1. Transforming services
Early Intervention and Prevention an Integrated Team
Including Occupational Therapy led Outstanding CQC Reablement service:
Assistive Technology: Sensory:
Julia McGowan BSc(hons)MSc

2. Introduction
The journey from stand alone services to an Integrated team
Team Make up
New Roles
Overview of team roles
One Front Door for community referrals
Reablement with care
Asset based approach “Deal for Adult Social Care and wellbeing
Future Developments
Find image of journey

3. Original Service Delivery
Originally we were 3 Stand alone services
A traditional Equipment and Adaptations Occupational Therapy Team,
Reablement service,
Assistive Technology team,
Sensory rehabilitation team - joined more recently
There were various separate duty systems
Different waiting lists for assessments
Duplication of assessments services users having to tell the same story
need to refer between services.

4. The Journey
The then Occupational Therapy Manager was seconded to develop the Reablement service
3 Occupational Therapists were then seconded to reablement to help develop and pilot the service
Providing advice support and training to the reablement team

5. First steps in Integration
Development of Locality Model.
The OT team moved into 3 localities along with Social care teams.
Realisation of the value of Occupational Therapy in Adult Social Care
The OT team moved into 3 separate localities to work along side social work colleagues.
Agile working and hot desks
Good networking and crossover of cases skills sharing and development

6. Integration
Following a year of planning and development by the management team the 3 stand alone services became an integrated team one team in each locality
Working closely with Social Workers and Social care officers
Shared data systems and assessments much more joined up working and skill sharing.

7. Team make up A Service Manager - Occupational Therapist.
3 Locality Team managers with lead responsibility across the teams for -
1)Occupational Therapy.
2)Reablement.
3)Assistive Technology and sensory
Over years worked to become multi-skilled.
Now OTs skilled to write Reablement, equip & adaptions, assess for AT. 
Reablement staff have been multi-skilled to assess for low level equipment. 
The managers worked together, and provided the training.
All unqualified staff put through NVQ and trusted assessing training –helped with health colleagues. To give them a national qualified certificate.
Each role has competencies and a training matrix

8. New Roles Developed
Primary Assessor – trained to assess for Reablement, Equipment and Adaptations, Assistive technology.
Early Intervention Co-ordinator – manages incoming referrals to the locality, replacing the multiple duty systems. Screen and allocate cases.
Call in on OT for support when required. Benefits for the person, one assessment no need to refer on reduces multiple waiting list.
Made up from existing Disability Officers and AT assessors with some new recruits
Developed training matrix and competencies.
For example a PA can assess for difficulty on the stairs, provide second stair rail – a reablement programme for stairs practice and a falls pendant .

9. Locality EI Team Makeup
Team manager
Advanced Practitioner Occupational Therapist
Occupational Therapists
Primary Assessors,
Reablement Managers
Reablement offices
Reablement support workers.
1 sensory rehab worker
1 TM
1AP
7 PA’s
3 Ra M
5 Ra O new role
20 SW

10. Overview of the other roles
Advance Practitioner Occupational Therapist – some line management and small case Load
Occupational Therapist – complex cases and clinical supervision of PA’s and Reablement Managers.
Reablement Managers - Line management of support workers, and reablement officers, Manage Rotas'
Reablement support officer - set up Reablement programmes for Hospital Discharge and Community.
Support workers – carryout Reablement programmes input feedback into Mosaic. (electronic records)
Developed competencies and training matrix for each role.
The LA service became an extremely skilled and adaptive OT service.   
An OT but at Assistant director level really helped.  Required a champion up there a strong manager to go out a sell the approach.
One of keys to the success is that the OT are available for support to the whole team and hep to progress more complex cases which can be where reablement need guidance on how to progree a case of where more complex adaptaiosn or specialist equipment is needed.

11. One Front Door Community referrals
Redesign so that all new cases including requests care are referred to Early Intervention and prevention. (A few obvious exceptions)
Reablement to reduce the need for care or clearly identify the level of care and support needed following assessment
Equipment and adaptations
Assistive Technology
Become more consistent that would go to Reablement, and an OT would support via a 6 week programme.
Part of a culture change -people won’t want care if you can show them the opportunity and possibility of real independence.
Put at front door, so if come asking for a care package you have to go through early intervention (unless obvious exception).
So OTs became the first port of call in many ways.  If we had done all we can but they do need a care package” Reablement / OT refer onto SW at the end with clear information regarding the person function and their ongoing needs . 

12. Hospital Discharges
Cases requiring ongoing support following hospital discharge are also referred to Reablement.
In April 2017 a Reablement with care service was developed for people who need a higher level care and support on discharge.
Service users can move seamlessly into Reablement if they have potential to improve
Or be provided with an appropriate care package based on assessment if required. .
. Reablement programmes are provided by the hospital Therapy team
This approach means that all individuals have the opportunity to reach their full potential following either an admission to hospital or a decline in the ability to manage in their own home.

13. Performance Information
From April 2016 to April 2017
91.7% of service users do not require ongoing support following Early Intervention
75.7% of service users do not require long term support following reablement.
Period from April 2016 to April 2017
Early Intervention
Number of case referred to Early Intervention (EI)N= 7050
Number of cases not requiring ongoing support following Early Intervention / 91.7%
Reablement cases from community via EI and hospital.
Number of cases starting Reablement in period 1136
Number of cases not requiring long term support / 75.7%
We recognise that as we take on reablement with care to support discharge that the number of service users requiring ongoing support is likely to rise, we will be able to record these separately but no figures are available yet.
Last year Wigan was one of the few adults social care budgets that balanced, council budgets have been significantly reduced whilst at the same time improving services and improving resident and staff satisfaction. Donna Hall CBE, (2016) Managing demand in health and social care through the Wigan Deal. Social care institute for excellence.

14. Title here for adult social care and wellbeing
Early Intervention an prevention
Wigan Councils Asset Based approach to providing services
The Deal for adult social care in embedded in all our services helping people to connect to their communities and having a knowledge of community assets

15. What is the Deal
The ‘Deal’ for Adult Social Care and Well Being see’s care as a whole care and support system.
It means people are viewed as unique individuals with assets, gifts and talents,
It liberates the whole workforce to work in creative and innovative ways
Permission and support
Positive rislk taking
Links well with the care act

16. The bigger picture Community Knowledge Officers Provider services
Early Intervention, Support, Safeguarding
Different conversations
Exploring options,
Sign posting
Sharing knowledge and ideas
Connecting as and when appropriate
Community Knowledge Officers
Understand what’s in the community
The community Book
Support front line staff
Locality Based
Gather and collate information re gaps in market
Market development officers
Develop solutions to meet the needs and aspirations of Wigan citizens, based on information re gaps
Community connectors and community link workers
A paid Community Link Worker or a volunteer Community Connector can provide buddying support to enable individuals to participate and engage in community opportunities
Provider services
Having different conversations
Developing services in a different way
Partnership working with the community
Enriching the lives of the people we work with
Volunteering
Community knowledge

17. Different conversations
Talking about different things
Conversation about what is important to their lives
Move away from formal assessment and reliance on forms
Values the whole person and their life story
Exploration of gifts and talents
Having an open mind
Taking the time to do it
It puts you in an amazing position to be able to do this
We give staff the permission and training to have these conversations and then go and make a change
Its about not having made your mind up about someone before asking them some different questions.

18. Core Values for Occupational Therapy
Asset based /strength conversations are the way we unlock what it is that engages people’s heart and minds.
Staff are encouraged to begin a conversation with a blank mind not a range of traditional solutions
Lives are changed because people are connected with something that has meaning to them.
The focus on the strengths, gifts and talents, and occupations that have meaning to the individuals underpins the core values Occupational Therapists.
Having the community knowledge, resources and the permission to be creative makes it possible.
Asset based /strength conversations are the way we unlock what it is that engages people’s heart and minds. The team have all had training in having a different conversation, staff are encouraged to begin a conversation with a blank mind not a range of traditional solutions, to view everyone as unique individuals who have strengths, assets, gifts and talents. Lives are changed because people are connected with something that has meaning to them, whether that’s bird watching, fishing, knitting, sewing, art classes, singing, volunteering, drama classes or gaining employment.
It makes sense to genuinely support people to have a good life. Formal health and care services can be essential, but they are at their best when they support people’s wellbeing and inclusion in life.
Wigan’s “Deal for Adult Social Care and Wellbeing” is enabled by the fact that staff are given time and permission to work innovatively and creatively to meet peoples needs rather than relying on inflexible traditional services.
The two overarching guidelines to this approach are to take time to have a different conversation, and know your community. Wigan Council worked together with groups and organisations to develop the communities to support local residents and the staff are encouraged to get to know their local communities and are supported by community knowledge officers and link workers
The Deal for Adult Social Care and Wellbeing which focuses on the strengths, gifts and talents, and occupations that have meaning to the individuals underpins the core values Occupational Therapists. Having the community knowledge, resources and the permission to be creative makes it possible.

19. Wendy’s Story
Wendy suffers from Cerebral Ataxia which is a progressive illness affecting her balance, co-ordination and resulting in slurred speech. She also had neuropathy in her hands and feet..
She was refer to Early Intervention as she was having difficult using her bathroom safely  
She lives alone in a rented flat since losing her husband to cancer in 2014. 
Wendy is a qualified nurse, she used to be in the army and has also worked as a prison officer and ran a bar in Lanzarote with her partner  
Before she was diagnosed she enjoyed keeping fit and taking part in sporting activities such as running and going to the gym.
Wendy also likes animals, especially dogs and occasionally looks after her friends dog .

20. The conversation
The Primary Assessor spent time talking to Wendy finding out about her past, what she liked doing and what she would like to be able to do in the future.
Wendy told the Primary Assessor that she did not get out very often, had low mood and had lost her confidence.
Her family and friends visited but they do not realise that she is lonely and needed to get out to improve her social life
The Primary Assessor explained her role and councils commitment to address social isolation and how we work closely with local communities.
Inspiring healthy life styles and some of the activities such as dog walking and swimming were discussed.
Wendy was very keen to have the support of the community link worker to give her confidence.
Recommendations for adaptations to the bathroom were made reducing her risk of falls.

21. outcome
Wendy was referred to the community Knowledge Officer and this resulted in her becoming a volunteer 2 days a week.
She has attended leisure walks and been introduced to a volunteer dog walker.
Her friends now invite her out rather than just visit.
She was initially worried about access to the swimming pool. Her self confidence is now improved with support from Inspiring Health lifestyles and she is now swimming on a regular basis
Her bathroom adaptations are progressing
Wendy is very happy with the outcome, she wanted help with her bathing and her life has been transformed.
Wendy has given her permission to share her story.

22. Volunteering at the Leigh community Cafe

23. Benefits A streamlined service for the service user.
All people are given the opportunity to improve their Health and well being.
There is a strong emphasis on People pursing full and active lives in their own communities.
Both staff and resident surveys show increased satisfaction.
Reablement service awarded Outstanding by CQC
Focus on benefits for service users
Reduced handoffs and duplication
Wigan Deal integral to the whole change process.
OT’s have regular peer support /CPD meetings
Outstanding CQC which was in part due to the integration an innovations  

24. The Future
We are now developing an Integrated Health and social care services that involves
Social care
Early Intervention and prevention
Health Therapists
GP’s
Community Matron’s District Nurses
Public health
Daily Huddles and Weekly MDT. Joint approach
Locality based co-location
Complex care – virtual ward
Active care step down – rehabilitation Reablement, adaptations
Prevention including a public health intervention and community engagement.
Developing Service Delivery footprints and
The Deal for Health
I have completed several workshops for health colleagues re providing major adapts to avoid duplication and overlap. .