“I am delighted to have received this award and immensely proud that the high quality service we have developed and which we deliver in Bradford has been recognised by the MS Trust and the judging panel. This type of recognition and praise inspires and motivates us even more to continue to improve services locally for those affected by multiple sclerosis, in what are very challenging times for all those of us working within the NHS.”

Liz Watson, Bradford Teaching Hospitals NHS Foundation Trust

 “Winning the Outstanding MS specialist nurse category was a fantastic surprise and I am absolutely delighted to have received it. I work with a wonderful team of consultants, clinical nurse specialists, occupational therapists, physiotherapists and a psychologist who all champion and support our patients. This award will mean we can continue to develop and raise awareness for people living with MS in order to provide help, education and advice, and ultimately improve patients’ quality of life.”

Sian Locke, Helen Durham Centre, Cardiff and Vale Health Board, University Hospital of Wales

“This award is recognition from peers that specialist allied health professionals are vitally important in enabling people with MS to live as full a life as possible. I am one of hundreds of AHPs around the country working with people with long-term neurological conditions such as MS and I do no more or less than many of my colleagues. This award is acknowledgement for all those AHPs who make a really valuable and often unsung contribution to helping people manage their MS.”

Wendy Hendrie, Norwich MS Centre

“Winning the Outstanding Neurologist category is a great honour and pleasure. The nomination is from my peers and a judging committee consisting of a diverse panel of patients, MS Trust representatives, MS paramedical staff and eminent neurologists. The award validates our approach and efforts in providing a comprehensive high quality service close to the patient, to maximise responsiveness to patient needs.”

Michael Douglas, Dudley Group NHS Foundation Trust

“The Tayside and North East Fife MS regional service is delighted to have won the award for Multidisciplinary team of the year. We endeavour to provide a multidisciplinary service working in a cohesive manner to cover all aspects of patient care from the community through the outpatient and inpatient services. To have been recognised for our achievements is just fantastic.”

Dr Jonathan O’Riordan, Consultant Neurologist, Tayside and North East Fife MS Service

“Being selected as a finalist, far less winning an award, is recognition at national level for a local service developed in Oban. It’s really quite humbling that this small-scale, local service has been named as a winner among a list of major MS centres and large teaching hospitals throughout the UK. Our vision was always to provide a patient-centred service built around the needs of our community and to have such a high profile endorsement of that vision is just incredible. I would like to thank the MS Trust, pharmaphorum and all the sponsors for their support and for giving us the opportunity to highlight this work.”

Derek Laidler, NHS Highland

“The Multiple Sclerosis Aqua Research Team (MSART) are delighted to accept the QuDoS in MS award for the Evidence in practice category. Burrswood’s MS service reflects our health and wellbeing approach to care where we work with patients to consider their psychological, physical, social and spiritual needs. This award will help to promote ongoing research and audit in clinical practice which in turn positively impact on the care provided to people with MS. We hope our win will give other service providers confidence in developing new aquatic therapy services so that more people with MS will have greater access.”

Krishna Kishore Garikipati, Multiple Sclerosis Aqua Research Team (MSART), University of Brighton and Burrswood Hospital

“As a team we are committed to supporting the whole family, including children, who are affected by MS and we are therefore delighted that our work in this area has been recognised through the QuDoS in MS awards.  We hope that winning the Judges’ Special award will help raise awareness of the needs of children who have a parent with MS and help us further develop and expand our innovative work in this area”. 

Rachel Tams, Family Focused Support Team, Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust

“To receive the Judges’ Special Award at the QuDoS in MS awards presentation was overwhelming and very special for me. The award was totally unexpected. To have recognition for my work in helping people with MS to improve their lives is a privilege and very much appreciated. The work and support the MS Trust has given to both myself and many clinicians over the years is invaluable. Their vision together with that of pharmaphorum and the pharmaceutical companies involved in deciding to create these awards enables us all to showcase the much needed and important work which goes into supporting people with MS.”

Christine Singleton, Birmingham Community Healthcare NHS Trust

WINNER

Sian Locke, Helen Durham Centre, University Hospital of Wales

Sian Locke shows outstanding compassion, empathy and advocacy for MS patients with complex and progressive disability in a very deprived area of the Welsh valleys.

One of her patients with progressive MS was a lady who was married with a young child. Sian provided support to the patient’s husband and family through her admission into intensive care,  her death and their ongoing bereavement  by offering advice, a shoulder to cry on, a listening ear, making tea and providing good old Welsh ‘catches’. The patient’s mother-in-law said Sian was “an angel, whose wings have surrounded them with comfort and strength. She has been the support that has got them through”

Sian’s compassion and advocacy of patients’ needs extends to being proactive in encouraging other MS team members to consider a more integrated pathway between them and local palliative care services. Sian believes that palliative care intervention is not so much about planning end-of-life care, but rather the promotion and support of patients in making informed choices about living well in the most disenabling stages of the disease.

Sian is often the voice of holistic care for her patients, ensuring simple things that make someone feel loved and human, such as a haircut. Choices such as eating a takeaway and caring for pets are also considered and placed in care plans.

She promotes the continence and sexual health and wellbeing of patients and is developing her skills through collaboration with a neuro-rehabilitation consultant, Health Board sexual health clinic staff and psychosexual counselling services.

COMMENDATION

Karen Vernon, Salford Royal Hospital NHS Foundation Trust

Since her appointment as consultant MS nurse, Karen has continued to influence the lives of the patients who she meets, as well as those across the conurbation. She has continued to develop the MS relapse service so that it is accessible at multiple sites, improving access and availability.

She has negotiated a considerable increase in MS nurse-led clinic provision across the whole area and championed new ways of working, providing patients with improved access to assessment, care and support, especially at the time of diagnosis.

Karen has led the team (and UKMSSNA) response to the NICE Guidelines and Quality Standards consultations. She has attended scoping meetings for a NICE technology appraisal. She facilitates the neurological examination course open to all MS Nurses, and has spoken at Trust and British Association of Neuroscience Nurses (BANN) conferences, as well as teaching on the MS nurse induction programme and Salford University’s degree programme.

Alongside these activities, which contribute to clinical excellence regionally and nationally, Karen has implemented clinical supervision, been integral in improving multidisciplinary working, continued to provide considerable support for the infusion service and effected local change through the clinical governance framework.

Karen’s leadership has inspired her team to participate in the Generating Evidence in Multiple Sclerosis Services (GEMSS) project, helping them to improve services to patients. She has supported the specialist nurse team to become the first local neurology nurse team to achieve green Commission on Accreditation of Ambulance Services (CAAS) status.

Her leadership skills have helped define the MS nurse role and develop key practice indicators that can improve patient experience and recognise the contribution that MS nurses make.

Karen’s considerable clinical experience, leadership and commitment make her an outstanding MS specialist nurse consultant. She impacts the lives of many patients, both through her own direct contact and through inspiring nurses locally, regionally and nationally.

WINNER

Liz Watson, Bradford Teaching Hospitals NHS Foundation Trust

There were no specialist MS services in Bradford before Liz Watson was appointed as the first and only specialist MS nurse in 2005. Her desire and drive to provide a high quality, holistic and local service for people with MS in Bradford combined with her initiative, strategic thinking and resourcefulness has led to significant expansion of her team. Through collaboration with local charities and lobbying of NHS managers/commissioners, funding was approved for a specialist MS physiotherapist and occupational therapist. Liz later provided evidence to support the recruitment of an MS consultant in 2010.

Liz is without a doubt the heartbeat of the MS service. She is the main point of contact between MS and coordinating services, running regular specialist clinics. She has been relentless in her efforts to improve the experience of people with MS.

Until 2007 there was no disease modifying treatment (DMT) service for MS patients in Bradford, with eligible patients assessed initially in Leeds. Since 2010 there has been a focused effort to diagnose, treat and support all patients in the Bradford District.

Liz extended her role in the management of patients with progressive MS, freeing up consultant time and providing a quality holistic service. She is instrumental in the DMT process, taking a lead in education, assisting with decision making, and coordinating both treatment and ongoing monitoring.

Liz always sees the person first as opposed to the MS. Patients feel at ease and can ask her anything without fear of judgement or criticism. She can also have those difficult and challenging conversations where patients know she is being honest but with their best interests at heart.

Liz completes all her work with an incredible energy, positive attitude and rare and refreshing touch of humanity. This very unassuming and humble nurse remains abreast of every development in the ‘MS world’ and prides herself on providing the best service and evidence-based care possible. She has truly transformed services for patients and provides hope and support in what can be incredibly difficult circumstances.

HIGH COMMENDATION

Tania Burge, Bristol and Avon MS (BrAMS) Centre, North Bristol NHS Trust

Tania Burge is an MS specialist physiotherapist at the Bristol and Avon MS (BrAMS) Centre, North Bristol NHS Trust.

Tania started at the BrAMS five years ago, initially in a temporary contract. Since then, she has set up specific patient-centred MS services, providing data and evidence with a strong business case to establish a permanent post of physiotherapy.

She has developed and led several specialist services, incorporating a multidisciplinary approach in both the hospital-based teams and individual patient locality teams to ensure seamless pathways of care. Her clinics have managed heavy caseloads ensuring timely interventions for patients. Tania has been involved in areas such as relapse management as well as a joint orthotic clinic in conjunction with a specialist orthotist to improve gait and function, reducing waiting times from 10 months to a maximum of four weeks. She also uses cool water hydrotherapy at a local leisure centre pool.

A high level balance group was developed two years ago to treat patients who were encountering problems that resulted in them stopping work and disengaging in activities. This work was used a model of treatment for people with MS at the National Chartered Society of Physiotherapy conference in November 2014.

Tania has shown great drive to provide service of an exceptional standard for her MS patients following latest evidence-based practice to develop rehabilitation in a creative and innovative way.

WINNER

Wendy Hendrie, Norwich MS Centre

Wendy Hendrie started working as a volunteer physiotherapist with people with MS 30 years ago at an MS Centre run by Action and Research for MS (ARMS). In 1989 she opened a home for people with complex neuro-disability (mainly for people with MS) and ran it for 20 years, offering day and respite care as well as having full-time residents.

The home was a preferred provider for the MS Society and the first in the country to receive the Investors in People award. Wendy devised and delivered a patient-centred training programme for care staff from other homes to teach them about MS – an unusually progressive approach at that time.

She also works as a clinical specialist MS physiotherapist at Norfolk Community Health and Care NHS Trust and at the MS Centre in Norwich. She sees people there with all stages of MS. She also runs a weekly exercise group at the Centre as a volunteer and visits people in the community voluntarily.

Wendy is recognised nationally as a physiotherapy leader. She co-chairs the TiMS Group, is on the Association of Chartered Physiotherapists Committee, and was the physiotherapy representative on the MS NICE Guidelines Committee from 2013-2014.

She has worked hard to develop the evidence the profession needs to be able to promote the services provided to people with MS. Her MSc dissertation researched MS and compliance with exercise and her PhD investigated the use of standing frames in people with MS. She gained National Institute for Health Research (NIHR) funding in 2015 to undertake a multi-centre randomized controlled trial (RCT) investigating standing frame use.

Wendy is always enthusiastic and positive, regardless of whether she is leading or collaborating. All that she does is underpinned by kindness, compassion and a desire to deliver the best possible service she can to each and every individual.

HIGH COMMENDATION

Avril Law, Musgrave Park Hospital, Belfast Health and Social Care Trust

Avril Law qualified as a physiotherapist in 1982 and has spent her career dedicated to the selfless compassionate care of her patients and the staff around her. She works in the regional neurology unit at Musgrave Park Hospital, which cares for neuro-palliative patients, offers respite care and also has regional rehabilitation beds. The majority of patients have MS.

The regional rehabilitation beds enable patients to have a full review of their needs and Avril works tirelessly to give patients the opportunity to maximise their physical ability, followed by liaison with community staff to ensure this care is continued at home.

During respite care Avril ensures needs are met, directly for the patient and/or for family carers, as well as quietly stepping in and setting up self-management plans to ensure patients can stay in their own homes as long as possible.

Her interest in working with long-term MS patients started in her early years as a rotational physio, when she met these often forgotten patients who were frequently bed-bound with contractures and respiratory symptoms. Avril ensures that the physiotherapy needs of neuro-palliative care patients are maintained, working alongside the occupational therapists on sleep systems and with dieticians and speech and language therapists for feeding and swallowing issues.

Avril is a very strong physiotherapy advocate for neuro-palliative patients, often having to argue the case for palliative care and respiratory comfort for the end-of-life patient.

Her patient-handling and treatment skills are highly regarded among her colleagues. She is continuously learning, improving her skills and teaching others, inspiring many other physios to work in the neurology field.

She has introduced new respiratory techniques into the unit, such as the NIPPY/cough assist ventilator and new splinting techniques. She also works with occupational therapists to minimise contractures and maintain tissue length in long-term patients.

Avril strives to provide care that offers meaningful day-to-day benefits for patients, family and carers to make life more active and comfortable. Her compassion and selflessness together with her excellent clinical skills are an inspiration to all those who work with her.

COMMENDATION

Christine Singleton, Birmingham Community Healthcare NHS Trust

Christine Singleton is a specialist physiotherapist and clinical lead for the Functional Electrical Stimulation (FES) Service at West Midlands Rehabilitation Centre (WMRC), a tertiary healthcare provider in Birmingham covering the West Midlands and beyond.

The FES service provides holistic care for clients with neurological conditions including the provision, when appropriate, of a medical device (stimulator) to facilitate the lifting of the foot during walking. A trigger for the device in the shoe of clients prevents trips and falls as well as reducing the effort of safe walking. People with MS make up 60 per cent of her caseload of 780 clients.

Post reorganisation in April 2013 the transfer of funds from one central commissioning organisation to the 78 Clinical Commissioning Groups (CCGs) was insufficient to cover service costs. This meant that, while the CCGs had to continue treatment for existing clients, all new referrals had to have funding agreed prior to commencement of treatment. The practical challenges of engaging with each new CCG were enormous.

In April 2013 there were 156 clients on the FES waiting list affected. By April 2014 this had increased to 245. Faced with the possible closure of the FES service Christine’s leadership skills came to the fore.

As a passionate advocate for clients on the waiting list, those receiving treatment and future referrals, Christine gathered information to argue the case for funding, including care pathways, evidence from published literature, client testimonials, results from client surveys, and data from a Friends & Family audit conducted by the patient experience team. The latter showed 97.5 per cent satisfaction rating for the FES service.

A request to continue to provide treatment for all clients now and in the future resulted in only one CCG opting out. With agreements in place, physios were recruited to assist with capacity issues, and by August 2015 the waiting list and time to assessment had halved.

Christine showed leadership, strength of character, tenacity, drive, determination and the ability to mobilise others to achieve financial security for the FES service for the benefit and wellbeing of clients.

WINNER

Michael Douglas, Dudley Group NHS Foundation Trust

Dr Douglas presented a successful business case for the establishment of the Dudley Group NHS Foundation Trust MS service, which was set up in January 2012, providing support for patients with all forms of MS.

Prior to 2012, patients in Dudley requiring tertiary level MS care were referred to the local neuroscience centre for assessment, initiation and monitoring of medications, with limited access to MS nurse services and difficulties with service provision.

The service has proved popular, effective and successful and is fully compliant with NICE guidelines, with excellent support from allied neuroradiological and rehabilitation services.

Dr Douglas leads the service, which provided 1,504 outpatient consultations, undertook 1,726 telephone consultations and managed 61 MS relapses between April 2012 and August 2014.

Achievements include selection of the service for the MS Trust-funded Generating Evidence in MS Services (GEMSS) study and leadership and participation in the second phase (GEMSS2), and NHS England approval as a provider of second line disease-modifying therapies (DMT) for ‘highly active’ MS patients, including infused biologicals. Further accomplishments include the provision for highly selected patients of NHS-funded access to the medication fampridine, the earliest adoption and provision of newly approved DMT (Aubagio and Tecfedira) for Dudley MS patients, and high participation rates in academic and industry-funded research studies (180 patients recruited in the past two years).

The Dudley MS service is an excellent example of a first-class specialised service provided in a decentralised manner to optimise responsiveness to patient needs, while maintaining patient safety and convenience, and is largely down to the efforts of Dr Douglas.

HIGH COMMENDATION

Owen Pearson, Abertawe Bro Morgannwg University Health Board

Dr Pearson became the lead Consultant for the South West Wales Neuro Inflammatory (MS) team, based in Swansea, in 2008. He arrived with passion and promise to work with the team to develop the service for all people with MS and he has certainly delivered.

He is the sole prescriber of disease-modifying drugs (DMD), offering support to over 1,600, and is committed to improving infrastructure to ensure the safe and effective delivery of treatments.

He has secured funding to double the MS team staffing over the past four years and fought for the provision of the specialist Jill Rowe Neuro-Ambulatory Unit, which opened in June 2015. This allows more streamlined diagnosis, rapid access relapse management and delivery of IV treatments. The service is patient-responsive via a telephone advice line and consultant-led multidisciplinary team rapid access clinics, which efficiently and effectively support and improve patient experience.

Aware of the challenges faced in delivering care across a large geographical area, he is the first in the UK to pilot the use of iPad/Skype technology for DMD monitoring direct to the home. He has brought numerous clinical trials to Swansea, is actively committed to developing the UK MS Register, and a member of the clinical advisory group.

Dr Pearson is a dedicated and caring consultant who is highly respected by his patients, colleagues and in particular his team. He has fully supported the upskilling of all staff and his excellent leadership skills and proactive nature have developed the team into a patient-centred, innovative service.

COMMENDATION

Bradford MS Specialist Team, Bradford Teaching Hospitals NHS Foundation Trust

South Asians represent 19 per cent of the total population of Bradford and the unusually high prevalence of MS among this group poses special challenges to the MS service. There are approximately 700 people with MS in Bradford managed by the MS Specialist Team, comprising Consultant Neurologist Dr Spilker, Specialist Nurse Liz Watson, Specialist Physiotherapist Emma Manchester and Specialist Occupational Therapist Emma Matthews.

Working together from the same departmental office allows excellent communication, easier case management and a single point of access for patients, carers and other care professionals. This unique way of working allows screening and delegation of referrals to the most appropriate team member, who is then the case lead in a holistic management approach.

Dr Spilker’s interest in MS in the South Asian population has helped the team to provide tailored care for this sector.

Liz Watson excels at breaking down concepts of aetiology, pathophysiology, disease progression and prognosis. She counsels on symptom management, treatment options, health promotion and practical issues.

Emma Manchester provides therapy aimed at improving mobility, balance and relapse recovery. She works closely with Dr Spilker to manage spasticity. She is the patient education lead, using the ‘Living with MS’ programme to help patients self-manage.

Emma Matthews has expertise in fatigue management, vocational rehabilitation, splinting and assistive technology, enhancing the holistic service. She advocates for patients’ employment rights and through her education and intervention has enabled numerous patients to remain in, or return to, work.

The MS team regularly advises primary care colleagues regarding acute symptoms and relapse management strategies to reduce inappropriate hospital admissions. For inpatient rehabilitation the team assists in discharge planning and coordination of follow up, ensuring a smooth transition back to community services.

Bradford has become recognised as a satellite service for MS, increasing patient satisfaction through reduced travel time, reduced time in hospital and improved local access to services.

The introduction of a rapid access relapse clinic available via self-referral to the Specialist Nurse has given patients timely specialist support, while a regular MDT outpatient clinic allows patients access to the whole team together.

They collaborated on an MS Society leaflet ‘Fasting and MS’, which is distributed at Ramadan.

The Bradford MS Team works with compassion, commitment and determination to see that patients with MS in Bradford receive the best care possible.

HIGH COMMENDATION

Spasticity Service, National Hospital for Neurology and Neurosurgery, UCLH

The spasticity service offers a comprehensive, patient-centred, responsive multidisciplinary service to those with spasticity, via outpatient and inpatient assessments, video clinics, specialist physiotherapy, nurse-led telephone clinics, botulinum toxin and intrathecal therapies. The team comprises two consultant neurologists, a specialist registrar (neurology), three clinical nurse specialists, three neuro physiotherapists and two administrative assistants.

The focus it to improve symptom management, independence and quality of life in people with MS. An outpatient multi-disciplinary clinic assessment by a neurologist, specialist nurse and specialist physiotherapist provides an understanding of how spasticity impacts on the patient’s daily life and tailored holistic treatments are offered. As well as anti-spasticity medications, referrals to the MS walking clinic, functional electrical stimulation and orthotics services are also available.

Those patients deciding to proceed with intrathecal baclofen therapy (ITB) pump surgery require regular dose monitoring and pump refills. Weekly clinics support this and offer a highly flexible service. Liaison with families, carers, GPs and community teams ensures the success of treatment. Support and links to facilitate decisions regarding palliative care and end of life are also provided.

In 2014 the team completed a project with support from the Foundation of Nursing Studies to evaluate the experience of ITB therapy from the patients’ and carers’ perspective. Subsequent improvements included use of a laptop for interactive education sessions, revamped information leaflets, a streamlined inpatient pathway and finding ways to allow patient networking and support. The finale was a Christmas party for the ITB pump patients and the launch of a patient forum group.

They are currently researching the cognitive benefits of ITB therapy in people with MS and the effectiveness of a novel drug treatment on spasticity in MS. The team also recently completed the second edition of a book called ‘Spasticity Management, a MDT guide’.

WINNER

Tayside and North East Fife MS Service

The multidisciplinary team works in a cohesive manner covering all aspects of patient care. A consultant neurologist collaborates closely with three MS specialist nurses who bridge the gap between primary and secondary care, a GP, an MS Study co-ordinator and, within the Dundee MS service, an MS physiotherapist and MS specialist social worker.

The service combines nurse-led and joint consultant clinics with home visits and telephone support for patients. It has the capacity to deliver around 1,800 clinic appointments between Ninewells Hospital and Perth Royal Infirmary, and 330 home visits per year, along with dedicated sessions for administration of disease-modifying drugs and regular patient group education sessions. Time is allocated before each clinic to discuss patients with each member of the team.

Between April 2014 and March 2015 the MS specialist nurse (MSSN) service delivered 1,317 outpatient consultations, 377 day case IV infusions, 124 home visits and received 2,665 telephone calls from patients.

Surveys from patients using the service and other healthcare professionals show that it has avoided other health service costs and unplanned care. Analysis based on data collected in the patient survey suggests that at least 897 neurology appointments, 500 GP appointments and 60 trips to accident and emergency have been avoided through MS specialist nurse intervention, together with hospital admissions.

Having a dedicated GP with a specialist interest in MS performing weekly clinics at the Ninewells site has increased the team’s understanding of primary care and bridges the gap between hospital and community.

Priorities for development include making contact with the 15 per cent of the caseload who have not been seen in the past year, looking to employ a support worker in the team to free MSSN time for more clinical activity, re-establishing and expanding patient group education, and making the case for specialist occupational therapy support for people with MS. An IT service is planned to manage the disease-modifying therapy (DMT) programme.

COMMENDATION

The Adult Ability Team, Staffordshire and Stoke on Trent Partnership NHS Trust

The Adult Ability Team (AAT) is a community-based team of professionals, working together to provide continual specialist nursing and neuro rehabilitation to people in East Staffordshire affected by a progressive neurological condition, such as MS, Parkinson’s and motor neurone disease. The AAT offers support and a trusted point of contact from diagnosis through to end of life.

The team works in a truly inter disciplinary way, with one contact number to a highly skilled and experienced administrator who accurately signposts the call, one set of case notes and operating standards.

The team comprises specialist nurses, occupational therapists and physiotherapists, an integrated support worker and a dedicated administrator, as well as a close partnership with neurologists and speech and language therapists from the neighbouring acute Trust. In one building the team has access to specialist pain management, continence and nutritional support teams, plus an integrated health and social care Trust, which enables a seamless interface with other essential services.

The AAT offers all 19 GP practices in its catchment area the opportunity for an annual multi disciplinary review with AAT members, which has been exceptionally well received, and ensures that people with MS are not lost to review if their condition is stable.

Clinics are held jointly with the neurologist, or with the nurses in local practices reducing the need to travel long distances to hospital. People unable to leave the house are seen at home.

The person is put in the driving seat for all treatment choices, and staff negotiate treatment plans/goals with the individual, focusing on their unique needs. Self-management is a core philosophy of the team, with educational programmes for fatigue management. Newly diagnosed courses have been developed, and the physiotherapy exercise groups have an educational component delivered by a variety of healthcare professionals. The team occupational therapists are developing a stress management programme, and are investigating electronic methods of delivering educational programmes and supporting people remotely.

The team has collaborated on national research such as comparing delivery of care in different care settings and developing outcome measures for people with long-term neurological conditions, as well as being part of a multi-centre fatigue management research programme.

HIGH COMMENDATION

Tania Burge, Bristol and Avon MS (BrAMS) Centre, North Bristol NHS Trust

Tania Burge is a MS specialist physiotherapist at the Bristol and Avon MS (BrAMS) Centre, North Bristol NHS Trust. Tania started at the BrAMS five years ago, initially on a temporary contract. Since then, she has set up specific patient-centred MS services, providing data and evidence with a strong business case to establish a permanent post of physiotherapy.

She has developed and led several specialist services, incorporating a multidisciplinary approach in both the hospital-based teams and individual patient locality teams to ensure seamless pathways of care. Her clinics have managed heavy caseloads ensuring timely intervention for patients.

Tania has been involved in areas such as relapse management as well as a joint orthotic clinic in conjunction with a specialist orthotist to improve gait and function, reducing waiting times from 10 months to a maximum of four weeks. She also uses cool water hydrotherapy at a local leisure centre pool.

A high level balance group was developed two years ago to treat patients who were encountering problems that resulted in them stopping work and disengaging in activities. This work was used as a model of treatment for people with MS at the National Chartered Society of Physiotherapy conference in November 2014.

Tania has shown great drive to provide service of an exceptional standard for her MS patients following latest evidence-based practice to develop rehabilitation in a creative and innovative way.

WINNER Derek Laidler and Andrea James, NHS Highland and Lorn and Oban Healthy Options

Team Lead Physiotherapist Derek Laidler saw the need for an outpatient rehabilitation service for people with MS in the Oban and Lorn area. Without the resources to run a full service he enlisted the help of local community enterprise service Lorn and Oban Healthy Options (LOHO). Initially set up to improve the health of  people with long-term conditions, LOHO employs exercise instructors who provide training programmes in a variety of locations including the local leisure centre, outdoors and in people’s own homes.

Derek provided training and support for Andrea James, the lead exercise instructor, and together they developed a rehabilitation pathway for people with MS. With very limited time, the pathway allows for a comprehensive assessment and treatment plan particularly if someone has had a relapse, developed new symptoms or is newly diagnosed, including clear joint goal-setting.

The treatment plan is then passed on to LOHO ready for a consultation with the LOHO exercise instructor who will explore what activities/environment the person would prefer to use. The instructor works with them to help them meet their goals, with the backup of an experienced physiotherapist.

This pathway allows local rehabilitation and a seamless service from hospital and other NHS services into a community setting utilising existing community resources.

One young service user with MS is training to become an exercise instructor and it is hoped that once he qualifies he will provide expert peer support for others with MS in the area.

Andrea James’ enthusiasm and determination have made the pathway work so well. The model has proved cost effective with a high standard of rehabilitation and could easily be adapted for other areas.

People with MS now have a real say on where and how they have their rehabilitation delivered.

COMMENDATION

The MS Specialist Team, Tayside

The MS specialist team in Tayside provides multidisciplinary care for approximately 1,300 patients with MS living in rural Scotland, many living a significant distance from the hospitals. Therefore it is important that care is coordinated and the team work closely with community staff to ensure effective joint work.  The service has sought to establish ways to maximise effective communication and collaboration with primary care in order to ensure patients receive safe, person-centred seamless care.

The MS specialist service offers people with MS regular reviews in clinic, at home or via telephone depending on patient preference. Patients also have open access to a clinician with MS expertise. Direct contact with an expert clinician is available for all healthcare providers and this enhances coordination of care. Feedback from GPs highlighted that this service had improved patients’ quality of care, improved GPs’ ability to manage symptoms and provided invaluable support to the district nurses.

A GP was included in the specialist team, bringing primary care expertise into the MS specialist service and a truly holistic approach. This GP with a specialist interest provides up-to-date knowledge of all the current clinical, practical and communication issues relating to primary care and the hospital-community interface.

Having a member of the team with GP expertise has increased the quality of MS care, particularly at clinic appointments. The MS specialist nurses have gained a greater understanding of the role of the GP, enabling them to assist the patient in making the most of NHS resources/therapies.

Collaborative working is important with regard to disease-modifying therapies, which are prescribed and supplied to patients at home by the specialist service; all other medications are prescribed by the GP.

It is essential for patient safety that GPs have accurate and relevant prescribing information about every medication patients receive to prevent drug interactions and ensure the community team is aware of possible side effects.

The content and processes for GP letters is being reviewed to include concise, relevant information for the GP and to ensure they are prompted to record hospital prescribing in the GP electronic record.

COMMENDATION

MS Team, Queen Elizabeth Hospital, Birmingham

The team explored all options for providing people with MS information on disease-modifying therapies (DMTs) and, after much debate, DMT discussion groups were set up. Initially 10 to 12 people with MS would attend, but this has reduced to three to six people, depending on need.

Initial DMT discussion groups were set up in close collaboration with MS Specialist Nurse Sally Thompson when she was based at City Hospital. Documentation has also been shared with the other peripheral nurses who link in with the centre and is available on the UK MS Specialist Nurse Association (UKMSSNA) website. Making a decision regarding therapies is not always easy as there is a lot of information out there. The team aims to provide the right level of information in an unbiased manner, providing people with a therapy that will fit in with their lifestyle.

People are invited to attend discussion groups and information on DMTs (MS Trust booklet) is sent to them along with the details of the MS Decisions website.

When the person arrives, screening tests and a screening booklet (with an explanation of the tests) is undertaken individually. Participants are then brought together for the main discussion of the therapies via a PowerPoint presentation and a practical demonstration. Patients can take notes throughout. The presentation covers the mode of action of the therapies, possible side effects and management, monitoring, screening and the process of initiating their chosen therapy.

They can handle the injectable devices and practice with them. The presentation also covers other medications, complimentary therapies, travelling, relapse management, pregnancy etc. The discussion groups use all learning styles to appeal to all.

A one-to-one session is held at the end to recap on the information and discuss the decision or aid the decision-making process. Further written/DVD information is provided on their chosen therapy or, if undecided, several information packs can be provided. Some people may require an additional follow-up appointment in clinic. A number of patients have developed friendships and stayed in contact with others in their groups.

WINNER

PML risk communication information resource, Gavin Giovannoni, Queen Mary University of London and Barts Health NHS Trust

The PML Risk communication information resource allows people with MS to make more informed choices about their treatment by explaining complex risk statistics in an engaging and simple way. Professor Gavin Giovannoni led the development of this novel tool.

In February 2012 he identified the need for data on the risk of people on Tysabri (natalizumab) developing a potentially fatal brain infection progressive multifocal leukoencephalopathy (PML) to be communicated to patients. He felt it was crucial that this be communicated in a format they could understand, as soon as it was published. At that time, the information available was paper-based (therefore quickly out-of-date) and required a certain level of statistical knowledge. Professor Giovannoni led a team of researchers, nurses, designers and expert patients to develop the tool over the next two years.

The tool is available in a number of different formats. As a physical tool it is used in MS clinics to facilitate conversations between health professionals and patients making treatment decisions. Initially tested in clinics at The Royal London Hospital, it has now been requested for use at other Trusts in the UK and around the world.

The main source of dissemination is the Barts MS Research blog, which has 190,000 views a month. Professor Giovannoni updates the resource with every change of risk statistics. The current version has had 1,490,886 views online. It is supplemented on the blog with further information and signposts to additional details. Professor Giovannoni and members of the Barts MS Research Team answer all questions posted on the blog regarding this resource, or any other MS related topic.

The tool also enables patients to make decisions about their treatment at home with the newly developed online interactive version. Professor Giovannoni is committed to ensuring that this information empowers patients to have confidence when discussing their treatment with their clinical team.

The tool has proved successful in communicating this complex and important information to patients and is also a resource to help other health professionals understand and explain it to their patients. A quick calculator enables health professionals to calculate the risk for their patients in the consultation room, showing a unique understanding of the patient’s and clinician’s perspectives of treatment discussions. It has become a go-to resource for the most up-to-date figures.

HIGH COMMENDATION

Barts MS Database Team, Royal London Hospital, Barts Health NHS Trust

The Barts MS Database Team is a multidisciplinary group led by Consultant Neurologist Klaus Schmierer and Epidemiologist and Medical Student Christo Albor. The database was started in 2012 with the goal of collecting and updating data of all people with MS known to Barts Health NHS Trust. All efforts have been made to keep the data accessible to clinicians and associated researchers to enable audits, research and clinical trial recruitment. So far, there are over 1,000 people with MS registered with the database with continuing collection of data on relapses, treatments, patient outcomes, disability measures, and risk factors.

One audit has been completed using the Barts MS Database on the use of natalizumab.

The audit identified that record-keeping of relapses in electronic notes and clinical correspondence was often insufficient for determining retrospectively whether patients were eligible for treatment at time of initiation. In presenting the audit findings, clinicians were encouraged to be more meticulous with recording relapses in order to track patients’ progress. However, positive findings included a comparable reduction of relapse rates after initiating natalizumab treatment when compared with clinical trial data, and a good rationale for stopping treatment when necessary. This audit is currently being expanded to include data from other NHS Trusts in London.

A re-audit is also envisaged to investigate whether record-keeping of relapses has improved, especially given the increased support from the database team, plus whether duration of treatment on natalizumab has changed since the advent of newer disease-modifying treatments.

A second audit is being conducted regarding the equitable provision of MS services in the local area for white, black, South Asian, and ‘mixed/other’ people.

Research using the Barts MS Database is very active. One project aims to evaluate the reliability of a web-based self-completed version of the physician-based expanded disability status scale (EDSS). Another aims to analyse the relationship between the MS Impact Scale 29 (MSIS29), the EDSS, and the European 5-dimension Quality of Life Score (EQ5D), in order to determine the best way to estimate morbidity among people with MS, and ascertain the possibility of imputing missing data using available statistics.

The Barts MS Database has also been used by clinicians for ‘filtering’ patients into lists of those who are potentially eligible for ongoing clinical trials. It has also been integrated with the National MS Register.

WINNER

Multiple Sclerosis Aqua Research Team (MSART), University of Brighton and Burrswood Hospital

Even though aquatic physiotherapy (AP) is a popular form of therapy in MS, research is limited, with no guidelines on the most beneficial frequency, duration and type. This gap in knowledge has been a challenge for developing new services and continuing existing services and, as the cost of an AP session is usually higher than a land-based session, evaluation is needed.

In 2010, Burrswood Hospital (BH) secured funding for three years to run a physiotherapy service. A service offering eight sessions of physiotherapy (aqua or land or both) was developed, which required a standardised data collection tool. A special research interest group, comprising academics from the University of Brighton and clinicians at BH, formed a Multiple Sclerosis Aqua Research Team (MSART) which developed the Burrswood Standardised Data Collection Tool (BSDCT) using the National Hydrotherapy Data Collection (HyDAT project 2009) as a model.

Over five years, MSART has completed 15 research projects. Quantitative studies analysed the data collected via the BSDCT following a standardised treatment approach. Students conducted qualitative studies by interviewing patients about their experiences and effectiveness of the AP on their lives. An audit with 100 datasets from patients was published as an e-copy. The audit tool and the results of the correlation study were presented at international aquatic therapy conferences.

The results of the audit and quantitative studies showed that AP is effective in improving fatigue, balance, gait and health-related quality of life. A positive correlation was found between the fatigue and health-related quality of life improvements. The qualitative studies reported a range of physical and psychological benefits from AP and were instrumental in securing further funds for the continuation of the service. MSART work led to a doctoral level study that secured funding to generate theory on the carryover effects.

WINNER

Christine Singleton, Birmingham Community Healthcare NHS Trust

Christine Singleton is a specialist physiotherapist and clinical lead for the Functional Electrical Stimulation (FES) Service at West Midlands Rehabilitation Centre (WMRC), a tertiary healthcare provider in Birmingham covering the West Midlands and beyond.

The FES service provides holistic care for clients with neurological conditions including the provision, when appropriate, of a medical device (stimulator) to facilitate the lifting of the foot during walking. A trigger for the device in the shoe of clients prevents trips and falls as well as reducing the effort of safe walking. People with MS make up 60 per cent of her caseload of 780 clients.

Post reorganisation in April 2013 the transfer of funds from one central commissioning organisation to the 78 Clinical Commissioning Groups (CCGs) was insufficient to cover service costs. This meant that, while the CCGs had to continue treatment for existing clients, all new referrals had to have funding agreed prior to commencement of treatment. The practical challenges of engaging with each new CCG were enormous.

In April 2013 there were 156 clients on the FES waiting list affected. By April 2014 this had increased to 245. Faced with the possible closure of the FES service Christine’s leadership skills came to the fore.

As a passionate advocate for clients on the waiting list, those receiving treatment and future referrals, Christine gathered information to argue the case for funding, including care pathways, evidence from published literature, client testimonials, results from client surveys, and data from a Friends & Family audit conducted by the patient experience team. The latter showed 97.5 per cent satisfaction rating for the FES service.

A request to continue to provide treatment for all clients now and in the future resulted in only one CCG opting out. With agreements in place, physios were recruited to assist with capacity issues, and by August 2015 the waiting list and time to assessment had halved.

Christine showed leadership, strength of character, tenacity, drive, determination and the ability to mobilise others to achieve financial security for the FES service for the benefit and wellbeing of clients.

 Family Focused Support Team, Oxford Centre for Enablement, Oxford University Hospitals NHS Foundation Trust

The Centre is committed to improving outcomes for families as well as patients, part of which involved developing an innovative resilience-focused day for children who have a parent with MS.  The team included members of the Clinical Neuropsychology department (including clinical neuropsychologists and assistant psychologists), an MS specialist nurse, and a Consultant Neurologist. The team all work within the Oxford University Hospitals NHS Foundation Trust with adults affected by MS and share an interest and enthusiasm in meeting the needs of the whole family, including child relatives.

When a parent has MS, children can experience psychosocial difficulties and providing information, coping strategies, and social support may reduce their impact. However, as few professionals routinely engage with children, the team decided to develop, provide and evaluate an ‘In the Know about MS’ day, which was attended by 14 young people.

It included information, problem-solving ideas, coping strategies, and connections with others. The team identified the children’s existing strengths and resources to develop a toolkit of what they could do to help them stay strong. Parents joined the last session to learn about the day’s activities, see their children’s achievements and ask questions.

The expertise of a range of professionals was essential in providing the children with up-to-date information in an appropriate format and helping them to share their experiences.

Both the team and the children enjoyed the day and outcome data collected suggested it was a success, with 100 per cent of the attendees saying they would recommend it to other children who have a parent with MS.

The team has begun to address an important gap in current service delivery to families affected by MS. By sharing their experiences and main findings, they aim to raise awareness and stimulate other professionals’ interest in this important area.