Vision and Evidence
The Welsh Assembly Government's strategic agenda, spelt out in Wales: A Better Country, emphasises the need to help people to live healthy and independent lives and to cut inequalities. The Wanless Report (Review of Health and Social Care) emphasises a major shift in the delivery of health care towards earlier intervention and support for people to take more responsibility for their own health and well-being. Local Action Plans, developed by Local Health Boards, in the light of the recommendations of this report, have confirmed the commitment to action and identified the importance of strengthening chronic disease management. The plan for the NHS in Wales, launched early in 2001, set out a vision to meet the needs of patients, professionals and the public, built on meeting people's needs by partnership between the public, private and voluntary sectors. It is concerned with remodelling and redesigning services, to reduce the unsustainable burden on the acute hospital sector, by providing services that support people's health and independence in their communities. The plan is also concerned with achieving real engagement of communities in decisions about services and how their health needs should be met. The TREAT Trust Wales charity has been set up in order to establish facilities in the South West Wales area specifically to meet the needs of those who need support in the community to improve their health and well being.
The TREAT concept can be summarised as follows:
- A facility that is funded and run by the voluntary sector but which receives both notional support from the local health, social care and private sector organisations, and financial contributions where appropriate.
- A structure that is located as close as possible to Morriston Hospital and that is open to all who wish to use it but which is designed to provide the best possible ambience and facilities for those with disabilities.
- A facility that will work with Abertawe Bro Morgannwg University Health Board to extend the conventional rehabilitation of those who have been treated at its Hospitals for a wide variety of conditions from whatever specialty. Impairment of health or function through any disease, disorder or injury is embraced in our concept of disability. Thus, for example, it includes paralysis following spinal injury or neurological disease, amputation, visual or hearing handicap, learning difficulties, and any chronic debilitating disorder.
- A service that will also be available to those who do not live in the area, hopefully attracting attendance from a wide geographical catchment and supported by other Health Boards.
- A facility that will also be designed, equipped and staffed to encourage greater self-management of chronic debilitating disorders such as diabetes, chronic obstructive airways disease, ischaemic heart disease, irritable bowel syndrome, inflammatory bowel disease, obesity etc, etc. The aim will be to encourage a shift from institutional care to greater self-management in the community, across the broadest spectrum of conditions.
- Resources that are available and attractive also to the fully fit and able, who would be welcome to integrate fully into activities.
The TREAT concept is fundamentally to enhance greater individual autonomy, self-management, fitness and esteem.
There is a growing body of evidence that targeted education, appropriate support and rapid access to specialist care will enable individuals with a wide variety of chronic diseases to look after themselves at home and in the community, with less demand on both primary and secondary care facilities. The evidence now applies to heart disease, stroke, chronic low back pain, chronic obstructive pulmonary disease, inflammatory bowel disease and irritable bowel syndrome. Specific rehabilitation and support programmes will also speed post-operative recovery and limit socially distressing conditions such as urinary incontinence in both men and women. It will also help patients with intermittent claudication.
Exercise has been shown to enhance self-empowerment in lung cancer. For orthopaedic disorders there is evidence that exercise will prevent disability, retard deterioration and speed rehabilitation for a wide variety of disorders, including osteoarthritis, rheumatoid arthritis, age-related musculo-skeletal injuries and degenerative disorders, including hip fracture, and osteoporosis.
There is also evidence that exercise has generic benefits in reducing mortality in the elderly, and those with chronic disease.It also has beneficial effects in preventing obesity in adolescence, improving mood states,and has a wide variety of other benefits in the elderly.
The TREAT Trustees intend to build and run a facility, close to Morriston Hospital, that will provide opportunities for education, exercise, support and therapy to individuals with a wide range of disabilities. It would also be open to those who are fully fit but who wish to preserve their physical and mental health, and would be available for all who could reach it. The location close to the M4 will aid access.
The facilities will include:
- Exercise and rehabilitation (swimming pool, gym)
- Arts therapy (The Wales College of Dance and Drama have indicated their wish to provide this)
- Education (Trinity College Carmarthen run a degree course on Exercise and Health and would wish to second students to help and learn through contributions to education)
- Specialist support.
A range of physical therapies would be provided, including:
- conventional physiotherapy
- continence advice
- occupational therapy
We believe that many individuals who would benefit from exercise and other physical therapies are inhibited from doing so in conventional facilities for the fully fit when their health, fitness, body image, emotional or mental state is already compromised. This view is supported by the success and benefits of facilities that have been established to cater specifically for the needs of those with a disability. Examples include The ASPIRE National Training Centre in the grounds of the Royal National Orthopaedic Hospital at Stanmore, the Burrage Centre at the James Paget Hospital, Great Yarmouth, and the Share Centre at Lisnaskea in Northern Ireland. The benefits and requirements of facilities for people with disabilities have been described in detail in a presentation to the RIBA Sports Forum in 2003.
The Treat concept will help the people of South West Wales achieve greater fitness. It is in tune with national strategies and the evidence suggests it will lessen demand on conventional services. It is likely that the facilities provided will be attractive to individuals from beyond South West Wales. The Trustees are now seeking support from the NHS in Wales in order that they can embark on a concerted programme of fund-raising to turn their vision into reality.