FAST ACCESS TO COMMUNITY SERVICES

1
FAST ACCESS TO COMMUNITY SERVICES Cheltenham
Tewkesbury
Caroline Holmes Assistant Director Gloucestershire
PCT/Adult Social Care
2
In the Beginning..

• Adult Social Care Duty System
• Rapid Response Teams (Physio/OT linked to AE)
• Physio attached to Adult Social Care
• The beginnings of Intermediate Care (Step
  Up/Step Down Beds and Flats)

3

• Exclusive Rapid Response but not very rapid...
• Duty by phone
• Limited Intermediate Care
• Too many entry points to Intermediate Care
  Services

Challenges
4
DEMOGRAPHIC GROWTHWhat does this mean for
services?
SourcesE W based on 2003 projection from
Government Actuaries DeptGloucestershire based
on 2003 projection from AGW
5
Now
6
FAST Outcomes for 2005-06

• OBJECTIVES
• To prevent
• hospital
• admissions
• To prevent
• untimely
• admission to
• long term care
• To act as
• an in-reach
• service for
• hospital crises

7
The Service User Experience
There has been such a marked improvement in her
both physically and mentally thank you again
Thank you all for what you have done for me, It
has helped so much and I am sure I will be back
to normal very soon
Glad to say she is doing well and is able to get
around just the same as before. You all do a
wonderful job
I thank God there was a place available for me
when I needed it.. I cannot thank you enough for
all your help
8
Our Experience

• Fluctuating Waiting Times for SW and OT
• Lack of nursing input to FAST
• FAST highly regarded by Acute Trust
• Need to support people with Long Term Conditions

9
Out of Hours Care Co-ordinator Project

• Initial pilot project in Cheltenham and
  Tewkesbury locality was extended across the
  county on 14th August 2006
• Care Co-ordinator is based at Ambulance Hub
  between 5.00 11.00pm weekdays, and between
  9.00am 11.00pm weekends and Bank Holidays
• Care Co-ordinator can arrange services such as
  emergency home care, or short-term respite care
  following assessment by the clinician making the
  referral
• During the 28 weeks the pilot ran in Cheltenham
  Tewkesbury, 73 unnecessary hospital admissions
  were prevented and 207 contacts were made to the
  service
• Project demonstrates effective joint working
  between Primary Care OOH services, Community
  Adult and Social Care and Ambulance Service

10
Outcomes
11
Next steps Phase 1- Autumn 2006

• Principles
• Reduce waiting times for
• Assessment.
• Complete timely reviews
• That are needs led.
• Everyone is
• considered for IC
• Ensure proportionality
• of Care Provision
• Ensure efficient management of
• Community Care Budget
• spend via a focus on
• rehabilitation and prevention

• All initial assessments within 5
• working days
• Limited, robust assessment.
• Specialist assessment when
• required
• People with short term needs
• Will receive a limited
• Assessment and allocation
• to progress assessment for
• services
• Intermediate Care is the bridge
• between FAST and Long
• Term Conditions work

12
Phase 2 March 2007

• 20 MDTs
• Complex cases for health and social care
• Complex with nursing needs case managed
• by Community Matrons
• Other complex cases managed by
• Key workers in MDT (appropriate discipline)

40 FAST Single Point of Access for all
District Nurse and Adult Social Care
referrals Helps manage demand for nursing care

• 40 Intermediate Care
• Now to include District
• Nurse first contact work
• (6 week case load)
• Integrated pool of
• generic support workers

Dom Rehab
13
Challenges

• Capacity in home care
• Modernisation of District Nurse Service
• Co-location and practicalities
• Increased demand from bed closures by March 2007

A problem shared is a problem halved!