovations in technology and practice should be introduced effectively with minimum delay. Beneficial developments and knowledge achieved Locally should be made available Nationally.

It must be recognised that some apparent/assumed psychological problems (e.g. presumed inability to accept changed appearance), may be due to the Service not being resourced to meet one or more of the 6Cs such as Cosmesis. Proposed further psychological research into these “problems” could then be contra-indicated and absorb scarce resources which could more effectively be deployed in Service provision..

Not a Blueprint:

This Patients’ Charter is a pathway to sharing improvements and best practices – not a blueprint for how services should be delivered. It recognises the need for mutual respect between patients/families/carers, and the providers of services whose skills and commitment are essential to maintaining the right mix of incentives, transparency, plurality of providers, practice-based commissioning and patient choice.