>>Esther: Hello, thank you very much for giving us an opportunity to speak today. My name's
Esther. I'm a paediatrician. We've got Raj, who's a consultant rheumatologist; Jane, who's
head of business development; and Gina, who's head of therapies.
And we're here today to tell you a story about an illness that I feel very passionate about,
but also give you a solution. And this is a solution that has not been talked about
yet, although I think when you hear it, you'll realise it's quite an obvious solution to
many of the problems that you currently face.
So the illness that I'm passionate about is chronic fatigue syndrome, or ME. This illness
is a disaster for teenagers. Most of the teenagers that come to my clinic are attending two days
or less a week of school. They've often been ill for two years. Their parents stop working.
And about 30% of the teenagers I see have comorbid mental health issues: anxiety or
depression.
There is some good news. There's a good evidence base for this illness. So if you access specialist
therapies, you've got a 65% chance of full recovery within six months. If you don't,
your chance of recovery is 6%. And the really bad news for these children is that only 15%
of children across the UK have access to specialist care that's local.
So our solution to try and drive down costs of secondary and tertiary care, and also reduce
inequalities, is a solution that we've implemented locally and started to implement nationally,
but we need help for [inaudible]. So our solution is that we employ local therapists embedded
in local teams in CAMHS, in physio, in occupational therapy departments to treat children. We
train them with speciality skills. They're part of our team, they attend our team meetings.
They get specialty training and they are specialists within a local service.
Now, this has got some advantages. The advantages to the patients are the patients are seen
locally. They're nearby. The therapists go to the same schools often as their children
go to. They are embedded in local teams, so they have specialist skills. It has a lot
of advantages for the therapists. Therapists... It improves recruitment and retention, we've
found, the therapists are engaged in a speciality area, they're trained to give a special therapy.
And it has advantages for local health care providers. We've noted reduction in secondary
and tertiary health care costs. We see parents returning to work. And it has advantages for
social care.
What have we done so far? Well, we've implemented this throughout Wiltshire, Gloucester and
Somerset. And we've also got a satellite model in Macclesfield. What do we want from vanguard
status? We'd like to roll this out for paediatric chronic fatigue syndrome across the UK. But
we also think that this is relevant for the long-term conditions, long-term conditions
where treatment is provided by therapists. And there's a range of conditions that you
can think of in paediatrics. It's also important for a range of adult conditions and without
running into a sticky wicket or having a googly, I'm going to pass over to my adult colleague.
>>Raj: Gosh, I feel quite bowled over. So as Esther said, my name's Raj. I'm an adult
rheumatologist. And adults with musculoskeletal conditions face the same issues as children.
Many of my patients say to me they travel a long way for what is a relatively short
outpatient appointment. And these patients need to be seen quickly. So what we've said
is that the rheumatologists and the registrars who are seeing these patients are probably
not the right people to see them. They would be better served by seeing therapists in the
community.
The Royal National Hospital for Rheumatic Diseases has a national and international
reputation for treating patients with musculoskeletal diseases. I'd like to take fibromyalgia as
an example. So the prevalence of fibromyalgia in the UK is around 3-5%. For Bath, that means
500 new patients and 400 follow-up patients every year. These are the patients we want
seen by the specialist therapists in the community.
Also in Bath, we run rehabilitation programmes for patients with ankylosing spondylitis and
fibromyalgia syndrome. These two- and four-week programmes really improve patients' lives.
And we're unique in the UK. We want to, again, develop and distribute and deliver these courses
all around the UK.
So if we're successful with the bid what we'd like to do in the first instance is to open
two or three satellite centres within the southwest of the UK. We'd get our specialist
therapists to see the patients with fibromyalgia and deliver the care closer to home. Once
we'd... At the same time, we would train up further specialist therapists.
Once we had the model that was sustainable, reproducible and codified, we would then take
it nationally. We also believe that this model could be used in other conditions, musculoskeletal
conditions like osteoarthritis, and non-musculoskeletal conditions like irritable bowel syndrome.
One of the really key things I'm passionate about is the use of technology in this bid.
So in bath over the last five years, we've been, we've been developing a programme on
the N3 NHS secure network, which allows patients to fill in their outcome measures from home.
This will then allow our therapists, when we've developed the model for fibromyalgia,
to really provide the right treatment for the right patient at the right time. It will
stratify the patients, rather than build up a backlog that we want to avoid. Jane.
>>Jane: So, hopefully, what you've heard is that our model isn't just about a franchise
solution for rheumatological conditions, but also developing a broader understanding of
how franchising can help support other patients with long-term conditions. We believe that
with our experience, we are really well-placed to further develop and enhance the evidence
base and protocols for treating patients with long-term conditions and help you as providers
decide how you can... How you can franchise your specialised services safely and cost
effectively.
We really want support from the vanguard programme to help us address the really thorny issues
we face around commissioning, governance and legal problems, but more importantly, we want
to help develop a process for systematising and standardising patient and stakeholder
engagement in the further development of franchise solutions.
We believe that through this approach, we will build a franchise model of healthcare
for which the NHS can become internationally renowned. Thank you.
>>Unidentified Male Speaker/s: Questions from the team from the Royal National Hospital
for Rheumatic Diseases, please? Right at the back, number 22?
>>Phil Corrigan: Hello. Phil Corrigan from Leeds West CCG. Could you just tell me a little
bit about how this impacts on the financial sustainability of the system?
>>Esther: Yes, so there's quite a lot of... I'm actually really a researcher most of the
time. There's quite a lot of research evidence on these particular... Group of conditions.
So before patients access therapy, they're seeing lots and lots of consultant times,
often across lots of different specialities. So children will see neurologist, paediatrician,
cardiologist and so on. And so... And... But once they access therapy in terms of [inaudible]
or whatever approach we're using for my condition - and it's the same for the others - what
happens is that those consultations stop. So you reduce secondary and tertiary care
level, healthcare costs, whilst actually trying to get the patient better.
>>Phil Corrigan: So have the costs actually been modelled?
>>Jane: I think probably that's something we probably ought to... What we want to explore
as part of the vanguard programme. Locally, we know, we've got a proven evidence base
for it to work. But, clearly, part of this approach is around scaling up what we do locally
in Bath and around the local centres we serve. And that's what we're passionate about doing
is bringing this out to the wider health care community.
>>Unidentified Male Speaker/s: Table number 15, please.
>>Gordon Cairns: Gordon Cairns from Cheshire. Could I ask...? When you take on all these
therapists what happens to the doctors and nurses that have been treating these patients
beforehand?
>>Raj: So thanks for the question. For us in Bath, we have over 2,000 follow-ups with
patients who still can't be seen. So, you know, there's a lot of work to do out there,
we just don't have enough staff. This, for me, is making sure you get the right clinicians
seeing the right patient and not just saying, you know, you're a rheumatologist, you can
see it all. We are being clever at who sees the right patient.
>>Unidentified Male Speaker/s: Question on number 19, please.
>>Gilbert Wheeler: Gilbert Wheeler, patient advisor for Wiltshire, Hampshire, Dorset.
Two things: I haven't seen this rolled out over Wiltshire yet. You said it was being
rolled out, so I have to look at that and check whether... More importantly, are you
looking for advice with this? Or are you looking for the financial support for the programme
to run?
>>Esther: So we have ten clinics in Wiltshire and I'd be very happy to talk to you about
that. We are desperate for advice, support. We've already actually got quite a lot whilst
being where, which has been great. As Jane said, there are really difficult problems
that we struggle with, they're really interesting... Well, difficult challenges over how you contract
out. They are difficult employment issues, difficult commissioning issues. We believe
very strongly in this model, but we are looking for help, support, advice and some funding
would be great too.
>>Unidentified Male Speaker/s: Question on table number nine, please.
>>Unidentified Female Speaker/s: Thank you. Great to see a model about therapy in the
community. I thought that was fantastic. I guess one of the things that therapists generally
benefit from is coming to the centre, the education, the networking with colleagues.
And it can be quite a lonely place in the community. So how will you do that? So how
do you do it?
>>Esther: Yes, I think... Well, I think that's something that we've really noticed and I...
It's taken me a couple of years to get my head around it. So what we do is we have teams...
They come twice a year for team meetings. They go to national events, which we pay for.
And then we have monthly or twice a month supervisions with them and we use videoconferencing
for that. We also have a whole system for email contact.
The really tricky issue is also how they deal with the very complicated patients. So we're
actually asking them to deal with the straightforward patients on the whole and they still need
help and support with the more complicated ones and that involves a process of upskilling
them. There's CPD days... It's a whole range. We have... It's not one solution, it's a range
of solutions you have to do.
>>Unidentified Male Speaker/s: Thank you. Any further questions? We have a couple of
minutes. No further questions. Okay. So can I have a big thank you from the team from
the Royal National Hospital?