Due to the increasingly elderly population and the need to focus on more personalised outcomes for service users, it is necessary to transform our current services as the demographic changes will make continued provision of traditional services unsustainable.
We need to focus on more preventive/upstream interventions to make the most effective use of our current and shrinking resources to assist people to lead healthier, fitter and fulfilling lives in their local communities. This resonates with service users themselves who have higher expectations and want support and services to help them to maximise their independence and wellbeing at home or in a homely setting… In 21st century social care services, it is imperative that we have the right people, with the right skills, in the right place at the right time which is the challenge we all face in terms of up-skilling our workforce to deliver outcome focused services through learning opportunities that are fit for purpose.
PLANNING / · a clear rationale, defined processes and focus on stakeholder needs· contributes to organisation’s goals and addresses current or emerging challenges
As a result of the Scottish Government’s Reshaping Care for Older People’s services and the single outcome agreement reached with COSLA, West Lothian Council embarked on an expansion of our reablement service and the creation of a Crisis Care (intermediary) Service. Reablement is generally designed to help people learn or re-learn the skills necessary for daily living which may have been lost through deterioration in health and/or increased support needs. A focus on re-gaining physical ability is central as is active re-assessment. West Lothian decided to strengthen this service by investing also in a 24/7 Crisis Care Service to further contribute to avoiding hospital admissions.
The role of the Learning & Development Team was to develop a skilled workforce with an individual approach to customers’ needs working proactively to provide a person centred outcome focused approach to care thus maintaining independence and giving real choice in relation to customer’s options and outcomes. We were required to equip the workforce with the necessary skill set to work with service users to set goals and targets, monitor and review progress and deliver on the personalised outcomes. This importantly included input on the motivation and enablement of individuals.
Social Policy applied the discipline of a project management approach to the planning for the implementation of reablement and crisis care. The Social Policy Learning & Development Team were involved at an early stage of the strategic planning to ensure that a robust training programme was developed to up-skill the social care workforce to deliver this innovative service to help us as a Council, respond to the changing needs and emerging demographic changes. This strategic group (which met weekly) also included representatives from within our Community Health & Care Partnership to ensure that they were able to provide input to the planning process and importantly, what their involvement in the service and supporting the service’s aims and objectives would be.
Our early involvement in the planning process assisted us to develop a comprehensive specification of the knowledge and skills required to ensure that our staff could deliver support to meets individual’s needs in a time of crisis. Key staff in Learning & Development were able to develop a solid knowledge base not only of key aims and objectives but also the detail of the proposed pathways. Being integral members of the strategic planning group from the outset generated a sense of ownership and enthusiasm which added value to the content of the training programme.
Training was initially delivered through 2 day bespoke training programme. This was planned operationally to ensure that staff moving from our domiciliary care services, undertook the training during planned scheduled transfer of care, thus ensuring service continuity.
However, it was recognised throughout that skill based training is most effective when attention is paid post training to the process of consolidation. With this in mind a key element of supporting skill development was the identification of mentors who offered a 2 week ‘shadowing’ process where staff were able to transfer learning to practice with appropriate support of experienced workers from the original small team.
The mentors were the experienced original reablement staff and as this was a key element, we put in place training which was delivered by our local college in partnership with the Learning & Development Team who provided the qualified staff to assess the mentors in practice.
DELIVERING / · implemented in all relevant areas and across all the required stakeholders· carried out in a structured and logical way , using robust and sustainable methods
The training model recognised that the reablement is an approach and not simply a service and that achieving maximum impact from the development would require culture and system changes at every level. With this in mind we not only used a range of disciplines to deliver aspects of the training but included other disciplines as attendees, contributing to the development of a robust foundation for integrated care services. Examples of other disciplines included hospital and community nursing staff, and other allied health care professionals. We worked closely with the manager of our Joint Equipment Store (CHCP wide) to access equipment for the practical skills training for use for the duration of the training programme.
Whilst the training was not formally accredited, it was a skills and knowledge based package to assist staff in the delivery of a service which promoted enablement and independence to maximise outcomes for service users. This was achieved by linkage to the skills audit and benchmarking of training delivered from other authorities which enabled the Learning & Development Team to establish a training programme which addressed the needs of the staff teams. This included training in:
- Service’s users perspective – what is important to a service user in their lives
- Empathic learning – transferring knowledge into the physicality of what it is like to have a long term condition
- SMART objective setting to ensure an individual outcome focus – setting realistic targets for the reablement process
- Increase knowledge and understanding of long and short term health conditions which can be improved through reablement and crisis care.
This training programme has been delivered to 84 members of social policy staff and 24 places were offered to health care staff.
Evaluation forms were used to create a dynamic learning process through feedback loops and linked to the ongoing supervision process within the service area to encourage reflective practitioners.
As a result of the delivery of this programme we are undertaking a further training needs analysis now that post holders have been in the job for a period of 6-9 months. We are doing this by taking a participatory research approach which will involve the staff themselves. This research is being support through IRISS and will be published and shared with all national stakeholders.
In terms of costs, funds were made available through the local transformational change fund supporting the reshaping care for older people’s agenda. However the potentially very high cost of the training programme was contained by using the skill and commitment of a range of disciplines within the CHCP. The training was led and co-ordinated by the in house Learning & development Team to ensure maximum capacity to deliver in a flexible manner to support this operationally. For example, the flexibility in the training timetable reflected the operational complexities in moving current domiciliary care provision to externally commissioned provision.
·Achieves genuine innovation or new ways of working
The most innovative part of this initiative was the creation of the Crisis Care element of the service. The Crisis Care Team operates 24 hours a day over 365 days of the year. It takes a new approach which involved working in partnership with community nursing services to provide assistance to people who are experiencing a health or social care emergency and dealing with the immediate crisis within their own homes thus avoiding either a hospital or care home admission. This includes partnership working with District nurses, Social workers, Physiotherapists, Occupational Therapists, Care and support staff
Our challenge was to devise a training programme to equip staff with the necessary knowledge and skill to:
- Respond to people who have fallen
- Provide emergency short term personal care
- Respond to telecare alerts
- Provide emergency short term respite for carers to enable the individual to remain within their own home
The training therefore included for example, falls prevention and specific safer people handling input for use when people had fallen, responding to health emergencies input and communication protocols and recording.
The Learning & Development Team envisage that the findings of the research project, previously mentioned, will provide a tool to improve current training and highlight future training needs within our authority and within the area of reablement and crisis care. The research report will be made available to others which we hope will encourage enhanced learning, improved partnership working and ultimately improve service objectives and personalised outcomes in reshaping care for older people.
The strategic group also considered research (for example, the Institute for Research and Innovation in Social Services (IRISS), benchmarking information we sourced from City of Edinburgh Council and the Joint Improvement Team’s website) in relation to the reablement process which highlighted the longer term cost effectiveness of the service’s potential to assist West Lothian’s residents to remain as independent for as long as possible and thus achieving better outcomes for individuals.
We are also at a point of early discussion and dissemination of our Crisis Care Service development with the Joint Improvement Team.
RESULTS + IMPACT / · a convincing mix of customer and internal performance measures·demonstrates howbetter outcomes are being achieved
· a full range of relevant results– either already achieved or with potential to deliverover time
The training programme equipped the workforce with new knowledge and skills to utilise within a reablement and crisis care environment. This was achieved through a combination of theory and practical input by both staff in the learning and development team and our partners. Post training evaluation highlighted that participants felt that they ‘had a better understanding of the role of the reablement worker, that they had a ‘better understanding of health issues including the use of inhalers and the impact of the condition Chronic Obstructive Pulmonary Disease’ and importantly that they ‘felt more confident in their role and enthusiastic about their new jobs’.
Post Training evaluation analysis stated that 100% of participants agreed that their knowledge and skills had improved as a result of the training.
The impact of this relatively new service will take time to realise cost benefits. However evidence to date includes positive feedback from professionals and service users alike. Jim Forrest, Director of West Lothian’s CHCP has reported having received ‘numerous unsolicited positive comments from a range of professional and most notably, from a number of General Practitioners’. Service user feedback, which is often the best measure of success included a statement from a woman who cared for her husband who was in the latter stages of dementia, whereby she stated that ‘with the aid of the crisis care team, she managed to get some sleep at a time of crisis allowing her to continue in her caring role’.
76% ‘rated the training as ‘excellent’ and 24% rated it as ‘good’.
Reablement and Crisis Care performance outcomes between 02.04.12 – 30.09.12:
144 service users received a reablement service:
- 96 service users have now completed their reablement service
- Of the 96, 54 reached full independence - saving 300 care hours per week
- 27 required long term packages of care – but in these cases the care package hours were reduced by 115 hours per week
- 15 were re admitted to hospital
426 calls received through our Careline service were referred to the Crisis Care Team for some form of immediate response for example:
- 159 responses to service user falls with a response time on average of 32 minutes (a significant percentage, if not all of these calls, would normally have resulted in a call to the ambulance service)
- 191 responses to need for personal care support with a response time on average of 31 minutes
- There were a total of 97 short term support packages provided which again, without the intervention provided from our Crisis Care Team, may have resulted in admission to hospital or a care home. Of these, 19 service users now manage independently again after the period of crisis and 33 of these packages were transferred to another care provider
COSLA EXCELLENCE AWARDS 2013 Page | 1
COSLA EXCELLENCE AWARDS 2013 Page | 1