Transcript Alderhey Childrens FT - Developing Carer Skills passportx

Developing a Carer Skills
Passport
for parents and carers of children and
young people with complex long
term conditions
Health Education Northwest
Integrated Care Demonstrator Site
Children with complex long term conditions
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2% of the childhood population
10% of hospital admissions
26% inpatient days
40% of hospital costs
Prevalence increasing by approximately 2.5%
annually
Health Education Northwest
Integrated Care Demonstrator Site
Children with complex long term conditions
• Considerable support to remain well and lead
active lives
– Dependency on enabling technologies e.g.
gastrostomies, tracheostomies, cough assist
– Complex medication regimes often 10 or more
medications by various routes
• Care needs often cannot be met by parents alone
– Continuing care packages for home and school
– Planned respite
Health Education Northwest
Integrated Care Demonstrator Site
Caring for children with complex long
term conditions
• Parents and carers trained to provide the
necessary care for their child
• No standard certificate to demonstrate
competency
• No standardised guidance as to how often
training should be updated
• Little or no formal training for medicines
administration for parents or carers
Health Education Northwest
Integrated Care Demonstrator Site
Lack of standardised training
• New care packages take longer to set up
• No standardised training or competency
assessment for parents using Direct Payments or
Personalised Budgets
• Care packages cannot be transferred across care
settings: increased risk in breakdown of care
– Governance issues
– Human Resources
• Particular difficulties with transition to adult
services
Health Education Northwest
Integrated Care Demonstrator Site
Carer Skills Passport
• For parents and professional carers of children and
young people with complex long term conditions
• Transferable across all care settings
• Assurance that parents and carers are competent to
provide safe, effective care
• Ensure a safe, effective, flexible workforce,
• Facilitates
– Person centred care
– in the most appropriate setting,
– continuity across care settings
• Reducing length of stay
Health Education Northwest
Integrated Care Demonstrator Site
Key deliverables
• A comprehensive training needs analysis
• A portfolio of standardised care competencies
supported by Key Partners
• A template “honorary” contract for carers in-reaching
into an inpatient setting
• A prototype Carer Skills Passport
– Can be used by parents or carers
– Core and additional competencies, assessment and
training requirements
– Transferrable across all care settings
• Directory of accredited trainers
Health Education Northwest
Integrated Care Demonstrator Site
Impact analysis
• Retrospective case study approach to evaluate
the potential benefit of introduction of the
Carer Skills Passport on
– Requirement for emergency admissions
– Length of stay
– Transfer of care
– Readmission within 91 days
– Continuity across care settings
Health Education Northwest
Integrated Care Demonstrator Site
Progress to date
• Nurse facilitator recruited
• First wave of competencies agreed
– Suction – there are detailed competencies already available but these need to
be cross agreed with adult services
– Oxygen
– Saturation monitoring
– Resuscitation – including modified resuscitation for children with Personal
Resuscitation Plans and/or tracheostomies
– Nebulisers
– Buccal medication
– Confidentiality, raising concerns, professional boundaries – this will be
significantly enhanced by filmed scenarios/simulation
• Appropriate training materials, and training model identified
• Training needs analysis in progress
• Impact analysis in progress
Health Education Northwest
Integrated Care Demonstrator Site
Metric improvements
• Impact analysis of the potential benefit of introduction
of the Carer Skills Passport on
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The requirement for unplanned admissions
Length of stay
Transfer of care
Readmission within 91 days
Continuity across care settings
Patient safety
• Cohort of children and young people registered with a
Liverpool GP and eligible for NHS Continuing Care that
accessed Alder Hey Children’s Hospital as inpatient in
2014
Health Education Northwest
Integrated Care Demonstrator Site
Emerging themes
• Extremely high level of interest in the project
– Providers
– Commissioners
– Patients and parents
• Significant differences in training and skills
– Different techniques and terminology
– Little or no training for parents
• Clinical Governance issues
– Human Resources Honorary Contracts
– Expectation of care provided by parents versus carers
Health Education Northwest
Integrated Care Demonstrator Site
Hannah Rose
Young person with Personal Health Budget
• “…I was … worried about making sure my
personal assistants were trained in all my care
needs. I was informed that the amount of
training required was at my discretion …This
worried me … I would have appreciated
having a suitably qualified person to assist me
through the process of training that could sign
my PA's off as competent. Nobody wanted to
take responsibility for this.”
Health Education Northwest
Integrated Care Demonstrator Site
Karen: mother of Katie Ellen
• “I think the training passport is a brilliant idea …it
would most definately cut down a lot of …
confusion between community's staff, parents
and carers …meaning the whole package process
runs more smoothIy. We find it frustrating when
we come into hospital or new carers are trained
to do a procedure a different way to how we
were taught. Parents and indeed grandparents …
have … no refreshers , updates etc. [families
should] have regular updates and reviews”
Health Education Northwest
Integrated Care Demonstrator Site
Karen: mother of Katie Ellen
• “I feel strongly that … carers should follow the
child if that be hospital or hospice as [when] we
have gone long periods without contact with
carers … my child missed her … the carer … had to
have re training as things had changed so much …
a trust has been built up that needs to be
maintained … the carers need stability in terms of
jobs … one of our carers didn't like the fact she
wasn't seeing Katie Ellen for weeks on end due to
hospital admissions and …. left”
Health Education Northwest
Integrated Care Demonstrator Site
Round table discussion
What are the Barriers and Facilitators
for implementation of the Carer Skills
Passport in your area?
Health Education Northwest
Integrated Care Demonstrator Site