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Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Jean MacLellan OBE
Head of Adult Care and Support Division
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Ruth Forbes
Carer
VOCAL Midlothian
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Michael Matheson MSP
Minister for Public Health
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
A Step Change for Carers
Reshaping Care Change Fund
direct and indirect support
12 March 2013
Thistle Hotel, Glasgow
Moira Oliphant
Carers Policy, Scottish Government
Manifesto Commitment/
Guidance
• …we will ensure that from 2012-13 onwards at least 20% of
the Change Fund spend is dedicated to supporting carers to
continue to care
• The optimum way of supporting carers is through a planned
combination of direct carer support and support for the
cared-for person
Why it matters
• Direct support to carers recognises their role as care
providers and ensures that they have the resources
to enable them to continue in their caring role
• Indirect support focuses primarily on the needs of
the older person; direct support improves wellbeing
Not one or the other
• Good quality, timely and reliable services for the
cared-for person indirectly support the carer, often
leading to a reduction in stress
• Carers still require an assessment of their own needs
– appropriate and timely intervention
Indirect support
• Not all older people have carers
• Degree of interpretation
• Examples:
- aids and adaptations; specialist palliative nurses for end-of-life
care; re-ablement services; telecare
• Additionality
Direct support
• Provided directly to the carer, often
following a carer’s assessment
Calculations: Indirect Spend
• % older people who have carers
• The impact the project will have for carers:
determine the % that supports older people
and the % that supports carers
Calculations: Indirect Spend
A service or intervention where the carer is not the main recipient but the
service or intervention aims to have a significant and measurable positive
impact for the carer in their caring role. Projects are included where 25%
or above of the project is directed to have a significant and measurable
impact on carers. Criteria for considering the degree of benefit for carers:
- proximity of the carer to the intervention; time benefit for the carer; degree
of involvement of the carer in the design and planning of the
service/intervention; service/intervention helps raise staff awareness of
the needs of carers.
Outcomes
• The extent to which carers are better
supported and the difference made
to their lives and to the lives of the
person or people they care for and
the wider family/community
Thank you!
Moira Oliphant
Carers Policy
St Andrew’s House
Edinburgh
[email protected]
Tel: 0131 244 3503
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Carers of East Lothian
Short Breaks Service
for Older People and their Carers
Time well spent!
Aim
To support people in a caring situation to arrange
breaks that are as beneficial as possible for both the
carer and the older person they care for
Background
Pilot Project
Dec 2011-May 2012
Short Breaks Service began
June 2012
Officially launched at the COEL AGM
September 2012
The Short Breaks Service
• Supportive discussions where both the carer and the person they
care for can think about their needs
• Research into short break opportunities
• Negotiations with short break providers
• Advice re social work provision
• Grant applications
• Referrals to other services
• Transport options
• Mobility equipment
Also…
Support with the emotional issues around organising breaks
The Short Breaks Service
More time apart…
Could the older person be left on their own safely for a short
period of time?
Would the older person benefit from spending some time with
other people e.g. at a day service or with a support worker?
Would the older person prefer to be cared for at home or away
from home while their carer has a longer break?
Quality time together…
Would the carer and the person they care for like to have a
break together but with other people undertaking the caring
responsibilities?
Outcomes
• Carers will find their caring roles more manageable
• Older people in need of care will be able to stay in
their own homes for a longer time
• Carers and the people they care for will maintain a
happier and healthier relationship
• Carers and older people will feel valued and
supported
Features
Plus Points
• Continuity for people using
the service
• A holistic approach
• A supportive environment
where caring issues are
understood
• Easy access, quick response
times
• A dedicated service
Challenges
• No budget for breaks
• Not a one-stop shop, some
assessments and services
still accessed through social
work
• Small scale – one worker
with administrative support
Work in Progress
• Ongoing evaluation of the service to respond to older people and
their carers’ comments and requests.
• Support for people managing their SDS individual budgets for short
breaks/respite
• A streamlined service to inform carers about spare capacity/short
break opportunities in care homes
• A growing membership with increased power to negotiate
favourable rates with holiday providers
• Involvement in shaping future short break provision
• Organised days out for carers as a break from caring
The Short Breaks Service
Thank you for your time
Any questions?
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Pharmacy Service role in supporting
informal carers
Inverclyde Pharmacy Change Plan
Natalie O’Gorman
Background
• The predicted change in demographics will place a significant strain on
health, social care and support services.
• Polypharmacy in the elderly is increasingly being recognised as a major
issue with over 40% of over 65 year olds now on >5 medications.
• Drug-drug interactions, medication errors, non compliance and adverse
drug reactions are all consequences of polypharmacy.
• Adverse drug reactions have been implicated in 5-17% of all hospital
admissions.
• In 2009, NICE reported that approximately 50% of all medicines prescribed
for long term conditions are not taken as recommended.
Background
• Previous local work has shown that medication review supports high
quality, safe, clinically effective and cost effective prescribing.
• Follows a previous local audit of medication reconciliation at the
primary/secondary care interface showing that improving communication
helps reduce discrepancies.
• Assisting patients with managing their medications is now a significant
part of the role of an informal carer.
• There is a need to support informal carers by providing them with
information and advice on the use and administration of medication.
Pharmacy Service
• 0.8 WTE Prescribing Support Pharmacist
• Medication Review as a domiciliary visit
• For patients over 65 years on polypharmacy/ high risk medicines to reduce
avoidable medication–related issues in primary care and hospital admissions
for avoidable medication-related issues
•
•
•
•
0.6 WTE Prescribing Support Technician
Medicine Reconciliation.
Compliance needs assessment.
Face-to-face medicine concordance and medicines reconciliation reviews for
recently discharged patients over 65 years and to liaise with other services to
ensure changes during admission are implemented in community and to
support elderly patients to manage their medicines in their own home.
• Based within the Prescribing Team, Port Glasgow Health Centre.
How does the service support informal
carers?
• Gives carers the opportunity to ask questions about the conditions and
medicines of the individual they care for.
• Assists carers at the point of discharge by communicating with the hospital
ward, GP practice and community pharmacy to ensure correct and timely
follow on prescriptions and supply.
• Reduces polypharmacy and improves medicines safety through
medication reviews to ensure that each medication has a current and valid
indication, all monitoring is up to date and where appropriate, reduce the
dose or dosing frequency of the medication.
….
• Reduces confusion and potential harm through the isolation of expired,
discontinued and stockpiled medications for return to a community
pharmacy.
• Aids compliance with medication by recommending formulation changes.
The service can review all the medications in a patient with a swallowing
difficulty and where possible recommend changes to a licensed soluble or
liquid preparation or give guidance on what medications can be crushed
and how to correctly administer them.
• Supplies and provides counselling for a variety of compliance aids e.g.
reminder charts, dosette boxes, eye dropper aids and inhaler aids which
promote independence in the patients they care for.
….
• Links with and sign posts carers to other services e.g. community
pharmacy collection and delivery services, social work, community alert
alarms, sensory impairment.
• ?? Offer medication review to carers themselves.
Example Case 1
•
•
•
•
•
•
•
72 year old female.
Lives with husband.
6 week admission (HDU).
11 changes to medications.
Significant changes to antidepressant
and anxiolytic medication.
Discharged with one week supply of
medication in a dosette box.
Discharge Rx posted to GP from
ward.
Discharge Medication
Medication at home
Metformin 500mg BD
Metformin 500mg BD
Aspirin disp. 75mg mane
Aspirin disp. 75mg mane
Atenolol 25mg mane
Atenolol 25mg mane
Senna two nocte
Senna two nocte
Peptac liquid 10mls QDS
Peptac liquid 10mls QDS
Atorvastatin 40mg nocte
Atorvastatin 40mg nocte
Amlodipine 5mg mane
Amlodipine 5mg mane
GTN spray two puffs prn
GTN spray two puffs prn
Diazepam 2mg prn
Diazepam 5mg TDS prn
Furosemide 40mg mane
Ramipril 2.5mg mane
Nicorandil 10mg BD
Dicycloverine 10mg TDS
Co-dydramol 10/500mg
Pericyazine 2.5mg
Case 1 contd.
•
•
•
Husband normally fills dosette box.
Husband also been unwell (admission to hospital).
No copy of discharge summary at GP surgery.
PHARMACY TECHNICIAN
•
•
•
•
•
Copy of discharge summary taken to GP for amendments to electronic
record and prescription generation.
Discontinued medication removed from home.
Communication with community pharmacy re new dosette box and delivery.
Counselling provided on medication indications and administration.
Follow up visits / phone calls to patient.
Example Case 2
•
•
•
•
•
•
•
83 year old male
Lives with wife.
PMHx – Insulin dependent diabetes, Angina, Osteoarthritis
On 14 repeat prescription medications.
Neuropathy in hands.
Finding it difficult to access medication.
Can’t drive now and has difficulty getting on and off public transport so
wife walking to get medication.
• Dosette box arranged with local pharmacy.
• Medications will be delivered.
Summary
• Change Fund Pharmacy Service – medication review and medicines
reconciliation to support patients and carers in managing medicines
• Aim to reduce avoidable medicines-related issues in primary care and
avoidable medicines-related hospital admissions
• Challenges – to focus medication review on patients/carers who benefit
most and developing referrals to new medicines reconciliation service
• Pharmacy Input/Presentation to Carer’s Network – in line with CHCP
Carer’s strategy and innovative Pharmacy service
• Assessment – intervention database and working with CHCP to assess
impact
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
A Step Change for Carers Developing Best Practice
through the Change Fund
12 March 2013
Julie Somers, Aberdeen City Council
Sandy Reid, Aberdeen Community Health Partnership/Aberdeen City Council
41
What have Carers Told Us?
• 2010 Carer Survey (148 responses).
• Most carers live with person they care for &
want to remain at home with good quality of
life.
• We didn’t realise that “Shared/Active” Respite
was a high priority for carers.
42
43
44
45
What Challenges Did We Face?
•
•
•
•
Services were traditionally for carers or clients/patients – but not for both!
Carers didn’t think it was for them
Staff scepticism (so they didn’t “refer” their client/patients).
Overcoming Stigma (can’t do/too frail/they’ve got dementia etc).
So… we invited them to join us! …. We got media interest to ‘spread the word’
e.g. Care Home “Globetrotters” coverage in Evening Express (3 pages);
Take On Life, 7 March.
46
How Will We Evidence Impact for Carers?
• February 2013 City Voice Survey
• Keep listening to carers.
• How much did they value it e.g. turning up in
December 2012 in the snow to “Musical
Memories”.
47
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Dementia Support Service
March 2013
Dementia Support Service – Why do it?
•
Fear of dementia means that people delay in coming forward for diagnosis and support.
•
Information and support after diagnosis for those with dementia and their carers has been
poor or non-existent.
•
Services do not always understand how to respond to people with dementia and their
carers, leading to poor outcomes.
•
People with dementia and their carers are not always treated with dignity and respect.
•
Family members and people who support and care for people with dementia do not always
receive the help to protect their own welfare and to enable them to go on caring safely and
effectively.
•
Dementia diagnosis is increasing.
Dementia Support Service – How to do it?
•
The dementia support service provides advice, accurate and up to date information and
specialist support which addresses the unique needs of people living with dementia and their
carers.
•
Support is provided at home or in the local community on a short-term basis.
•
We offer advice and information that is both flexible and responsive to your needs and aim to
improve both you and your carer’s quality of life.
•
We will help you to continue to live at home for as long as possible and provide support to
your carer.
•
The service is available 24 hours a day and 365 days a year.
•
The service has it’s own blog which provides up to date information surrounding the
dementia support service and the local memory cafes.
Engagement – What did people ask for ?
•
Service users and their families had been asking for support as part of assessments carried
out.
•
Service users and their carers have had little in the way of engagement with specific
reference to dementia.
•
Staff in the Partnership had told us that they had little to refer service users to.
•
Service users had told us that they needed more support in a more flexible way.
•
Carers asked for our support with training and are trained along with the staff teams.
•
We have developed engagement through Carer Surveys, Service Questionnaires, Support
Groups, Newsletter, Twitter, Our Blog, Carers Events and through the Partnership with
particular reference to colleagues within Mental Health services.
Referral Process
Dementia
Support
Staff
Telecare
Family
Service
user
ACM
Team
GP
CMHT
Dementia Support Service
March 2013
Current Position
•
We currently have 7 Dementia Support workers across North Ayrshire with an 8th being
appointed in April.
•
We are currently developing the service on the Islands of Cumbrae and Arran in conjunction
with Health Partners.
•
We have memory café’s within every locality (6 in total).
•
The service is free and available to all age groups.
•
The service has been mainline funded away from the Change Fund for 2013/14.
•
We have provided services to over 284 people with dementia and their carers in North
Ayrshire.
•
The service has a twitter account which has over 185 followers and has “tweeted” over 902
tweets informing the audience of various articles surrounding dementia and sharing good
practice.
The Future
•
Dementia Support Service fully mainline funded from 01 April 2013.
•
1st Year Report due at 31 March 2013.
•
Further Partnership working within the role of the Keyworker.
•
Continued and ongoing delivery of the Promoting Excellence Framework.
•
Engagement work continues through support groups and through events run by the
Partnership.
•
Further informal and formal engagement with Service users, Carers and Carer’s Groups.
Come talk to us – Engage
•
Call us 01505684362
•
Tweet us @NAdementia
•
Blog www.northayrshiredementia.wordpress.com
•
Visit us
http://www.northayrshire.gov.uk/SocialCareAndHealth/HelpForAdults/DementiaSup
port.aspx
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
A Step Change for Carers: Developing
Best Practice through focusing on
personal outcomes
Emma Miller
Joint improvement Team
Outcomes as part of the whole story
• Carer engagement
• Developing practice in direct and indirect
support to carers of older people and
older carers
• Measuring the impact of direct and
indirect support for carers
The person – and their outcomes – at
the centre (IRISS)
But how the person is involved is critical
Exchange Model of Assessment
1
EXCHANGE INFORMATION
- Identify desired outcomes
2
User’s view
Carer’s view
NEGOTIATE
3
AGREE
OUTCOMES
Assessor’s view
4
RECORD
OUTCOMES
Agency’s view
‘EXCHANGE MODEL’ OF ASSESSMENT
Engagement, recording and use of information
(TP practical guide)
I am not a number!
References/Resources
Cook and Miller (2012) Talking Points: A Practical Guide, JIT
http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carerinvolvement/
Reshaping Care and Support Planning
http://content.iriss.org.uk/careandsupport/
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Carer Outcomes
Reshaping Care Improvement Network
A Step Change for Carers: Developing Best
Practice for Carers through the Change Fund
Lucinda Godfrey
The Journey
• Carer involvement
• Participative structures
• Change Plan
• Carers Workstream
Carer Outcomes
•
•
•
•
Continue to care
Improved Health and Wellbeing
Reduced Isolation
Carers identify improved
outcomes following a Carers
Assessment
Direct services
•
•
•
•
•
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•
Time 4 U
On the Spot
Early Intervention Service
Research on short breaks/respite
Carer/workforce Training
Befriending
Moving and Handling Support
How???
• Integrated
• Carers Impact Assessment
• Identification of measures
What Next?
• Review of impact
• Do carers feel the
impact??
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund
Evidencing
that it works
Capturing carers’ personal
outcomes in Midlothian
Eibhlin McHugh, Director of Communities and
Wellbeing, Midlothian Council
Julie Gardner, VOCAL
Carer as partners in Midlothian
Carers Action
Midlothian
Carer led and
linking to carer
groups
Carers Strategic
Planning Group
Representation
from all
partners
Other planning
groups eg.
Change Fund
Caring Together in Midlothian
Local Carers’ Strategy
• Developed through the planning structure
outlined and taking a whole systems approach –
everything from short breaks to employability and
income maximisation
• Key commitment in the strategy is to have an
overarching personal outcomes framework to
measure impact, alongside SMART objectives
• Not enough to count activities/interventions need
to understand what impact they have on carers
Capturing carers’ personal outcomes
Conversations with carers
• Shifting from carers’ assessments to conversations
with carers, having the right conversations with carers
is fundamental to this process
• Supporting staff to have the right conversations
- Permission to do so
- Training and reflection
• Looking at the systems around the practice
• Building this into strategic planning and thinking
Capturing carers’ personal outcomes
So what are we doing?
Realise this is a change process which will take
time, work includes:
Training programme for staff – team leaders and
front line practitioners
Different model for Short Breaks Bureau –
building practitioners’ capacity to create short
breaks
Work with Care at Home providers
Capturing carers’ personal outcomes
So what are the challenges?
• Recognising the challenges for professionals in
moving from process driven to focus on
personal outcomes
• What is a social work intervention?
• Whole systems change which will take time
and commitment to achieve
•
VOCAL – key lessons after 4
years
of
implementation…
The outcomes approach has involved a major shift in
practice – shifting the focus from tasks/resources to
focus on what we are trying to change
• Supporting this change in practice is crucial – training,
team meetings and supervision
• Revisiting and reinforcing communication skills is key
to the shift as it is an approach based on capturing and
reviewing outcomes through conversations with the
carer
• It is a whole systems change – managers, front line
practitioners , data recording and analysis – so the
systems have to support the change
VOCAL – key lessons after 4
years of implementation…
• It is crucial to separate out the conversation from the
recording tool – the recording tool should be used to record
the salient points but is not the framework for the
conversation
• Engaging staff in ongoing debate and discussion is key as this
creates a feedback loop for ongoing learning
• It takes time, perseverance and commitment – we are still
learning and improving – current focus is on data analysis
• It works - for the carer, for the organisation and for joint
planning
Personal outcomes and partnership
working
• Focus on personal outcomes has allowed us as a
carer organisation to open up the conversation
with carers and with other practitioners
• Provides a shared language which can create a
shared understanding
• Creates a shared sets of outcomes to which the
carer, and practitioners, working in partnership
can contribute
•
The personal outcomes
framework
Feeling valued and respected during their involvement in
the planning and shaping of services and support whether
through a carers assessment or through engagement in
planning structures.
• Being able to have a say in service planning and
development whether through a carers' assessment or
through engagement in planning structures.
• That their expertise is recognised in service planning and
development whether through a carers assessment or
through engagement in planning structures.
• Having positive relationships with practitioners and planners
in service planning and development whether through a
carers' assessment or through engagement in planning
structures.
The personal outcomes
framework
• Being better informed about issues linked to their
caring role.
• Improved confidence in their ability to shape services
and support.
• Improved confidence in managing their caring role.
• Improved physical and mental wellbeing
• Improved confidence in their ability to deal with the
changing relationships resulting from the caring role
• Improved social wellbeing
• Improved economic wellbeing
• Improved personal safety in relation to their caring role
Reshaping Care Improvement Network
A Step Change for Carers: Developing
Best Practice for Carers through the
Change Fund