1. Who Needs Advocates, Navigators and Brokers? Developing the Role of the Care Manager in the Single Assessment Process Dr Michelle Cornes Research Fellow Social Care Workforce Research Unit

2. Aims To explore Care Outside Hospital in terms of the likely implications for social work care managers To identify ways of developing care management through research findings on – Person centred care – Proactive responses – Seamless services

3. Services should be person-centred, seamless and proactive… Sadly the organisation and provision of our services do not help everyone to meet these goals consistently Independence, Well-being and Choice Department of Health 2005 1:3/1:7

4. Delivering Choice and Control From client to citizen through: Self Directed Care (self assessment) Direct Payments Individualised Budgets

5. New Supporting Roles… Person Centred Planning Facilitator (helps people develop their own aspirations) Care Manager (case management of complex cases) Care Navigator (develops a sustained pathway of care) Care Broker (helps to formulate the care plan, negotiate funding and monitor services)

6. New Supporting Roles in Health… 3,000 Community Matrons by 2007 who will lead the case management of patients with complex needs

7. New Supporting Roles… The Mental Capacity Act 2005 will see the introduction of the IMCA (Independent Mental Capacity Advocate)

8. Clarity of the relationship of these roles between advocacy, social workers/care managers and community matrons was sought Responses to the Green Paper Consultation CSIP 2005 p14

9. Haven’t we been here before? The Community Care legislation was the biggest false dawn, in that it took a really good idea, which was freedom and creativity for social care staff to use money to tailor individual packages for a relatively small group of people, and made it a national framework for rationing access to residential and nursing home care Andrew Cozens (Former ADSS Director) Community Care 2003

10. Single Point of Contact One agency should be identified as the lead agents responsible for assessing ALL care needs and where appropriate inviting other agencies to undertake specialist assessments. Finally, the Care Manager will co-ordinate all this information on one overall care plan. 1990 NHS & Community Care Act Guidance

11. Single Assessment Process To a degree the stages of [single assessment] reflect Department of Health Guidance that councils have been working up to for 10 years Department of Health 2002

12. What should be the direction of travel? Should we support the introduction of a range of new ‘professional’ and ‘non-professional’ roles (e.g. appointing Navigators and Brokers to work alongside Social Workers/Care Managers)? OR Should we develop the role of the Care Manager in the Single Assessment Process (e.g. developing navigation and brokerage as skills which form part of the Care Managers role)?

13. The Research Study 1: Assessment in Community Care: Disputed Territory (2001) 39 cases ‘tracked’ through the community care system Study 2: Older People’s Experiences of Intermediate Care (2005) 35 cases ‘tracked’ through the transition from intermediate to mainstream care (both studies focus on older people)

14. What is person centred care? “Recognising that older people and carers have a life outside of their medical notes” Study Participant – Voluntary Sector Worker

15. Off the peg To be able to manage self care To be able to manage the stairs To make a light snack/hot drink To be able to make own bed To be able to manage other ADL (washing- up, ironing

16. A tailored approach “To use the talking book machine”

17. Seamless Service Through Comprehensive Assessment Comprehensive (Community Care) Assessment Specialist Physiotherapy Assessment Specialist Nursing Assessment Specialist Occupational Therapy Assessment

18. Duplication Mrs Jones needs Help putting to bed Mrs Jones needs Help putting to bed Mrs Jones needs Help putting to bed Mrs Jones needs Help putting to bed

20. Good practice example With the help of the rehab team Mrs Jessop will become sufficiently mobile to use the commode herself in the morning. Extract from a Multi-disciplinary Care Plan

21. Good practice example Mrs Jessop said she was happy and was now able to transfer from the bed to the commode without any trouble… Rehab Team withdrawn and [district nurse] visits reduced to once a day ‘pop in’… Reviews reduced to 3 monthly intervals Extract from Notes of a Review Meeting

22. Delivering the vision… Ensuring ‘monitoring’ and ‘review’ are exceptionally well integrated Assessment Care Planning Monitoring and Review

23. Revolving Door Assessment Care Plan

24. Barriers Person Centred (Pro-active/Micro Surgery) Time & Resources Crisis Centred (Reactive/Sticking Plaster)

25. Five days later I was contacted by an occupational therapist… She apparently knew all about my home circumstances, but how she came upon this information I do not know as neither myself nor my husband were party to any such discussions Service User Perspective

26. Summary Developing navigation, brokerage and self- directed care (good practice in care management ) depends on: Having a shared understanding of the SAP process Sufficient time and resources Being realistic and honest about what is possible

27. Contact Details Dr Michelle Cornes Research Fellow Social Care Workforce Research Unit King’s College London, Franklin Wilkins Building, 150 Stamford Street, SE1 9NN Telephone: 01768 486462 michellecornes@aol.com