www.halton.gov.uk

Marie Lynch Divisional Manager Care Management & Assessment ADASS Residential And Nursing Care For People In the North West Region THE HALTON “STORY” Marie Lynch Divisional Manager Care Management & Assessment

Outcome: Delaying and reducing the need for care and support. Adult Social Care Outcomes Framework (ASCOF) (2A) Long-term support needs met by admission to residential and nursing care homes, per 100,000 population Outcome: Delaying and reducing the need for care and support. Rationale: Avoiding permanent placements in residential and nursing care homes is a good measure of delaying dependency, and the inclusion of this measure in the framework supports local health and social care services to work together to reduce avoidable admissions. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential care. However, it is acknowledged that for some client groups that admission to residential or nursing care homes can represent an improvement in their situation. The outcomes framework is recorded in the statutory return for SALT.

The table below shows all 23 North West Local Authorities and what their rate of long term Residential and Nursing placements was during 2014/15 and 2015/16.

AQUA: Permanent admissions to Residential/Nursing care Aged 65+ (per 100,000 pop 65+) October 2015 – September 2016 Data Source: NHS & Local Government Quality and Efficiency Scorecard for Frail Elderly North West Benchmarking, October 2015 -September 2016

Permanent admissions to Residential/Nursing care Aged 65+ (per 100,000 pop 65+) October 2013 – September 2016 Data Source: NHS & Local Government Quality and Efficiency Scorecard for Frail Elderly North West Benchmarking , October 2015 -September 2016

NHS & Local Government Quality and Efficiency Scorecard for Frail Elderly North West Benchmarking The data on Permanent Admissions to Residential / Nursing Care is collected directly from Local Authorities (LA). The data parameters/specification for source data - Number of LA supported PERMANENT admissions aged 65 and over to residential care, nursing care and adult placements (excluding admissions to group homes)

Halton Performing Well Halton was the Local Authority that saw the largest reduction, with 17% fewer people accessing long term Residential and Nursing Care compared to 2014/15, and this had the effect of moving Halton below the national average.

Story Starts Over 10 years ago, this was an area of poor performance in Halton, with high numbers of admissions to care homes for people in crisis. Changes to management and team culture resulted in: Development of Prevention services Drive to keep people in their own home Close scrutiny of proposed care home admissions This culture change pervades.

Demographics Halton has strong communities that live in extended family groups so these provide care and support for elders. This is even more so in Runcorn and is probably reflected in the even lower Runcorn admissions.

Early Intervention & Prevention Strategy Halton Borough Council (HBC) continues to make considerable investment in implementing our Early Intervention and Prevention Strategy. Our key approach is that interventions are required across the whole spectrum of need, to help older people who are healthy to continue to live independently for longer and to assist older people who are unwell to regain their independence or to prevent or delay the onset of further health problems, examples of this include the work on Falls Prevention and Loneliness.

Sure Start to Later Life A low level assessment, early intervention and prevention team, helping older people make informed choices about their lives. We work towards ending loneliness and providing the right information at the right time in the right format. We provide a gateway to information, services and activities. Early intervention not only improves the likelihood of achieving the desired outcomes for people but can also reduce the longer term costs of care, e.g. reducing the need for support by carers, hospital bed use and potentially delaying the need for more intensive long term care services.

Intermediate Care Services Our Intermediate Care Services are resourced by multi-disciplinary teams of clinicians, nurses, therapists’ and social care staff who provide rehabilitation services for people needing rehabilitation, to promote independence, prevent unnecessary hospital admission and admission to care homes, and facilitate discharge from Hospital.

Rapid Clinical Assessment Team (RCAT) The last 12 months has seen the development and implementation of a consultant lead Rapid Clinical Assessment Team (RCAT) in Halton. GP led Primary Care Teams have the opportunity to refer to RCAT for an enhanced Rapid Clinical Assessment, including access to associated/necessary diagnostics, providing appropriate treatment to patients in their own home thus helping to prevent hospital admissions in the frail/elderly population of Halton. Of the referrals received between April 2016 and October 2016, 94% of the referrals resulted in hospital avoidance and helping to reduce permanent admissions to care homes.

Proactive Discharge Planning The Halton Integrated Discharge Team (HIDT) at Warrington Hospital and the Whiston Integrated Discharge Team (WIDT) at St Helens and Knowsley, take a proactive approach to supporting the discharge process. Dedicated multi-disciplinary teams of health and social care professionals, including Nurses, Social Workers, Community Care Workers etc. have been brought together to support the discharge processes at the Trusts. As such the team delivers on all the discharge pathways out of the Trusts including Social Care, CHC, Community Health Services and Intermediate Care.

Development of Halton’s Older People’s Integrated Pathway Patients will enter the pathway at different levels, or may require identification in primary care in order to access appropriate services along the pathway. Frail older people at different stages of the pathway will require a range of interventions that are clinically effective and appropriate for their level of frailty.

Continuing Health Care (CHC) Placements The integration of CHC nursing staff with care management teams in June 2014 continues to have a positive impact on the use of 24 hour care and associated financial impact as a result of closer working with care management staff. This is seeing an increasing use of alternative support to 24 hour care by the CHC staff including use of family support networks and Direct Payments at home, preventative approaches as well as creative care management approaches.

Social Care in Practice (SCiP) Social Care in Practice ( SCiP) has been funded by the GP surgeries approximately 8 years. It provides 6 social care workers and one manager, to be based within the surgeries in Widnes and Runcorn. This has enabled GPs and other health professionals to have access to social care, to make easier referrals, to promote joint working and a better understanding of the roles of each profession. Social care workers have fostered positive working relationship with the GPs community matrons and the district nurses.

How SCiP benefits avoidance of admissions to Residential & Nursing Care. Earlier identification of vulnerable people from MDTs, GSF and from district nurses and community matrons enables support to be introduced sooner and prevents decline into crisis Health and social care staff have a better understanding of each other’s roles and the services that each organisation provides, which makes identification of preventative support easier for all workers Surgeries are becoming far more aware of the wide range of preventative services available and are now less likely to assume that the only option for a patient is 24 hour care Wider wholescale MDT development of this approach.

Length of Stay in homes Currently the average length of stay in a nursing home is circa 10 months and 13 months in residential home! This suggests that the care home option is very much seen as for people who are nearing their end of life, have high risk issues and lack family / community support.

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