Executive Summary. Unified Assessment Community of Practice Baseline Self Assessment 2007

Transcription

1 Unified Assessment Baseline Self Assessment Audit Tool Analysis of Responses

2 Executive Summary Community of Practice (CoP) methodology sits within the concept of organisational knowledge management and to date has largely been focussed within the private sector in companies such as IBM, Xerox, The World Bank and Ernst & Young. The term was coined by Etienne Wegner in 1991 and has a focus on social learning. It recognises the importance of common sense theories, as well as more academic knowledge, as drivers in everyday practice. There is an emergent view that CoPs have an important complementary role to play within the current NHS drive for improvement, particularly with respect to closing the gap between knowledge and implementation. In other words, it is recognised that some of the most creative and sustainable work comes from facilitating passionate and committed people to share experiences and knowledge in order to bring about the change in practice. The aim is to develop a more interactive model for learning and a social network for joint problem solving. The Communities of Practice for Unified Assessment were formed in 2006, with regional workshops in North and South Wales incorporating members from health and social care services. At the first meeting of the Mid & West Wales Regional CoP members proposed that a baseline self assessment be undertaken to gauge progress with implementation across Wales. The assessment proforma was devised by Mick Collins of Powys Social Services and circulated to all members of the community of practices for UA. The purpose of the assessment was to facilitate shared learning across members of the COP, identify where different communities had made progress and agree areas for joint development within the CoPs. The baseline nature of the assessment required the format to be simple and non technical, in order to facilitate completion by a wide range of people working with Unified Assessment in practice. The self assessment audit proforma was then circulated to every member of the CoPs. Responses have been received from: Neath Port Talbot CBC, Bridgend CBC, Bro Morgannwg NHS Trust (joint response) Cardiff & Vale Partnership Gwynedd Local Health Board Monmouthshire County Council Powys LHB, Powys Social services (joint response) Ceredigion Social Services Pan Gwent Unified Assessment Partnership (joint response) Carmarthenshire NHS Trust Carmarthenshire County Council Conwy & Denbighshire Unified Assessment Partnership North West Wales NHS Trust Flintshire Unified Assessment Partnership The following document contains a narrative analysis of the overall responses, reported within the same format as the self assessment. It was agreed with the CoPs that the results of this assessment would be shared with the University of Bangor, currently undertaking a review of Unified Assessment commissioned by WAG. Page 2 of 9

3 Implementation Structure Unified Assessment Community of Practice Baseline Self Assessment What structure have you got in place locally to support the implementation of Unified Assessment? (Provide overview of Executive Group, Implementation Group and any working groups) There was wide variation in the content and types of response and subsequently in the organisational structures identified. Everywhere reported a tripartite organisational structure with multiagency participation at each level. There also appeared to be separation between a strategic group, with overall responsibility for UA implementation; and a more specific operational management group. The operational groups coordinate the work of a variable number of smaller task & finish groups dependent on the theme, or size of the health community. 2. Can you provide an outline of the membership of your Local Implementation Group? There appears to be broad multiagency representation in every locality although scale and level of representation varies, e.g. Conwy & Denbighshire with 27 representatives of separate departments to Gwynedd with 7 representatives of agencies. Common theme: Voluntary sector representatives were only listed in two areas and no representative reported from the independent sector and no patient or carer representatives were listed. Not every area reported specific representation from Mental Health services. 3. Who has got the Executive Lead for Unified Assessment within your organisation? (Please provide contact details) There was a consistent response across all communities Common theme: Each organisation has nominated a lead person at very senior management or Director level and in practice these responsibilities are often delegated to other people who actually attend the meetings and take forward the work. Page 3 of 9

4 Documentation 4. Please note if the following documentation has been developed whether this was a joint development and when the documentation was implemented. Comment Enquiry form Ceredigion: all forms under review Flintshire: part of summary record Bro Morgannwg: not used in health Conwy: not in health Referral form Flintshire: part of the summary record Gwent and Carmarthen use the enquiry form to refer Gwynedd: no separate referral form Powys: not used in health Contact assessment Bro Morgannwg two versions in use 1 for acute 1 for community Carmarthen: not used in health Gwent: not universally used in health Overview assessment Monmouth: no separate assessment Conwy: not used in health Powys: not used in health Other versions Conwy, Flintshire, Monmouthshire, Carmarthen & Powys joint paperwork adapted to complement nursing records Personal plan of care form Cardiff: not in use Carmarthen: not used in health Powys: not used in health yet Summary record form Flintshire: held by care coordinator also forms the framework for some patient user records Carmarthen: under development Bro Morgannwg: no form Client patient held record Not in place in Ceredigion, Gwent, NWW, Gwynedd, Cardiff, Carmarthen, Powys, Neath Conwy: patient given copies of summary record and care plan Flintshire: patients have hand held records in yellow folder Monmouth: in place but greater consistency needed Page 4 of 9

5 5. Have you got Care Co-ordinators in Place? There was a wide variety in the content and detail of the assessment responses and almost all responded positively. Some have the responsibilities within existing roles (most frequently social workers) and some have roles and responsibilities clearly defined within policy and others are in the process of doing so: Carmarthenshire have a jointly agreed protocol for the role of a care coordinator. The document is a very clear exemplar and was submitted with the self-assessment Flintshire are about to role out formalised care coordination across the community Bro Morgannwg noted an audit in place to record establishment of care coordination for complex cases Pembrokeshire have care coordinators in place across each agency, have started multi agency joint training and are in the process of formalising the transfer of care between care coordinators. Although the general concept has been embraced the practical application varies from community to community. Clearly applying the concept with some local responsiveness is a good practice and the COP will look into whether there are gains to be made in standardising some elements of the role and responsibilities. 6. Have you got an Information Sharing Protocol developed and in place? (If yes can you provide a copy of the documentation and process in place, if no please indicate current status of the Information Sharing Protocol) Generally everyone responded positively, but local ISP s are now under review following the publication of the Wales Accord for the Sharing of Personal Information. Carmarthen reported the development of consent documents and FAQ leaflet together with literature for service users. Neath Port Talbot and North West Wales provided copies of working protocols Local developments seem to have halted or slowed down while organisations consider the implications of the WASPI. Page 5 of 9

6 7. Has the UA process been reconciled with CPA? Responses varied greatly from one Yes ; the majority reported Partial Progress ; to two outright No : Gwynedd LHB reported a pilot of electronic integration of UA with CPA Carmarthen reported joint discussions around integration and have identified barriers within software and local protocol There are reports that Mental Health teams for older people are open to integrating UA with CPA. However some areas reported that acute mental health services are more resistant to integrating CPA with UA. No community has achieved full integration in practice and there is a need for some collective development work across organisations, agencies and communities. Training 8. Outline the arrangements you have in place for UA training within your organisation (Details to include who provides the training external or internal and the training programme/content.) In general the responses contained detailed content of the plans and schedules for delivering training: Neath Port Talbot already have joint training in place and are expanding scope to include primary care, with guidance notes to support the training. A Pan Gwent training group have completed a training needs analysis. Joint training is delivered with external support and local training is also in place and delivered internally, tailored to meet the needs of specific teams or practitioners Gwynedd LHB reported the development of training strategy for voluntary and independent sector nursing homes North West Wales reported a detailed training plan and schedule including outreach into specialist and community based services Carmarthenshire reported the use of a UA e-learning tool available on the Trust internet Flintshire have developed a foundation training pack for managers to use with all staff Cardiff have tailored training packages aimed at specific staff and professional groups e.g. District Nursing A significant amount of training was reported across all areas. Communities without a designated UA lead reported a lack of capacity to achieve training requirements and it was also noted that training in several localities is dependent on one or two specific people. Page 6 of 9

7 ICT Infrastructure 9. Please describe the arrangements in place. It was noted that documentation has been made available electronically in several areas, mainly social services where in general there appears to have been greater development of ICT solutions. In health agencies there was little evidence of UA resources being available electronically. Gwynedd reported a pilot of an electronic template populated with information from GP systems and accessed by district nurses In Flintshire work is ongoing to develop joint electronic information sharing process. Two areas reported the development of local solutions, however health organisations are generally lagging behind social services with a number of communities waiting for the development of an electronic solution through the IHC strategy Performance Management Arrangements 10. What arrangements if any have you in place around performance management of the Unified Assessment process? There was wide variation in the performance management arrangement across the communities, and subsequently benefits realisation is difficult to define and aggregate from locally designed datasets, tools and techniques: Neath Port Talbot noted joint performance indicators reported through the local authority. Monmouth noted a suite of reporting methods including; specific outcome audits; professional supervision and service user experience through mystery shopper and expert patient interviews. Powys are developing a multiagency audit tool and a competency framework that links into KSF and national working standards Carmarthen reported 6 monthly reports to Trust Board together with the production of multi agency reports submitted to WAG Cardiff reported performance indicators and evaluation framework currently in development Where dedicated project managers are not in place there are limited performance management arrangements. Page 7 of 9

8 Outcomes & Evaluation Tools Unified Assessment Community of Practice Baseline Self Assessment Have you undertaken any evaluation work to be able to demonstrate the following impacts from the implementation of Unified Assessment? More Person Centred More Outcomes Focussed Reduction In Duplication Increased Professional Trust Increased Information Sharing Other Impact Yes/No Evidence Only Monmouthshire and Neath Port Talbot reported that formal evaluation work had been undertaken to establish the benefits of UA implementation Carmarthen and Powys reported some initial audit and evaluation with frameworks under development. 11. Have you undertaken any work around user satisfaction with the Unified Assessment Process? (If yes can you summarise the results and outline the tools used to collect this information) Most communities noted the current development of systems for gaining user feedback through audit tools and questionnaires within an evaluation framework: Monmouth and Newport LA and Gwynedd LHB reported satisfaction work completed. There is a clear need to develop resources to collect and learn from user experience of the process on a wider or more universal scale. 13. As an organisation what are your top three areas of success in relation to implementation of Unified Assessment? A wide variety of successes were reported both operational and strategic, overall the success correlated with three categories: 1. Greater organisational integration and partnership working: collocation of assessment nurses with social services in Powys 2. Joint training programme and resources implemented: Gwent and Ceredigion noted improvement in overall assessment skills 3. Joint Agreements on format of documentation was reported as top 3 success for a number of communities Page 8 of 9

9 14. As an organisation what are your top three priorities areas for progressing Unified Assessment? There was a high level of consistency from all communities over what to do next: 1. Development of interagency ICT solution 2. Increase engagement with health organisations and staff in primary and secondary care 3. Consistency in application of the process through common understanding, joint training and competency and changing culture For further information please contact the Change Agent Team: Lynda Chandler: Lynda.chandler@nliah.wales.nhs.uk Matt Wyatt: Matt.wyatt@nliah.wales.nhs.uk Jane Rook: Jane.rook@nliah.wales.nhs.uk National Leadership & Innovation Agency for Healthcare Innovations House, Bridgend Road LLANHARAN CF72 9RP Telephone: ; Facsimile: Page 9 of 9