In hospital or at home, therapists provide children joined-up care
Physiotherapists from hospital and community services are working closely together to care for some of our Trust’s youngest and most vulnerable patients.
Specialist paediatric physiotherapists Kathy Hammond, who usually practices at the West Suffolk Hospital (WSH), and Caroline Fitzjohn, a community colleague based at Bury’s Child Development Centre, are working more closely due to a recent innovation to join up the care for babies and children. The West Suffolk NHS Foundation trust (WSFT) provides care in the hospital and a broad range of specialist care to children across Suffolk through the integrated paediatric community service.
Caroline now practises at the hospital’s neonatal unit every Monday, joining consultant paediatrician Dr Ian Evans on his ward round to identify and assess babies with developmental concerns, for example premature infants born under 30 weeks, so that physiotherapy can start right away, with continuity when they go home. “Previously these babies were seen by paediatric physios from the acute team, and then referred to the community team for developmental follow-up when they went home,” said Caroline. “But now we can start sharing the care while they are on the unit. This is not just providing specialised therapy, it’s also talking to parents about their children’s ongoing needs.” She said that advances in medical care mean that the outcomes for even very premature babies can be positive.
Caroline, who has worked in the NHS for 19 years and in Suffolk’s community services for 10 years, also supports the hospital’s outpatient clinic where premature babies receive follow-up care, so that any problems can be identified and managed. “This means we can share information from my physiotherapy colleagues in the community who are caring for children in their homes, or refer children who need support to the community service. This joined-up way of working ensures we can tailor therapy to an individual child’s needs and help them have the best outcomes in life.”
Kathy Hammond has been at the WSH for 19 years and has been a physio for 30 years. “We have always had close links with our community colleagues, but we knew we could do better. Working together in hospital and the community and exchanging staff has proved to be a success and improved the care we can offer.” The innovation sees a member of Kathy’s WSH-based physio team working in the community on a six-month rotational post, caring for pupils at a school for children with special educational needs. “Having a hospital physio in the community enhances their skills, for example in managing longer term conditions. Not many hospitals do this and it also helps us to recruit and retain therapists,” she said.
“Our work is varied, caring for children from birth to 19 years old, who may have complex health and developmental needs such as cerebral palsy or genetic conditions,” explained Caroline. Kathy explained the difference in roles: “We see outpatients to treat musculoskeletal conditions, as well as on the children’s ward. We see poorly children who are known to our community colleagues, and can be admitted with chest infections for example, and it is a great help to have the detailed knowledge of the child and their family shared with the hospital teams.”
Children who have had a fracture or surgery will often need follow-up physiotherapy once they leave hospital, and as well as working with the community team, the WSFT runs outpatient/outreach clinics in Sudbury, Stowmarket, Newmarket, Mildenhall, Botesdale and Thetford.
As well as working with health colleagues, therapists work with professionals across the west Suffolk health and social care system. For example a community paediatric occupational therapist (OT) may organise a seating system or splinting for a young person with special needs, focusing on function and participation. They will also consider their environment and access to allow them to go to school. Disabled children and young people OTs from social services, run by the county council, will see to major adaptations in the child’s home. Working together across the system enables colleagues to share ideas and expertise for the benefit of patients.
Both clinicians agree their work has changed over the years. “Children don’t stay in hospital for as long as they used to,” said Kathy. “For example, we used to have children on the ward for many weeks being treated for femur fractures. Treatment has changed over the years, and now these children can get back to their normal activities much sooner.” She said developments in drug therapy have also brought great improvements in the treatment of conditions such as juvenile arthritis.
“The aim of physiotherapy is to maximise potential. It is never just for an hour a day, it’s 24/7, getting activity, comfort and enjoyment into the everyday routine, so it is very important that we work closely with parents and carers as well,” emphasised Caroline.
She said that more children with significant needs are now living longer, and can often be cared for at home rather than in hospital. “Our work involves lifelong management of the children we care for, and we are privileged to see them through their life’s journey.”
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