Integrated Care

Naomi ComptonDales Locality Manager

Integrated Care – The Model

Person centred

Community and Personal network

Core Team – GP, Community Matron, Care Coordinator, Social Worker

Locality Team – OTs, Physios, District nursing teams, re-ablement

team etc.

Specialist resource – Specialist acute – day or admissions

Voluntary Sector Contribution to Practical Wrap-around Support

• Purpose

To increase the ability of people in the Dales to remain independent in their

own homes through the availability of good quality, reliable, ‘wrap around’ services.

• To increase the ability of people in the Dales to regain independencefollowing discharge from acute services through identifying needs and securing supportive ‘wrap around’ services that will meet their needs.

• To build community engagement and enable community members to support their ‘neighbours’.

The proposed ‘menu of services’ is as follows:-

1. Collecting and delivering prescriptions/medication in places where there is no delivery service offered by the pharmacy.

2. Reminders at the appropriate times of day/evening for people who tend to forget their medication.

3. Daily communication/telephone call for those who are vulnerable and lonely.

4. Collection and delivery, and un-packing if necessary, of fresh produce/basic shopping.

5. Social visit to lonely and vulnerable people in their own home.

(cont) The proposed ‘menu of services’ is as follows:-

6. Social contact through supported participation in an interest/activity group, including transport arrangements where necessary.

7. Support with basic house cleaning.

8. Overnight sitting service for people who are worried at night, especially when returning from hospital.

9. ‘Welcome home’ package of support for people returning from hospital, including turning on the heating, making sure there are basic provisions etc.

10. Any other?