Everyone’s needs are different, and it’s the job of rehabilitation healthcare professionals to help people reach their goals and live their lives.

It’s a complex task, but one that QuDoS Outstanding MS Physician, Dr Barbara Chandler, Consultant in Rehabilitation Medicine at Inverness’ Raigmore Hospital, relishes.

“I’ve always been interested in developing community services because it involves helping people with their day-to-day lives, as opposed to during that snapshot of time while they are in hospital,” she said.

“If you take someone with MS who has a range of symptoms, they may come into hospital and receive some fairly intense therapy to get them going again.

“It’s great to see that improvement but they still have problems when they go home. That’s where I see the challenge – supporting individuals and their families with ongoing difficulties to contend with any issues.”

Individual goals

Varying combinations of symptoms, such as cognitive impairment, mobility issues, fatigue and spasticity, can result in a whole range of quality of life concerns. One person’s priority, for example, may be to stay in work while another’s will be to be able to do the school run.

There’s no “one-size-fits-all” approach, but through home visits and satellite clinics right across the Scottish Highlands, Dr Chandler, who works across neurological conditions, helps people to set individual goals.

No one is ever discharged from the service, unless they want to be, and Dr Chandler aims to see people at least once a year to check progress and address any new concerns.

She said: “Empowering patients to self-manage is really important, but I find that sometimes people just put up with problems. They either think there is nothing that can be done or, in the case of things like bladder and bowel problems or sexual problems, they are too embarrassed to talk about it.

“With things like swallowing difficulties, I have found that people just accept that they cough or splutter a bit when they have a drink. It’s only when you sit down with them and ask that they realise something can be done. If we just leave things like that with the individual, they may end up suffering in silence.”

System-wide approach

While symptom management medication plays an important role in her work, Dr Chandler also liaises with other groups of professionals and organisations to develop tailored care plans.

“Rehabilitation is not a speciality that sits in isolation,” she said. “From a medical point of view, it’s thinking about whether there is any medication that could help them to achieve their goals.

“But it’s also thinking about whether there is anything that can be done from a physiotherapy perspective, whether occupational therapy could assist in adapting the person’s environment and whether we need to look at carers coming in or involve social work.”

The complexity of working with such a varied group of services is compounded by the large geographical area Dr Chandler covers. Patients may live many miles from her base in Inverness, meaning she spends a lot of time on the road, and the teams she can access on behalf of her patients varies from area to area.

“I work with some fantastic MS nurses and we have really good district nurses, but everyone is stretched. We try to give people with advanced MS as much support as we can, but it’s not always easy,” she told the QuDoS team.

Joint working

It means the area’s MS teams have to be creative in how they provide that support – as demonstrated by a “really exciting” new agreement with the Highland Hospice.

“There are periods when someone can really benefit from an intense period of rehab, but the pressure on beds in our inpatients’ rehabilitation unit makes it really difficult to admit anyone from the community,” Dr Chandler explained.

This has led to her team working with hospice colleagues to start a rehabilitation programme for people with chronic neurological diseases. The service, which mirrors a pre-existing chronic respiratory disease programme at the hospice, started last year.

“We select neuro patients to be assessed by the hospice team. If they feel they can help, the individual is admitted for 10 days of intensive therapy,” explained Dr Chandler, adding that nine people went through the programme last year, all of whom had either fully or partially achieved their goals.

“They are all planned admissions in dedicated rehab beds that aren’t going to get filled with emergencies. It means people can be told months in advance when they will be coming in. It’s a fantastic resource to be able to offer people with more advanced disease,” she said.

Winning combination

It’s just one example of how joint working is paying dividends for people with advanced MS living in the Highlands – and why Dr Chandler wants to share her QuDoS accolade.

“When I found out about the nomination, I was astonished,” she said.

“There is something really humbling about being given an award. But in my speciality, it’s very much about working as a team, both with other professionals and with the patients.”