Implementing the Single Assessment Process across the South West Peninsula Basic awareness

What is the Single Assessment Process (SAP) ? Originated from the National Service Framework (NSF)Older People Standard 2: Person Centred Care - a single agreed approach to assessment for health /social care -type of assessment is appropriate to needs -agencies do not duplicate assessment -effective contribution by range of professionals/agencies - resulting in a single holistic service or care plan -contributed to and agreed by all (including the person) In South West Peninsula SAP will cover all adults 18+ except mental health

Who will be using SAP? All health & social care staff South west peninsula partnership All organisations using same tools and eSAP system PCTs, adult social care,acute trusts,(Devon doctors,SWAST eSAP) For full list of partners see SAP website

“Don’t you people talk to each other?!”

National guidance “Provides a rigorous framework that will lead to convergence of assessment methods and results over time irrespective of the tools chosen for local use”

What is an assessment? - it involves the gathering of information about the health and social status of the person,analysis of that data, and the making of a professional judgement to meet the person’s needs -within SAP this is always carried out with the person being assessed and is proportionate to need.

SAP 4 types of assessment Contact Overview Specialist Comprehensive

Contact Assessment Not every contact needs one - an initial contact if needs recording -multi-agency referral form -basic personal information -difficulties, risks & significant life events -any staff member who is trained -not necessarily professionally qualified -may be partially completed and added to

Overview -More detailed assessment -At any stage in SAP -More complete picture of an individual -Incorporates core information -Includes information on providers/agencies -Risk triggers -Identifies need for further assessment

Specialist - Specific difficulties identified at contact/overview -One or more specialist professionals -Unstable,unpredictable or complex needs -Specialist tools/scales/measures -each profession SAP Health needs assessment (HNA) is the only specialist assessment in place across the SWP and on eSAP – other specialist assessments will be carried out on existing tools or using FACE second line tools but not on eSAP) – e.g Care Programme Approach for Mental health, Housing, Speech & language etc

Comprehensive ( in the SWP a process not a tool) Contributions from different professionals / teams Co-ordinated by appropriately skilled professionals Evidence base for detailed care planning Includes all domains of overview / specialist Intensive & prolonged level of support / treatment Complex care packages - e.g. residential/nursing care

Care Plan The Care plan is joint agency and identifies what care or treatment is in place and who is providing this. Includes contingency plan for emergencies Diary sheet shows who visits/when Copy should be given to service user & record that this has been done No longer needs service users signature

Review All care plans should set review date A review should take place with the person and their carer The review tool is to record this and set next review date FACE review form includes headings from overview assessment

Making the links with SAP Managing long term conditions Falls Mental health and specialties Continuing Care/Funded nursing care Intermediate Care Delayed discharge Medicines Fair access to Care (FACS) Person centred one assessment across health & social care it can impact on all this and more….

What is FACE ? FACE stands for : Functional Evaluation of Care E environments FACE is a national SAP tool supplier accredited by Dept Health Each partner in the SAP south west peninsula has bought a licence to use the SAP FACE tools. SAP is still the same as ever – FACE just provide the tools to use

Protecting & Sharing Information -Don’t you people talk to each other! -Information can be shared providing the person has given written or verbal consent and this is recorded once on the : “ Consent to share and protect your information” form Use other assessment tools to check still applies with every new assessment Agreed protocol in place across the health & social care agencies in SWP – see website

What FACE tools replace FACE tools will replace most existing documentation and SAP home-grown tools some SAP tools were previously numbered like SAP 1 Now all tools are known by their name Not all FACE tools will be on eSAP Only these key tools will need sharing across agencies

FACE tools on eSAP Background & Contact Assessment Overview Care Plan Review Learning disability Core Assessment Consent to share and protect information Heath needs assessment ( HNA) – SWP version

What is eSAP? SAP can’t work without IT! eSAP enables assessment and care plan information to be stored electronically, shared with professionals across health and social care and sent to each other This is possible using your own computer and your organisation's IT system Web based browser- very safe & secure

Benefits of eSAP In addition to being better for the service users and carers……. Reduction in delayed transfers of care -Improved communication/access to information Reduction in unplanned admissions -Better information /improved risk management/ better decisions -reduce unnecessary admissions Better use of workforce -Reduce duplication and staff time spent in recording. -Easier and faster transfer of information between agencies. -More appropriate use of skills Less faxing, photocopying, storage

Personal held record Folder (usually yellow) held in person’s home Contains SAP documentation, communication sheet diary, self-care information Enables service user and carer to be and kept informed professionals to communicate Useful for emergencies Flag on eSAP will show it is in place Issued by PCT providing following criteria is met:

Criteria for Person Held Record complex care packages delivered in own home treatment and care by number of practitioners / agencies known to request frequent unscheduled care have required a number of unscheduled admissions to hospital at ‘risk’ of needing emergency care managed for a ‘long term condition’ or ‘complex care pathway’ palliative diagnosis including malignant or non-malignant

Single Assessment Process For further information contact: SAP Programme Team exeter-PCT.nhs.uk :Tel: Website address Or staff area- (all tools, guidance, newsletters etc)