Demonstrating the Impact across Change Fund investment work streams A project management, personal outcomes focused approach Tuesday 26 February 2013 Tim Eltringham Head of Health and Community Care , ER CHCP Zaid Tariq RCOP Planning and Development Officer, ER CHCP Stephen McGinty, Voluntary Action ER www.eastrenfrewshire.gov.uk/reshapingcare Today Background Approach Examples Background • East Renfrewshire integrated CHCP • Commitment to Talking Points Personal Outcomes approach: embedded into Shared Assessment which feed into CareFirst, the review process highlights if these are being achieved • Acting on information from personal outcomes data (Miller, E. and Dally, E. 2013 Measuring and Understanding Outcomes: The Role of Qualitative Data; IRISS) Background Background . Approach Measures: Why: Transparency, Multi-purpose Process: -How much we do Simple, routine, de-mystified, PDO co-ordinates Qualitative: -How well Good reflective practice -Impact Engagement: RCOP Planning Group and 1:1 sessions with all project leads Approach Measures: Why: Transparency, Multi-purpose Process: -How much we do Simple, routine, de-mystified, PDO co-ordinates Qualitative: -How well Good reflective practice -Impact Engagement: RCOP Planning Group and 1:1 sessions with all project leads RCOP Planning Group CCB Steering Group Evaluation sessions Events Supervision Approach First 3 areas to be reported each calendar month Approach First 3 areas to be reported each calendar month Reported monthly Overview of Networks CCB Practitioners Network Overview of Networks CCB Practitioners Network Networks provide synergy, working together, overcoming barriers RCOP Initiatives CCB Community Transport Dementia PDS Falls Prevention LTC / Advanced Nurse Practitioners Day Opportunities OAMH Wise Connections Carers’ Short Breaks Telecare Responder Service Assistive Technology / Telehealth Homecare Reablement End of Life care Medicines Management – Early Intervention Medicines Management – Med Rec Discharge Liaison Intermediate Care / Delayed Discharges Care Home Support / Training CPN Care Home Liaison GP engagement Housing – Review of Adaptations Service Preventative and Anticipatory Care Effective Care at Times of Transition Proactive Care and Support at Home Hospital and Care Homes Enablers RCOP Initiatives Community Transport Falls Prevention Day Opportunities Telecare Responder Service Care Home Support / Training Assistive Technology / Telehealth End of Life care Medicines Management – Med Rec Discharge Liaison Intermediate Care / Delayed Discharges GP engagement Housing – Review of Adaptations Service CPN Care Home Liaison Preventative and Anticipatory Care Effective Care at Times of Transition Proactive Care and Support at Home Hospital and Care Homes Enablers Examples Demonstrating impact First Outcome of Change Fund • Strengthened partnership working • Regular joint meetings for all aspects of RCOP – – – – – – – RCOP Planning Group CCB Steering Group CCB Practitioners Network RCOP Networks OP Reference Group Stakeholder Events Joint Strategic Commissioning Group Advanced Nurse Practitioners Fiona Ralph, Shona Adam Improving quality of care to patients within their own home and assist them to remain at home or a homely setting for as long as they can and wish to do so, through anticipatory care planning. Each ANP aligned to a GP cluster. Quantity Quality Total Patients on Caseload 10 9 9 8 8 7 6 5 4 3 2 1 0 Aug-12 Sep-12 Oct-12 Total Patients on Caseload ANPs have active caseload, Initial focus older people With COPD Positive feedback From colleagues And older people on Anticipatory approach And intensive assessment. Older people focused On ‘Staying as well as I can’ And ‘Reducing symptoms’ Impact Each ANP has successfully managed a patient with an exacerbation of COPD at home in conjunction with GP. Re-ablement Reablement changes the culture of home care from task and time to better outcomes and it shifts from ‘doing to or for’ the service user to undertaking tasks with them. In turn this maximises the services users’ long term independence and quality of life. Although the reduction in ongoing support is a key objective of reablement, we need to ensure that the aim of improving people’s wellbeing is at the heart of the service. Quantity Impact Re-ablement Referrals April - October 2012 Re-ablement Discharges October 2012 25 Number of Referrals 21 20 17 17 1, 8% 16 14 15 No ongoing service 1, 8% 12 10 5 Re-admitted to hospital 3 Other 0 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 10, 84% Month •Launched April 23rd 2012. •Phased in approach to introduction of staff. •100 referrals Apr – Oct 2012 •60 discharges in the same period •September and October snapshot show +80% require no ongoing service Wise Connections (Older Adults Mental Health) • Older adults are under-represented in the Primary Care Mental Health Services in East Renfrewshire and whilst many enjoy an active and fulfilling later life, many may develop physical and psychological problems. People Seen / Face to Face interactions 100 88 90 80 80 70 69 70 69 57 60 50 40 30 43 50 50 47 Aug-12 Sep-12 43 42 20 10 0 • • Long term conditions are common in older people and psychological factors have an important role in helping or hindering people’s responses to treatment for physical conditions. Failure to address psychological elements hinders rehabilitation. This projects aims to reduce isolation for those who are particularly vulnerable; target those who have experienced falls; increase the capacity and skill in delivering low key/early psychosocial interventions of those currently working with older adults and their carers, and to increase engagement with the community. May-12 Jun-12 Jul-12 People Seen (PIMS) Oct-12 Number of Face to Face interactions Quantity 433 face to face interactions between May and Oct 2012 Quality Majority of individuals report the service has helped them Deal more effectively with their problems (self management) Impact Case examples of avoiding hospital admission related to medication issues. Wise Connections: Case Example #1 • Female patient referred by GP for low mood following bereavement of spouse. Issues present were low self-esteem and relationship with adult children and avoidant behaviours. • Patient and therapist jointly agreed on 1:1 guided self-help CBT with areas chosen by patient to focus on were improving selfesteem, assertiveness, SMART goals and activity scheduling. • Reduction in CORE10 scores from clinical category of 'moderate severe', to non-clinical category of 'healthy' at end of treatment. Wise Connections: Case Example #2 • 69 yr old lady with physical disabilities, anxiety and low selfesteem. • Treated with 1:1 CBT. • Reduction in CORE 10 score from clinical category moderate to non clinical category of healthy. "This service has been a great confidence booster. Knowing it's confidential helps you to relax in to it". Carers Short Breaks • What it offers: Outcomes • • Tailored flexible short breaks for carers to enable them to continue in the long-term in their caring role. • Examples: Sitting service, Spa break, Hotel stay, Aromatherapy session. • How many • Total of 38 carers have accessed short breaks between July – December 2012. Evaluation forms completed by carers to date have shown carers reporting positive outcomes including: – Reduction of stress for carer – Spending quality time with cared for rather than doing caring tasks – Relaxed knowing cared for being looked after – Personal freedom – Freedom from financial hardship – Felt valued and respected Early Intervention Service • Evidence suggests that people who are on high risk medication or on a variety of medication are at a high risk of hospital admissions that are related to their medication. Early Intervention Service 12 10 11 8 6 8 9 8 4 5 2 0 3 3 6 6 4 0 2 2 0 • • The pro-active screening and identification of people who are on high risk medication, or on a lot of medication, by the Early Intervention Pharmacy Team aims to reduce future medicine-related hospital admissions by putting in plans for the individual. This supports the Reshaping Care for Older People vision to support older people to enjoy full and positive lives in their own home or in a homely setting. Apr-12 May-12 Patients Seen Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Patients Followed Up Quantity 67 people seen Apr-Oct, 218 screening of information. Quality -Individuals reporting feeling more confident in managing their medicines “Service removed all my worries” Impact -3 High risk drugs stopped, 2 reduced. -10 non high risk drugs stopped, 2 reduced. -2 cases of reduction in required homecare support through medicines administration. Examples of cost avoidance through stopping of medication (£317, £390). Early Intervention Service – Case Examples • Checked patient’s blood pressure (BP) at visit – found to be low and significant postural hypotension on standing (though assymptomatic). Returned the following day to re-check and similar readings found. GP contacted and antihypertensive medicines reduced. • Impact: Potential for fall / collapse due to low BP could lead to injury, fractures and admission to hospital • Patient with severe rheumatoid arthritis. Originally wary of service as under rheumatology consultant. However, during home visit was able to review and reduce analgesia, with no reduction in pain control. Also reviewed and changed inhaler + GTN formulations to improve adherence. • Impact: Adverse drug reactions minimised and ability to manage medicines improved. Early Intervention Service Early Intervention Service Dementia Post Diagnostic Support • What it offers: • The Dementia Post Diagnostic Service provides information and support to people who have recently been diagnosed with dementia and their families and friends. • It helps people with the process of coming to terms with, and understanding, their diagnosis and helps people to develop ways of coping with the effects of dementia. • The service also provides opportunities for peer support to help people regain their confidence, and provides opportunities to plan ahead for their future needs. Case example: Alistair – person with dementia Mandy – Alistair’s niece Dementia PDS Measure 3: What the impact is CASE STUDY - Alistair • • • • • • • • • • Hello my name is Alistair. I was told I had dementia when I was aged 55. When it first hit me I found I just wanted to stay inside, and not go out or see people. It was very upsetting, taking me down. It has slowly come back that I can go outside, and take the dog for a walk, that sort of thing. There’s no way I could do that earlier. I think I’ve got a lot of help from the project. What has helped has been dealing with people who were helping me to do what I wanted to do. I used to do a lot of walking. Speaking with other people in the group there were a few of us who wanted to go walking and Tracy helped us to link up with a walking group in Barrhead. The walks we have been doing as a group have been great. In some situations I can be quite shy. However, I find there is always something to see on our walks that I can chat to others about. We are also coming up with other ideas such as taking photos or sketching what we see and talking about the nature or history we come across. A small group of us have started meeting up and have organised trips and that has given us things to look at, and think about, and gives us a focus to be together. Using the underground for the first time we each thought we are not going to be able to do this but we helped each other. I like the idea in our group that we all help each other. I feel more confident now. I have improved because I have got more focus again. My speaking skills have improved as I have developed ways to still make myself understood when I am stuck for a word. Spending time with other people in the same boat has given me more confidence. Dementia PDS Measure 3: What the impact is CASE STUDY – Mandy (Alistair’s niece) • • • • • • Hello, my name is Mandy. This project gives you hope. When you first hear about the diagnosis you think the worst, you think of the very end stages of the illness. You don’t realise there are other stages. It was such a relief to see other people at the groups and not be able to tell who had dementia and who are family members. Its reassuring to know that life isn’t suddenly over just because you have a diagnosis of dementia. When we first came to the cafés we didn’t know anyone but everyone was really friendly and we started looking forward to coming and seeing people. You might be feeling really tired or a bit down but when you leave you feel so uplifted. People in the group bolster each other and it’s nice to be able to speak to other people who are in the same boat as you. If we hadn’t known about this group we would all be sitting at home alone, separately, doing nothing, not going out much. The project has allowed us all to get together and make friends. I can see a big difference in Alistair between when he was first diagnosed and now. I think that he was very depressed when he was first diagnosed and he seemed really isolated. Now he has met people in the same boat and they get on with each other and it’s great to see that Alistair is helping them too. I think he seems a lot happier now and is more on the ball. This gives me peace of mind. Community Capacity Building • What it offers: • Volunteering opportunities for older people • Befrienders • Community group activities • Organisational development, support and training Reducing isolation, increasing engagement • How it can be accessed: • Stephen McGinty, Change Plan Co-ordinator, Voluntary Action tel: 0141 876 9555 • Alan Stevenson, Community Link Worker, Kirkton Day Services, tel: 0141 800 7070 • Belinda Arthur, Community Health Development Worker (HIT) tel: 0141 577 8480 • Case example: Mousemates •Co-production Approach •Appreciative Enquiry •Resident Questionnaire • Volunteers Recruited • Equipment provided • Programme Delivered •Pre-Course assessment •Post Course Evaluation(s) •Social Impact Assessment Framework Residents Comments • “This gets me out of my room, and I can meet people that I would not otherwise have met – and I enjoy it and it’s something to look forward to!” (Millie – 94) • “I have always been an outspoken person and I can now also do this on emails – if necessary!” (Julia – 97) Staff Comments • “One lady feels some of her typing ability is improving, she thought she had lost it for good due to arthritis.” • “Service users are sorry to see the end of the session, and would like to continue with further sessions”. Multiple Impact • Residents • Volunteers • Staff Impact - Residents • Improved Wellbeing • Improved Independence • Improved Social Interaction • Improved Skills Impact Staff Volunteers • Increased Engagement • Having Things to do • Improved Skills • Improved Social Interaction • Increased Confidence • Improved Wellbeing Thank you Any questions? For more information please contact: Zaid Tariq Reshaping Care for Older People Planning and Development Officer East Renfrewshire CHCP [email protected]