Developing a role emerging placement across Fire and Health Services. Sarah Addy.

Aims of the session: -To understand the rationale of joint working between an Occupational Therapy(OT) service and the Fire Service -To develop an awareness of the process for developing the role emerging placements -To understand how role emerging placements can be used to develop interagency working and better outcomes for individuals

The organisations involved: Nottinghamshire Healthcare provides mental health, intellectual disabilities and community healthcare services for the people of Nottinghamshire with an annual budget/income of £400 million. Nottinghamshire Fire and Rescue Service (NFRS) serves more than one million people in Nottinghamshire. Notts H/C see about 190,000 people a year The mental health services for older people directorate provides community based and inpatient services through a range of teams including intermediate care services, CMHT’s, MAS, day services, inpatient wards and DOT’s who will visit service users who are in residential care. 3

National Drivers Nothing Ventured, Nothing Gained, DoH 2012 Making Every Contact Count, Public Health England 2016 Working Together….executive summary, NHS England 2016 Recovering ordinary lives COT 2006 Fire and Rescue Services Act 2004. Economic drivers Reduced actual fires Nothing Ventured… Introduced the concept of risk enablement when working with clients with cognitive difficulties. Making every contact… this is a cross organisational plan to encourage and help people to make healthier choices and positive long term behaviour change to promote their health and wellbeing. Recovering ordinary lives – NHS England: The aim of the piece of work is to support vulnerable people and those with complex needs to get the personalised, integrated care and support to live full lives and sustain their independence for longer. how health, social care and fire and rescue services can increase their reach, scale and impact through joint working,

Aims of partnership working between MHSOP and NFRS. Raising awareness and education Joint visits with joint goals Understanding of referral processing and triaging systems Development of role emerging placements For OT students to support NFRS to become more person centred in their approach. What is the link between fire and OT – It’s the same population – this will become clearer still over the next few slides Joint working risk of cooking smoking keep house warm Fire service seeking advice on env , people’s abilities, communication styles, risk enablement. Role of OT in NFRS and should OT be more aware of fire risks – could OT students show need, develop improved outcomes

Service User Profiles

Key Vulnerabilities: Smoking Medication Cooking and Cooking distraction Social Isolation Substance Misuse including alcohol

Vulnerabilities (continued) Physical Health / Mobility Issues Emollient use Financial difficulties Hoarding Electrical fires

The local picture 5 Fire related fatalities in the last year All over 65 All confirmed to live alone Smoking related fire in 3 cases 1 with a mental health diagnosis 1 hoarding behaviours In addition to these statistics there was a further fire in April of this year and the individual remains in a critical condition.

Why develop a role emerging placement? ‘an important learning experience for students and as a means of expanding the boundaries of practice and disseminating the value of OT’ COT 2006 Developing the OT profession Consolidating teaching and influencing from within Identify future opportunities for clinicians within NFRS We have completed teaching sessions with NFRS on dementia, communication and risk enablement approaches and having the students within the PART team has consolidated this and begun the process of embedding it into the practice of the PART team.

Developing the placement: Work completed by NHS Tayside Offering placements to two students reflects conclusions from Wiley in 2002 Liaising with the University of Derby Identifying complimentary clinical areas Preparatory work with colleagues in NFRS.

Developing the placement: practicalities Management support from both agencies Liaison with University of Derby placement team Preparation Projects Supervision Work place cultures The importance of preparation cannot be stressed enough, in particular communicating the expectations of the placement. Projects – gave the students ownership of the placement and their experiences and also a legacy to the fire service when the placement was completed. Two examples – elearning package and reviewing home safety check form to encourage client centred practice. Work place culture – ties into expectations and the need to develop strong working ties with the partnership organisation, (responding to pressure example)

Outcomes: Students: ‘assisted in building my skills as an autonomous practitioner and my time management and reflective skills’ ‘enabled me to show others and myself that I am adaptable and possess transferable skills and knowledge’ These quotes are from a piece we completed for the OT news last year and asked the students to give us their reflections on the placement experience

Outcomes NFRS: the students ‘observations and recommendations for improvements has formed the basis of fundamental policy changes that the service is starting to implement’ ‘I observe people’s mobility, how they switch on their heating and make drinks, which has really helped me to understand the problems they’re facing’ (member of PART) Changes have included looking at communication, an increased understanding of positive risk taking,

Outcomes OT Service: ‘how an individual performs occupations has a significant impact on fire risks. The placements have enabled us to make invaluable gains in highlighting this to our fire service colleagues’ L.Beck. OT Clinical Lead

What Next? Further joint placements with NFRS NHS England, Working Together…(June 2016) - Increase understanding of the links between mental health and fire risk - Assistive technology and telecare Future role emerging placements facilitated by MHSOP OT staff and other agencies

Conclusions: We are working with the same population Positively influencing partners Improving outcomes for our clients For a successful placement the background preparatory work is essential. Same population – NFRS service users meet the profiles of our clients in the CMHT. 17

Thank You Any Questions? Sarah.Addy@nottshc.nhs.uk 18

References: College of Occupational Therapists (2006) Developing the Occupational Therapy Profession: Providing New Work-Based Learning Opportunities for Students. College of Occupational Therapists Guidance 4. London: COT College of Occupational Therapists (2006) Recovering Ordinary Lives Department of Health: Nothing Ventured, nothing gained; risk guidance for people with dementia. 2010 NHS England: Working Together – how health, social care and fire and rescue services can increase their reach, scale and impact through joint working. Executive Summary. June 2016.