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Adult Ability Team (Staffordshire)




Location and Contact details


Staffordshire and Stoke-on-Trent Partnership NHS Trust
Morston House,The Midway
Newcastle-under-Lyme
Staffordshire
ST5 1QG

Telephone: 0845 602 6772

www.staffordshireandstokeontrent.nhs.uk/Servi...

Type of organisation

  • NHS Service

Descripton of organisation

  • Out patient
  • Community Based Service

miles (straight line)
miles (approximate road distance)

Entry last updated

Nov 2, 2012

Further Details

The Adult Ability Team is a group of medical and health professionals, working together to ensure a co-ordinated and high quality service for people with a progressive neurological condition living in the Community. Clients are regularly reviewed and care plans agreed, with the main aim of assisting clients reach their desired / maximum health potential, to enhance quality of life.

Who is the service for?

Any person over the age of 18 years diagnosed with a progressive neurological condition

Rehabilitation: Specialist Neurological Occupational / Physio, Speech and Language Therapists, Parkinson’s Disease and Multiple Sclerosis Nurses are available to offer personalised rehabilitation, symptom management and medication support. These staff organise regular, and ongoing intervention packages to assist service users to maintain maximum functional abilities and physical and psychological wellbeing with the aim of promoting an holistic approach to self management. Although home is usually the preferred option for intervention, clients also have the choice of being seen in clinical areas, such as clinics and health centres. Clients can also be supported in local leisure centres, utilising exercise on prescription sessions, or in their preferred independent leisure facilities. Clients can be supported with work related issues or access to a range of social and leisure activities.
Structured Education/ Group programmes: Several structured education/ group programmes are either in place or in development. These include falls management education group for clients with Parkinson’s disease (in conjunction with the Falls Team), fatigue management education programs and newly diagnosed courses for clients with MS/PD. Adult Ability Team staff also informally support local disease specific voluntary groups with educational sessions.
Review: A formal monthly multidisciplinary clinical review meeting with colleagues in the acute/community health settings, and health and social care takes place to aid communication, prevent duplication of work, and ensure clients are getting the optimum package of care possible for their needs. (Clients may be reviewed on an annual, bi-annual or monthly basis depending on need). Clients may also be reviewed at weekly Adult Ability Team meeting by their key worker as necessary. Clients with non complex needs will receive at least an annual written review, (more regular depending on choice), inviting them to discuss any issues which may require support from the team. The team also holds monthly Adult Ability Team clinics with Neurologists based at Queens Hospital Burton, for those clients with complex needs.
Telephone Support: In line with supporting self management, clients are encouraged to take ownership of their condition, and contact the team for advice if new needs arise, to enable timely support and reduce the development of unnecessary complications or unscheduled hospital admission. This is a very well utilised resource.
Respite Care: The A.A.T. have always recognised that for a package of care to be maintained at home, it is important that carers can plan ‘time out’ hence service users have traditionally been offered 2 weeks planned respite per year. This care has been delivered via 3 rooms at the Barton Health and community care centre. AAT monitors these rooms to ensure efficient use of resources’, and will continue rehabilitation in this unit for those currently receiving interventions.

Services available

ABI Specialist National Regional Local
Community support no no no yes
Equipment no no no yes
Neurology no no no yes
Neuropsychology no no no yes
Occupational Therapy no no no yes
Physiotherapy no no no yes
Speech & Language Therapy no no no yes
National = country wide, Regional = offering a service within 150 miles, Local = offering a service within 50 miles

This service adheres to the following Regulatory Frameworks / is affiliated to the following bodies:

NHS Service

Referrals can be made by

GP yes
Consultant no
Healthcare Professional yes
Self/Advocate/Family no
Other professional eg Social Care/Case Manager no

- What is the referral criteria for the service?

• Any person over the age of 18 years diagnosed with a progressive neurological condition and registered with a South Staffordshire, East Locality GP. The Adult Ability team also offers Occupational and Physiotherapy services to clients in South Derbyshire with a progressive neurological condition, who traditionally utilise the services of the neurologist at QHB (specialist nursing care also under negotiation).

Who may refer to this service?

Any medical or health care professional worker.
Voluntary organisations

How are services paid for?

yes Publicly funded - individually commissioned
Regularly Sometimes Never
NHS yesnono
Social Care Services nonoyes
Jointly funded by NHS & Social Care Services nonoyes

Typical duration that a service is offered

No Data

This Service was mapped by West Midlands ABI Forum. See HERE for more information

Services available are defined by the following EHIG Rehabilitation Codes

For an explanation of the codings please click here

REHAB AT HOME

[Code 70]
Patient description
Medically stable, able to actively participate with and benefit from therapy. Will include spectrum of initial severity of injury with a small minority derived from Code 05 category

Sites
Domiciliary or day hospital

Description of rehabilitation input
Interdisciplinary co-ordinated management therapy aimed at community re-integration/inclusion by enhancing independence, wellbeing, & assist return to work/education. In collaboration with Social Services, neuropsychiatry, voluntary and statutory services. Includes treatment of patients in their own homes, or with live-in carers.

CONTINUING REHAB WHEN YOU NEED IT

[Code 100]
Patient description
Medically stable, but permanent disability

Sites
Domiciliary, residential or nursing home, respite unit

Description of rehabilitation input
Life long prevention of avoidable complications involving residual physical, cognitive, emotional and behavioural problems, on a domiciliary, outpatient or respite basis.

SOMEONE TO TALK TO

[Code 110]
Patient description
Information and guidance over a continuum. Family support and outreach. Advocacy

Sites
All sites

Description of rehabilitation input
Information and guidance over a continuum. Family support and outreach. Advocacy

This service is defined by the NMDS (National Minimum Data Set) codes as:

For an explanation of the NMDS, please click here

Level 3A (other local specialist services): Treat patients with Category C needs and is led/supported by consultants trained in specialties other than rehabilitation medicine

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