south ayrshire reshaping care event october 20 th 2011 what was said in june 2009 & progress...
TRANSCRIPT
South Ayrshire Reshaping Care event
October 20th 2011
What was said in June 2009 & progress since then
Jean Hendry - Health Care Manager NHS Ayrshire and Arran
Headlines from 2009…
THE BLOOMING GOOD LIFE!
CARE TAILORED FOR YOU!
PERSONALISED SERVICES
DESIGNED BY YOU!OLDER PEOPLE ON THE MOVE!
SOUTH AYRSHIRE SCOOPS AT THE
FIRST CARE OSCARS
HOSPITAL IN YOUR OWN
HOME!
Headlines from Older People’s Vision event – June 2009
ON LINE SERVICES AVAILABLE IN AYR HIGH STREET –Older people & their carers can get access to the full range of health, social care and voluntary services at the press of a button
PRIMARY CARE STRATEGY A SUCCESS
AS AYR HOSPITAL BECOMES CENTRE OF
EXCELLENCE FOR TELE-REHABILITATION
SOUTH AYRSHIRE VOTED THE BEST
PLACE FOR OLDER PEOPLE
TO LIVE IN SCOTLAND
A LIBRARY OF CHOICE
To nurture Re-ablement and care at home, all services need to work together and commit to change:
support people to be as independent as possible,
simplify and aligning systems and processes
provide flexible and responsive services,
Re-ablement and care at home
You said…
Re-ablement and care at home – you said
develop a joint service with pooled resources
make best use of new technologies, invest in staff development recognise informal roles and the
substantial roles of carers and the service recipients themselves.
Re-ablement and care at home – what we have put in place so far…
DVD Case Study…
To support anticipatory care we need better upstream approaches, easily accessible
information on services, more locally based interventions with easier points of access and
better connections to other linked services such as leisure. We need patients to assume more
responsibility for their own health and care and to work in partnership with them to develop health
improvement and self-management programmes. Services should be better integrated, for example,
day care.
Anticipatory Care
You said…
Anticipatory care – what we have put in place so far…
DVD Falls Case Study
integrate telehealth and telecare into new service models (for example, for Falls Management)
provide adequate infrastructure to enable the technology to be rapid, effective, reliable and supported
raise awareness of the potential of telecare/telehealth
focus on opportunities at the new Girvan Community Hospital that could be used to demonstrate effective technologically based services.
Telehealth and telecare
You said…
Telehealth and Telecare– what we have put in place so far…
DVD Case Studies…
Value the role of carers by involving them in service provision and service changes
provide a range of supports (including training, information and advice, social opportunities and better forms of respite)
recognise that carers’ needs differ widely
ensure professional staff are aware of the needs of carers.
Supporting carers
You said…
Supporting carers – what we have put in place so far…
DVD Case Study
Identify the early signs of dementia quicker
Provide early intervention to slow disease onset
Improve early care planning
Provide more staff training
Involve service users and carers in planning support needs
Use technology,
Supporting the 3rd sector providers
Create specialist multi-disciplinary teams with potential to increase support available in people’s own homes.
Supporting those living with dementia
You said…
Supporting those living with dementia– what we have put in place so far…
Increased GP early diagnosis
Range of supports for family and carers
New Nursing liaison posts with Care Homes
Provide more staff training through use of additional South Ayrshire based training post
Communication and Consultation
You said…
Communication, communication, communication!
Vital Invest in it Get out there! Tailor to the different needs Use plain English, free of jargon short and snappy Use local newspapers.
Communication and Consultation
You said…
Single points of contact Really value people’s opinion! Be honest and transparent Run a large stakeholder event at County
Buildings Develop local ‘champions’ Address cynicism – engage with hearts and minds Develop open and two-way channels of
communication understand each other’s roles Manage expectations
Communication and consultation - what we have put in place so far…
Events (such as this!)
Change Fund events - consultation in January, VASA event
Presence and inputs into other event
4 Newsletters and basic summary guide
Good use of existing arrangements in place (like PPF)
Change Fund support for Community Development, South Ayrshire Senior’s Forum
Some pan-Ayrshire information materials developed
Plan for new service directory by January 2012
Delegates highlighted that older people should not be seen as burdens and service
recipients, but rather as community members who have contributed and will
contribute greatly to their neighbourhoods and who want to live active and fulfilled
lives
– embed into the vision for the future!
South Ayrshire’s approach to supporting change:
(meets national guidance and evidence of what might support change and
improved outcomes)
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Fundamental to addressing the ‘demand’ within the health/social care system is an emphasis on community
well-being and utilising universal services. This approach will be
founded upon community development and asset based
principles and will involve investment in community capacity building,
supporting volunteering, developing a range of community services,
supporting the third sector/community infrastructure, providing information
and supporting carers.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Change Fund investments
• Community Development posts linked to hubs
• Support for South Ayrshire Senior’s Forum
• Community Directory + local directories
• Community Transport
• Carrick Centre Community Care room
• Dementia bibliography
• Access to IT for OP
• Telephone Befriending
• Carers support workers, health checks, support programmes
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
The approach, at the next ‘tier’ aims to sustain independence and promote self-management. This will include work to provide supportive physical
and environmental infrastructure (including equipment and adaptations,
telehealthcare, targeted falls interventions (eg ‘prehab’ through group exercise programmes), and
strengthening co-creation approaches (for example, in relation to respiratory disease). An Ayrshire-wide approach
to transform timeous access to equipment will be developed.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Change Fund Investments
•Falls pre-hab service (Invigor8)
•Targeted Adaptations
•Ayrshire-wide equipment access
•Trusted Assessors training and capacity building
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Geographical Rehabilitation and Enablement ‘hubs’ will focus on better co-ordinated re-ablement approaches. Additional capacity for ‘rapid response’ to older people with emergent health/care needs will also be linked to these ‘hubs’ as will additional community geriatric services. There will be strong links within the hubs, with Elderly Mental Health Services and other appropriate services including community pharmacy. Community Nursing and AHP teams will be configured to allow full support for the work of the hubs.. Falls prevention will also become a core part of all staff’s remit within the hub.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Change Fund investments
• Significant investment in Re-ablement approaches to allow to move to new model of working
• Service hubs with Single Point of Contact
• Premises investment to allow co-location
• New Intermediate Care and Enablement Service (ICES) investment
• Falls prevention linkage (eg TI triaging)
• Additional AHP inputs
• Girvan Community Hospital related work
• Community Pharmacy investment including working with Carers and developing new Community based supports linked to hubs
• Telehealthcare investment in equipment and capacity
• IT investments (eg Community Nursing)
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Linked to the ‘hubs’ at the ‘Intensive support’ part of the model will be work supporting ‘enhanced complex care’
involving extended primary care services (Community Wards) that will
target higher ‘tariff’ cases and will include additional dedicated GP and
nursing capacity. The work of Managed Clinical Networks (particularly in relation
to respiratory disease) will be strengthened to allow a better flow from acute to community based health care.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
Linked to the ‘hub’ based work will be a concentrated work to improve the response to older people ’out of
hours’ in evenings, overnight and at week-ends. This will involve telecare
(alert) staff, out of hours nursing, ADOC, Scottish Ambulance Service and Rapid Response and will ensure more ‘joined up’ approaches together
with additional capacity. (This will involve using existing staff resources
smarter and building additional capacity for overnight support, respite
and care.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
The local dementia strategy work will be strengthened through additional specialist nursing
capacity (who will link closely with the care home sector) and through
additional training resource.
SPOC
Shifting the
Balance of Care
and Resourc
es
Hospital Based Services
Acute/Specialist Care
The whole system approach underpinned by robust change management.
Change Fund plan will be underpinned by an outcomes based approach
There will be robust monitoring and the outcomes will be directly linked to economic analysis through the Integrated Resource
Framework with a view to ensuring sustainability subsequent to the existence of
the Change Fund.
Housing
Social care
Carer support
Health Care
Self Management
Social support
Older Person
Linking this together…