reshaping care improvement network a step change for carers: developing best practice for carers...

Reshaping Care Improvement NetworkA Step Change for Carers: Developing Best Practice for Carers through the

Change Fund

Jean MacLellan OBEHead of Adult Care and Support Division


Change Fund


Change Fund

Ruth ForbesCarer

VOCAL Midlothian


Change Fund


Change Fund

Michael Matheson MSPMinister for Public Health


Change Fund


Change Fund

A Step Change for CarersReshaping Care Change Funddirect and indirect support

12 March 2013Thistle Hotel, Glasgow

Moira OliphantCarers Policy, Scottish Government

Manifesto Commitment/Guidance

• …we will ensure that from 2012-13 onwards at least 20% of the Change Fund spend is dedicated to supporting carers to continue to care

• The optimum way of supporting carers is through a planned combination of direct carer support and support for the cared-for person

Why it matters

• Direct support to carers recognises their role as care providers and ensures that they have the resources to enable them to continue in their caring role

• Indirect support focuses primarily on the needs of the older person; direct support improves wellbeing

Not one or the other

• Good quality, timely and reliable services for the cared-for person indirectly support the carer, often leading to a reduction in stress

• Carers still require an assessment of their own needs – appropriate and timely intervention

Indirect support

• Not all older people have carers• Degree of interpretation• Examples:

- aids and adaptations; specialist palliative nurses for end-of-life care; re-ablement services; telecare

• Additionality

Direct support

• Provided directly to the carer, often following a carer’s assessment

Calculations: Indirect Spend

• % older people who have carers• The impact the project will have for carers:

determine the % that supports older people and the % that supports carers

Calculations: Indirect SpendA service or intervention where the carer is not the main recipient but the

service or intervention aims to have a significant and measurable positive impact for the carer in their caring role. Projects are included where 25% or above of the project is directed to have a significant and measurable impact on carers. Criteria for considering the degree of benefit for carers:

- proximity of the carer to the intervention; time benefit for the carer; degree of involvement of the carer in the design and planning of the service/intervention; service/intervention helps raise staff awareness of the needs of carers.

Outcomes

• The extent to which carers are better supported and the difference made to their lives and to the lives of the person or people they care for and the wider family/community

Thank you!Moira OliphantCarers PolicySt Andrew’s [email protected]: 0131 244 3503

mailto:[email protected]


Change Fund

Carers of East Lothian

Short Breaks Servicefor Older People and their Carers

Time well spent!

Aim

To support people in a caring situation to arrange breaks that are as beneficial as possible for both the

carer and the older person they care for

Background

Pilot Project Dec 2011-May 2012

Short Breaks Service began June 2012

Officially launched at the COEL AGM September 2012

The Short Breaks Service

• Supportive discussions where both the carer and the person they care for can think about their needs

• Research into short break opportunities• Negotiations with short break providers• Advice re social work provision• Grant applications • Referrals to other services• Transport options• Mobility equipment

Also…Support with the emotional issues around organising breaks

The Short Breaks ServiceMore time apart…Could the older person be left on their own safely for a short period of time?

Would the older person benefit from spending some time with other people e.g. at a day service or with a support worker?

Would the older person prefer to be cared for at home or away from home while their carer has a longer break?

Quality time together…Would the carer and the person they care for like to have a break together but with other people undertaking the caring responsibilities?

Outcomes

• Carers will find their caring roles more manageable

• Older people in need of care will be able to stay in their own homes for a longer time

• Carers and the people they care for will maintain a happier and healthier relationship

• Carers and older people will feel valued and supported

Features

Plus Points• Continuity for people using

the service• A holistic approach• A supportive environment

where caring issues are understood

• Easy access, quick response times

• A dedicated service

Challenges• No budget for breaks• Not a one-stop shop, some

assessments and services still accessed through social work

• Small scale – one worker with administrative support

Work in Progress

• Ongoing evaluation of the service to respond to older people and their carers’ comments and requests.

• Support for people managing their SDS individual budgets for short breaks/respite

• A streamlined service to inform carers about spare capacity/short break opportunities in care homes

• A growing membership with increased power to negotiate favourable rates with holiday providers

• Involvement in shaping future short break provision

• Organised days out for carers as a break from caring

The Short Breaks Service

Thank you for your time

Any questions?


Change Fund

Pharmacy Service role in supporting informal carers

Inverclyde Pharmacy Change PlanNatalie O’Gorman

Background

• The predicted change in demographics will place a significant strain on health, social care and support services.

• Polypharmacy in the elderly is increasingly being recognised as a major issue with over 40% of over 65 year olds now on >5 medications.

• Drug-drug interactions, medication errors, non compliance and adverse drug reactions are all consequences of polypharmacy.

• Adverse drug reactions have been implicated in 5-17% of all hospital admissions.

• In 2009, NICE reported that approximately 50% of all medicines prescribed for long term conditions are not taken as recommended.

Background

• Previous local work has shown that medication review supports high quality, safe, clinically effective and cost effective prescribing.

• Follows a previous local audit of medication reconciliation at the primary/secondary care interface showing that improving communication helps reduce discrepancies.

• Assisting patients with managing their medications is now a significant part of the role of an informal carer.

• There is a need to support informal carers by providing them with information and advice on the use and administration of medication.

Pharmacy Service• 0.8 WTE Prescribing Support Pharmacist • Medication Review as a domiciliary visit• For patients over 65 years on polypharmacy/ high risk medicines to reduce

avoidable medication–related issues in primary care and hospital admissions for avoidable medication-related issues

• 0.6 WTE Prescribing Support Technician• Medicine Reconciliation. • Compliance needs assessment.• Face-to-face medicine concordance and medicines reconciliation reviews for

recently discharged patients over 65 years and to liaise with other services to ensure changes during admission are implemented in community and to support elderly patients to manage their medicines in their own home.

• Based within the Prescribing Team, Port Glasgow Health Centre.

How does the service support informal carers?

• Gives carers the opportunity to ask questions about the conditions and medicines of the individual they care for.

• Assists carers at the point of discharge by communicating with the hospital ward, GP practice and community pharmacy to ensure correct and timely follow on prescriptions and supply.

• Reduces polypharmacy and improves medicines safety through medication reviews to ensure that each medication has a current and valid indication, all monitoring is up to date and where appropriate, reduce the dose or dosing frequency of the medication.

….• Reduces confusion and potential harm through the isolation of expired,

discontinued and stockpiled medications for return to a community pharmacy.

• Aids compliance with medication by recommending formulation changes. The service can review all the medications in a patient with a swallowing difficulty and where possible recommend changes to a licensed soluble or liquid preparation or give guidance on what medications can be crushed and how to correctly administer them.

• Supplies and provides counselling for a variety of compliance aids e.g. reminder charts, dosette boxes, eye dropper aids and inhaler aids which promote independence in the patients they care for.

….• Links with and sign posts carers to other services e.g. community

pharmacy collection and delivery services, social work, community alert alarms, sensory impairment.

• ?? Offer medication review to carers themselves.

Example Case 1

• 72 year old female.• Lives with husband.• 6 week admission (HDU).• 11 changes to medications.• Significant changes to antidepressant

and anxiolytic medication.• Discharged with one week supply of

medication in a dosette box.• Discharge Rx posted to GP from ward.

Discharge Medication Medication at home

Metformin 500mg BD Metformin 500mg BD

Aspirin disp. 75mg mane Aspirin disp. 75mg mane

Atenolol 25mg mane Atenolol 25mg mane

Senna two nocte Senna two nocte

Peptac liquid 10mls QDS Peptac liquid 10mls QDS

Atorvastatin 40mg nocte Atorvastatin 40mg nocte

Amlodipine 5mg mane Amlodipine 5mg mane

GTN spray two puffs prn GTN spray two puffs prn

Diazepam 2mg prn Diazepam 5mg TDS prn

Furosemide 40mg mane

Ramipril 2.5mg mane

Nicorandil 10mg BD

Dicycloverine 10mg TDS

Co-dydramol 10/500mg

Pericyazine 2.5mg

Case 1 contd.• Husband normally fills dosette box.• Husband also been unwell (admission to hospital).• No copy of discharge summary at GP surgery.

• Copy of discharge summary taken to GP for amendments to electronic record and prescription generation.

• Discontinued medication removed from home.• Communication with community pharmacy re new dosette box and delivery.• Counselling provided on medication indications and administration.• Follow up visits / phone calls to patient.

PHARMACY TECHNICIAN

Example Case 2

• 83 year old male• Lives with wife.• PMHx – Insulin dependent diabetes, Angina, Osteoarthritis• On 14 repeat prescription medications.• Neuropathy in hands.• Finding it difficult to access medication.• Can’t drive now and has difficulty getting on and off public transport so

wife walking to get medication.

• Dosette box arranged with local pharmacy.• Medications will be delivered.

Summary

• Change Fund Pharmacy Service – medication review and medicines reconciliation to support patients and carers in managing medicines

• Aim to reduce avoidable medicines-related issues in primary care and avoidable medicines-related hospital admissions

• Challenges – to focus medication review on patients/carers who benefit most and developing referrals to new medicines reconciliation service

• Pharmacy Input/Presentation to Carer’s Network – in line with CHCP Carer’s strategy and innovative Pharmacy service

• Assessment – intervention database and working with CHCP to assess impact


Change Fund

41

A Step Change for Carers Developing Best Practice through the Change Fund

12 March 2013

Julie Somers, Aberdeen City CouncilSandy Reid, Aberdeen Community Health Partnership/Aberdeen City Council

42

What have Carers Told Us?

• 2010 Carer Survey (148 responses).• Most carers live with person they care for &

want to remain at home with good quality of life.

• We didn’t realise that “Shared/Active” Respite was a high priority for carers.

46

What Challenges Did We Face?

• Services were traditionally for carers or clients/patients – but not for both!• Carers didn’t think it was for them• Staff scepticism (so they didn’t “refer” their client/patients).• Overcoming Stigma (can’t do/too frail/they’ve got dementia etc).

So… we invited them to join us! …. We got media interest to ‘spread the word’ e.g. Care Home “Globetrotters” coverage in Evening Express (3 pages); Take On Life, 7 March.

47

How Will We Evidence Impact for Carers?

• February 2013 City Voice Survey

• Keep listening to carers.

• How much did they value it e.g. turning up in December 2012 in the snow to “Musical Memories”.


Change Fund

Dementia Support Service March 2013

Dementia Support Service – Why do it?

• Fear of dementia means that people delay in coming forward for diagnosis and support.

• Information and support after diagnosis for those with dementia and their carers has been poor or non-existent.

• Services do not always understand how to respond to people with dementia and their carers, leading to poor outcomes.

• People with dementia and their carers are not always treated with dignity and respect.

• Family members and people who support and care for people with dementia do not always receive the help to protect their own welfare and to enable them to go on caring safely and effectively.

• Dementia diagnosis is increasing.

Dementia Support Service – How to do it?• The dementia support service provides advice, accurate and up to date information and

specialist support which addresses the unique needs of people living with dementia and their carers.

• Support is provided at home or in the local community on a short-term basis.

• We offer advice and information that is both flexible and responsive to your needs and aim to improve both you and your carer’s quality of life.

• We will help you to continue to live at home for as long as possible and provide support to your carer.

• The service is available 24 hours a day and 365 days a year.

• The service has it’s own blog which provides up to date information surrounding the dementia support service and the local memory cafes.

Engagement – What did people ask for ?

• Service users and their families had been asking for support as part of assessments carried out.

• Service users and their carers have had little in the way of engagement with specific reference to dementia.

• Staff in the Partnership had told us that they had little to refer service users to.

• Service users had told us that they needed more support in a more flexible way.

• Carers asked for our support with training and are trained along with the staff teams.

• We have developed engagement through Carer Surveys, Service Questionnaires, Support Groups, Newsletter, Twitter, Our Blog, Carers Events and through the Partnership with particular reference to colleagues within Mental Health services.

Referral Process

Service user

Dementia Support

Staff

Family

ACM Team CMHT

GP

Telecare

Dementia Support Service March 2013

Current Position

• We currently have 7 Dementia Support workers across North Ayrshire with an 8th being appointed in April.

• We are currently developing the service on the Islands of Cumbrae and Arran in conjunction with Health Partners.

• We have memory café’s within every locality (6 in total).

• The service is free and available to all age groups.

• The service has been mainline funded away from the Change Fund for 2013/14.

• We have provided services to over 284 people with dementia and their carers in North Ayrshire.

• The service has a twitter account which has over 185 followers and has “tweeted” over 902 tweets informing the audience of various articles surrounding dementia and sharing good practice.

The Future

• Dementia Support Service fully mainline funded from 01 April 2013.

• 1st Year Report due at 31 March 2013.

• Further Partnership working within the role of the Keyworker.

• Continued and ongoing delivery of the Promoting Excellence Framework.

• Engagement work continues through support groups and through events run by the Partnership.

• Further informal and formal engagement with Service users, Carers and Carer’s Groups.

Come talk to us – Engage

• Call us 01505684362

• Tweet us @NAdementia

• Blog www.northayrshiredementia.wordpress.com

• Visit us http://www.northayrshire.gov.uk/SocialCareAndHealth/HelpForAdults/DementiaSupport.aspx

http://www.northayrshiredementia.wordpress.com/


Change Fund

Emma Miller Joint improvement Team

A Step Change for Carers: Developing Best Practice through focusing on

personal outcomes

Outcomes as part of the whole story

• Carer engagement• Developing practice in direct and indirect

support to carers of older people and older carers

• Measuring the impact of direct and indirect support for carers

The person – and their outcomes – at the centre (IRISS)

But how the person is involved is critical

AGREE OUTCOMES

User’s view Carer’s view

Assessor’s view Agency’s view

NEGOTIATE

RECORD OUTCOMES

‘EXCHANGE MODEL’ OF ASSESSMENT

1

2

3

4

EXCHANGE INFORMATION - Identify desired outcomes

Exchange Model of Assessment

Engagement, recording and use of information (TP practical guide)

I am not a number!

References/Resources

Cook and Miller (2012) Talking Points: A Practical Guide, JIT http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/Reshaping Care and Support Planning http://content.iriss.org.uk/careandsupport/

http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/

http://www.jitscotland.org.uk/action-areas/talking-points-user-and-carer-involvement/

http://content.iriss.org.uk/careandsupport/


Change Fund

Carer Outcomes

Reshaping Care Improvement NetworkA Step Change for Carers: Developing Best Practice for Carers through the Change

Fund

Lucinda Godfrey

The Journey

• Carer involvement• Participative structures• Change Plan• Carers Workstream

Carer Outcomes

• Continue to care• Improved Health and

Wellbeing• Reduced Isolation• Carers identify improved

outcomes following a Carers Assessment

Direct services

• Time 4 U• On the Spot• Early Intervention Service• Research on short breaks/respite• Carer/workforce Training• Befriending • Moving and Handling Support

How???

• Integrated• Carers Impact Assessment

• Identification of measures

What Next?

• Review of impact• Do carers feel the impact??


Change Fund

Evidencing that it worksCapturing carers’ personal outcomes

in Midlothian

Eibhlin McHugh, Director of Communities and Wellbeing, Midlothian Council

Julie Gardner, VOCAL

Carer as partners in MidlothianCarers Action

MidlothianCarer led and

linking to carer groups

Carers Strategic Planning GroupRepresentation

from all partners

Other planning groups eg.

Change Fund

Caring Together in MidlothianLocal Carers’ Strategy

• Developed through the planning structure outlined and taking a whole systems approach – everything from short breaks to employability and income maximisation

• Key commitment in the strategy is to have an overarching personal outcomes framework to measure impact, alongside SMART objectives

• Not enough to count activities/interventions need to understand what impact they have on carers

Capturing carers’ personal outcomesConversations with carers

• Shifting from carers’ assessments to conversations with carers, having the right conversations with carers is fundamental to this process

• Supporting staff to have the right conversations- Permission to do so- Training and reflection

• Looking at the systems around the practice

• Building this into strategic planning and thinking

Capturing carers’ personal outcomesSo what are we doing?

Realise this is a change process which will take time, work includes:

Training programme for staff – team leaders and front line practitioners

Different model for Short Breaks Bureau – building practitioners’ capacity to create short breaks

Work with Care at Home providers

Capturing carers’ personal outcomesSo what are the challenges?

• Recognising the challenges for professionals in moving from process driven to focus on personal outcomes

• What is a social work intervention?

• Whole systems change which will take time and commitment to achieve

VOCAL – key lessons after 4 years of implementation…

• The outcomes approach has involved a major shift in practice – shifting the focus from tasks/resources to focus on what we are trying to change

• Supporting this change in practice is crucial – training, team meetings and supervision

• Revisiting and reinforcing communication skills is key to the shift as it is an approach based on capturing and reviewing outcomes through conversations with the carer

• It is a whole systems change – managers, front line practitioners , data recording and analysis – so the systems have to support the change

VOCAL – key lessons after 4 years of implementation…

• It is crucial to separate out the conversation from the recording tool – the recording tool should be used to record the salient points but is not the framework for the conversation

• Engaging staff in ongoing debate and discussion is key as this creates a feedback loop for ongoing learning

• It takes time, perseverance and commitment – we are still learning and improving – current focus is on data analysis

• It works - for the carer, for the organisation and for joint planning

Personal outcomes and partnership working

• Focus on personal outcomes has allowed us as a carer organisation to open up the conversation with carers and with other practitioners

• Provides a shared language which can create a shared understanding

• Creates a shared sets of outcomes to which the carer, and practitioners, working in partnership can contribute

The personal outcomes framework• Feeling valued and respected during their involvement in the

planning and shaping of services and support whether through a carers assessment or through engagement in planning structures.

• Being able to have a say in service planning and development whether through a carers' assessment or through engagement in planning structures.

• That their expertise is recognised in service planning and development whether through a carers assessment or through engagement in planning structures.

• Having positive relationships with practitioners and planners in service planning and development whether through a carers' assessment or through engagement in planning structures.

The personal outcomes framework• Being better informed about issues linked to their

caring role.• Improved confidence in their ability to shape services

and support.• Improved confidence in managing their caring role.• Improved physical and mental wellbeing • Improved confidence in their ability to deal with the

changing relationships resulting from the caring role• Improved social wellbeing• Improved economic wellbeing• Improved personal safety in relation to their caring role


Change Fund

reshaping care improvement network a step change for carers: developing best practice for carers...

Documents

carers time

carers assessment slide

needs of carers

outcomes carers

stress carers

change fund slide

person slide

breaks slide