St Neots Neurological Centre
Patients with complex needs can find engaging in therapeutic rehabilitation challenging for a variety of reasons, ranging from lack of motivation and mental health issues to multifaceted physical needs. These challenges mean that patients can fail to reach their full rehabilitation potential unless a specialist Multidisciplinary Team (MDT) is supporting them.
In this EveryExpert article we speak with the MDT at St Neots Neurological Centre in Cambridgeshire about the key factors needed to achieve positive patient outcomes within complex neurological and psychiatric care.
Continuity and flexibility of the MDT
St Neots Neurological Centre is a hospital and can support people who are detained under a section of the MHA, so the MDT are well accustomed to supporting individuals with complex needs. St Neots offers high quality, therapeutic rehabilitation pathways and nursing care to people within a small-scale setting (38 beds), who have an acquired or traumatic brain injury or other neurological condition.
Anand Annamalai, Occupational Therapist and Therapy Lead at St Neots, works as part of the expert MDT who also offer psychiatric and psychological care to individuals with complex behaviours. When working with this particular type of patient group, Anand believes there is great benefit yielded from the flexibility of a smaller but highly specialist team.
Anand says: “In some ways it is a huge advantage for us to be a smaller service because we get to work closely with the individuals we support. We learn what motivates them and we can see first-hand the challenges they face. As an MDT we can then move quickly to tailor care to each person’s individual needs and implement changes in their care plans.
“It’s not uncommon for patients to experience dips in engagement levels, this is perfectly natural considering the amount of challenges they face. But we are able to counteract those dips with ongoing support, ensuring their rehabilitation is not interrupted. It’s this combination of flexibility and continuity that really allows us to make progress where other care settings might not be able to.”
Patient determination and therapy team expertise
One example of such progress is with a patient called Mr. Smith who was admitted to St. Neots with an acquired brain injury and a concurrent diagnosis of diabetes with peripheral neuropathy. The neuropathy significantly affected his balance, leading to multiple falls. Initially, Mr. Smith hesitated to participate in therapy because he was able to walk independently without assistance. However, his peripheral neuropathy and balance issues resulted in several falls with minor injuries, and then culminated in a major fall, causing a fracture of his right femur that required surgical intervention with intramedullary nailing.
During his acute rehabilitation at the hospital, Mr. Smith’s engagement with therapy varied, reflecting his ongoing struggle between the need for support and his desire for independence. He relied on the Sara Steady device for transfers and used a wheelchair for mobility within the facility.
Upon returning to St Neots, the MDT worked closely with Mr. Smith to improve his engagement with therapy, and a turning point occurred when he began participating in strengthening exercises during therapy sessions. Consistent physiotherapy and other therapy sessions offered by the team yielded positive results, and he gradually regained strength and joint range of motion.
Mr. Smith achieved a significant milestone when he started transferring with the assistance of a zimmer frame. This marked the beginning of his gait training with the physiotherapist. His determination grew with each step, and eventually, he could walk with the zimmer frame under staff supervision.
As Anand explains, Mr Smith’s journey from assisted transfers to using the zimmer frame independently was a remarkable achievement and a wonderful example of what patient determination and therapy team expertise can achieve together.
Anand says: “I think Mr Smith’s journey shows the challenges and triumphs of rehabilitation. Not only does it emphasise the critical role of consistent therapy and professional support but also the power of individual determination. His ability to overcome setbacks and achieve a level of independence is very impressive and we are delighted that he has made such progress.”
Wider MDT benefits
Farah Azam is a Senior Occupational Therapist, at St Neots and for her, working as part of a specialist but close-knit team means that care can always be tailored to individual needs.
Farah says: “In larger teams sometimes you don’t always get the opportunity to work closely with the people you support, but here at St Neots we do. This way of working ensures that we can be truly patient-centred, regularly updating care plans informed by our actual therapeutic experience with them. This means that no two care plans are the same, each one is tailored to the individual, based on what we have seen first-hand in our sessions.”
Farah’s sentiments are echoed by her MDT colleague, Sonia Stephen who is a Physiotherapist at St Neots Neurological Centre.
This is the first time Sonia has worked in a service that provides specialist mental health support, alongside acquired brain injury rehabilitation. So as well as seeing the benefits the patients receive from care at St Neots, for Sonia there has also been significant personal development from working in this new clinical environment.
Sonia says: “Working in a specialist neuro mental health setting has been an excellent learning experience for me these past two years, and it has been wonderful to be part of such a close-knit team. Our MDT is incredibly supportive and this is vital in the work we do. We have a mixed patient group, each with complex needs, so a holistic approach to care depends on great teamwork and collaboration.”
Career progression at St Neots
Ensuring personal development of the MDT, alongside delivering a high standard of care for patients, is a central theme for the leadership team at St Neots. As Anand Anamaldi explains, the contribution of each team member is valued and they are supported to develop their own knowledge and skills alongside fulfilling the requirements of individual care plans.
Anand says: “Every single one of our team members is so passionate about what they do, and we try to support them to develop as individuals as much as possible. When that passion is enabled with extra training, more opportunities and responsibilities then we see further improved outcomes for our patients.”
Therapy Assistant Angela Carrera is a wonderful example of this ethos in action. Angela has been supporting patients at St Neots for nearly 10 years, having begun her career as a Healthcare Assistant back in 2016. For Angela connecting with patients, seeing their progression and helping them fulfil their potential through therapy is why she loves her job.
Angela says: “I first joined St Neots back in 2016 as a Healthcare Assistant. I really enjoyed my job but I was keen to move into a role that involved therapeutic aspects of care, rather than focusing on personal care. I wanted to engage with residents in a meaningful way, connecting with them as a person and helping them to achieve their rehab goals.
“In 2019 I was promoted to be a Therapy Assistant (TA) which was wonderful. As a TA I have more responsibility, I’m involved in reporting and care plans. I’m learning new skills and improving my communication. I feel like my contribution has lots of value and I’m making a difference.
“I really enjoy working here at St Neots, the team are very caring and the care we provide is of a very high standard. We are a small service and so we do a lot of community-focused therapy, which means we are often out in the local area, in the park to incorporate therapy sessions or going for coffees or ice-cream. In my role I have to be very flexible and be aware of the patient’s needs so that I can choose the most appropriate timing to suit them.”
Currently flourishing in her career, Angela has no plans to stop there and continues to look forward to further progression at St Neots.
Angela says: “In the future I would like to continue moving forwards in my career, I’d love to become an OT and specialise in supporting patients with acquired brain injury. I’m particularly interested in how an individual’s home environment can be adapted to help someone return back to their family.”
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