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Welcome to our regular online bulletin bringing you news about the network and the wider world of neurological conditions

New network launched 
We have now formally commenced as the Greater Manchester Neurorehabilitation & Integrated Stroke Delivery Network, bringing together the neurorehabilitation and stroke networks that have overseen service improvement in their respective clinical pathways since 2015.
On the 22nd September, the network Board formally approved the new governance arrangements and structures, as well as a new model for clinical leadership that will see an expansion of expertise and clinical support. You can watch a short video about the launch of the network here and find out more about the merger in our recent update.

 
We are currently recruiting a new Facilitator to the team and will shortly advertise for additional Clinical Lead roles. The network team currently comprises of:

We have a new Twitter handle @GMNISDN and if you don't already follow @GMISDN then please join us. Our YouTube channels which contain loads of training resources have been merged and can be found here. A brand new website with a fresh look and better functionality will launch in November but for now we will maintain both existing sites.
New spinal cord injury funding
Salford Royal, working together with the Royal Preston Hospital and the Walton Centre, have successfully bid for recurrent funding from NHS England aimed at improving the care of patients. The funding was introduced to improve the care of patients managed outside of the Specialist Spinal Cord Injury Centre, whether they are pending transfer to Southport or not for transfer for whatever reason. The bid included resources for the three Major Trauma Centres as well as for Southport, and for Greater Manchester this will include:
  • A new Specialist Nurse post
  • A new Psychology post
  • New therapy roles covering PT, OT and SLT
  • Some time for consultant-led clinics to provide more local management of patients needing on-going medical follow-up
  • Equipment to support mobilisation and posture of patients e.g. specialist seating
This resource will be based at Salford but is expected to outreach to sites across Greater Manchester to review and support patients with spinal cord injury.
Wigan community team transformation a success
During the past 5 years, the networks have been working closely with stakeholders to enhance the care provided to neurorehabilitation and stroke patients in a community setting. A number of areas such as Eastern Cheshire, Salford, Stockport and Wigan have made substantial investment and their local services have worked hard to transform to meet the requirements of the networks' community models. Progress on transformation has recently been made in Trafford and Manchester - more details to follow.
As a result of this work, many more Greater Manchester patients and their carers are receiving needs led support from better staffed, more integrated, multi disciplinary specialist community teams working closely with the voluntary sector and other services. This model of care has been incorporated into the national stroke programme, with the new model largely reflecting the work started in our region.
Gill Rowlands. Assistant Director - Community Commissioning & Transformation, NHS Wigan Borough Clinical Commissioning Group said:
"The Community Neuro and Stroke service has undergone a huge service transformation over the past 18 months, working towards bringing two very established small services together - Community Neuro and Community Stroke Teams (pictured below). The service has gone from strength-to-strength, building a workforce across all disciplines that has enabled patients to access timely, and seamless specialist interventions that will have a direct positive impact on their lives. The staff have overcome many challenges and barriers along the way, which at times have not been easy, however the resilience of the staff, along with their professionalism and enthusiasm to continue to drive the service forward has been remarkable and something that we are all very proud of. We are excited to continue on with this journey as a team, and look forward to developing this further with our partners across the wider Wigan Health and Social Care networks, GM Networks and 3rd sector partners.
The Wigan Integrated Team have worked together over the last 18 months to ensure that merging the neuro and stroke pathways was as seamless as could be for our patients, families, carers and the teams themselves, to aid a smooth transition. By relocating, better communications and partnership working, this was made easier throughout the COVID-19 pandemic when pressures were at an all-time high.
Even now, there is still more to be done, transformational work, more integration with system colleagues that is very much work in progress, but having the links with Wigan CCG and colleagues at the acute trust, and meeting regularly, has been extremely beneficial and has led to a more meaningful discussion with our GM Network colleagues."

Amanda Swift. Wrightington, Wigan & Leigh FT Health Integrated Manager added:
"The transformation the Community Neuro and Stroke Service have been through over the last 18 months is a credit to the passionate, professional and motivated staff within the team. The service upholds the WWL values and beliefs to the highest esteem to allow patients to access seamless specialist interventions. Working closely with our partners; GM, CCG, Social Care, acute division, charities, families, and carers to ensure a full holistic approach is embedded. Every staff member should be proud of their contribution in the service’s development during the COVID-19 pandemic. The service is looking ahead to continue with the transformation for all the patients and families within our care."
Training and education
We have some great webinars coming up, with face to face events likely to resume in early 2022:
The management of Patent Foramen Ovale in stroke webinar – 19th November 

Planned future sessions include:

  • Advanced vision workshop
  • Neurogenic bladder & bowel
  • MND
  • Vocational rehabilitation
  • Functional Neurological Disorder 
We offer a range of online training on stroke care on our Moodle learning platform for different professionals, with additional neurorehabilitation eLearning packages available here (log in to the website to access). Further online training resources including pre recorded webinars are on our YouTube channel although many of the the NR Webinar Series events are unlisted due to confidentiality but can be accessed here. You can find out more on our neurorehabilitation and stroke website training pages which will be merged when our new website is ready.
Greater Manchester Neuro Alliance

Do you want to give a bigger voice to the neuro community and its 600+ conditions? Help effect change in GM and improve support and services for our people? Then please join the Greater Manchester Neuro Alliance and work in partnership with us to do just that. Annual membership starts from £15 for organisations/charities/groups with 4 committee members/employees or less and £35 for those with more. Parkinson’s, MS Society and the MND Association are already part of our organisation but we need you. Contact us for more details via our website.
Exercise groups are restarting
The Community Neurorehabilitation Team in North Manchester have successfully relaunched the PHIT exercise class, which is based around the PD warrior principles for exercise for people with Parkinson's Disease. The class has been designed to be COVID-19 secure with social distancing in place and each participant being allocated their own exercise station to be able to exercise safely.
The sessions take place on Mondays at Number 93 in Harpurhey for a 10-week block. Participants have reported how fantastic it is to be able to return to the class and how much they are enjoying it. The team are delighted to be able to welcome patients back to group exercise.
Pathway updates
Vocational rehabilitation
A group of NHS and voluntary sector professionals are meeting regularly, focusing on delivering training sessions for staff. They are also updating our proposed pathway/model in line with national guidance and in light of best practice across the country. We are also liaising with the Department of Work and Pension and organisations delivering return to work contracts for the Greater Manchester Health and Social Care Partnership.


Seating
The network's Task & Finish Group, which includes representatives from the Cheshire & Merseyside stroke network, recently met to hear from services in London and Oldham. The areas shared their local seating pathways and the great work they are doing to ensure everyone has equitable access to static seating. The session was really informative and helped the local regions identify opportunities for development going forwards. A paper is currently being worked up to highlight the local issues in each region for respective local authority and commissioning leads.

Improving psychological rehabilitation
Following the network merger, this work has been expanded to include neurorehabilitation. The network recently met with senior managers from the mental health Trusts and the region's Neuroscience Centre to discuss next steps for clinical psychology. An inclusive group, including patients and carers, has made good progress in developing a pathway, with current work focused on creating a performance dashboard to help measure and monitor compliance with the pathway. This information, coupled with recent scoping of the psychology workforce by the network, will help inform a business case to ensure each locality has access to all the key elements of the pathway.
Bolton Community Stroke Team share their work
The Bolton Community Stroke Team have been promoting their service on social media recently. This has been spearheaded by Specialist OT Mel Charmer and you can follow her to see all the stories on Twitter.
The team were featured in their local paper showcasing their participation in the BP@Home scheme led by their Nurse Elizabeth pictured left. They have been sharing other examples of how they help their patients such as Mick's story below (reproduced with his consent). Mel writes:

"Mick and his wife contracted COVID-19 in October 2020. Whilst Mick was rushed to hospital and into ICU, his wife sadly passed away at home. Several days later as Mick started to improve, his doctors noted that he had some right sided weakness and neglect. Following a brain scan, it was confirmed that he had suffered a stroke and he was transferred to the stroke unit at Royal Bolton Hospital.
In the first few weeks, Mick physically improved quite quickly, however, cognitively he showed little change. He was unable to recall that his wife had passed away and had to be told regularly about the events of admission and the sad news of his loved one. Due to the severity of Mick's cognition problems, an Inpatient Neuro Rehabilitation Unit was considered. However, a Neurorehabilitation Consultant conducted an assessment and felt he had some post COVID-19 ICU delirium and home should be tried.
Following a lengthy graded home programme including 2-3 months of regular visits, it was agreed to discharge Mick home. Wrap around care, assisted technology and early intervention from the Community Stroke Team played a key role in getting Mick home. With this support in place,  Mick finally left hospital in April.
His main focus became returning his children to live with him as they had been staying with his eldest daughter. Regular input from the team's Occupational Therapists (including Mel pictured right with Mick) and Therapy Assistants has been essential in keeping Mick safe at home.  The therapy has focused on supporting him in establishing a routine to manage the house, with a focus on ensuring Mick can safely get to and from school with his hemianopia and has a routine that supports his memory loss.

In June, following a series of weekend stays support by the stroke team and Child Social Services, Mick's children were reunited with him at home. Although Mick continues to struggle with the cognitive impacts of the stroke, support is being put in place for Mick and his children to help them live together in the long term."

MND poster now available
The network has facilitated the design of a new MND guideline poster for AHPs, based on the NICE guideline. This has been developed to act as a quick reference guide/toolkit for those AHPs working with MND clients. This sits alongside the PD and MS Guideline Posters that have previously been developed and can be accessed here. Please let us know if your team would like any of these colour printing and laminating.
Helping more people with aphasia
Speakeasy’s mission since 1985 has been to make a positive difference to the lives of people with aphasia and their carers across the region - support when people need it and for as long as they want it. Their members help their speech and language therapists (SLT) to craft a range of constantly changing activities which suit people’s needs. These therapeutic activities link with NHS input, engage with members individual goals, and create opportunities for building skills, confidence and communication; they support people to work towards improving their emotional and physical health, and to re-establish links with their communities.
Recent Speakeasy activities, which are mostly co-designed and co-delivered by people with aphasia, have included:
  • Communication partner training
  • Opportunities for developing communication skills for group discussions
  • Skills for volunteering and return to employment
  • Designing aphasia accessible documents especially for COVID
  • Increasing awareness of aphasia   
  • Image and self-esteem
  • Involvement in research projects and developing accessible research resources
  • Individual communication skills work using specialist software and apps
  • Technology skills support and courses
  • Reading group
  • Assertiveness skills for carers and confidence building
  • Therapeutic activity using art, music, exercise,
In 2020, the stroke network provided funding to support development of an "At Home" service which help increased activity during lockdown to support people remotely and assist SLTs with input much earlier in the journey. This will continue but the team are now re-starting more face to face support across the region and from their offices in Ramsbottom. As with many voluntary sector organisations, funding is a big issue with the future always uncertain and the charity are urgently seeking funding to continue. Talk to the team by email or visit their website.
Twitter
Website
YouTube
Find out more
Websites: www.gmisdn.org.uk & www.gmneurorehab.org.uk
Twitter: @GMNISDN
YouTube
Phone: 0161 209 2109

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