Transcript Community Learning Disability Teams – National Survey

Community Learning Disability
Teams – National Survey
Debra Moore
Managing Director
Debra Moore Associates
www.debramooreassociates.com
01723 371446
07950 333884
[email protected]
Busy landscape
• Lots of health related policy and guidance
impacting on the role and function of CTLD’s
• CTLD’s the ‘frontline’ of provision
• Feeling the need to respond to a range of
initiatives such as Mansell 2, Michaels Report,
DRC etc etc
Mission impossible?
Background to the research
• Development
programme for
Community Learning
Disability Teams based
around the 6C’s Model
• Revealed information
about current ‘state of
play’ and raised
questions about future
role and modernising
the workforce
Background to the research
…what people were saying….
• Need to reduce health inequalities and supporting the delivery
of VP objectives e.g. HAP’s etc
• Need to support mainstream NHS including mental health
• Reducing out of area placements
• ‘Personalisation’
• Safeguarding
• Changes in demography
• ‘Boundaries’ between teams e.g. children & older people
• Supporting criminal justice system
• Workforce issues
• Financial pressures
• Some concerns about choice and quality of provision
Pressure to ‘rescue’
• In some localities the
community based team are
increasingly ‘rescuing’
situations created by
‘specialist’ social care
providers (often ‘importers’)
• Also ‘recovering’ problems
created by changes in other
parts of the system e.g. day
services - the ‘buck stops
here’ position
• Safeguarding
‘Being painted into a corner’
Background to the research
‘old chestnuts’
• Issues raised about time spent on health
related activities and social work
activities as opposed to ‘care
management’
• Questions about the content of the work
of individual CTLD members & blurring
of roles within the team
• Concern about capacity for ‘face to face’
contact and time spent on admin/IT and
in meetings
• Concern to make sure that the CTLD is
part of a wider care pathway
Methodology
• A brief electronic survey
• A number of key questions generated by
emergent themes from work with CTLD’s
• Self selecting participants
• Survey link posted on various professional
websites and out via networking groups etc
• Information was collected over a x week
period
• 500+ responses
• Gleaned information about social work but
today focus on health professionals and in
particular nurses
What percentage of your working week is spent
across the following 4 areas?
• Care Management
• Admin & IT
• Face to face contact
with service users
• Review meetings
Other questions
• If A&T service in locality or behavioural
support team
• If strategic health facilitator in locality
Will be ‘mapping’ provision onto survey findings
What percentage of your working week is spent
on care management?
0-25%
25-50% 50-75% 75-100%
75%
15%
8%
2%
Social 34%
Worker
91%
AHP
48%
13%
5%
7%
2%
0%
Nurse
Care Management - nurses
• Most nurses who responded (75%) said they
spent up to a quarter of their working week
on care management activities
• 10% nurses who responded spent over 50% of
their working week undertaking care
management activities
What percentage of your working week is spent
on face to face contact with service users?
0-25%
25-50% 50-75% 75-100%
38%
43%
17%
2%
Social
Worker 80%
14%
5%
1%
27%
49%
21%
3%
Nurse
AHP
Face to face contact - nurses
• Most nurses who responded (43%) said they
spent between 25-50% of their working week
in face to face contact with people who use
services
• 38% of nurses said they spent up to a quarter
of their working week in face to face contact
with service users
• Around 19% spent over half of their working
week in face to face contact
What percentage of your working week is spent
on administration and IT?
Nurse
0-25%
25-50% 50-75% 75-100%
38%
47%
14%
1%
34%
45%
9%
48%
8%
0%
Social
Worker 12%
AHP
44%
Admin & IT - Nurses
• Nearly half of the nurses who responded said
they spent between 25-50% of their working
week undertaking admin and IT duties
• Not clear how much of this is related to
inputting client information into electronic
care planning systems etc
• Not sure how much time is due to a ‘poor fit’
with IT system or how much due to poor
‘technical’ skills
What percentage of your working week is spent
in review meetings?
0-25%
25-50% 50-75% 75-100%
81%
17%
1.5%
0.5%
Social 74%
Worker
23%
3%
0%
8%
0%
0%
Nurse
AHP
92%
Health professionals – what percentage of your
working week spent on health action planning &
health facilitation?
Less
than
10%
Nurse 29%
1025%
2550%
5075%
75100%
32%
25%
12%
2%
56%
30%
9%
4.5%
1.5%
AHP
Health Action Planning and Health
Facilitation
Health professionals – what percentage of your
working week spent on training and supporting
mainstream health professionals?
Less 10-25% 25than
50%
10%
11%
Nurse 49.5% 36%
AHP
57%
28%
15%
5075%
75100%
3%
0.5%
0%
0%
Regional variations – face to face contact - nurses
Less than
10%
10-25%
25-50%
50-75%
75-100%
North East
0%
0%
75%
25%
0%
Y&H
0%
39%
44%
14%
3%
North West
10%
35%
40%
15%
0%
East Mids
3%
24%
41%
29%
3%
West Mids
0%
47%
35%
12%
6%
Eastern
22%
33%
45%
0%
0%
South West
32%
42%
16%
10%
0%
London
5%
50%
35%
10%
0%
South East
3%
19%
56%
22%
0%
Some regional variations
Face to face contact
• In the SW region 74% of nurse respondents
said they spend less than a quarter of their
working week in face to face contact with
service users
• In Yorkshire and Humber it was 39%
• In the North East the answer was 0%
• Need to investigate why
Some regional variations
Care Management
• In the Eastern Region over a third of nurse
respondents spend between 50-75% of their
working week undertaking care management
work
• In the East Midlands Region more than two
thirds of nurses spend less than 25% of their
working week undertaking care management
work
Integrated teams – what difference did
it make in relation to the 4 key areas?
• No discernable difference across care management,
face to face contact and reviews
• However the amount of time spent on administration
and IT was higher for those who were in an integrated
team
Probably raised as many questions as
answers
• Why are there such big variations
between regions and how does this
effect outcomes?
• What does admin & IT consist of?
• If health professionals reduce care
management activity what will be the
implications?
• If health professionals focus on
‘health related activity as a first
priority’ what will be the outcomes?
Being bold
Next steps
• More detailed analysis of survey
• Drilling down on emergent
themes
• Examine patterns of provision
e.g. A&T, Out of Area placements
etc
• Consider how we map against
outcomes such as health checks,
numbers of HAPs etc
• Discussion with commissioners
• Inform CTLD Development
Programme
• Publish findings