Planning for health and care provision in the Isles of Scilly - what do people at the sharp end think?

Transcription

1 Planning for health and care provision in the Isles of Scilly - what do people at the sharp end think? Staff and community engagement, November 2013 Report to IOS Health and Wellbeing Board Planning Group HWIOS/CC/ IOS community & staff engagement Nov 13

2 Context 1 What words describe a good life? 3 What provision is required? 4 Gaps in current provision 5 Arranging and accessing care services 6 Staff: I wish I could 7 What needs to happen? 8 What are the challenges? 9 Appendices: invitations to discussion workshops 10/11 HWIOS/CC/ IOS community & staff engagement Nov 13

3 Background The Council of the Isles of Scilly asked Healthwatch to undertake some engagement which could inform the Health and Wellbeing Board multi agency planning process for integrated health and care provision for the islands. It was agreed that this should include local health and care staff as well as community members. A key question would be about the words and phrases that would describe someone who is well cared for and supported, in order to produce outcome statements which can be used to monitor and evaluate provision. Format Five discussion workshops were arranged during the last three weeks of November 2013 for hospital staff, health centre and dental surgery staff, adult social care staff, and two for the community. Despite this exercise being about integration, it was decided to hold separate sessions for different staff groups, partly for reasons of organisation and convenience, and partly to focus on the challenges and opportunities within each sector. The two community sessions were held in the day and evening, for access. Invitations went to health and care staff, the wider Healthwatch membership, and members of the Elder Care Forum (appendix 1 and 2). Additional advertising of community sessions went out via the Healthwatch bulletin, on Radio Scilly and in social media. We asked people to book a place in order to distinguish the exercise from a public Q&A about current provision, and reinforced the message that this would be an opportunity to bring ideas, rather than questions or complaints. Each session began with a brief introduction about the context of the exercise: that there is a government drive toward integrated health and care; that this will be supported by funding for integrated service delivery from 2015; that Cornwall & IOS have pioneer status to develop and roll out integrated services over the next five years; that this has begun in the Newquay pathfinder programme; that changes in the way IOS services could be organised are under discussion by a multi agency planning group under the IOS Health and Wellbeing Board. We also looked at the recommended delivery model for supporting people with long term health needs and what might happen through population impact if nothing else changes. Each session then followed a question and answer format which developed into a wider discussion as we went along. The notes from each staff session were written up and circulated back to staff for review, and to allow people who hadn t attended to give their input. There will be an opportunity for the Council to gather further community feedback at the Elder Care Forum meeting on December 17 th. Twenty three staff and fourteen members of the community attended the workshops. Although, as is often the case in Scilly, the numbers are small, there was a high level of contribution to each discussion and most sessions went on longer than planned. HWIOS/CC/ IOS community & staff engagement Nov 13 1

4 Feedback The feedback presented here is the summary of comments and suggestions made on a flip chart at each session. There is clear consensus in a number of areas and some ideas which are worth highlighting: Signposting Every sector identified a need for much better and clearer information about service provision - what is available, how to access it, what are the referral pathways and what are the lines of accountability. Staff are sometimes unsure about what other agencies, on the mainland and even in Scilly, can provide, or how to make a referral. Members of the community would like a single point of contact for information, support and advice, including who to turn to if you have a problem with your treatment and care. Much of this information is available, but it is piecemeal and not clearly signposted. A number of agencies have a role in providing information, but limited capacity. People felt that there is a need for a properly joined-up service, either with a single point of contact or several, as long as the information is comprehensive, accurate and easily accessible. Integration of provision across the state, private and voluntary sectors The idea came across very clearly at the community sessions that private and voluntary services should be part of the overall provision and referral map. Co-ordination There was a sense at all the sessions that although there are individuals with appropriate skills and training, there are gaps in provision because of a lack of co-ordination across services. The community sessions identified a number of supportive activities which could be undertaken by volunteers but this needs to be co-ordinated and well organised. Autonomy for IOS People said that much can be achieved through improved communication and co-ordination between services. Staff sessions went further in talking about developing IOS pathways which are different to Cornwall, and making radical changes to governance structures which would allow greater local co-delivery of joined up care. HWIOS/CC/ IOS community & staff engagement Nov 13 2

5 SESSION FEEDBACK 1. What are the key words which would describe a good life for someone who needs care and is well supported? safe and secure stress free not worrying about the help they need and how to get it not frightened about how they ll cope confident that problems will be solved, that professionals/others will not give up on them well supported receives early intervention not a burden comfortable (warm, well fed, pain free) physically and mentally healthy strong mobile active, and has activities to do can see and hear well enough for the activities they want to do has social interaction is socially included happy has fun, laughter, joy has fun has companionship independent has domestic help and personal care can stay on the island/at home has good access (transport) has choice - able to make decisions and be listened to has control - empowered to do what they want and how is able to challenge decisions made about them advocacy - has someone to speak for them if they can no longer make decisions themselves has motivation and a sense of purpose has self determination has a life plan has quality of life is always treated respectfully is visible is valued HWIOS/CC/ IOS community & staff engagement Nov 13 3

6 2. What are the services/facilities/support required to live a good life? Prevention of deterioration in physical, mental and spiritual health Primary and community health care diagnostics/acute and secondary health care - including more local provision Continuity of care Assessment/review at home Assessment of at risk patients Health support at home from qualified staff Good social care support at home preventing escalation of health problems/ needs Reporting and referring on Falls prevention/ home assessment Sensory aids and home adaptation Support after hospital : convalescence, rehabilitation/re-ablement/ support at home Exercise on prescription: for prevention and control of disease, chronic ill health; for health maintenance and general well being Self help and self management Expert Patient Programme Domestic help including cleaning, gardening, shopping Meals/ Nutrition advice Personal care Family support /neighbourly keeping an eye Social interaction Companionship, visits Day centre activities/provision including access to regular activities like the pub, meals out Access and transport Carers support Respite care, day and night Residential care Long term nursing care Dementia care Support through life changing events - chronic health conditions, post stroke etc., bereavement Mental health support Choice and self determination in a supported life plan and a death plan Access to information about available support/ financial and general advice HWIOS/CC/ IOS community & staff engagement Nov 13 4

7 3. Are there gaps in provision? diagnostics/acute and secondary health care could be provided locally via technology/ Hospital/paramedic service/ GP and primary care Time and opportunity for assessment/review and health support at home Joined up services offering continuity of care Continuing support: mental health/ bereavement/ re-ablement programmes/ enabling therapies and support Access to self help groups and support Convalescent ( stepping stone ) care Night time care at home Choice/provision of respite care Choice/provision of residential care facilities Nursing Home Falls prevention programme Exercise on prescription Bespoke re-ablement service Access to eye tests Bespoke home care service lack of staff and resources Flexible, old fashioned domestic help Organisation and co-ordination in voluntary sector Access to information about available support/ financial and general advice HWIOS/CC/ IOS community & staff engagement Nov 13 5

8 4. Who arranges these services? Are there several points of contact? There is a need for much better signposting so the community knows who to contact for services/ support and where to get information and advice Staff also need much clearer information in order to make appropriate referrals There needs to be better information about lines of accountability and who to complain to 5. Could there be just one point of contact? Who would that be? A dedicated post to signpost to services and also help co-ordinate and arrange access to services A single point of contact should be 24/7, this could be the hospital with all calls being referred to the Hub 6. Where are these services are provided? Could they be provided somewhere else? Where could that be? Activities need to be somewhere central Would be good to have regular social activities/lunches arranged in places like hotels and the Club Create clinical treatment rooms closer to the patient, i.e. at Park House, and make better use of off island facilities 7. Transport/access Transport is good on St Marys (Buzza bus) but poor on off islands Evening transport is a problem, also poor street lighting and lighting at entrance to venues, makes people frightened of a fall HWIOS/CC/ IOS community & staff engagement Nov 13 6

9 8. Staff: I wish I could Call on an extra pair of hands when needed Sit down and spend time with a patient/client Have time Follow through a referral to get someone home (by Friday) - with all home care services in place Get things in place in a timely manner Cut out the red tape/cut down on paperwork Have time to do re-ablement work or be able to pass it on to someone and know it will happen Have more training Do the things I m trained for, but which lack funding Make home visits for assessment/treatment Assess how well people are managing their medication/avoid waste Provide treatment at home or nearer to home for patients for whom access to the surgery is difficult Improve access and provision for off islanders Zap anyone who goes on about empty beds at St Marys Hospital Be part of a really autonomous local service HWIOS/CC/ IOS community & staff engagement Nov 13 7

10 9. What needs to happen? Planning: start with a blank sheet and design services around need, rather than trying to re-arrange existing provision to cover the gaps Break down barriers about who is allowed to do what. Make the system flexible and encourage innovation. A whole system structure which reflects understanding of what staff are dealing with day to day and supports staff, patients and clients - i.e. in management, training and specialist input Create a single accountable provider for IOS but reduce the number of chiefs and direct more resources to front line services State/private/voluntary provision in a co-ordinated network to provide choice and fill gaps in provision. All sectors must be able to work together Better referral to activities/ private/ self help provision Better communication and information sharing between services/departments More health input into care plans Enable and support people to exercise personal choice. i.e. regarding therapies and treatment Much better information about available services and how to access them: o a directory of local and mainland based services o someone to explain what is available, not just a collection of leaflets o a folder to take home with all the services and support available, i.e. like the one provided by Age UK for post stroke support, with a return visit from someone to help you go through your options and arrange the services you need o Better signposting and encouragement to seek help, encourage a can-do attitude and remove the stigma of asking for help A single point of contact and a single assessment More flexible needs led provision, where staff follow the patient, ie. provision of personal care by domiciliary staff whether at home or in hospital Create a higher paid, skilled home care team who can undertake home assessment/review and make referrals Others said: assessment and review at home should be undertaken by the appropriate qualified clinician Grow your own staff more careers guidance and local training A community health visitor/mental health support post to provide continuing support, assessment and care reviews More treatment available on island, reduced need to travel. Many people have a real fear of travelling/being isolated on the mainland Develop IOS pathways: o Provide local emergency X-ray especially for suspected fractures o can and should be able to treat fractures on island - the Cornwall pathway automatically sends patients to Treliske (not even West Cornwall which would be easier for IOS patients) for a 1 st appointment o relax targets such as waiting time for an outpatient appointment, which can force patients to travel to the mainland instead of waiting an extra couple of weeks to be seen on island o hold more clinics on St Marys, especially those with a high number of IOS patients o offer follow up orthopaedic appointments by telephone/video conference More local specialists, ie. physio, for stroke/aftercare rehabilitation. Would still need intensive aftercare on mainland, but patients make better progress at home with the right therapies/support Improve delivery of re-ablement programmes. HWIOS/CC/ IOS community & staff engagement Nov 13 8

11 Create more clinical space for shared use/use by visiting clinicians. If a number of mainland based clinicians are visiting there is pressure on available rooms Create clinical treatment rooms closer to the patient, i.e. at Park House, and make better use of off island facilities Site services in the same building or improve means for cross service communication Provide dedicated accommodation for use by visiting clinicians/locums across all services Provision of a dedicated nursing home/provision of continuing nursing care which is NHS funded Improved residential facilities for people with dementia A convalescent ward run by healthcare assistants, funded by the patient More respite provision, i.e. at home, or secure night time care for sufferers of dementia so their partners/carers get much needed sleep Skilled input from volunteers Encourage/enable more evening and weekend activities - this involves the whole community Start a cooking group, teach people to cook, include advice from a dietician Improve evening transport provision (accessible transport) Re-instate a regular lunch club Ensure inclusion of/accessibility for off islanders Encourage more people to volunteer - a very small thing can make a difference Co-ordinate voluntary support so connections can be made easily between the person offering help and the person who needs it Promote sports facilities for beginners/use of facilities for staying active, re-ablement When carrying out consultation/surveys, include visits to people to enable them to tell their story Take engagement exercise to off islands 10. What are the challenges? Recruitment and retention of staff - need to be the right calibre and ability and have appropriate training Maintaining an adequate level of staffing to support people with complex health needs and a high level of dependency Housing for staff Travel and transport: time constraints on visiting clinicians, clinic cancellation, disruption to services, transport of bloods Patient travel Separate governance and budgets There is limited choice of provision and resources, i.e. domestic help, contractors to carry out home adaptations Lack of co-ordination meaning untapped skills and gaps in provision HWIOS/CC/ IOS community & staff engagement Nov 13 9

12 APPENDIX 1 Flexible, integrated health and social care services in the Isles of Scilly how would you do it? We would like to put you in charge for an hour, and get your expert knowledge, feedback, and ideas on how you would design the provision of joined up adult health and social care services locally, to meet island needs now and in the future. There is a government drive for local development of truly integrated health and care. The people who plan and run services to and on the islands recognise that things may need to work differently in order to work well. They are talking to each other and want to hear from you. Time and place Feedback, suggestions and recommendations from these workshops will go to the Kernow Clinical Commissioning Group, the IOS Health and Wellbeing Board, and will be presented to the next meeting of the Elder Care Forum planned for December. We look forward to seeing you, Carol Clarke, Healthwatch Isles of Scilly Aisling Hick, Council of the Isles of Scilly HWIOS/CC/ IOS community & staff engagement Nov 13 10

13 APPENDIX 2 Flexible, integrated health and social care services in the Isles of Scilly What would you like to see? There is a government drive for more joined up health and social care. Funding will be targeted at out of hospital care. Cornwall and the Isles of Scilly have pioneer status to develop integrated systems over the next five years. How will this work in the Isles of Scilly? What community based services and facilities do we need to enable us to stay healthy and well supported? What, if anything, needs to change? We are holding two discussion sessions to get your views, suggestions and ideas on provision to meet island needs now and in the future. (These will be workshop events, not open meetings.) Time and place To book your place please contact: Carol Clarke at Healthwatch contact@healthwatchislesofscilly.co.uk Feedback from the sessions will go to a planning group of commissioners and service providers, the IOS Health and Wellbeing Board, and will be presented to the next meeting of the Elder Care Forum planned for December. Please take the opportunity to have your say. HWIOS/CC/ IOS community & staff engagement Nov 13 11

14 Healthwatch Isles of Scilly Thorofare, St Marys Isles of Scilly TR21 0LN