Transcript Rotherham`s Social Prescribing Services

Rotherham’s
Social Prescribing Services
Sarah Whittle – Assistant Chief Officer
Wendy Allott – Deputy Chief Finance Officer
Rotherham CCG
HFMA
18th November 2015
1
Social Prescribing Service:
• Connects people with long term conditions,
referred through case management teams, to
sources of support in their community
• 5 VCS Advisors, employed by VAR, linked to 35
GP practices, work with referred people to find a
service or activity that meets their needs
• 26 VCS organisations receive funding to provide
a menu of 33 different services and activities
• Provides a gateway to a wider pool of VCS
services that are not directly funded through
social prescribing, predominantly provided by
local community centres and groups
• Extended to a pilot project working with RDASH
mental health teams. Pilot started 1st April 2015
Why are we doing it?
Strengthening individuals, strengthening communities
• Huge efficiency challenge - £70m over 4 years
• Increasing numbers with long term conditions
• Above average unplanned hospital admissions
• Recognition that patients need support with non-medical issues - creates a
wider range of options for primary care and patient
• Shift of focus to prevention and early intervention - increases independence,
resilience of individuals and communities
• Supports integration and personalisation
• Doing things differently – ‘more of the same’ is not an option
Outcomes for patients and carers
• Quantitative and qualitative evidence points to a range of
improvements for patients and carers:
 improved mental health
 greater independence
 reduced isolation and loneliness
 increased physical activity
 welfare benefits
• Social Prescribing represents an important first step to engaging
with community based services and wider statutory provision
• Without Social Prescribing many patients and carers would be
unaware of or unable to access these services
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Social Prescribing - referrals
to services
Fire Safety Assessment
Rehabilitation services (NHS)
Library services (Home…
Assistive Technology
Carers Assessment
Community Activity -…
Home Exercise
Information and Advice -…
24/7 Community Alarm
Community Exercise…
Counselling
Social Care Assessment
Information and advice - Other
Fire Safety Assessment
Community Activity - Exercise
Dementia Support Worker…
Advocacy
Carer Respite
Enabling (one to one…
Complementary Therapies…
OT assessment
Community Link Worker…
Community Transport
Befriending at home
Information and Advice -…
Community Activity -…
0
 5865 referrals out to VCS
services (4571 to commissioned
services 1294 to non
commissioned services)
 3627 referrals in to SPS
 1487 referrals out to non-VCS
 2058 signposts
 35 GP practices
500
1000
1500
5
Evaluation by CRESR, Sheffield Hallam
939 clients included in evaluation.
Non-elective Inpatient Admissions:
• Finished Consultant Episodes (FCEs): 7 per cent reduction
• Inpatient Spells: 11 per cent reduction
• Bed Days: no statistically significant change
A&E Attendance:
• All patients: 17 per cent reduction
This data is for all patients and doesn't tell the whole story: more detailed
analysis shows marked differences between different types of patients, in
particular:
• By age
• By level of engagement with SPS
6
When patients over the age of 80 are excluded from the analysis - reductions
are greater. (513 patients remaining)
Non-elective Inpatient Admissions:
• Finished Consultant Episodes (FCEs): 19 per cent reduction
• Inpatient Spells: 20 per cent reduction
• Bed Days: no statistically significant change
A&E Attendance:
• All patients: 23 per cent reduction
• Highlights importance of ensuring SPS is appropriate for patients who are
referred
• Impact of SPS on older (80+) patients needs to be understood through other
measures
7
When patients continue to access VCS services after initial service has
ended much larger reductions are now seen to be evident
Non-elective Inpatient Admissions:
• Finished Consultant Episodes (FCEs): 53 per cent reduction
• Inpatient Spells: 51 per cent reduction
• Bed Days: 43 per cent reduction
A&E Attendance:
• All patients: 35 per cent reduction
Highlights the importance of sustained engagement with VCS services
8
Cost/Benefits
 The service costs £1,171 per patient substantively engaged
 Reductions in in-patient and A&E lead to savings of:
9
Wellbeing Improvements
• 83% of patients made progress in at least one outcome area
Proportion of low scoing patients making progress
Percentage of low scoing patients
80
70
70
60
65
59
68
62
58
50
56
52
40
30
20
10
0
Feeling
positive
Lifestyle
Looking
after
yourself
Managing
Work,
symptoms volunteering
and social
groups
Money
Where you Family and
live
friends
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It is a win/win!!
 The CCG benefits, as it addresses inappropriate admissions.
 The GP’s benefit, as it gives them a third option other from
referral to hospital or to prescribe medication.
 The Voluntary and community sector benefit, as it supports their
sustainability.
 And most importantly - the Patient and Carers love it as it
improves quality of life, reduces social isolation and moves the
patient from dependence to independence.
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Key learning Points
• The need for key contacts, building and maintaining relationships and
champions – get the CCG, GP’s and VCS on board
• Leap of faith – the importance of time and scale
• Role of lead bodies – implications for contracting and micro –
commissioning
• Be prepared to be challenged and to challenge professional
boundaries
• The vital role of KPI’s and quantative as well as qualitative
independent evidence to argue the case
12
Case Studies
Three broad outcome themes emerged:
 Improved well-being: in particular mental well-being, anxiety and depression,
personal confidence and self-efficacy.
"If it wasn’t for the group, I might not be here now because I’d been that down and
depressed….just getting out of the house has helped me with the fear, anxiety…talking to
people lifts your mood and forget about problems at home."
 Reduced social isolation and loneliness: linking people with limited mobility
and social contact with the wider community.
"It’s someone coming to talk to me and with me and they acknowledge me…because you
can sit and stare at space and people take no notice whatsoever…I feel like I belong to a
society."
 Increased independence: linked to improvements in physical health. Includes
undertaking in independent social and community action.
"I was on my own, I was totally on my own…Each day I’m getting better and better…before
I could hardly walk…I’m feeling very positive, each day I get up and I just can’t believe how
much I’ve come on."
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Social prescribing Mental Health
To help service users overcome the barriers which
prevent their discharge from secondary mental
health care services. The programme helps
service users build and direct their own packages
of support, tailored to their specific needs, where
they are encouraged to access services in the
community and develop their own peer-led
activities.
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Aims and Objectives
• Creating opportunities for Mental Health service users
(cluster 7&11) to sustain their Health & Wellbeing outside
secondary Mental Health Services
• Creating more capacity within secondary Mental Health
services
• Creating efficiencies within Mental Health services.
15
• Cluster 7: This group suffers from issues associated with long
term anxiety and depression or other non-psychotic
disorders. They will have received treatment for a number of
years and although their symptoms are improved and stable, as a
result of long term ill-health they are likely to have a level of social
disability that effect their day to day functioning, and leads them to
be over dependent on others.
• Cluster 11: This group will have a history from a psychotic
symptoms that are currently controlled and causing minor
problems if any at all. They are likely to be experiencing a
sustained period of recovery, but require support to regain
confidence with day to day life skills, such as sustaining
meaningful relationships, and re-entering the work place. They
may also have some long term dependence issues.
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Aims Of The Service
•
•
•
•
Increase social activity
Reduce social isolation and dependence
Improve confidence and self esteem
Focus on quality of life, positivity and
happiness
• Support healthy and sustainable
discharges from services and create
capacity
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Social Prescribing for Mental Health Pathway




1:1 Keywork
Peer support – group
Peer support – individual
Specialist support/advocacy
Funded VCS
Services
Wellbeing
Advisor
Review
and dormant
Care plan issued
Transition
Group
 Guided
Conversation
 Menu of
Options
 Recovery Plan
Weeks 1-6
Weeks 7-10
Weeks 11-18
Weeks 19 - 22
Self Care
Sustainable
Activity
Community
Review and
discharge (SPS)
 Cluster 7
 Cluster 11
 Discharge
Ready
SPS
Joint
RDASH
Weeks 23 - 26
Positives
• A positive and productive partnership has been developed
between RDASH and VAR
• We have a service that empowers teams to be more recovery
focussed
• The individual outcomes of participants so far has been well
beyond our expectations, and in some cases truly remarkable
• The opportunities that have been resourced via the CCGs
commissioning of voluntary groups are diverse, exciting and
delivered with infectious enthusiasm!
• We have no doubt that this is one of the best developments in
service provision in a long time – it works!
19
Challenges
• We have underestimated the cultural shift required in both
staff and service users to embrace the service and
understand the opportunity that it provides – this has meant a
slower referral rate than we hoped for but we are working
hard on this
• The process of preparing service users for this new journey
can be labour intensive, and this has created work pressures
• There are still barriers to moving on, regardless of rate of
recovery (117, depots etc)
20
David
• Chronically anxious for most of his adult life. Fears death daily,
becomes overwhelmed easily. Has tried all available treatments
• “David, you’re always going to be anxious, why don’t we focus on
having a good quality of life despite your anxiety?”
• Through social prescribing David rediscovers a love of art, and
begins an over 50s social group - “ I can’t explain to you why, but
for three hours I was loving it so much, I forgot to be anxious”
• At his 10 week review, he encourages me to cut short my visit –
“I don’t want to throw you out, its just that I don’t want to be late
for my group”
• Discharge: “You hit the nail on the head when you said the words
‘quality of life’, that’s what I’ve got now”
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Helen
• Gave birth to a severely disabled daughter at the age of 16.
• Cared for her 24/7 until she had no choice but to put her in
to care 20 years later.
• Having struggled with her mood throughout – this decision
plunged her further in to despair.
• Taken multiple medications over the years, and is still on a
vast regime.
• House has been repossessed because husband is a
gambling addict.
• Self – esteem is non existent and she is overwhelmed by
guilt.
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Helen (cont)
• Persuaded Helen that it was time to invest in herself –
and she agreed to be referred. After a positive initial
meeting – VAR advisor informs RDaSH that second
meeting was less positive and she was not confident she
would get to the chosen group. VAR Advisor decides to
take her.
• Helen reluctantly attended ‘Radiance and Relaxation’
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Helen (cont)
• 10 Week Review: “ I was terrified about going back on my
own – but I had loved it, so I had to go”
• “ There are steps up to the building, by the time I got to the
top I was so anxious that I couldn’t feel my legs - but I did it,
and I’ve kept going “
• Discussed with Helen what she might do going forward.
“ I want to be a helper at the group – I want to be
the person at the top of the steps smiling, telling
people that they don’t need to be frightened about
coming in”
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