Holistic Assessment Rapid Investigation HARI Holistic Assessment Rapid Investigation

HARI Definition A multidisciplinary community service for adults with complex medical and rehabilitation needs

HARI Vision Keeping people well Prevent unplanned hospital admissions Reduce the risk of falls Enable independent living Rehabilitation  

Referral Criteria Patients: registered with a Merton GP aged 18 years + requiring therapeutic intervention from more than one health professional including: Consultant Physician; Advanced Nurse Practitioners; occupational therapists; and physiotherapists. Pharmacist – coming soon! with mental capacity to participate in group and individual based rehabilitation Complete single referral form SMCS website – tick “HARI”or “rehabilitation” Provide information to outline anticipated patient outcomes and choose an appointment with an appropriate health professional if known Transport can be offered for those unable to travel independently

HARI Referrals The referrer can select a choice of 2 service options:- A full assessment by the whole team including a full Consultant/ANP assessment, plus therapy assessment, falls screening and rehabilitation. For this pathway, referrals can only be made by the GP 2. For those requiring rehabilitation only, referrals can be made by GPs but also directly from SMCS rehab teams e.g. Rapid Response, Falls Prevention Service and also, if appropriate, patients with Parkinson’s Disease will automatically be reviewed on a 4 – 6 monthly basis team Patients will be offered a routine appointment within 10 working days

Meet the HARI team Consultants Physicians Advanced Nurse Practitioners Nurses Health Care Assistant Occupational Therapists Physiotherapists Rehabilitation Assistants Administrators Pharmacist – coming soon Podiatry – Regular sessions

Assessment and Investigation The team will provide assessments, request investigations and formulate management/ care plans Holistic – reviewing patients, carers and their needs With Advanced Nurse Practitioners, consultants, physiotherapists and occupational therapists Investigations, as required, can be organised during the initial visit or with subsequent visits

HARI Rehabilitation Based at the Nelson Health Care Centre Assessments are carried out at the Nelson and therapists also assess in patients’ homes. Patients have the option of a morning or afternoon session On arrival patients are offered a hot drink and have their nursing observations before commencing therapy AM therapy sessions start from 9.30 – 11.30 PM therapy sessions start from 13.30 – 15.30

Rehabilitation: Occupational Therapy Full Occupational Therapy Assessment – seeking to promote independence at home and within the community. Home Assessments to assess an individual’s functional ability within the home to assess for home hazards and reduce the risk of falls. Prescription of specialist equipment to promote independence Wheelchair assessments and practice Moving and Handling Risk Assessments Upper limb and Hand Assessments and hand rehabilitation Orthotic Fabrication Cognitive Assessment Anxiety Management Training, psychological support and the promotion of wellbeing and healthy lifestyle choices Health Promotion and advice for patients and carers

Rehabilitation: Physiotherapy Full Physiotherapy assessment including balance, strength, mobility and falls assessment. Gait assessment and re-education including outdoor mobility practice Provision and review of walking aids Individual and group exercise within gym environment Home assessments to review mobility Home exercise programme Onwards referrals to Falls Prevention Service and Community Support Services

Falls Service Provision Three key teams provide the SMCS Falls Service Holistic Assessment & Rapid Investigation (HARI) CRISIS/Community Rehabilitation Team Falls Prevention Service (FPS) PLUS Other Falls Pathway Teams Community Neuro-Therapy Team (CNTT) Rapid Response Team (RRT) Community nursing

External Collaboration HARI Secondary Care-Specialist Teams Mental Health General Practice/ Primary Care staff Dementia Hub Social Services The Voluntary Sector

Internal Collaboration HARI Community Rehabilitation Team Community Nursing Teams Community Prevention of Admission Team Continence Service Speech and Language Therapists Falls Service

Patient Example

Future Innovations New HARI pharmacist to support medicines optimization Improve links with Mental Health Services including links with new Dementia Nurses Currently recruiting 2 new Occupational Therapists to link in with the above and 1 new Physiotherapist.

Contact details Referral Queries- Adult Referral Centre HARI Queries – HARI – Holistic Assessment Rapid Investigation Contact details Referral Queries- Adult Referral Centre Sutton and Merton Community Services Administration Centre Tel: 0845 567 2000 HARI Queries – to speak to a clinician HARI Nelson Health Centre Kingston Road Raynes Park London SW20 8DB Tel: 020 8245 8240