Managing a long-term condition (LTC) can be a daunting task for anyone, particularly when the specialist education and activity support they’ve received in hospital comes to an end.
The Solihull Rehabilitation Pathways programme helps patients overcome the challenges they may face in continuing to improve their health and sustain the benefits of appropriate exercise back in the community.
Working with Solihull Metropolitan Borough Council leisure services, and private contractor Parkwood Leisure, which runs North Solihull Leisure Centre and Tudor Grange Leisure Centre on the council’s behalf, means the programme delivers continued support, enabling NHS staff to focus on the initial rehabilitation and the most complex patients.
Limited capacity for pulmonary rehabilitation classes meant that most Heart of England hospital patients only had twice weekly sessions during the initial two to three month rehabilitation programme. A small number were able to carry on attending a maintenance class, some had been doing so for several years, but service could not cope with the demand for long-term support of large numbers of people.
Hospital staff provided patients with information about exercises to carry on doing at home and on local sports and leisure facilities, but most found it hard to continue without extra support. As specialist therapy services lead Helen Reilly explains: “Going to the gym, or even just for a walk, can be physically and psychologically daunting for these patients, if they need an oxygen tank with them, for instance. And getting to an exercise class can be a challenge too. For some people the class is one of the only times they go out of the house during the week.”
The answer has been to provide leisure services staff with the skills and knowledge to offer that level of support, modelled around a patient’s individual needs and physical capacity assessed during the introductory hospital classes, ensuring exercises are within their capabilities and familiar enough to encourage them to attend.
Fitness instructors shadowed the hospital classes and completed a British Lung Foundation accredited training course, supported by physiotherapists, so they could offer Better Breathing classes at Tudor Grange and North Solihull Leisure Centres and as an outreach service in Dorridge Surgery.
Helen points out: “As well as training to deliver suitable exercise classes for this patient group, we have worked with the instructors to help them understand what a big thing it is for people with poor health and a long-term condition to come to regular classes, and how much encouragement and support, care and nurturing they require to keep going.”
The council staff have proved willing participants, which has been crucial to the programme’s success. The venues were chosen to be accessible by bus or the Ring and Ride scheme, and class times based on what patients said would suit them best.
“The biggest barrier was getting people to go a leisure centre instead of coming to us, especially those who’d been going to the maintenance class for ages,” says Helen. Patient focus groups and accompanied visits to learn about the centres’ equipment all helped overcome this fear of change. And the team keep a close eye on patients. Physiotherapists regularly drop in on leisure centre classes, and instructors can contact them with any concerns.
What has also really helped patients settle in to both classes at the hospital has been the small but enthusiastic band of volunteer ‘buddies’ who welcome them on their first visit. “Our volunteers are invaluable because they’ve already been there and recognise what a big step it is,” says Helen. “They’ll talk a new person through what to expect, make them feel welcome and help with form-filling and so on. We hope to develop this to also use volunteers to support people to transfer to the leisure services classes after they complete the initial NHS programme.”
The pathways build on existing links between the hospital therapy and council leisure services teams, originally developed to deliver weight management schemes, and the leisure services’ ambition to engage more with hard-to-reach groups, including people with LTCs.
The two teams meet regularly to iron out any issues before they become real problems – often practical things like the price of a cup of tea in a leisure centre café or what time the Ring and Ride service drops people off. They also keep communicating with patients and listen to feedback, such as requests for certain pieces of equipment.
Leisure staff are now much more skilled at dealing with people with complex needs, including recognising when an individual is unwell and needs to be referred back to hospital.
It has taken a year to get up and running, but now a model is in place the concept has been readily transferable to other patient groups.
Further training for instructors by hospital therapists has meant hospital classes for people with Parkinson’s disease and multiple sclerosis have also been shifted to leisure centres. This has not only benefited the patients, it has freed up neurology staff to focus on the most complex cases. The leisure services team has independently set up classes for patients following cancer treatment and is for cardiac rehabilitation.
“Depending on the conditionand the needs of the people attending the classes, we might need to design special classes, or just provide better access to existing ones,” says Helen.
And the programme hasn’t required extra resources – in fact, it’s self-funding. Patients pay a small attendance fee, with leisure services charging the same rate as they do for exercise on prescription. So people can keep going for as long as they like. The leisure services team is happy to run extra classes if the demand is there and the space is available. More staff have been trained to make sure there’s cover and continuity, and it’s rare that classes are cancelled.
“The pathway helps us stay in contact and keep up patients’ motivation. It gives people a proper exit route from hospital classes while continuing to offer them the right support. And as they gain confidence and become more physically capable, those who are able to do so get help to make the transition to mainstream physical activity,” says Helen.
Secrets of our success
- Build on existing community links
- Share specialist knowledge and skills
- Actively involve patients in shaping and delivering services
- Recognise individual fears and address them in a positive way
- Find a model that works and is transferable