The pool offers a unique service to the people of Cumbria. It offers the known benefits of hydrotherapy in a supportive environment that builds confidence and allows privacy. The benefits include improved mobility, easing of pain and growth in confidence for patients with Physical and Mental Health Issues. Our main objectives are to deliver this therapy at an affordable cost (so as not to exclude the vulnerable users), to provide personalised and specialist sessions and to maintain the pool environment to a high standard.
We have SIX trustees and a small and dedicated group of volunteers, the ‘Friends of Sandgate Hydrotherapy Pool’ raise funds from events etc.
Historical Background: -
It is over 40 years since the Westmorland Mencap Society began a very ambitious plan to raise money to build a Hydrotherapy Pool in Kendal. They had the foresight to recognise the potential benefits for children and adults with disabilities, both physical and mental, exercising in warm water in warm surroundings. On Saturday 12th November 1977 the Hydrotherapy Pool was opened by Mr Peter Naylor, Chairman of Cumbria County Council.
To ensure the Pool remained viable the South Lakeland Hydrotherapy Trust (SLHT) with charitable status was formed in 2002. SLHT secured some service provision funding from Cumbria County Council (CCC), South Lakeland District Council (SLDC), Kendal Town Council (KTC) and Cumbria Primary Care Trust (Cumbria PCT).
The funding from CCC, SLDC and KTC continues to this day, but over the years due to NHS structural changes the funding from the PCT (now replaced by Morecambe Bay CCG).
Hydrotherapy, also known as Aquatic Physiotherapy, is a specific form of physiotherapy treatment conducted in a heated pool. Hydrotherapy treatment incorporates individual assessment, diagnosis and the use of clinical reasoning skills to formulate a treatment program appropriate to each patient’s needs.
This treatment is therapeutic and assists with relaxation, decreases pain, increases muscle strength and enhances overall mobility of the patient. The key benefits of hydrotherapy are from the heated water and resistance that the water provides.
The impact of this is far reaching and multi-facetted. Some of the conditions that hydrotherapy can help are:
- Neurological conditions e.g. strokes and brain and spinal cord injuries, Multiple Sclerosis, Muscular Dystrophy
- Musculo Skeletal Conditions
- Pain Relief
- Orthopedic conditions e.g. trauma (fractures and soft tissue injuries), arthritis, pre and post joint replacement and amputation
- Spinal conditions e.g. acute and chronic lower back pain and pre and post spinal surgery
- Chronic rheumatological conditions such as rheumatoid arthritis, fibromyalgia and chronic fatigue syndrome.
- Sensory or learning or profound and multiple difficulties
- Mental Health Patients and Psychological well-being
- Terminally ill Patients
Hydrotherapy has been around for a long time but is not core to NHS service delivery. (Margaret Reid Campion, Hydrotherapy, Principles and Practice, 1997)
The NHS Five Year Forward view identifies that the need for a radical upgrade in prevention and public health. Endorsing exercise through hydrotherapy encourages exercise in the community, which patients can continue independently, giving them greater control of their own care and encouraging healthy lifestyle choices.
People that have experienced severe pain frequently suffer ‘fear avoidance’ to exercise and movement in case the pain returns. This results in deconditioning and secondary health problems. Many patients are unable to exercise on land but can do so in water, so hydrotherapy provides rehabilitation that they would otherwise be unable to access.
Hydrotherapy treatment incorporates individual assessment, diagnosis and the use of clinical reasoning skills to formulate a treatment program appropriate to each patient’s needs, and to screen for contraindications to hydrotherapy. This is performed by a referring physiotherapist in GP surgery triage or in physiotherapy.
There is evidence of the benefits of hydrotherapy including:
General example – Pain relief
“The relief of pain by immersion in warm water may be due to a number of contributory factors, depending on the origin of the pain. The increase in sensory input from temperature (presumably through pain gating); water turbulence and hydrostatic pressure (McNeal 1997). There is the suppression of the sympathetic nervous system during immersion; as demonstrated by Mano (1985) and the reduction in muscle tone experienced on immersion. Franchimont et al (1983) describes the decrease in striated muscle tone when warm thermo receptors are stimulated. Cunningham (1997) suggests that the decreased tone observed during immersion in warm water be partly due to the lack of proprioceptive stimulation, plus the reduced weight bearing may lead to reduced pain.”
General - Muscle Strengthening
“Water offers resistance to movement through its properties of viscosity, and weight. These can be harnessed, together with buoyancy and turbulence, for both general and specific muscle strengthening and graded according to ability. Buoyancy can be harnessed to assist in the re-education of muscle activity (Becker 2009).”
Example – Neurology
“Morris (1995) reviews the application of aquatic physiotherapy in neuro-rehabilitation; he describes it as a useful adjunct to traditional brain injury rehabilitation programmes. The author suggests that future research areas should include the effects of immersion on cutaneous sensory input and proprioception; the effects of aquatic neuro-rehabilitation in acute phases of recovery and the carry-over effect of aquatic exercise to land based activities.”
“The handling of these (and most other patient types) is easier in water, as the Therapist is not having to support the weight of the patient or their limbs. Thus, handling can be more sensitive to patient movement, tone etc.”
Measure Yourself Medical Outcome Profile (MYMOP)
Previously we have only been able to assess the effectiveness using an Outcome measure of the number of Individual Pool User Sessions, 21,610 in 2016-17.
To help evaluate the difference the hydrotherapy services make to the lives of pool users, we
have introduced an annual cycle of surveys to assess the benefits derived by clients from
using the pool and its services. The MYMOP questionnaire is completed on two occasions
over a period of time and measures the differences in the responses provided, to determine
whether they feel better about the symptoms for which they were referred to the pool.
The first year of the survey has provided some really valuable information around reported
improvements in the initial symptoms, as well as respondents reporting an increased
capability to undertake a range of activities, and an improvement in general wellbeing.
A full copy of the evaluation report is available on request, and the survey will be undertaken
each year during the Autumn period, focussing on new pool clients.
Feedback from patients also demonstrate the benefits of hydrotherapy, please see the Headway Video
The pool offers a unique service to the people of Cumbria. It offers the known benefits of hydrotherapy in a supportive environment that builds confidence and allows privacy. The benefits include improved mobility, easing of pain and growth in confidence. Our main objectives are to deliver this therapy at an affordable cost (so as not to exclude the vulnerable users), to provide personalised and specialist sessions and to maintain the pool environment to a high standard.
The pool costs around £140,000 a year to run and brings in over £80,000 in income form pool charges. We would not want to see an increase in pool charges and currently as can be seen from the timetable the pool is operating at high capacity. Higher charges would be prohibitive and discriminatory to the most vulnerable users of the Pool.
We have significantly reduced running costs in the last few years by improving the equipment that is used to sanitise and heat the pool which has saved money. It is now a priority to undertake the improvements suggested in the Cumbria Action for Sustainability (CAfS) energy report (which is attached) to further lower running costs.
The Pool is open Seven days a week 12 hours a day for week-days and about 6 hours on Saturday and Sunday. There were 21,600 Individual User Sessions 2016-17.
UHMB NHS FT (Consultants and Physiotherapists), Medical General Practioners and Physiotherapists currently refer patients to Sandgate Hydrotherapy Pool along with Health and Care Groups (Cancer Care, Arthritis Care, Multiple Sclerosis, Breast Care, Stroke Club, Sight Advice, Adult learning and training groups, Whinfell and Windmill, Headway, Sandgate, Underley Schools, WOSP (Kendal Day Services))
South Lakeland Hydrotherapy Trust (SLHT) is responsible for:
- Applying for Grants and fundraising to support and maintain the provision of Hydrotherapy Services, cover any shortfall in revenue maintaining affordability to the vulnerable users.
- Fundraising in the local community to continue to improve the Pool facilities and services
- Advice on financial matters including appropriate admission prices
- Promotion of the Pool and the services provided
- Opportunities for the development of services and the Pool building
- To support the initial vision of MENCAP to help the disabled in our community
- To help ensure that all areas of disabilities are offered support by the pool
- To help make the Pool a Centre of Excellence
The hydrotherapy services at Sandgate pool are funded through:
- Patients/ groups paying for sessions
- Long term partnership funding arrangements with several key stakeholders, including Cumbria Clinical Commissioning Group, South Lakeland District Council, and Kendal Town Council
- Additional fundraising
The key benefits of hydrotherapy are:
- Supported within the Trust - offering physiotherapy in a group setting, enabling two or three Physiotherapist to treat up to 30 patients in an hour at a time, compared to a maximum of 7 that would be treated in the physiotherapy department by the same number of staff.
- Provides a cost-effective way of therapeutic reactivation
- Encourages independence through reconditioning and empowers patients
- Reduces need for GP appointment, medication
- Extremely valued resource within the Acute and Community sectors with many GPs and consultants referring patients.
- Patients preference of hydrotherapy
The management of chronic pain and disability poses a huge financial challenge to the NHS. Local NHS pain clinics have lengthy waiting lists and pain management programs are outsourced at great expense. A local active rehabilitative hydrotherapy Programme:
- Provides a cost-effective way of therapeutic reactivation
- Encourages independence through reconditioning and empowers patients
- Helps to reduce patients frequenting the revolving door of the NHS.
- Reduce GP appointments
- Reduce the need for prescription medication
- Reduce burden on physiotherapy departments.
Cost of service:
To ensure the pool remained viable the South Lakeland Hydrotherapy Trust (SLHT) with charitable status was formed in 2002 and has now a working partnership with CCC along with grant funding from other major stakeholders. In the last financial year (2016-17) the pool’s operating costs were £143,929 and CCC gave £44,000, Kendal Town Council £2,500, SLDC £2,500 and Cumbria Clinical Commissioning Group 15,000. The rest is made up from the operating income (charges) etc.
Sandgate Hydrotherapy Pool is open seven days a week and last year there were 21,610 individual user sessions
- It provides a service across traditional boundaries, i.e. to Acute Sector and Community Sector patients.
- It provides a service that is both a treatment and a maintenance of Health and Well-Being for Physical and Mental Health Conditions.
- It works across partner organisations involving NHS Commissioners, Acute and Community NHS providers, County Council Health and Well Being and 3rd Sector (SLHT).
THE PROPOSED PROJECT: -
The future of Sandgate Hydrotherapy Pool will depend on being able to continue providing a first-class hydrotherapy service at the best possible costs. The Hydrotherapy Pool Renewable Energy Project will not only address the escalating costs of providing hydrotherapy services but also will be environmentally friendly maximizing the use of ‘green energy’ and energy conservation.
The aim of the project: -
The project will be costly, and we have been specifically raising funds for the last three years. We currently have assets on deposit of about £50,000 which will cover our costs for a about a year as funding is not certain from any of our main partners. We also have reserved funds of about £100,000 in addition for The Renewable Energy and New Roof Project. We intend to contribute significantly to the project from these current deposits which have accumulated from fundraising in the community and generous donations from users and their families. However, to complete the project, we will need additional grant funding from a range of sources.
We need to avoid passing on the rising energy costs which are a significant part of our budget, to the Pool users by reducing the burden as much as possible by making the pool more energy efficient and utilising renewable energy technology. As energy prices continue to rise it may become a problem for the continued running of the pool as it is so important to maintain a high pool and ambient temperature.
The project will deliver a reduction in running costs, resulting in increased sustainability enabling us to continue the prudent management of the pool. It will also demonstrate a commitment to reducing carbon emissions. It may even result in generating revenue if excess energy is created. The options available for reducing energy costs were assessed and recommended in the Cumbria Action for Sustainability (CAfS) report (Attached as 1). This report showed that the roof which is a double skinned fibre-glass roof and is over 40 years old loses a lot of heat energy. A survey by Lakes Renewables reported that it was NOT possible to install Solar PV Panels on the present ‘wave’ roof which will NEED to be replaced.
The External and Internal Pictures of the Pool below show the unsuitability of the present roof.
This application comes at a stage in the overall project outlined in the CAfS report, we have undertaken some of the recommendations, and now need to undertake the final recommendations of replacing the old roof and to install solar voltaic roof panels.
We have been working through the CAfS report as follows: -
1) The front entrance repairs have been carried out and new automatic doors installed.
2) The large glazed window at the bottom West Wall has been removed and bricked up.
3) The Vent Axia Air Handling Heat Exchange Units have been replaced. This is estimated to save about £100 per month on heating.
4) The Pool cover has been replaced.
5) A full roof survey for Solar Voltaic panels to be installed (flat roof and/or the 'wave' roof areas) has been completed.
This costs for these improvements recommended in the CAfS report was covered with funding raised by South Lakeland Hydrotherapy Trust (SLHT).
The project will reap immediate benefits in terms of reduction in energy bills which is quantifiable and easily measured. Some figures are suggested in the CAfS reports.
At this stage we have specific quotes for Solar PV Panels (Lakes Renewables) in the range of £26,500 to £29,500, which will depend on a new roof suitable to take the Solar Voltaic Panels. We have been given an estimated additional target of a further £170,500 for the new roof.
This project will not create additional running costs, it will in fact lower them substantially the project will deliver reduced running costs for the pool. It is estimated by “Lakes Renewables” that if we have both the flat roof on the entrance hall and the main pool roof fitted with panels we could anticipate a 35% reduction in energy costs.
During 2017 (the 40th Anniversary of Sandgate Hydrotherapy Pool) the ‘Friends of Sandgate Pool’ part of SLHT have raised about £12,000 from events they had organised. This commitment from the ‘Friends’ along with the continued determined support of the Pool users, their friends and families and local businesses will continue. We have already raised £100,000 towards the overall costs which are held in a reserved fund. I would like to pay tribute to how hard the ‘Friends of Sandgate Pool’ work with coffee mornings, Bingo and Race nights, Quizzes etc and the tremendous support from users of the Pool and the whole community.
Costs of Replacing Roof on Sandgate Hydrotherapy Pool and Installing Solar PV Panels
Costs Excluding VAT
Solar PV Panels
Cumbria County Council (CCC) have been approached to support this with Project Management. CCC are now processing an Architectural report with full costings which is not yet available.