Community Learning Disability Teams Debra Moore Managing Director Debra Moore Associates

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

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

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%

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%

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%

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%

Integrated teams – what difference does it make? 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?

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

Lessons for nurses Health related activity as a first priority Outcomes Person experience Universal and mainstream services Look after one another Don’t give up Use an appreciative eye – what do you want more of?

Don’t get the Dibley’s! Strong leadership Earn your place at the table Ensure people who use services and their families are at the table No piccalilli and tuna sandwiches!

Finally Keeping the message simple - ensuring the ‘me and mine’ test is passed JY JY