Community Learning Disability Teams – National Survey Debra Moore Managing Director Debra Moore Associates

Busy landscape Lots of health related policy and guidance impacting on the role and function of CTLD’s CTLD’s the ‘frontline’ of provision Feeling the need to respond to a range of initiatives such as Mansell 2, Michaels Report, DRC etc etc

Mission impossible?

Background to the research Development programme for Community Learning Disability Teams based around the 6C’s Model Revealed information about current ‘state of play’ and raised questions about future role and modernising the workforce

Background to the research …what people were saying…. Need to reduce health inequalities and supporting the delivery of VP objectives e.g. HAP’s etc Need to support mainstream NHS including mental health Reducing out of area placements ‘Personalisation’ Safeguarding Changes in demography ‘Boundaries’ between teams e.g. children & older people Supporting criminal justice system Workforce issues Financial pressures Some concerns about choice and quality of provision

Pressure to ‘rescue’ In some localities the community based team are increasingly ‘rescuing’ situations created by ‘specialist’ social care providers (often ‘importers’) Also ‘recovering’ problems created by changes in other parts of the system e.g. day services - the ‘buck stops here’ position Safeguarding

‘Being painted into a corner’

Background to the research ‘old chestnuts’ Issues raised about time spent on health related activities and social work activities as opposed to ‘care management’ Questions about the content of the work of individual CTLD members & blurring of roles within the team Concern about capacity for ‘face to face’ contact and time spent on admin/IT and in meetings Concern to make sure that the CTLD is part of a wider care pathway

Methodology A brief electronic survey A number of key questions generated by emergent themes from work with CTLD’s Self selecting participants Survey link posted on various professional websites and out via networking groups etc 500+ responses Gleaned information about social work but today focus on health professionals and in particular nurses

What percentage of your working week is spent across the following 4 areas? Care Management Admin & IT Face to face contact with service users Review meetings

Other questions If A&T service in locality or behavioural support team If strategic health facilitator in locality Will be ‘mapping’ provision onto survey findings

What percentage of your working week is spent on care management? 0-25%25-50%50-75%75-100% Nurse 75%15%8%2% Social Worker 34%48%13%5% AHP 91%7%2%0%

Care Management - nurses Most nurses who responded (75%) said they spent up to a quarter of their working week on care management activities 10% nurses who responded spent over 50% of their working week undertaking care management activities

What percentage of your working week is spent on face to face contact with service users? 0-25%25-50%50-75%75-100% Nurse 38%43%17%2% Social Worker 80%14%5%1% AHP 27%49%21%3%

Face to face contact - nurses Most nurses who responded (43%) said they spent between 25-50% of their working week in face to face contact with people who use services 38% of nurses said they spent up to a quarter of their working week in face to face contact with service users Around 19% spent over half of their working week in face to face contact

What percentage of your working week is spent on administration and IT? 0-25%25-50%50-75%75-100% Nurse 38%47%14%1% Social Worker 12%34%45%9% AHP 44%48%8%0%

Admin & IT - Nurses Nearly half of the nurses who responded said they spent between 25-50% of their working week undertaking admin and IT duties Not clear how much of this is related to inputting client information into electronic care planning systems etc Not sure how much time is due to a ‘poor fit’ with IT system or how much due to poor ‘technical’ skills

What percentage of your working week is spent in review meetings? 0-25%25-50%50-75%75-100% Nurse 81%17%1.5%0.5% Social Worker 74%23%3%0% AHP 92%8% 0%

Health professionals – what percentage of your working week spent on health action planning & health facilitation? Less than 10% % % % % Nurse 29%32%25%12%2% AHP 56%30%9%4.5%1.5%

Health professionals – what percentage of your working week spent on training and supporting mainstream health professionals? Less than 10% 10-25%25- 50% % % Nurse 49.5%36%11%3%0.5% AHP 57%28%15%0%

Regional variations – face to face contact - nurses Less than 10% 10-25%25-50%50-75%75-100% North East0% 75%25%0% Y&H0%39%44%14%3% North West10%35%40%15%0% East Mids3%24%41%29%3% West Mids0%47%35%12%6% Eastern22%33%45%0% South West32%42%16%10%0% London5%50%35%10%0% South East3%19%56%22%0%

Some regional variations Face to face contact In the SW region 74% of nurse respondents said they spend less than a quarter of their working week in face to face contact with service users In Yorkshire and Humber it was 39% In the North East the answer was 0% Need to investigate why

Some regional variations Care Management In the Eastern Region over a third of nurse respondents spend between 50-75% of their working week undertaking care management work In the East Midlands Region more than two thirds of nurses spend less than 25% of their working week undertaking care management work

Integrated teams – what difference did it make in relation to the 4 key areas? No discernable difference across care management, face to face contact and reviews However the amount of time spent on administration and IT was higher for those who were in an integrated team

Probably raised as many questions as answers Why are there such big variations between regions and how does this effect outcomes? What does admin & IT consist of? If health professionals reduce care management activity what will be the implications? If health professionals focus on ‘health related activity as a first priority’ what will be the outcomes?

Next steps More detailed analysis of survey Drilling down on emergent themes Examine patterns of provision e.g. A&T, Out of Area placements etc Consider how we map against outcomes such as health checks, numbers of HAPs etc Discussion with commissioners Inform CTLD Development Programme Publish findings

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