Social care avoiding emergency admissions

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Social care avoiding emergency admissions

• Cancer reform strategy care in the most
• appropriate setting
• 21 October 2008
• Simon Williams
• Director of Community and Housing
• London Borough of Merton

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For want of a nail
Chair raiser breaks on saturday
Person cant get in and out of chair
Cant get a Chair raiser
No solution found In 4 hours
Care agency Cant cope
So person Taken to AE
Due to lost Mobility goes to ICT bed
Person admitted, Acute bed for 5 days
Home, less Confident And mobile
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Contents

• Taking a whole population strategic approach
  learning from POPPS
• Intervening at the key points in urgent care
• Case study Integrated Care Co-ordination Service
  in Brent
• Case study Hospital Discharge/Urgent Care
  Service in Merton
• Making this happen

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Partnerships for Older People Projects

• Funded by DH
• Organised by CSIP (Care Services Improvement
  Partnership)
• Aims
• -Provide person centred and integrated
  responses for older people
• -Encourage investment in approaches that
  promote health, wellbeing and independence for
  older people
• -Prevent or delay the need for higher intensity
  or institutionalised care.

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Whole population prevention model POPPS model
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POPP evaluation
The POPP programme has two waves of pilot
sites. Nineteen pilot sites were established in
May 2006 and have developed 193 projects. A
further 10 pilot sites came on stream a year
later (May 2007) with 52 projects. The pilots are
delivering a diverse range of interventions aimed
at promoting independence for local older people
in line with local needs
The national evaluation is being carried out by a
partnership of the University of Hertfordshire,
Personal Social Services Research
Unit, University of Keele, John Moores University
and University College London.
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Encouraging early results, but use figures
carefully
With these caveats in mind, the early findings
are When compared with non-POPP sites, there
are indications that POPP pilot sites appear to
have a significant effect on hospital emergency
bed-day use. The results show reductions
against trend that would produce an average
potential cost saving in the order of for every
1 spent on POPP, 1 will be saved on hospital
bed-days. Despite such savings, the challenge
for the POPP pilot sites will be in extracting or
removing such savings from the secondary care
contracts. Future cost analysis will explore
older peoples reported levels of quality of life
alongside any data on overarching
cost-effectiveness. This will ensure that any
benefits to individuals resulting from their
involvement in the POPP programme are captured.
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Intervening in DH urgent care model
Identification of likely users Access
arrangements
Assessment arrangements
Phone access
Walk in access
Consistent assessment of urgent care need
Emergency ambulance response
Urgent face to face response
Booked appointments
Advice and self care
Service response
Major illness Specialist care
Emergency social Care and crisis intervention
Resuscitation Major trauma
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Identification and access

• Shared list of those at top of care triangle
• Shared contingency plans
• Single or few access points for referral and self
  referral
• Where more than one point, easy and automatic
  ways to be signposted to right area
• Build on existing 24/7 capability, e.g. telecare

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Assessment

• Screening/eligibility need to pull people into
  admission alternatives and find solutions avoid
  the not me response
• Requires local mutual trust between councils, NHS
  and others more important than waiting for the
  perfect system
• Must look at whole patient, inc housing, family,
  mental health
• Shared approach to risk taking

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Service response

• Whats the simplest thing to fix?
• Use of contingency planning/advanced directives.
  Part of my space on health e-records?
• Practical
• Get in service quickly, provide for 6-14 weeks,
  then review
• Use promoting independence principles

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Integrated Care Co-ordination Service in Brent

• Targeted for those 65 at risk of admissions
• 10 care co-ordinators, cost of 750k
• 500 case referrals (40 from GPs) pa. (1500
  each)
• Can commission range of services from
  NHS/Council/voluntary sector
• Annual net savings to date of 1-3.5m in reduced
  admissions and AE attendances. Nearly all of
  this is for NHS

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Provisional findings from ICCS
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Hospital discharge/crisis care in Merton

• Not evaluated as POPP pilot, but what works
• Starts care immediately and parallel tracks full
  assessment
• Fast access to equipment, environmental, telecare
  and housing services
• Trialled falls service with ambulances
• Attitude is key Needless days in hospital are
  affront to service
• Among lowest DTCs in country

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Making collaboration happen

• Are social care around the key table (e.g. Urgent
  Care Network)?
• Is there openness about money? Are there aligned
  incentives and clear apportionment of risk and
  benefits?
• Is shared planning based on clear business cases
  with measurable benefits?
• Are professional groups prepared to give and take
  to make these benefits happen?
• Is all this based on the experience and views of
  local service users and carers?