PARTNERS FOR INTEGRATION
› Partners for Integration across Scotland
Collaboration in North Ayrshire
North Ayrshire HSCP was one of the first partnerships to invite Independent Sector representation at Integrated Joint Board level and to be included in the Strategic Planning Group. This allowed the provider representative and the Independent Sector Lead to be informed about the direction of travel for the sector. The aim was to support providers and to ensure that they were not isolated in their efforts to offer a mixed provision of care that meets the needs of the population. The representative on the IJB is a local provider and the Independent Sector Lead post provided ongoing support and sharing of information. The partnership made a commitment to the sector to work together and look at future models of care in a collaborative approach.
West Lothian Care Home Providers’ Forum
In West Lothian HSCP, the Care Home Providers’ Forum meets on a three-monthly basis. All Independent care home services within West Lothian are invited, as well as representatives from West Lothian HSCP care homes. Other regular participants in the forum include West Lothian HSCP Senior Manager, Group Manager Older People, Chief Nurse, Clinical Nurse Manager, Scottish Care and representatives from the Care Inspectorate. Other relevant representatives are invited as and when appropriate. The aim is to provide a setting where matters relating to Care Homes within West Lothian can be openly discussed between providers and representatives of the Partnership.
Engagement in Dundee
In Dundee HSCP, engagement with non-statutory (independent) providers continues to be a primary focus. At the end of 2018-19, engagement was 60% for care at home services and 46% for care homes, an average of 51%. In the previous year, 2017-18, engagement across care at home and care home providers was only 8%. Dundee Care Providers Network (DCPN) has been set up to encourage providers to come together more frequently and to engage openly with each other regarding good practice and issues/solutions. It was created to address a need articulated by local providers and will be dependent on their continued engagement. Care will be taken in how this network evolves to promote continued engagement between provider and with the Independent Sector Lead role.
Renfrewshire Care Home Partnership Group
The Care Home Partnership Group in Renfrewshire HSCP was formed to provide a forum to discuss, develop and review current and future partnership working with care homes. A key focus was to:
- Improve pathways for care home residents who require unscheduled care in hospital and reduce levels of preventable admissions
- Ensure that care home residents receive the right care at the right time in the right place within Renfrewshire HSCP.
The group aims to:
- Collate and provide context to data collated from various data sources
- Consider evidence of pathway models of care used in other areas, assess the impact and use to explore the feasibility of implementation in Renfrewshire
- Identify new data to capture and support evidence-based service improvement planning
- Describe current support mechanisms and gaps within care homes, including training opportunities and service in-reach
- Create a virtual group to ensure awareness and opportunity for engagement for all care homes within the partnership area
- Ensure effective communication of proposed new pathways and ways of working.
West Dunbartonshire Integrated Care Home Providers Forum
Historically, this forum was organised by what is now West Dunbartonshire HSCP. Statutory staff and providers attended, however the agenda, venue, minutes and all other aspects of the forum were coordinated and written by the HSCP staff. Through discussion, it became apparent that there were frustrations with the forum in its existing format from both the attendees and organisers. At the same time, the initiative My Home Life (MHL) was taking place in West Dunbartonshire. Before MHL began, services that were geographically close to one another had little or no contact. MHL fostered the environment to create a more effective and collaborative relationship, with the care home managers (both independent sector and local authority) taking part. This in turn led to an awareness of the need for better networking.
The outcome of this developing relationship and better networking was a commitment, desire and willingness for providers to work with their HSCP quality and development colleagues and the Independent Sector Lead to form a joint steering group for the forum.
Meetings are now held quarterly, with the steering group taking responsibility for organising venues, arranging speakers, welcoming participants and taking minutes.
The forum is evaluated, and the steering group review the evaluations, using these to inform how the next meeting will look. There is also a commitment to reach out to those who don’t regular attend to promote the benefits of the forum and to encourage engagement.
My Home Life has been transformational in West Dunbartonshire in creating opportunities for greater joint working. The practices from the programme have been introduced to the meeting to create a standardised way of working coupled with the continued funding of the programme in the area over a prolonged period.
Consulting care homes in Aberdeen
In July 2017, staff from Scottish Care in Aberdeen City HSCP met with managers of Independent Sector care homes to:
- Inform managers about ACHSCP and about the newly funded Engagement Project
- Gather information about current involvement in the integration process
- Identify any key challenges and/or opportunities.
The report ‘Voices from the Independent Sector Care Homes: Consultation with Care Homes in Aberdeen City’ was published in November 2017.
In January 2019, it was decided to follow up this earlier consultation to see what had changed in the
interim. Independent Sector Leads from Scottish Care’s Aberdeen City team met with managers from 18 out of the 20 Independent Sector care homes. to:
- Scope current communication and involvement with ACHSCP
- Learn about local independent care homes workforce and practice development
- Gather information regarding the relationships between care homes and external organisations
- Identify any next steps.
The report, ‘Voices from the Independent Sector Care Homes: Consultation with Care Homes in Aberdeen City: Volume 2’ was published in April 2019. A consultation with care at home agencies is in the planning stages.
Getting the right care in the right place in Edinburgh
In Edinburgh HSCP, the Crossover IoRN (indicator of relative need) is being used to improve older people’s experience of care and support. It is the key response to ‘therapeutic nihilism’, the phenomenon of older people being admitted but any treatable problems including mobility issues, visual and hearing impairment, chronic pain, incontinence, depression, and delirium are normalised and go untreated, thus wasting the inpatient opportunity to improve an individual’s quality of life at any age. Many needs characterised as ‘minor’ can significantly affect independence, wellbeing, and social engagement. Day of Care audits in hospitals consistently demonstrate an increasing number of individuals are ‘not where they should be’, and the IoRN illustrates where holistic interventions can augment clinical care to enable discharge and preclude re-admission or progression to further care management.
Reducing Delayed Discharge in Acute and Community Hospitals Dumfries and Galloway
Dumfries and Galloway HSCP wanted to address the challenge of delayed discharge across the area. The decision was made to establish a Community Health and Social Care Tactical Liaison Group. This group did not have a strategic remit but adopted a more tactical one looking at operational level solutions to presenting problems. One idea from the group was to look at the Flow and Discharge process to gain an understanding of everyone’s role.
‘Flow, Discharge and Me’ awareness sessions were arranged. These sessions were designed, planned and facilitated by the Independent Sector Lead and her team. The support, planning and facilitation for the sessions came from the Locality managers and their teams. The agreed focus of the sessions was to raise awareness of the services which support and facilitate hospital flow and discharge:
Glasgow City Deal Pilot
The Glasgow City Deal Pilot was established with Glasgow HSCP to support in work progression, to relieve people in work poverty and to support business growth and sustainability for Independent sector care home providers to ensure future demands can be met. Set within the context of facilitating business growth and development, the overall aim of the pilot is to devise, implement and refine a sustainable model of employee progression which improves the skills and increases earning potential of low paid employees in the care sector.
The pilot is three-fold:
- Provide business support for employers to support financial stability and sustainability by identifying business opportunities and development needs of companies in the care sector and improving access to the range of business growth and development interventions available in the city
- Identify the support needs of care sector employees and improve access to and uptake of interventions to support them to improve their skills, increase their earning potential and ensure organisations have the appropriate skill mix that is fit for the future in terms of providing a mixed provision of care
- The pilot also seeks to identify to what extent the delivery model can be rolled out to other business sectors.
There are several key learning points highlighted, one being the need for a more robust data gathering process, which has to be considered for any future delivery model. Management information was provided by five of the 20 participating care homes. This indicated that between 2015/16 and 2018/19 turnover (+28%), gross profits (+39), employee numbers (+24), full time employees (+44%), and employees receiving training (+22%) all increased. In addition, net profits moved from negative to positive.
The evaluation of the pilot is being considered at various levels and with a range of stakeholders to look at the way forward. It has been suggested that a more refined model could be developed to support the care at home providers operating in Glasgow City as a way of supporting the sector as demands increase in line with the demography and national drive for people to remain at home or in a homely setting.
John’s Campaign in North Lanarkshire HSCP
John’s Campaign began as an access campaign in hospitals, promoting the right of carers of people with dementia to stay with them. After being introduced into the hospital environment, it has been shown to reduce falls, delirium and incidents of stress or distress. People eat and drink better, they and families are more content, even at the end of life. People’s individuality and dignity is retained. All Lanarkshire hospitals have pledged to join the campaign and by January 2019, following development work by the Independent Sector Lead, all North Lanarkshire care homes also joined. The campaign:
- Welcomes family/carers who wish to visit and help support their loved ones living in the care home.
- Adopts the principle of ‘person centred’ visiting.
- Uses insights from families to improve person centred care.
A successful launch day took place in January and a great sense of positivity was evident within the group. The next steps are to ensure that good news stories are shared and that care homes receive recognition for the relationship centred care that they have always delivered. There are also plans to hold a pan-Lanarkshire Celebration Event in October 2019 where care homes can share their experiences and good news stories with the wider local communities.
My Home Life in Fife
An exciting opportunity to work in partnership with the University of the West of Scotland’s My Home Life Programme was agreed in April of this year between Fife HSCP and Scottish Care. A bespoke and collaborative approach to embed an evidential base in the promotion of quality of life in care homes for older people established joint priorities, focusing on four specific themes:
– Creating communities
– Improving health and health care
– Keeping workforce fit for practice
– Promoting a positive culture.
Working together, Fife HSCP and Scottish Care identified candidates within the statutory and independent care sectors, agreeing a timetable of workshops and action learning events to take place from April 2019, leading to a validation event scheduled for late February 2020.
The agreed programme promotes both national and local drivers as set out within the new Quality Framework for Care Homes for Older People and will deliver on core principles and values within the Fife HSCP Strategic Plan. A mid-cycle meeting has been agreed between Partners and the University of the West of Scotland for late August to review progress and to plan and support the latter stages of the Programme, including the evaluation.
Hearing awareness support in South Ayrshire
Following conversations at Scottish Care’s conference – The Right to be Heard: human rights, hearing and care – local connections were established with the Independent Sector Lead, Action on Hearing Loss Project Leads, the Sensory Impairment Team and HSCP Facilitator In South Ayrshire HSCP to roll out a support and hearing impairment awareness training project for local care homes. The Independent Sector Lead’s support to the project includes dissemination of a baseline survey, engagement opportunities with care home providers and project leads and informing & reporting on progress and outcomes to relevant Partnership initiatives at strategic level.
A key outcome is to ensure care home residents with a hearing impairment can
effectively communicate ‘what matters to me’ and be involved in how people supporting them go about achieving these things. Other outcomes include evidencing partnership and integrated working across statutory, independent and third sector agencies in a front-line community context and contributing to data collection and mapping of services to help inform the Partnership’s Transformational Change programme supporting an outcomes approach to service delivery.
Visual awareness support in Angus
In the past, Angus homes have been able to access visual awareness training on an ad hoc basis with staff traveling to a session run by a local group. These sessions were open to all homes but only a small number of staff from each home could attend.
It has now been several years since any sessions took place. The See/Hear group discussed how visual awareness training for care home staff could be improved. Following this discussion, a local third sector organisation was approached for funding. North Eastern Sensory Service (NESS) was asked to develop a resource for care homes to be used in a variety of ways to meet the homes’ individual needs. Two boxes were created for homes to share. The resource would include PowerPoint presentations, DVDs, experiential resources and aids. The homes would be given six weeks to develop a plan on how best to use the resource.
So far six homes have used the resource and have developed individual learning packages to suit their needs. Two examples of how the resource is being used are staff blindfolded then moved in bed using a hoist; and staff assisted with eating whilst they were wearing different types of spectacles. Homes have tailored the training to meet the needs of individual residents. The training has also allowed them to identify what information they need from opticians to better support residents with certain eye conditions.
Care About Physical Activity pilot 2017 in Inverclyde
In 2017 an application was submitted for care at home, day care and sheltered housing and respite staff in Inverclyde HSCP to be involved in a pilot of Care About Physical Activity (CAPA). For those attending the pilot there was a struggle to understand that CAPA was not the development of an exercise programme, more an awareness raising programme to encourage staff to support people they worked with to be more active in everyday life.
Being involved in the programme has been transformational for the staff involved and for the people they work alongside. Indeed, one of the
major benefits of being involved in CAPA has been that both workers and those receiving services have made helpful changes:
- A resident who only ever mobilised using a wheelchair has the confidence to walk with sticks to increase her independence
- Someone using day care is now swimming again as they used to do this when they were young
- Care plans have developed to encourage increased levels of mobility and record this in order that the person can reflect back on their achievements
- Staff awareness of the programme means that they are more likely to work along with people rather than do things for them
- A library of resources is available for providers to access in order that they can share with each other
- Providers are willing to share ideas and will visit each other to become involved in activities
CAPA has been transformational in developing the awareness of staff who deliver services but also in developing a sense of agency amongst people who use services. CAPA has supported such people to have a greater sense of what they can achieve and also what they can expect to be involved in.
Care cooks’ course in Highland
The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard with terminology and definitions to describe texture modified foods and thickened liquids used for individuals living with dysphasia of all ages, in all care settings, and for all cultures. NHS Scotland directed all health boards to implement IDDSI by April 2019.
A task and finish group within Highland was put together to support the implementation of IDDSI across all care settings in the region. Personnel from NHS Highland, Highland Council and Scottish Care created a working group in April 2018. Part of the remit of the group was to identify potential issues around the implementation and signpost solutions. The overwhelming feedback from the sector focused on the practical skills required to modify food and liquids in line with the IDDSI guidelines.
Scottish Care in Highland approached the University of the Highlands and Islands in September 2018 to create a practical cookery course aimed at addressing the identified need across all sectors. Also involved in the discussions was the Care Inspectorate Improvement Team, as this piece of work would tie in with the recently created spotlight on Food, Fluid & Nutrition resource centre on the online resource THE HUB. Working alongside independent sector providers, NHS Highland catering teams and UHI lecturers, we have designed a four-part practical cookery course that starts in September 2019. The format of the training is four three-hour practical masterclass session concentrating on IDDSI levels 3, 4, 5 and 6, covering dishes from all meal periods including morning and afternoon tea.
Prevention of Pressure Ulcers: an initiative that promotes integrated ways of working together in Perth and Kinross HSCP
The Independent Sector Lead has been promoting a preventative model and supporting the staff who are caring for increasingly frail people in their own home or homely setting, by giving them the tools and knowledge to enhance the care they provide and be supported by the appropriate staff within the partnership in a timely and integrated way. The aim was to develop a trainer in each care at home and care home service who would take on the role of training all their staff in the prevention of pressure ulcers. The care staff from each service receive a training pack and the aim is the staff who are the trainers will continue to meet as a peer support network.
One of the successes has been doing the training in each locality. This has increased the uptake of places and the integration between the care at home and care home sectors. The support staff in community hospitals are now also going to attend to ensure the same practice across the Partnership as a whole. There is a self-assessment and evidence gathering tool to allow the staff to reflect on the care they provide and the feedback is that the areas who have used this feel it has been a benefit to evidencing how they are meeting the Standards.
Care Home Continence Project in South Lanarkshire
The Care Home Continence project set out to improve approaches to continence care, using small changes to make a big difference in South Lanarkshire HSCP. This initiative has markedly improved the lives of people in Lanarkshire care homes. The project led to a number of improvements including a reduction in falls, of 65% urinary infection being halved and skin damage reduced by one third. The project has also significantly reduced the use of continence aids within care homes. The project’s tailored two-day training was embraced by care home staff and five care homes participated in each cohort. The glue for sustainability was the weekly support and guidance visits by the Independent Sector Lead. This continues to produce excellent results, the fourth cohort has already received training. It is expected that by the end of 2020 all South Lanarkshire care homes will be involved and it will be the routine continence support for all care homes.
This is a multi-award winning project and Professor Jason Leitch, National Clinical Director of Healthcare Quality and Strategy for the Scottish Government said, “This is ground-breaking and innovative partnership working at its best – centred around human dignity”.
Improvement methodology workshops
The Independent Sector Leads commissioned workshops in East Renfrewshire, Falkirk and Argyll & Bute HSCPs along with the improvement support team (IST) from Care Inspectorate to provide a simple and user-friendly awareness of quality improvement (QI) methodologies, where these methodologies have come from and what they are used for. Visiting inspections teams and external providers along with the IST delivered a full day tailored workshop to equip the delegates with the knowledge and skills of Quality Improvement Methodologies.
In their respective workshops ,45 delegates took part in Argyll and Bute HSCP, 30 delegates in East Renfrewshire HSCP and 40 delegates in Falkirk HSCP. Using worked examples with different delivery methods i.e. presentations, group working and a world café, we discussed how to introduce and use Improvement Methodology in the workplace on a regular basis.
Topics used to aid discussion were:
– Tissue viability & reducing pressures ulcers in care homes
– New Care Standards
– Falls innovation.
The workshops aimed to enable participants to:
– Develop an understanding of Quality Improvement
– Share best practice working collaboratively to learn from one another
– Understand and increase confidence in using Improvement Methodology and the Plan, Do, Study, Act processes.
Following on from the workshop in Falkirk, the HSCP has had regular meetings with providers to refresh the Market Facilitation Plan. This ensures all partners have a good understanding of the current levels of need and demand, in order to help support and shape the demands of the Partnership’s services for the future.