Item 11 - First Point of Committee (Evaluation of Learning)
North Lanarkshire Council · 31 August 2022
Back to IJB Performance, Finance and Audit Committee — 31 August 2022 and its agenda
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1 REPORT Item No: 11 SUBJECT: First Point of Contact – Three Conversations Highlight Report TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief officer Author(s) of Report Morag Dendy, Head of Planning, Performance and Quality Assurance DATE: 31st August 2022 1. PURPOSE OF REPORT This paper is coming to the IJB For approval For endorsement x To note 2. ROUTE TO THE BOARD This paper has been: Prepared By: Head of Planning, Performance and Quality Assurance Reviewed By: Chief Officer Endorsed By: Strategic Leadership Team 3. RECOMMENDATIONS 3.1 1. Seeking endorsement of our approach from IJB PFA 2. Seeking endorsement of the approach to exploring the principles of First Point of Contact to inform the Strategic Commissioning Plan 2023-26 4. VARIATIONS TO DIRECTIONS? Yes No N/A
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2 5. BACKGROUND/SUMMARY OF KEY ISSUES Background 5.1 North Lanarkshire faces a significant increase in service demand as a result of demographic change as well as the impact of the pandemic. It is recognised that there needs to be a focus on assets, adopting a strength-based approach to continue to shift the balance of care and develop services, focusing on prevention, early intervention, and self-management. There is a need to build on the areas of excellence across the HSCP by continuing to demonstrate compassion, continuity, clarity in communication and shared decision-making across all services/supports. 5.2 Access Social Work is the main entry point into social work services. To inform a baseline position, analysis was carried out over three separate weeks 24th February 2020, 13th July 2020 and 5th October 2020. The review highlighted that response to contacts by or on behalf of the public varied considerably not only between services but also within services. Some people’s journey into the service and their outcomes were very clear and well recorded. Other interventions however were very service driven and focussed on outputs, typically by the provision of equipment and/or services. There was clear evidence of people encountering one part of the service then in short time periods coming into a different part of the service again as a new user. Essential knowledge was not always shared across teams. There were multiple handovers between services and often duplication. 93% of referrals received over the three separate weeks, were handled by more than one service and 18% of all referrals received for adult services were handled by more than two services. Where this was the case, there was potentially missed opportunities to take a preventative approach and to build people’s resilience. Background to the 3 Conversation Approach 5.3 Partners4change are a change management organisation committed to innovation and financial sustainability specialising in the 3-conversation approach. They have evidenced working with 75 council areas in the UK in relation to reform, redesign, financial sustainability, and personalisation. Of the 75 councils, 35 councils delivered whole system change through the 3- conversation approach. 5.4 In March 2020 a subgroup of the First Point of Contact (FPOC) steering group visited Edinburgh HSCP who had developed the 3 conversations approach across adult services. The learning from this visit highlighted they had made significant differences in service delivery with financial benefits. 5.5 Additionally, there was noted non-financial benefits such as increased productivity, improved staff satisfaction and improved service user outcomes. The 3 Conversations Model 5.6 The three conversations model is described in more detail in appendix 1 but includes: Conversation 1 – listening and connecting
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3 Conversation 2 – working intensively with people in crisis Conversation 3 – building a good life. 5.7 There are very specific rules associated with the 3 conversations approach that are necessary to produce desires outcomes including a very different culture, practice and behavior in comparison with the usual default system. These include the exhaustion of conversations 1 and 2 which focus on community, family, and individual support before moving to conversation 3 which involves a major input from statutory services. Throughout the early stages there are no hand offs, referrals, triage, or use of waiting lists or allocation process. If someone is in a complex situation then work is undertaken with them on what needs to change intensively for a short period of time, and this may or may not lead to service provision. One of the most important rules is that there must be no long-term planning with people in crisis, it is essential to avert the crisis first. Motherwell Innovation Site 5.8 Partners4Change supported an innovation site in Motherwell locality to test the 3-conversation approach across adult services including Access Social Work, hospital social work, GP link workers and the 3rd Sector. Partners4Change commenced working for a six-month period in July 2021. Introductory briefing meetings were held with staff across the NLHSCP to highlight the approach and look for willing volunteers to become involved. Additionally, the FPOC steering group agreed to support a locality to be an innovation site. The agreed innovation site was Motherwell Locality including adult social work, health colleagues from the locality, acute services, and 3rd Sector partners. 5.9 A project group was created to support the innovation site and they meet on a fortnightly basis to understand activity, offer guidance, problem solve and learn from the activity undertaken. The project group consisted of members of the FPOC steering group and first line managers in the locality with a breadth of social work, social care, 3rd Sector and health services experience. One of the initial tasks of the project group was to record an organisational story, attached at appendix 2. This story captured the baseline values, principles and what matters to the HSCP, partners and the people living in North Lanarkshire. Creating this story acted as a starting point of the innovation site in telling staff about this area of work and encouraging their involvement. 5.10 The 3 conversations innovation site started in November 2021 and ran until March 2022. It started with 9 innovation team members, reducing to 7 because of system pressures and further reducing to 6 with data protection issues impacting on the 3rd Sector representative. 5.11 Steps undertaken Initial response Conversation 1, 2 or 3 Focus on family, friends, neighbours, and community
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4 Initial action – treatment, rehab, reablement, recovery Outcome focus Innovators and connectors working together Ongoing supports only when necessary 5.12 Organisational Our Story, Our People and Our Change? 82 people had meaningful conversations with 6 people requiring longer term supports. There were 82 conversation 1s, 2 conversation 2s and 19 conversation 3s. People connected to the innovation site were seen within one or two days of a referral being made. The response from the team was quick and effective with limited handovers and no duplication of service. There was time for reflection and learning throughout. The focus was on prevention and early intervention with people being supported through conversation to find the solutions to their difficulties as the starting point for intervention. The strength in this was the multi- disciplinary aspect of the team and the focus being community based where possible. The accent was on getting things right first time and listening to what people felt was important to them. Having an occupational therapist aligned to the team gave service users direct access to technology as well as to some equipment to support independence. Innovators were the staff involved in the site and they all reported an increase in job satisfaction and in their learning through shared experience. The use of a short meeting/huddle with everyone in the innovation site each morning, in exploring options for people kept the group focused. Connectors were a variety of people across services and partners that offered advice, information, and community opportunities. Service users’ expectations and wishes were adjusted when discussions focussed on reablement and wellbeing and the use of natural supports. £1000 was available to finance small purchases which would prevent services being introduced. Very little of this money was used as people focused on what they could do for themselves rather than what social work or services could do for them. Only low-level equipment was used to support people. Only one individual budget through Self Directed Support (SDS) intervention at a reduced level was initiated with family and friends dovetailing with individualised support codesigned through the principles of SDS. Recording was simple and was accepted by services and others as being adequate and containing all pertinent information.
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5 5.13 Achievements Quick response Good conversations built on trust and committment Innovation site activity during the pandemic Multidisciplinary approach Colocation Clear objectives identified in ‘Our Story’ Good, quality conversations Shared learning Focus on prevention and early intervention Flexibility Outcome focus Limited resources with successful outcomes Improved responses Less duplication Limited handovers Community and partner support Increased job satisfaction Increased innovators and connectors knowledge and skills Service development Potential for further development The evidence that the prevention and early intervention focus should be at the first response with 3rd Sector 5.13 Challenges Withdrawals from the innovation site midway as a result of system pressures External Management advised to be at arm- length Partners4change didn’t fully support the evaluation process Recording issue impact on innovators especially 3rd Sector innovator Service challenges/barriers Direct involvement of NHSL in the innovation site was limited Unprecedented service demands Other pressure points
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6 Further awareness needed across the HSCP Measures of success 5.14 The Motherwell Innovation Site was a success with much learning. 5.15 The team was dynamic, energetic, and enthusiastic in their pursuit of following the 3-conversation approach. 5.16 The emphasis was an introduction to a whole system, multi-disciplinary team approach embodying coordination, collaboration really focusing on communities and person-centred approaches. The sharing of knowledge and experience at the daily huddles supported the teams learning and meeting people’s outcomes. 5.17 The protected time brought a speedy response to people and facilitated a depth to conversations. 5.18 The colocation of innovators added value to everyday practice and supported people’s outcomes. The different way of working reduced barriers and the basic recording system met legislative needs. It was found that 3rd Sector links were better as early as possible for quality outcomes and supporting people with better lives. 5.19 The focus on outcomes led to the success of the innovation site and ultimately success for people in our communities. The engagement with people was meaningful and there was limited access to services for longer term supports. 5.20 All innovators were of equal value. The protected time for the innovators assisted planning, preparation and strengthened the whole system collaboration. 5.21 Unfortunately the 3rd Sector innovator could not access electronic records to comply with data sharing requirements. 5.22 Appendix 3 provides more detailed analysis of the data from the innovation site work. 5.23 Appendix 4 provides stories gathered to demonstrate the impact of 3 Conversations. 6. CONCLUSIONS 6.1 One of the most important ambitions of the Health and Social Care Partnership is to ensure that when people make contact with health or social work services that the response is quick and effective, with a focus on helping people to help themselves first and getting things right first time. The development of First Point of Contact requires good conversations. The three conversations approach was tested in an innovation site in Motherwell Locality over a three-month period. A multidisciplinary team was established to work through the model, focusing on what people feel is most important to them, and building on the assets, strengths and capabilities of people, families, and communities. This paper summaries the findings from the innovation work.
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7 6.2 Recommendations Development of further innovation work with the 3rd Sector, building on the increased capacity through the Winter Planning and Enhanced Support Business Case Addressing how we bridge the gap between 3rd Sector and statutory services, creating trusted pathways. Further emphasis on prevention and early intervention. Further embed an awareness of the 3-conversation approach across the HSCP and partners including a programme of training across IRT, Home Assessment Team and across HSCP locality teams Build on the success of the Motherwell locality innovation work and recognise their willingness to be actively involved in the next steps. Build clear links with the range of work across the whole system supporting improved first point of contact, informing the development of the 2023-26 Styrategic Commissioning Plan – in particular: GP link workers Mental Health in Primary Care Developments Development of the CAPA (Choices and Partnership Approach) model in CAMHS Home assessment team High resource users work Rapid rehousing 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES This paper covers all nine national health and wellbeing outcomes, but particularly outcomes one and two. 7.2.1 ASSOCIATED MEASURE(S) The range of associated performance measures within both the national outcome indicators and our own local performance framework will be refreshed alongside the development of the SCP 2023-26 and continued development of the Programme of Work. 7.3 FINANCIAL Financial Planning will be an important element of the SCP 2023-26 This paper has been reviewed by Finance:
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8 Yes x No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT 7.5 PEOPLE Residents across North Lanarkshire, third and independent providers operating in North Lanarkshire and wider stakeholders with a link to North Lanarkshire will be involved in the development of the SCP 2023-26. 7.6 STAKEHOLDER ENGAGEMENT (Detail below any stakeholder engagement that has taken place). 7.6.1 Discussion at the First Point of Contact Steering Group 7.6.2 Through the range of structures supporting the Motherwell Innovation Site 7.7 INEQUALITIES & FAIRER SCOTLAND DUTY The approach outlined in the report will seek to address inequalities and promote fair work practices by creating opportunities to engage and participate in the development of First Point of Contact. EQIA Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 7.8 CARBON MANAGEMENT IMPLICATIONS N/A 8. BACKGROUND PAPERS# This content in this paper links directly to the following: • Strategic Commissioning plan 20-2023 https://www.hscnorthlan.scot/wpcontent/uploads/2020/07/Strategic-Comm- Plan-20-23-FINAL.pd 9. APPENDICES Appendix 1 – 3 Conversations Approach Appendix 2 – Presentation Appendix 3 – 3 Conversations Pilot Breakdown of Data Appendix 4 – Good News Stories
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9 ............................................................................. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact Morag Dendy on telephone number 01698 332000.
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10 Appendix 1 ‘3 Conversations’ Approach Partners for Change The Three Conversations Approach is a paradigm shift in how to deliver adult social care, and how it collaborates with NHS, Housing, Voluntary Sector, and other colleagues to make the whole joined up system of community-based support work differently and better. It seeks to replace the ‘contact, re-ablement, then assessment for services, culture with a new approach based on the assets, strengths and capabilities of people, families, and communities. It is built on and has proven the assumption that if you collaborate with, and allow people to be co-designers of their support, then their quality of life goes up, and their use of health and social care resources goes down. There are very precise rules associated with these conversations that are necessary in order to produce a very different culture, practice and behaviour in comparison with the default system. These include – you have to exhaust conversations 1 and 2 before you are allowed to move to conversation 3, you are not allowed, ever, to plan long term with people in crisis, you are never allowed to hand off or refer people, or triage them, or use a waiting list or allocation process. If someone is in crisis you ‘stick to them like glue’ and work with them on what needs to change intensively for a short period of time. Making it happen is a huge challenge because of the power of the status quo to reinvent itself. So we have to learn to stop using some key words, phrases and associated activities – that includes assessment, review, respite, services, triage, referral, signposting etc. Instead after socialising these ides and finding out where ‘the grain’ is i.e., who really wants to do it, we create innovation site with their own new and different rules. Our innovation sites have included ‘the front door’, long term teams, GP ‘at risk of admission’ lists, an acute hospital ward, people waiting for a review and more. Innovation sites collect data every day about what happens to people when we approach them different. What we have learnt is – if you change the conversation then people’s lives change. Appendix 1 ‘3 Conversations’ Approach Partners for Change The Three Conversations Approach is a paradigm shift in how to deliver adult social care, and how it collaborates with NHS, Housing, Voluntary Sector and other colleagues to make the whole joined up system of community based support work differently and better. It seeks to replace the ‘contact, re -ablement, then assessment for services’ culture with a new approach based on the assets, strengths and capabilities of people, families and communities. It is built on, and has proved the assumption that if you collaborate with and allow people to be co-designers of their support – then their quality of life goes up, and their use of health and social care resources goes down. There are very precise rules associated with these conversations that are necessary in order to produce a very different culture, practice and behavior in comparison with the default system. These include – you have to exhaust conversations 1 and 2 before you are allowed to move to conversation 3, you are not allowed, ever, to plan long term with people in crises, you are never allowed to hand off or refer people, or triage them, or use a waiting list or allocation process. If someone is in crisis y ou ‘stick to them like glue’ and work with them on what needs to change intensively for a short period of time. Making it happen is a huge challenge because of the power of the status quo to reinvent itself. So we have learnt to stop using some key words, phrases and associated activities – that include assessment, review, respite, services, triage, referral , signposting etc. Instead after socialising these ideas and finding out where ‘the grain’ is i.e. who really wants to do it, we create innovation sites with their own new and different rules. Our innovation sites have included ‘the front door’, long term teams, GP ‘at risk of admission’ lists, an acute hospital ward, people waiting for a review and more. Innovation sites collect data every day about what happens to people when we
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11 The results: the numbers of people with ongoing packages of formal care significantly goes down – we aim to halve it – with the consequent savings to health and social care budgets. People and families say how much they like the different approach – where workers are allowed to really listen and be interested in them as people, where they do what they say, and where the response is fast and effective. Staff satisfaction and productivity shoots up, and they say things, ‘I love my job, it is inspiring’, ‘don’t make me go back to the old way of working’. We have learnt that you can usually make rapid progress and at the same time achieve seismic change. Our programme usually looks something like: Month 1 and 2: socialize these ideas and co-design your innovation sites. Month 3 to 5: run your first phase of innovation – collecting data every day. Month 6: evaluate – collect and share your compelling evidence form your data about what happens when you work differently – both numbers, and ‘stories of difference’. Month 7 to 9: run an expanded area of innovation to prove you can scale it and deal with any challenges from phase one. Month 10 to 12: evaluate and get ready for business as usual. We have now done this enough times in enough different environments to know, and be able to prove, that it works with all areas, and all people. We really can support
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12 better lives for people and families, more satisfying and productive jobs for our staff, and save significant amounts of health and social care resource. Appendix 2 FPOC%20-%203%20 Conv%20Our%20Story%20Pres%20v5%20-%20created%2014%20July%2021.pptx
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13 Appendix 3 Conversations Pilot breakdown of data Referral Routes During the first 13 weeks of the pilot, referrals were received via multiple routes. The most referrals were received via Access Social Work, our first point of contact for all social work referrals. The total number of new people seen was 87. Access – 34 Switchboard – 11 Hospital – 20 Community Care – 11 Rehab – 6 Other – 4 Explanation of traditional referral process detailed below:-
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14 *bathing – some people may have had to be passed to Rehab depending on ability to use equipment **stairs – if handrails in situ these would be passed to rehab ***SDS/carers assessment/Social Opportunities – these would have been passed to community care. Conversation Type: Number of Conversation 1 – 61 Number of Conversation 2 – 2 Number of Conversation 3 – 19 Number of Conversation 1 who then transferred to Conversation 3 – 6 Non-Engagement – 5 Emerging Themes: Training for staff regarding updating knowledge of occupational therapy and physiotherapy in relation to bathing assessments and walking aids. Significant number of requests for bathing assessments. Consideration must be given regarding bath environment. Often it can be wrong type/style of bath, consideration may have to be given by housing regarding future proofed housing stock. Current system hub/Access as first point of contact, staff have to be able to highlight possible outcome of request i.e., bathing assessment but often people require wet floor but do not want to remove bath. If this information was passed to them at initial contact stage, people would have more realistic expectation of outcome and be able to make an informed decision. Overall, there was a lack of request for people to access social activities. This may be a result of the pandemic. Even when we talked about it there was an overall reluctance to engage. Connectors were viewed as positive by team. Quick response either regarding advice, update on social opportunities, or follow up visits. Data shows that we responded quickly to requests which in turn created a positive response from people. Information was given that this was a pilot and therefore a time limited intervention. Overall people responded positively to this resulting in a positive experience. The team started with no current work therefore if required people could, and were, seen often. This allowed development of relationships and discussions around options and impact this could have on their life. Intervention was person centred as options were provided and people could make the best decision for themselves. The main difference in the 3 Conversation Approach is involvement quickly on contacting Social Work department and access to connectors. Observation was made regarding current system. We have developed a culture of gatekeeping rather than holistic assessment. Through the multi-disciplinary approach of 3 Conversations and use of connectors, particularly OT, we have been able to provide a holistic assessment often in the first visit. It is hoped that this will results in less referrals or crises developing. Consideration should be
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15 given to tracking people that 3 Conversations have worked with to see if/when they return to service. Numbers of new people each week for the 13-week pilot: Response Time: Out of the all the individuals on the spread sheet, 82 had information about 1st contact and 1st discussion and on average there was 1.39 business days to respond. 47 individuals out of the 83 were contacted on the same day they contact Social Work or when the pilot group was passed the information. Outcomes: There was a wide range of outcomes generated from the referrals with a wide range of outcomes. in 3 conversation approach is involvement quickly on contacting with SW department and access to connectors Observation was made regarding current system. We have developed a culture of gatekeeping rather than holistic assessment. Through the multi-disciplinary approach of 3 conversations and use of connectors, particularly OT, we have been able to provide a holistic assessment often in the first visit. It is hoped that this will result in less rereferrals or crisis developing. Consideration should be given to tracking people that 3 conversations have worked with to see if/when they return to service. Numbers of new people each week for the 13 week pilot: Response Time Out of all the individuals on the spread sheet 82 had information about 1st contact and 1st discussion and on average there was 1.39 business days to respond. 47 individuals out of the 83 were contacted on the same day they contacted SW or when the pilot group was passed the information. 3 6 9 15 9 16 9 1 4 6 8 2 1 WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6 WEEK 7 WEEK 8 WEEK 9 WEEK 10 WEEK 11 WEEK 12 WEEK 13 NEW PERSONS SEEN PER WEEK OF PILOT FROM WEEK BEGINNING 11/11/21 UNTIL WEEK BEGINNING 31/01/22 Persons seen
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16 Information for chart above: Local Groups – 11 7% 14% 24% 14% 3% 4% 3%1% 7% 5% 4% 3%1%5%1%1%1%1%1% Coversation Outcomes local groups11 Home care equipment and adaptations ot assessment care homes housing physio/rehab link with GP Community alarm keysafe lanarkshire carers FIT SWF Not engaged no needs Deceased respite blue badge driving licence lesson grant
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17 Homecare – 22 Equipment/Adaptations – 36 OT Assessment – 22 Care Homes – 5 Housing – connect to/applications/ repairs – 6 Link with physio/rehab – 5 Link with GP – 1 Community Alarm – 10 Keysafe – 8 Lanarkshire Carers – 6 Link with FIT – 5 SWF – 2 Not Engaged – 7 No Needs – 1 Deceased – 2 Respite – 2 Blue Badge – 1 Driving Licence Lesson Grant – 1 Hospital Discharge – 20 Duplicate Referral – 1 Fire Safety Home Visit – 3 SDS – 3 Deep clean of house – 1 Handyman – 1 Food Parcel – 1 Hospice – 1 Number of people with business concluded by innovator response:
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18 21 concluded and 77 are ongoing Waiting List/Connectors: We never had to implement a waiting list although we recognise that if we had continued taking request this may have had to change. Connectors – workers linked in with connectors in various ways either email, telephone, referral, face to face. Occupational Therapy – 16 Physiotherapy – 4 Lanarkshire Carers – 5 Befriend Motherwell – Community Mental Health Team – 1 Disability Forum – 2 Wellness Hub – 1 IDS/Locality Groups – 3 Locality Social Work Manager – 2 Use of Huddle: Huddle was daily for approximately one hour, longer if required. No data available regarding who was discussed, if we needed to, we discussed situation, we also decided who was taking work. Very democratic system. Team was made of workers who knew each other and others who did not. Daily huddle allowed us to develop as a team by sharing knowledge in relation to any work that we were dealing with. Observation is that although we had staff in office, we would also have others working from home, we still created positive, professional working relationships. Peer support is the overall benefit of daily huddles. Allowing for sharing of experiences, concerns (given this was a new approach of working) and questions. Result was that everyone in huddle benefitted from sharing and hearing knowledge and possible solutions to situations. Leading to upskilling of all the team members. Huddles also allowed us to be more confident in contacting co-working for advice/guidance at any time. Clear evidence of good relationships having been built. Conclusions/Recommendation: We found conversation paperwork succinct, and outcome focused. No issues were raised by a service who received Conversation paperwork, all relevant information was included, paperwork had been disseminated to home support,
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19 care homes, LPG and Locality Social Work Manager for SDS. Given this it would be our recommendation that Conversation paperwork be adopted within IT system. It is felt that the paperwork is compatible with the requirements of Community Care, hospital social work, rehab team and Access. By utilising Conversation paperwork, which is less time consuming that current assessment paperwork, staff would have the capacity to undertake more work resulting in waiting list decreasing. Innovation sites should be multi-disciplinary and DAILY huddles should be adopted. This allows discussion regarding sharing of outstanding work and for multi-disciplinary approach being utilised. This also provides peer support, which in the current climate is essential particularly for newly qualified staff or students. We were able to develop this even when using hybrid model of office based and working from home. Feedback from Members of Steering Group From Disability Forum Aspiration At the start of this process, we were excited, as we already work in a person centred, solution focussed way providing light touch (Conversation 1) and sometimes more involved support. We are always looking for new supports in NL and make sure we have a database that is up to date which is available to anyone who needs it. We felt that our expertise could benefit the other members of the Innovations Site and it felt inclusive to be able to share our knowledge. Involvement NLDF was keen to be a part of this work and committed one member of staff, as mentioned we are already committed to providing low level supports to those in NL with a need. Due to data protection issues it was agreed after a five-week period that an integrated approach would not be possible, and we continued as a connector, which worked well. With this being one of the big aims coming from this work it did come as a disappointment. Participation When it was realised that we could not work within the hub, communication was poor, and it took five weeks for this to become a decision. This was an obstacle, and it felt that the time and expertise of our worker was not valued, and it would have felt more inclusive for the conversations to have taken place much quicker and being more transparent. I have continued to attend the Project group and steering group as I want to show my commitment to the next stages of innovation of H&SC and as Chair of the SDS Network through Community Solutions, I believe there is a real link there is terms of facilitation and would welcome further opportunities to explore this. Moving On We are now keen to seen where Phase 2 takes us. I feel a more important part of the process is for the voluntary organisations in NL to be recognised as experts in their own field, there are also trained professionals working in voluntary organisations with
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20 degrees, with life experience and with excellent communication skills. The people we work with don’t have to fit in a box or go on a waiting list. We are very efficient and work collaboratively with other organisations – voluntary and statutory. I feel with some planning this could be offered in a structured way and would perhaps offer that trust in 3rd Sector that I voiced from others at today’s meeting. Funding being invested in the 3rd Sector to tackle the lower-level work would not only alleviate busy statutory workers but would also offer a sense of commitment and buy in by HS&SCNL to the voluntary sector, boosting the sector’s capacity. Conversations around the Innovation Site are about taking it outside of ‘Service Land’ but to do that ‘Service Land’ must let others be involved or have confidence in the organisations who have been doing it successfully for a number of years.
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21 Appendix 4 Good News Stories Example 1 Mrs J was discharged from hospital after a two-week admission with no clear reason as to what had caused her to become ill. Her husband was provided with social work out of hours number and advised to contact them if further service was required. He did this as Mrs J was struggling with toileting, resulting in her soiling herself. Community care senior was advised of outcome of contact with SWEG: weekend district nurse team contacted; continence garments provided. SWEG felt that a further visit was required. As couple meet 3 conversation criteria, innovation site progressed. Writer contacted Mrs J’s husband, arranging a visit for the following day, as it was evident neither was feeling confident in their circumstance. Writer also contacted GP surgery and arranged GP consultation for the couple, as they evidently needed some medical advice as well as referral to continence team, which has to come from GP. Writer visited with another colleague who could carry out bathing assessment. We talked to both Mrs J and her husband, they advised that bathing was the main issue. Consideration was given to which aids and adaptations would be most suitable after consideration it was agreed that installation of rails would provide the most appropriate solution. The couple also agreed to community alarm and key safe being installed. They were managing other aspects of day-to-day life. Everything was in place within two weeks and MRs J and her husband were happy with the HSCP intervention. Mrs J’s health was settling, and she was not struggling to was or toilet herself. They had the extra security of community alarm and key safe. Mr J advised that they were happy for HSCP to withdraw and gave us 5 out of 5, in the following weeks he also sent a card thanking us. Example 2 A is 47-year-old woman who lives with her husband and her daughter, who is the youngest of her four children. A was diagnosed with multiple sclerosis (MS) four years ago. She has since given up working and spends most of her days in her home. Her daughter, who has just turned 21 is her main carer. Access team had received a letter from MS nurse requesting assessment for aids and adaptation for A as she was struggling currently. Unfortunately, there was a delay in receiving this letter. It was agreed innovation site would work with A. On first engagement with A, it was evident that she was struggling with accepting her diagnosis and the impact it was having on her life. She was resistant to accepting any MS groups or more information as her sister has been diagnosed with MS for about 6 years. She talks about MS dominating her life, we talked about what she wanted which was to feel like her old self again getting dressed up putting makeup on and going out, engaging with others, having a purpose. Since working with A I have carried out 4 visits, 2 with OT colleague, each lasting approximately an hour. By our last meeting we have provided A with options about possible adaptations she could do to her home and what would future proof it for her.
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22 She has external rails fitted to her back stairs; this was a significant request for A as she has been resistant to accepting any adaptations. At last visit she was provided with a walking stick, again a significant step. She was also provided with a list of community-bases activities in her local area, we agreed that on next visit she will have identified a group that she is interested in. Her daughter has also been linked in with Lanarkshire carers for support. My observation of my involvement with A is that if A had gone through her initial referral pathway, she would have had an initial visit from access worker I believe she would have not been able to identify anything that she required, A would have said she was coping, and initial referral was made at a bad time in her life. Given the pressures on Access system they would have withdrawn advising to contact department if anything changed. Example 3 E is 86 years old and lives with her husband A who is her main carer. Both E and A were referred to Access Social Work by their son and daughter-in-law to request carer support for A and home care support for E. E was diagnosed with Alzheimer’s in February 2021 and her husband who has his own health issues has been struggling to care for his wife. Daughter-in-law has recently moved into the property as E cannot be left alone. Daughter-in-law has been allowed to work from home at the property by her employer, but this only a temporary measure and she and A have been struggling to assist E with personal care tasks including getting up in the morning to take medication at breakfast time and assist with a shower. E can be quite grumpy with A, and he often does not get much sleep or respite. A and E used to be very active, but this is no longer possible, and A can no longer drive due to his own health issues. Family report that E cannot accept she needs help, and this has resulted in a log of stress for her husband and family. A would like carer support and advice on caring for E. E will not go out anywhere without her husband. Family would like advice on local community resources they could both attend. E has support from CPN and community nurses and has been invited to attend a wellbeing group with A. There is a stairlift and wet room in place at home and family have requested home care help morning and evening to relieve the pressure on A. E often does not get up until late in the day and does not take her medication without prompting. E is prescribed a lot of medication and it is vital she takes this 4 times a day and is assisted to get up in the morning and supported with medication without prompting. 3 conversation workers visited the following day after referral and met A and his son and daughter-in-law. E was asleep in bed and family reported concerns about the stress A was under and difficulty having a routine for E to get up in the mornings to take prescribed medication. A often does not get much sleep and E will not attend any resources without him. A follow up home visit was completed the following week with E present and home care support was requested and commenced within a week. Lanarkshire carers referral was completed and connector for Innovation team from Lanarkshire Carers contacted A and he was registered as a carer and given lots of advice and support groups. A stated this feeling of recognition and support as a carer
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23 had made him feel much better and he would look to access community resources / support groups once home care has started giving him a much-needed break from his caring role. Example 4 Mr B’s son contacted the HSCP requesting an assessment for his father with a view to possible supports. Mr B is an 82-year-old man who lives alone in a single level home within a sheltered housing complex. His wife died in 2020 and his son and daughter live in England. Discussions have taken place with the son as he would like his father to move to be near him however Mr B is happy and does not wish to move. Son is concerned regarding his father’s ability to manage medication and meals. On discussing his son’s concerns at the initial visit with Mr B he advised he did not wish support however was finding using his microwave difficult to heat his meals. Microwave was large and the buttons and heating instructions were complicated. A simpler microwave was purchased in the hope that this would help him remain independent and there would be no need for services. Medication was also checked. This is delivered from the local pharmacy in blister pack and on checking all medication that as required to be taken was – appears to be no issues. He advised on one occasion he had taken it at the wrong time as he had woken through the night and was confused regarding the time, as it is dark, he assumed it was 3pm and not 3am. He assured the worker that this was an isolated incident. On checking on further visits Mr B is managing this task without difficulty. During the visit Mr B advised he was feeling isolated and at times lonely as most of his friends had died and most recently his wife. He has COPD, angina, mobilises with the aid of a walking stick and has low blood pressure therefore only manages to walk to his local shop due to extreme breathlessness. Befriender service was discussed with Mr B, and he agreed for a referral to be made to Befriend to support with isolation. Mr B appeared to be managing his daily tasks albeit slowly and at his own pace however on speaking to his daughter after the festive period she had raised concerns regarding his poor personal hygiene and struggle he has with doing his laundry. Mr B had visited with his family at this time and had refused to shower in over a week and his son had noticed the large amount of clothes in his laundry basket. Writer carried out a home visit to discuss the concerns his daughter had raised. Mr B said that he is struggling to shower due to lack of confidence and the effort that it takes for him to complete this task. He is left exhausted therefore has not had a proper wash in some time. Homecare support was identified to assist him to shower twice weekly. Laundry service was also discussed, and Mr B was happy to pay for this service. Writer arranged with Scrubbers Laundry Service who will pick up and drop off laundry on a weekly basis. Support was given to contact Sky TV on his behalf and arrange for an engineer to attend his property free of charge to fix his Sky box. Mr B was not receiving the full package of channels he was paying for each month. This has been rectified.
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24 Mr B is happy with all the support that has been provided and is keen for the Befriender Service to start. The writer had kept his daughter abreast of the situation with Mr B’s permission and she is very pleased that her father has engaged and is receptive to the support as she stated it gives herself and her brother peace of mind. My observation is that as Mr B was part of 3 Conversation time was taken to provide him with the appropriate support he needed. A good rapport was built up over several visits whereby Mr B was more comfortable with discussing his needs and difficulties he was having day to day. It allowed for better more in-depth discussions to take place thus providing Mr B with a better service. Example 5 OT Connector 64-year-old gentleman with following health conditions, type 2 diabetes, peripheral vascular disease, Ischaemic gout, left above knee amputation, pulmonary fibrosis. C requires to use wheelchair both indoors and outdoors. Currently in hospital SW (innovation site) facilitating assessment for hospital discharge. C is currently living in a local authority tower block with his wife. The tower block is due to be demolished. NLC housing are currently trying to identify alternative suitable property. C is currently a car driver and enjoys shopping, social outings, and day trips with his wife. Request from SW to look at property identified by housing as suitable for C and his wife. Joint visit carried out with SW, C and Housing Officer. Property was unsuitable due to restricted turning space in hallway, unable to access bathroom due to door width (which couldn’t be altered), restricted wheelchair access into bedroom. Viewed second property (dispersed property) which again was identified as suitable for wheelchair access. OT was able to respond quickly again unfortunately there were 3 steps to access the property and was unsuitable for wheelchair access. The property would not allow C to access his local community or outings independently. Linking promptly with SW has allowed me to intervene and advice C not to accept properties which are unsuitable in meeting his needs and allowing him independence. The second property identified was a dispersed property which I viewed myself in the 1st instance so as not to raise any expectations C would have with regards to being offered a suitable tenancy to allow his discharge from hospital. Example 6 OT Connector P is 80 years of age and lives with her husband in a terraced property with bedrooms upstairs and a bathroom on the ground floor. P’s husband made contact with departments to request aids and adaptations to support his with within her home environment. P was connected to OT via SW. Before OT was able to arrange appointment P was admitted into hospital therefore OT assessment did not take place until she was discharged. Upon discharge from hospital OT carried out a joint visit with SW.
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25 P has the following health conditions, chronic obstructive airways disease, arthritis, hypertension, type 2 diabetes, wears an ankle support due to her leg being shattered in an accident many years ago. P was admitted into hospital due to fluid retention, she still has some level of fluid in her left knee. P currently mobilises with the use of a wheeled walking aid indoors. P has a stairlift in situ therefore is able to access the upstairs of her home independently, she has a bed rail in situ and transfers in/out of bed independently. The main area P was having difficulty was transferring off her chair due to the lack of exercise and deterioration in her mobility whilst in hospital. P was sitting in a suitable high back chair with arm rests, the chair was appropriate for her height. On assessment P demonstrated attempting to stand this was carried out with effort. OT gave advice on alternate way to transfer from the chair, P was encouraged to bring herself to the edge of the chair before attempting to stand. P demonstrated this and was able to stand with less effort. P was experiencing some breathlessness and pain in her knees when carrying out the transfer she does not have confidence and feels she is going to fall back if her legs give way. Both her and her husband felt she required a riser recliner chair and requested that this be provided. OT recommended that a period of physiotherapy intervention would be beneficial to strengthen P’s muscles and practice chair transfers to build her confidence. P advised she would give it a try and her husband was also very supportive. SW will connect with Physiotherapist from Integrated Rehab Team to arrange assessment and intervention. P will also be supplied with a wheeled trolley to enable her to transport items from the kitchen. Within the innovation team OT had the capacity to visit P within a few days of her discharge, this was crucial to identifying there was rehab potential, and a riser recliner chair was not required. Having access to Connect to physiotherapist will allow the intervention required to strengthen P’s muscles, improve her ability to carry out safe transfers and improve her mobility which would allow her to return to enjoying outings with her husband and participate in managing household tasks which she has missed. Example 7 OT Connector T 75 years of age he lives with his wife in a mid-terraced property with bedrooms and bathroom upstairs. He has the following health conditions, Parkinson’s disease, type2 diabetes, arthritis, cataract, bulging discs. T is very independent and enjoys socialising with his wife. He has recently had to give up driving, they used to enjoy driving holidays. T’s wife now does all the driving they enjoy day trips and socialising with friends. T would like to resume holidaying in the near future and is keen to try a coach trip. T is also keen to return to his Rotary club as he enjoys socialising and the charity work they do. OT has been connected at the request of SWA (innovation site) who informed that T was having difficulty negotiating the internal stairs. SWA became involved when T made contact requesting an assessment for any aids/ equipment which would support
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26 his independence within his home. OT was able to respond quickly and attend and carry out stair assessment. T mobilises slowly he has a shuffling gait with poor balance, her requires to use a walking stick at present he feels he does not require any further walking aids. T advised he is experiencing pain hi his legs and back when he negotiates the stairs, his balance is poor, and he feels he is going to fall. For this reason, his wife supports him on the stairs to ensure his safety. OT observed T negotiating the stairs he was very slow and was unable to place his full foot on the stair this was causing him to be unsteady, he also experienced pain when lifting his foot as this was putting pressure on his back. He required to hold onto the banister and his wife was behind him offering support. This was putting both of them at risk. On completion of the task T was breathless and exhausted with the effort he was unable to descend the stairs immediately. OT recommended installation of a stairlift as this would enable T to negotiate the upstairs of his home in a safe and independent manner. This would also reduce the risk of injury to his wife when supporting him. OT discussed recommendation at housing solution meeting this was agreed. OT completed paperwork requesting survey and quotation for installation once this was received the stairlift was ordered via care plan. T is independent with selfcare tasks he has a shower cubicle in situ., which he wasn’t very confident in accessing. OT has provided rails and shower stool to support independence. A raised toilet seat and external rails were also provided. The small aids provided has made such a difference and increased his confidence especially when accessing outdoors. Upon request for a stair assessment T’s assessment was carried out very quickly due to the fact that a referral did not have to be made to Rehab Team where the referral would have been placed on a waiting list. During this period T could have fallen on the stairs causing himself or his wife serious injury and possible hospitalisation, this has been prevented due to being part of a full multi-disciplinary team and not having to refer onto another team for assessment. Both T and his wife were very grateful for the quick response to their request for supports as they were both becoming very anxious and had concerns around T’s limited availability to access the upstairs of his home independently.