The joint national Spinal Cord Impairment action plan is about providing the support necessary for people with a Spinal Cord Impairment (SCI), so they can achieve maximum independence and good health outcomes – whether in the home, community or at work.
ACC and the Ministry of Health (MoH) have led the development of a joint national SCI action plan. The action plan covers the full range of care and life long impacts for people with a SCI and their family/whānau.
A SCI is a compromise of the spinal cord as a result of
• traumatic insult
• vascular disruption
• a disease process
It may be immediate or insidious in onset.
The consequence is a significant loss or reduction in voluntary motor function, sensory deprivation and disruption of autonomic function related to the level and severity of the cord damage.
New Zealand has the potential to become a leader in spinal rehabilitation service delivery.
The need for national coordination and leadership has been identified, along with opportunities to improve services for people with a SCI across the patient pathway.
What are the action plan’s objectives?
- Improve acute clinical outcomes for adults requiring acute SCI care
- Improve outcomes for children and adolescents
- Improve information sharing
- Provide a nationally-consistent SCI rehabilitation service and extend community–based rehabilitation
- Review and align Ministry of Health and ACC processes for access to equipment, housing modifications and transport
- Develop peer support services
- Build health and disability workforce capability
- Support improvements for carers taking a cross-agency approach.
What progress has been made?
A high level summary of progress against the SCI action plan is shown in the table below:
Progress as at 30 September 2015
Acute destination policy implemented from 1 August 2015.
No refusal policies in place at Middlemore and Christchurch Hospitals ICUs.
Children and adolescents
Acute destination policy implemented 1 August 2015 includes children and adolescents. Starship Hospital has established protocols for receiving referrals.
Paediatric sub-committee formed to progress the objectives.
Clinical leadership and governance for SCI rehabilitation established. Protocols developed / in progress by Starship Hospital specific to SCI.
Work underway to describe a model of care for national paediatric specialist rehabilitation services which includes SCI.
Registry pilot project completed with a recommendation to adopt the Rick Hansen Spinal Cord Injury Registry – governance committee has endorsed the recommendation.
The recommendation will now be taken to funders.
Shared care plans are being slowly implemented as the introduction is dependent on patient information systems development and training for general practitioners
ACC contract re-design is nearing completion that describes the service delivery model for both spinal rehabilitation services.
Referral guidelines have been reviewed and established for both spinal rehabilitation services.
Acute pathways project underway and includes the role of shared care plans in reducing avoidable admissions.
Community reintegration and discharge planning work programme is being scoped.
Work to establish a shared quality framework between the Auckland Spinal Rehabilitation Unit and the Burwood Spinal Unit is underway.
Opportunities to improve residential support services are being discussed by ACC and the Ministry of Health
Equipment, housing modifications, transport
Principles for an asset transfer process between ACC and the Ministry of Health have been established. Processes for the reissue of pool equipment and asset transfer have been described (and ready to implement in the near future).
ACC has adopted the recently revised Ministry of Health credentialing programme for vehicle assessors.
Planning is underway to bring a post-graduate course to New Zealand in early 2016 for vehicle assessors.
ACC tender of vehicle assessors (based on transport for independence contracts) is nearing completion.
A review of income and asset testing thresholds was completed by the Ministry of Health but no changes are proposed as a result of the review which was unable to assess fiscal implications.
ACC has been working alongside The Association for Spinal Concerns and the NZ Spinal Trust to identify and develop a suitable nationally consistent Peer Support Framework. This has included an international review undertaken by ACC Research.
Work is underway with the University of Auckland to review post graduate specialty qualifications in orthopaedics to include spines.
Acute clinical nurse specialist inclusion on an on-call roster at Middlemore Hospital.
Successful completion of an eight month spinal fellow at Counties Manukau District Health Board (DHB) and recruitment of a second spinal fellow.
National work programmes with Disability Support Services explicitly includes the SCI workforce.
A spinal consumer advisory group has recently been convened at the Auckland Spinal Rehabilitation Unit.
Disability Support Services is finalising a procurement process for the development of a carer learning and well-being resource. ACC participated in this process.
Who is leading the implementation of the action plan?
Lead agencies have been appointed for specific actions outlined in the action plan.
Lead agencies include: Counties Manukau DHB, Canterbury DHB, Auckland DHB, Major Trauma Network, National Ambulance Service Sector Office, Waitemata DHB, NZ Paediatric Society, Burwood Academy of Independent Living (BAIL), The Association for Spinal Concerns, the NZ Spinal Trust, Ministry of Social Development, Ministry of Health and ACC.
Most lead agencies also have members on the national governance committee. The committee monitors progress against the action plan, provides national direction for SCI services, monitors quality and promotes innovation.
Key stakeholders are people with a SCI, their families/whānau and supports, DHBs, service providers, primary healthcare representatives, spinal units, community allied healthcare, employers, community support organisations (eg NGOs) and client and family carer organisations.
ACC and MoH value the input of our key stakeholders and are dedicated to working collaboratively throughout the implementation of the action plan.
What research has informed the action plan?
Research has been fundamental to the development of this evidence based initiative.
There are three areas of research that have been carried out. These are:
UMR Research was commissioned for the consumer research piece of work.
They’ve provided qualitative evidence that describes from the consumer (people with a SCI/families/whānau – including children and the aged) perspective their experience of SCI service delivery from initial impairment/injury through to living in the community.
The focus of the research, from their perspective was on what worked, what did not work, and what could be improved along the continuum of care.
The University of South Australia carried out the evidential review. Work included a literature review across the continuum which identified strengths and gaps. Gaps have been reported to the appropriate reference group for further investigation and reporting back.
This piece of work focused on the coding/quality of national service data collected by ACC and MoH/DHB’s about people with a SCI.