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Vanbrugh Pain Management and Rehabilitation Service

DSC_2304 Community pain rehabilitation service (Greenwich CCG) for patients whose conditions have not responded to mainstream treatment. The service was created to develop and demonstrate the relevance of anthroposophic health care for the NHS when tackling conditions generally regarded as difficult to treat.
Year established
2009
Number of staff
1FT staff, 1 volunteer
Number of users
50
Is there a charge to users?
No charges
What makes your project sustainable?
NHS income underpins the funding of medical and therapeutic activities and covers part of the rent of premises.The charitable arm of the project, KRT, has attracted substantial start-up funding and is enabling grant applications for the social & occupational aspects of the project as well as remaining outstanding rent.Refurbishment of new premises: materials and labour are being donated by Mace Construction. Our current premises are to be demolished by them in April 2015.A service evaluation is currently being planned by Professor Pat Schofield, Department for Health and Social Care, Greenwich University.
Demographics
Project users are adults living within Greenwich CCG and suffering more than 3 months persistent pain. The majority have already attended secondary or tertiary care (hospital pain clinics) and have not made progress. Referral via GP by any health professional.Conditions are commonly long term and multiple complicated by personal, social, occupational, cultural and financial factors.
Innovation
The service is setting itself up to take account of the complex problems that are commonly associated with any long term illness including:

  1. Physical loss or disturbance of bodily function affecting mobility, sleep and energy;
  2. Psychological upheaval affecting levels of pain, anxiety, depression, mood swings, loss of motivation & will;
  3. Personal factors: loss of self-confidence & esteem, inability to exercise a sense of self, frustration of ambition, loss of independence & sense of purpose;
  4. Biographical events: previous trauma, abuse, bereavement;
  5. Social factors: isolation through loneliness, lack of friends, dysfunctional relationships;
  6. Work-related and financial influences: job loss, debt and Benefits Agency problems;

The following aims are addressed:

  • Clinical assessment, individual therapy and ongoing management to reduce the burden of symptoms, also monitoring and appropriate reduction of medication;
  • Personal: to encourage principles of self-development, strengthen self-confidence & esteem, kindle motivation and will;
  • Educational: to broaden outlook, improve language & communication skills, develop new interests;
  • Social: to meet, work alongside and befriend others within and outside the project;
  • Work-related: to develop and exercise new skills with an increasing sense of empowerment and responsibility, to move on to voluntary and part-time employment;
  • Financial: to receive advice and representation for all benefit, housing and other eligible claims;

The pathway begins where the patient’s condition and concerns demand. The patient’s situation is frequently reassessed in order that interventions are appropriate and sufficiently challenging. Social, volunteering and fund-raising activities provided by KRT enable patients to take their recovery further. In the process they become the agent for change of others through their help and example, as well as sharing in the development of a young charity.

Challenges:

  • Close co-working with health professionals responsible for the patient’s care;
  • Co-working with ATOS & DWP to encourage attitudes which are realistic, fair and productive as far as returning to creative activity and work are concerned.
  • Furthering more social and work-related opportunities.
Patient-centred, whole person preventative approach
2014-12-02 15.32.42The fundamental aim of the approach is to nurture, affirm and provide for the humanity of individuals in order that they may develop the resources and find strength to take back the reins of their lives.The anthroposophic model regards life as meaningful. Accepting let alone see anything positive in a long term condition is however a tall order when one is run down and exhausted. Many patients therefore need help before they are in a fit state to begin to engage. Once one can engage, feeling part of the team dealing with the problem at hand, relevant work and social activities may begin to act as a springboard for self-development. The clinic endeavors to provide a setting which facilitates such development encouraging resilience at all levels body, soul and spiritPatients are involved in the service activities as follows:

  1. IN THERAPY: The nature of our one-to-one therapeutic interventions is that they can engage the person, ‘warm’ them up (physically and psychologically), restore patterns of sleep and lift mood. They then begin to have some energy to play with and feel motivated to start facing their situation. Many patients feel that they are up against their problems alone and worth very little. They have given up thinking that they could have any impact on their condition or that they could change their adverse circumstances e.g. problems with relationships, benefits, finance & occupation. Through regular one-to-one therapy the chances of them attending and engaging are increased. If they can be ‘brought into play’ during the therapeutic period they have generally proven terribly keen to share and contribute in more social activities. Examples of individual involvement follow:
  2. HELPING ONE ANOTHER: Knowing and having experienced what another person is suffering gives one understanding and often sympathy for the other facing similar difficulties. Moral support and a strong camaraderie can develop between individuals who discover they are facing the same trials.
  3. FUNDRAISING: A number who have received help and felt the benefits have turned their hand to fundraising for us e.g. boot-fairs, stalls at fayres, cakes & craft sales
  4. HELPING RUN EXISTING ASPECTS OF THE PROJECT: Our little choir was the idea of one our patients. It is led by one of our therapists. A patient who is a piano teacher has joined in by bringing music and doing some of the directing.
  5. INITIATING NEW ASPECT OF THE PROJECT: When funding for a craft workshop leader ran out, new individuals appeared and decided they would run one between themselves, teach each other what they were able to do and sell the proceeds for the new charity.
  6. JOINING THE RESEARCH TEAM: The National Institute for Health Research (NIHR) Patient Benefit Fund requires that patients help run the project under evaluation. Three patients have keenly volunteered to do this.
  7. GIVING OF THIR OWN SKILLS: a solicitor who suffered a serious road accident understood the difficulties of completing benefits forms. He is now helping those that we have identified as needing help to do their forms more effectively.
  8. REPRESENTING THE PROJECT: A group of 5 patients attended a public meeting called by Greenwich CCG to hear opinions of the their musculo-skeletal services which they had identified were in need of reform. They reported so positively about our little project that the CCG promptly visited and highlighted the benefits of Kairos at the first commissioning meeting of health professionals.
  9. ACTIVITIES OUTSIDE: A Turkish Cypriot widow generously took it upon herself to re-decorate and help furnish the flat of a Somali single mother of 4 children.
Evidence informed practice/audit and evaluation
The following clinical outcome measures are used: 1) PHQ-9 for depression 2) Brief Pain Inventory (short form), 3) EuroQOL, 4) MYMOP2, unvalidated saticfaction questionnaire.20 short (consented) clinical case studies were reported in 2013.
Multi-disciplinary collaboration, and professional communication
The team of 2 GPwSI’s (pain management), physio, acupuncturist, eurythmy therapist and rhythmical massage therapist meet 1/2 h weekly to discuss cases and organizational topics.A weekly one hour meeting of GP and anthroposophic therapists gives opportunity to do in depth case studies. The GP further meets weekly with each therapist for 30 min to discuss individual patient progress.The clinic informs the patient’s GP of treatment in the usual ways.Each member of the team is involved in teaching activity within their professional fields and act as mentors for students on placements.
Contact details
Vanbrugh Health Centre,
Vanbrugh Hill,
Greenwich,
SE10 9HQTel: 077128 10108
Email: info@kairosrehabilitation.org.uk
Web: www.kairosrehabilitation.org.uk