Right Therapist, Right Time : Collaboration and Partnership Barbara Stoker Clinical Director Integrated Therapies

Integrated Partnership

2013…………….. Clinical skills; expert knowledge; planning Integrated working; training Protect Prevent Defend Reduce Impact Essential Future Proofing Maintaining partnership stability ?Future markets ?Future funding ?Future proof resources Core competencies service delivery Uncertainty Change

Strengths Proactive Person Centred Skilled staff and resources Consistent approach across the service Recruitment of high calibre staff Flexible workforce Partnership Board

Attitude is a little thing that makes a big difference. (Winston Churchill)

Clinical skills; expert knowledge; Planning Integrated working; training Protect Prevent Defend Reduce Impact Essential Future Proofing Maintaining Partnership stability Future markets Future funding Future proof resources Core competencies service delivery Staff Development Service Improvement

Common Aims Prevent avoidable hospital admissions Prevent admission to care home Reduce length of stay Reduce social care waiting lists Take care (therapy) closer to home = Rehab

Oscar Wilde said……. So it was time to make some noise! There is only one thing in life worse than being talked about, and that is not being talked about.

Shaping Future Services Capacity and demand in community services – Sampling/walkabout/new:review/levels of rehab Identify gaps and consider the impact – Tolerate and wait – Moniter and collect data – Measure the impact and report (service plan) Where is the money to support development/change? Information & data – Everyone needs a ‘Jayne’ (performance pictures) Representation at all levels – Targeted groups/meetings/people – hard & soft sell The right ‘currency’ to use – what do you count?

Prevent avoidable hospital admissions: A&E Therapy Funding SHA  CCG winter  BCF Supporting metrics – Referred- Response time – Discharged- Discharge destination – Assessment & Level- Outcome – Follow up- Patient story samples – Age- Activity sample weeks Reports completed to increase capacity 8am – 8pm 7 days Supports A&E/AAUs Direct access to Rapid Response/PCH beds/Intermediate Care/Reablement/Community Rehab

Prevent avoidable hospital admissions: Rapid Response Therapy Commissioned by CCG but funded with nursing Limited funding for therapy 7 day service – Staff consultation 7 day community – 7 day with 5 day funding – 8 am – 8pm – Now permanent (STees CCG) Rapid Response equipment package training provided to nursing and sub store access to prevent hand off Referrals via central point

Prevent admission to care home: Reablement Middlesbrough Reablement provided in house to follow up discharge from Intermediate care and provide specialist reablement Direct access to community rehab Out sourced Human Support Group. – Provides OT & support workers – Integrated Therapy provides training – Operational group chaired by social care OT Redcar & Cleveland Rablement in house. Therapy provided by Integrated Therapies Redcar Reablement Unit – 7 day therapy seconded. Activity Therapy directed. Pilot extended further 18 mths Direct access to community rehab

Reduce Length of Stay Middlesbrough Reablement Time2Think – Yr 1 health commissioned local care home with Integrated Therapies – Yr 2 social care commissioned alternative provider – Yr 3 health commissioned local care home with Integrated Therapies – 6 beds dementia 14 assessment/recovery beds – Access via Single Point of Referral Redcar & Cleveland Rablement Discharge Decision not made. – Assessment/recovery beds commissioned by social care from care homes – Integrated Therapies via Reablement with direct access to community rehab

Reduce Length of Stay: Early Supported Discharge (ESD) Stroke Stroke pathway commissioned by Stees CCG via IMProVE programme Closure of 2x community bed bases reducing beds from 18 to 12 Staff consultation to provide 7 day stroke rehab within PCH and ESD. Recruitment to ESD Completed within 12 weeks Completes pathway from acute community to social care Collaboration with social care reablement to provide on going support Pushed the rehab debate for trauma, neuro and complex cases

Reduce social care waiting times Impact on social care of treating people at home is often overlooked, e.g.specialist equipment, housing adaptation Increasing demand v fluctuating capacity New computer system Increase in complex cases – Adapted social work complexity tool to provide common understanding – Monitor caseloads through regular snap shot caseload analysis – Performance report through Partnership Board Care Act Increase in staff resource (non recurrent funding)

Skills sharing Equipment – Self assessment of competency – Levels of training provided – Themed packages – Equipment prescribing - widening permission – Nurses/Social Workers/OTs/Physios/Support staff Next – Respiratory – Dementia – Stroke – MSK

Top Tips Building a set of metrics that support the messages and if you havent got one find a ‘Jayne’ Invest / nurture project leadership Annual service plan – Staff/Service Delivery/Quality/Development Use representation at every level Look for the gap and make a business case for this regardless of who will provide as the right service in place benefits everyone Build skills into the workforce which reflect the make up of your area. Pathways should lead on to networks of support to prevent relapse, social isolation and ensure community reintegration

For the patient/customer Services funded separately but these are connecting up across STees health and social care Whole system to meet need and provide choice There are still gaps most notably in community rehab but through the CCG IMProVe programme there is to be significant investment in community therapy to provide rehab close to home. This will include 7 day PCH, rehab coordination, single point of access, higher level of rehab in a person’s own home

Its all happening……. The right time is now!