A programme for people living with multiple conditions
Living with multiple conditions is increasingly common and has an impact across all areas of peoples’ lives. People with long-term conditions are twice as likely to be admitted to hospital, they will stay in hospital longer, and they account for 60% of hospital bed days used. People with long-term conditions are also more likely to experience psychological problems and are more likely to be disadvantaged across a range of social indicators including employment, educational opportunities, home ownership and income.
Despite all of this it is still common for healthcare services to be delivered in single disease silos. The result is fragmented care from multiple professionals and teams; this has the potential to disrupt lives, increase the burden of treatment on individuals, their families and carers, and increase costs, waste and risk of harm.
As a result of the above, a team of staff working across Ayrshire and Arran are trying to do things differently. In April 2015 the team set out to realign its rehabilitation services to the needs of individuals rather than individual conditions. Working with local partners, which included teams from across NHS Ayrshire and Arran, leisure trusts, local authorities, third sector organisations and service users; a tiered, menu based rehabilitation programme was developed for people with cancer, COPD, cardiac conditions, stroke or a high risk of falls, and at least one other condition. The programme was named Healthy and Active Rehabilitation Programme (HARP) and since November 2015 it has been available across North, South and East Ayrshire.
As mentioned previously, individuals are offered a menu of options when they are referred in to the programme. Following a thorough assessment, carried out by a specialist nurse and physiotherapist, people can go on to what we call ‘full HARP’ i.e. a maximum of 10 weekly circuit-based exercise classes led by a physiotherapist and a nurse with support from a technical instructor; this class is followed by an educational talk which covers a variety of topics that support self management. Alternatively, people can choose a home-based programme; they can attend a 5-week intensive self-management course co-facilitated by a lay volunteer who has previously completed the programme; they can access an individual or group weight management programme delivered by the same staff offering HARP; or they can be referred on to local smoking cessation services, psychology, and vocational rehabilitation. Those who complete HARP can also volunteer their time and support others through the programme by becoming an ‘activity friend’, or they can be signposted on to other volunteering options through HARP staff. Following HARP, or if an individual does not require the support of medical staff, people are referred on to local leisure services who offer a variety of exercise classes. Alternatively if someone requires a greater level of support they can be referred on to a condition specific class or one to one support if that is required.
To date nearly 500 people have been referred in to the programme illustrating that this approach is feasible and acceptable. A great deal of time was invested from all staff involved in the delivery of the programme; learning new specialities and developing processes, pathways and professional relationships. And, despite initial trepidation, there has been an overwhelmingly positive response with staff now reporting improved partnership working and greater job satisfaction. Participants in the programme have also reported feeling safe, confident, and uplifted whilst reporting that they are treated as individuals with access to expertise and support.
A full evaluation is in progress but if you’d like to know more about any aspect of the programme please contact Jane Holt HARP Project Manager by e mailing Jane.Holt@aaaht.scot.nhs.uk
AHPs across health and social care. 
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