Pole position - Postural care in Yorkshire

Senior physiotherapist Rebecca Vickers has played a central role in ensuring that people with learning disabilities living in accommodation provided by a Leeds-based NHS trust receive better postural care.

Ms Vickers took up the challenge of improving provision after it was realised that patients were losing out as a result of a local service reconfiguration.

The creation of a single referral pathway and a different referral system for physiotherapy services had resulted in a rise in critical incidents linked to poor postural care among patients living in supported living services provided by Leeds and York Partnership NHS Foundation Trust.

‘With the changes that had taken place, carers had to highlight need and refer to us,’ Ms Vickers explains. ‘We had noticed a drop in referrals and a rise in the number of critical incidents.

There were areas of poor practice regarding pressure care and postural management. As a secondary complication, there were a number of incidents in which people experienced muscle shortening.’

She says that these statistics prompted the team to look again at their approach to referrals and in particular to postural care management across the 12 learning disability care homes the trust runs.

In June 2010 the trust seconded Ms Vickers, a band 7 physiotherapist, for six months into its learning disability homes, specifically to address the loss of skills in postural management among the staff teams.

Postural management champions

Ms Vickers says the trust recognised that the standards of skills among the specialised supported living services staff had been compromised due to the reorganisation of the physiotherapy team.

This meant that care staff no longer had regular contact with physiotherapists or access to postural management training.

‘I was seconded to the supported living services for six months specifically to focus on postural management for learning disabilities patients. About 80 per cent of them have cerebral palsy. For those six months I did not have any other caseload,’ Ms Vickers explains.

‘It was important for me to work in the homes and get to know the staff and what the culture and managers were like.  It helped me to tailor my training.’

She explains that she developed a training package for all the 133 members of staff in the supported living service to address the needs of 48 tenants.

Looking back, Ms Vickers believes she helped to create a shift in culture. Whereas initially she found that some members of staff team were unaware of the postural needs of their tenants, now they show much more much knowledge about the dangers associated with poor postural care.   

She says that they now also have the knowledge and skills to address these and know when to contact specialists. This has led to a tripling in referral rates since the training started.

Each home now has two postural management champions who act as role models and continue to motivate and support their staff teams to deliver good postural care at all times.

Ms Vickers warns, however, that high caseloads mean many physiotherapists rely on care workers to ensure that patients have the correct postural management

She says more needs to be done to ensure ongoing training on this topic is offered to care staff.

‘There is a high turnover of support service staff but unfortunately there is not the funding in place to ensure that a physiotherapist is regularly training these staff in postural care management,’ says Ms Vickers.

Her concerns are echoed by physiotherapists around the country and don’t just apply to patients with learning disabilities but to those with a wide range of conditions and restricted movement.

24-hour management approach

Jenny Tinkler chairs the Association of Chartered Physiotherapists for People with Learning Disabilities.

A clinical specialist in complex needs, Ms Tinkler is one of two band 7 physiotherapists based at Tees, Esk and Wear Valleys NHS Foundation Trust providing a 24-hour postural care management for adults with learning disabilities.

‘We recognised we needed to do more for patients with regard to postural management and body shape. We reconfigured the physiotherapy service so that two physios can concentrate on this area, which frees up the other physiotherapists. This has been done without any additional funding,’ Ms Tinkler explains.

She says the focus is on the training and education of carers in good postural management.

‘Unfortunately it is not the norm in the NHS to have dedicated physiotherapy  posts in postural care management.’

Ms Tinkler suggests that such is the importance of postural care for a variety of patients that it should be a dedicated standalone service much like that of a wheelchair service, which would subsequently become part of a wider postural management service.

‘Good postural care management can make such a difference especially if you get in earlier enough, but it is never too late to start,’ she says.

Ms Tinkler view is backed by Elspeth Dixon, a learning disability specialist physiotherapist at 2gether NHS Foundation Trust who has a child with learning disabilities agrees.

‘Locally we have not had a problem getting funding and getting postural care equipment for our patients but I think it is piecemeal and this is not happening around the country.

‘I think every trust, not just those catering for people with learning disabilities, should have a dedicated physiotherapist who is postural care management lead.’ fl

Why is postural care important?

Failure to protect body shape can result in lots of health complications, for example:

• contractures – where the muscles tighten up and the person can’t straighten their limbs

• scoliosis – curvature of the spine

• difficulty breathing

• poor digestion

• constipation

• pressure on internal organs

These complications can cause suffering, pain and even death. 

What postural care services are needed?

Commissioning postural care services should be a key part of the local strategy to meet health needs.

The following should be provided:

• Information

There needs to be good information available for families about local postural care and training services.

• Training

Postural care is a simple, practical approach but it is not intuitive, so professionals and families must get the information and training they need to do it properly and safely.

• Postural care pathway

There needs to be a clear postural care pathway in place, which involves professionals and families working together to support someone’s posture.

A postural care pathway will involve:

• early identification of people who have, or are likely to develop, postural care needs

• assessment using measurements of body symmetry

• training for all involved developing a postural care plan for the individual and getting the right equipment

• ongoing monitoring and reviewing of the support needed.

Funding for equipment

There must be funding available to enable people to get the equipment they need – for example, a sleep system. Source: Postural Care Action Group

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