EVALUATION REPORT: HEALTH AND SOCIAL CARE ASSESSMENT OF NEED (HaSCAN)
Contents Introduction:... 3 Background:... 3 Vision:... 5 Methodology:... 6 Evaluation:... 9 Benefits:... 13 Conclusions and Recommendations for future developments:... 15 Appendix 1 Design group members... 17 Appendix 2 Evaluation Criteria... 17
Introduction: The Common Assessment Framework for Adults programme (herein after referred to as the CAF programme) is a national programme commissioned by the Department of Health with twelve local authority led partnership sites. The East Cheshire CAF Partnership is led by Cheshire East Council with partners including Mid Cheshire Hospitals NHS Foundation trust (MCHT), Central and Eastern Cheshire PCT (CECPCT) and the East Cheshire Trust (formerly Cheshire East Community Health to April 2011). The East Cheshire CAF Partnership was a Phase 2 site in the national programme and started formal work in January 2010 with an end date of 31 March 2012. The main aims and vision for the East Cheshire CAF programme were broadly in line with the national programme aims and focussed its work in discrete areas. These areas are summarised as: Assessments of individuals with health care and / or social care needs Hospital discharge of people with complex care needs People involved with the NHS Continuing Healthcare and Funded Nursing care team People involved with the health and social care Intermediate Care Team Connecting the social services assessment system (IBM-Esprit ShareCare) to the NHS Spine Personal Demographics Service (PDS). Access to information, advice and resources and contacting health and social services This report concerns the area of assessments of individuals with health care and / or social care needs. It sets out the national and local context for the work on assessments, the vision and process used in developing a joint health and social care assessment of needs, an evaluation of the process, solution, benefits and costs. Background: This section provides both the national and local context for looking at the process and tools used in the assessment function in East Cheshire. The concept of an individual having or undergoing an assessment is not a new concept in either health or social services. The issue that has been, some would say, lost is the purpose of assessment or that assessment is not just about filling in an organisational determined form. In social work terms, assessment involves collecting and analysing information about
people with the aim of understanding their situation and determining recommendations for any further professional intervention 1. The DH CAF Programme aimed to improve the assessment process, in particular making it more personalised, proportionate and integrated across health and social care. In CEC, there were several similar assessment forms in use: The MDS, which has different forms for different levels of assessment: contact, overview and comprehensive. This was primarily used for assessing individuals who may require residential care. The Cheshire East Community Care Assessment (CECCA), which was primarily used for assessing individuals who may require community care. The feedback from social care workers in Cheshire East Council was that they felt the CECCA was primarily a tick box approach to assessment and that it did not give them the chance to engage in a discussion with the client / their carer. This view is reflected by Hall et al (2003 in SCIE, 2011) 2 that notes assessment made by the social worker represents his or her construction of a narrative or story about the situation in question and may, accordingly, reflect the perspective of the social worker more than of the client. This criticism of the CECCA is in part due to its origins. It was designed to support the introduction of the Resource Allocation System (RAS) approach to allocating resources to meeting assessed needs the colloquially known approach of points mean pounds ( ). The feedback from social care workers about the MDS was that it was overly long and again had primarily a tick box approach to assessment. In addition, the different forms meant a service led approach to assessment rather than a person-centred assessment and duplication if, for example, someone was assessed for community support using a CECCA and then turned out to need residential care, requiring completion of an MDS. Community Matrons and District Nurses from Cheshire East Community Health (CECH) (from April 2011 part of the East Cheshire Trust (ECT)) recognised that a lot of the information that was recorded in both health and social care was common data i.e. it was the same or similar. Examples of same data include demographics (name / address / date of birth / GP / carer details) and of similar data include the domains within which assessments were being carried out, e.g. mobility, personal health, emotional well-being. CEC and CECH / ECT recognised that closer working and co-location of teams would support the patient experience, contribute to the council efficiency and NHS QIPP programmes and 1 Crisp et al (2003) in Learning and teaching in social work education: textbooks and frameworks on assessment. SCIE. 2005. 2 SCIE Guide 18: Assessment in social work: a guide for learning and teaching
support more integrated working. The aim of a single assessment approach that could also be shared in the same IT system would support the local and national CAF programme aims of reducing duplication and effort in collecting and recording data. CECH staff were very positive about the move to IT based recording of their assessments one of the early issues noted from CECH staff was access to computers at their place of work and that very often there was only 1 desktop PC to be used by nursing staff. Staff also noted that some surgeries required them to record on the EMIS patient record as well as the local management reporting system. In addition, the SAP programme envisaged the use of the ShareCare system as well. Staff also noted that there was no formal community nursing IT system but they were aware of local and national pressures to acquire one. Later in the programme there was a local NHS decision to purchase EMIS Web as the recording system for community healthcare. EMIS Web was also envisaged to interface at some stage in the future with the GP based EMIS system. Vision: This is the vision that was encapsulated in the CAF bid documents to the Department of Health and the original project documentation that was further reviewed in April 2011. One assessment tool that could be used across health and social services Assessments recorded on 1 IT system ShareCare to enable sharing Assessment data to be electronically transferred from ShareCare to Paris to save duplication of recording by social care workers CECH staff to be provided with laptops to support mobile and IT enabled working An assessment tool that would replace the two assessment tools currently in use in Cheshire East Council (the CECCA and the MDS) An assessment tool that enabled the assessor to engage in a discussion with the client and record that discussion An assessment tool that contained some tick box style questions where a Yes / No answer was deemed to be the most appropriate answer An assessment tool that would be multi-disciplinary at a non-specialist level of assessment that could be shared with experts to provide a background to an individual and support the rationale for a specialist assessment request
A recognition that the new assessment would need to be flexible and adaptable to new situations and changes in policy An assessment that could be used in both hospital and community settings An assessment where the data could be reused by either health or social care employees An assessment that could be shared with individuals or their official representatives Name to reflect integrated assessment hence Health and Social Care Assessment of Need abbreviated to HaSCAN - chosen To reflect proportionality of assessment, the tool to be defined in domains that could be selected to be used or not also to reflect nurses requiring specific information that social care may not collect and variation in need of individuals To have a proper pilot and evaluation period with recommendations for amendments made before a decision on future plans to include stop and cancel / amend / roll out across areas. Methodology: The basis of the methodology was co-production. This method was described in the original PPF Concordat (December 2007) as involving the end users of new services (or redesigned / re-provided services) from the design stage onwards. In effect this does not just mean consultation or participation; but full and equal involvement in the design / build / test / launch and evaluate stages of the product life cycle. Delivery: Common data set identified across health and social care assessments in use in East Cheshire March 2011 New HaSCAN designed by end May 2011 ICSMT agreed format and pilot area June 2011 HaSCAN template submitted to Esprit 16 July 2011 East Cheshire Trust de-scoped from CAF programme November 2011 HaSCAN delivered in ShareCare November 2011 Training and ongoing support delivered November 2011 SMART and Hospital Team started using 3 December 2011 Design Group:
Design group met on defined dates for a defined time with a pre-defined and agreed agenda (for a list of attendees and organisations represented please see Appendix 1). Design group was informed by a piece of analysis carried out previously that identified a common data set across assessments in use currently in community health and social care in East Cheshire. This identified common data items (largely demographics and biographics) and common assessment domain headings. Design group members fed back and fed from their individual groups and / or organisations and were the representatives of that group / organisation and did not speak uniquely. IT partner was an equal member of the design group, but we recognised that due to contractual obligations we would also need to define our requirements formally in a Requirements Specification that could be worked towards by IBM-Esprit Design Group also included CAF team members. They were tasked with doing and enabling the work to happen (specifically Mark Jones, Marion Chambers, Tim Dalby & Jan Hoogewerf). The CAF team also met with senior managers from CEC and CECH / ECT to note progress. Meetings were also held with Cheshire NHS ICT Services regarding the progress of the CAF programme with NHS staff, procurement of laptops for the ECT staff and latterly around the implementation of EMIS Web. There was a separate workstream looking at the interface between IBM Esprit ShareCare assessment system and the Civica Paris case management system in use in CEC adult social care. This group met with Esprit and Civica on a number of occasions. A design specification was produced. Unfortunately Civica was unable to schedule the work required in its timetable before the end of the CAF programme. This meant that this element of the programme was unable to be delivered. This did result in an under spend on the CAF budget of around 240k. Constraints: The CAF programme is a demonstrator programme funded by the Department of Health. This means that the products developed are to demonstrate that they can be developed and do what they are supposed to. Funding and development does not imply that at the end of the programme that the products are funded on an on-going basis and decisions regarding future funding would be made at or near the end of the CAF programme. The HaSCAN was not launched as a full Cheshire East Council / NHS product from the outset as it needed to be properly piloted and evaluated.
As other workstreams within the CAF programme were focussed on the Crewe and Nantwich area, this area; along with the Leighton Hospital Social Care Team, was chosen as the pilot / demonstrator area. As noted above, the East Cheshire Trust began the roll out of EMIS Web to community healthcare staff at the end of 2011. At a meeting with CAF team members on the 25 October 2011, the East Cheshire Trust formally de-scoped themselves from the CAF Partnership Programme. Thus the roll out of the HaSCAN with associated laptops to community matrons and district nurses in the Crewe & Nantwich area did not happen. As noted above, there was a dependency on 2 IT suppliers Esprit and Civica. Whilst Esprit were able to fulfil their contractual obligations in this area, Civica were not and thus the electronic transfer of assessment data from ShareCare to Paris was unable to be realised.
Evaluation: Methods: Formal and informal meetings with groups and individuals using structured questions and unstructured discussions Current management reporting tools in use in social services (mainly from ShareCare and Paris IT systems) Involvement and Process: For details of the criteria used, please see Appendix 2. 1. Was the range of stakeholders adequately represented? It was considered that the range of stakeholders was adequately represented as there was representation from across the SMARTs and Leighton Hospital social care team and from district nurses, occupational therapy and community matrons. They liaised with colleagues. The engagement with stakeholders is evidenced through the following comments: 3 members of the team were involved from the early stages, felt like it took a long time to get going people fed back to the team (the progress) and asked us our thoughts. The (design) group had people on it from across health and social care Trusted workers were on the (working) groups including a senior social worker who is also good at (IT) systems This brought CEC staff together with health (staff) to develop a new system We read about programme on Centranet and RADAR briefings We had a lot of emails and invites to meetings 2. Was co-production an effective way of working (e.g. delivered on time, in line with user requirements)? Co-production was welcomed by those participating as providing many of them with their first opportunity of being involved in designing a new solution. It was considered to be an effective approach. The use of software to mock up forms for people to review prior to finalising the design was also considered a good approach. This is evidenced by the following feedback: There was a glimmer of hope that things were changing as we were now involved decisions were being made with us and not just done to us Operational staff were on the ground developing (it) and it is now going down well
The (business analyst) spent time with us and we showed him our forms and he understood our processes. Other developments have been done by people who don t understand what we do (It) is useful to share with other professionals who understand it The team has really felt that it has been listened to and the ideas taken on board It didn t seem like a change for change s sake This programme has been the first one I ve been involved in where we felt we were part of the solution and not just something dumped upon us we weren t part of (developing) The demonstrations of the form as it went along (through the iterations) was good as it showed us the possibilities 3. Did the HaSCAN deliver the full scope of the vision? The HaSCAN delivered major elements of the scope of the vision. The area where it was unable to deliver related to electronic sharing of information: between ShareCare and Paris and with community matrons and district nurses, as both were taken out of scope for different reasons and at different points in the programme. People have fed back various comments including: It looks a lot better when sharing with clients and their families Obvious to consider consent and capacity at start of form not at the end (as with the CECCA) this is better You can assess people just on the domains that matter The old form was ridiculous and felt immoral to operate and ask irrelevant questions We use computer for around 65% of our job it is important to have a useable document this is better I really like (the HaSCAN) and feel it enables me to do my job better It feels more like a conversation with the client rather than just having a load of tick box questions It is better (than the CECCA) but there are still problems - but these are related to ShareCare I think and not the form The table below indicates scope of delivery: Vision One assessment tool that could be used across health and social services Assessments recorded on 1 IT system ShareCare to enable sharing Scope of Delivery HaSCAN jointly developed. In use in CEC and a variation used in East Cheshire Trust in EMIS Web. Not delivered ECT de-scoped from CAF programme.
Vision Assessment data to be electronically transferred from ShareCare to Paris to save duplication of recording by social care workers CECH staff to be provided with laptops to support mobile and IT enabled working An assessment tool that would replace the two assessment tools currently in use in Cheshire East Council (the CECCA and the MDS) An assessment tool that enabled the assessor to engage in a discussion with the client and record that discussion An assessment tool that contained some tick box style questions where a Yes / No answer was deemed to be the most appropriate answer An assessment tool that would be multi-disciplinary at a non-specialist level of assessment that could be shared with experts to provide a background to an individual and support the rationale for a specialist assessment request A recognition that the new assessment would need to be flexible and adaptable to new situations and changes in policy An assessment that could be used in both hospital and community settings An assessment where the data could be reused by either health or social care employees Scope of Delivery Not delivered Not delivered Civica were unable to complete development in timescale. Esprit produced interface design architecture documents. CECH / ECT staff de-scoped from programme in October 2011. Equipment therefore not provided. HaSCAN replaced CECCA and MDS. Confirmed as appropriate by ICSMT per roll out in March 2012. In part Feedback indicates that this was delivered. Laptops were not felt appropriate to record on to directly. Felt more like an assessment related to social work values / what an assessment should be. As per HaSCAN Designed and able to be used by health and social care staff. OT reports useful to start specialist OT assessment. Not evaluated with other specialists e.g. CPN / Physiotherapist. Able to be added or amended by Esprit in ShareCare as required. Has been amended by ICSMT for word version. In use in CEC SMART and Hospital teams and no issues identified with form. Data can be reused as current functionality in ShareCare. Form can be shared with health colleagues for re-use of data but not electronically to date.
Vision An assessment that could be shared with individuals or their official representatives Name to reflect integrated assessment To reflect proportionality of assessment, the tool to be defined in domains that could be selected to be used or not also to reflect nurses requiring specific information that social care may not collect and variation in need of individuals To have a proper pilot and evaluation period with recommendations for amendments made before a decision on future plans to include stop and cancel / amend / roll out across areas. Scope of Delivery by CAF programme. Affected by CEC ICSMT decisions. Staff report feel comfortable sharing with clients / official representatives. Feel it is more of an assessment record as opposed to a tick box record. Health and Social Care Assessment of Need abbreviated to HaSCAN - chosen Assessors can select domains to assess client against. Can select / deselect domains at any time in process to reflect changes / unknown needs. Pilot and evaluation 12.2011 03.2012. Due to decommissioning of ShareCare in CEC, decision made to roll out to other CEC teams before end of pilot and formal reports produced. Some shortfalls in the vision were also commented on: It s a pity it couldn t link the outcome of the assessment to the Care & Support Plan (this item was de-scoped due to changes requested by ICSMT that could not be met in the development timescales). It s a shame that it (ShareCare) couldn t be linked to Paris as this would have made it easier and we could have spent less time doing things that aren t relevant to social work Companies like Amazon can have a system that does exactly what you want it to do why can t CEC have a system (ShareCare) that supports workers? 4. Were changes required to the content of the HaSCAN identified? Area to record carer s views on the assessment if the carer didn t want a formal carer s assessment In appropriate domains drop down lists to include an option to record client unable even with help Area to record carer and service user views on the assessment content
When printing out completed assessment, only assessed domains to be printed 5. Was the HaSCAN sufficiently easy to use? Yes - within the confines of existing ShareCare functionality Benefits: Keep it simple message has been taken on board Anticipated benefits are listed on the table below, together with an assessment of the extent to which they have been realised. The main area where benefits were reduced from those anticipated was in sharing and re-use of information due to removal from scope of community nurses and the interface between ShareCare and Paris. Anticipated Realised? Measure Yes Rationalised forms provide improved data set and apply a consistent approach Increased sharing and re-use of information Reduction in duplicate data held less time spent on input with a greater reliability / consistency of data Staff spend less time asking irrelevant Only very limited In part Feedback from Hospital and SMART staff in CEC of 1 form only in use. ECT de-scoped from CAF but use form similar to HaSCAN in EMIS. Scope of sharing reduced: possible to share between hospital and community social care and CHC team only. ECT de-scoped from CAF but use form similar to HaSCAN in EMIS. They could use secure email to share if this was set up locally (e.g. NHS Mail/GCSX). Demographic info obtained from NHS Spine link. Yes Staff complete sections questions / inputting a neutral answer relevant to client only. Reduced training costs due to normalised processes gained from use of a single system and generic assessment approach No Similar form in use in CEC and NHS, but no joint training as using separate IT systems in NHS and social care. Less time spent completing a shorter form Yes Feedback from Hospital and
Reduction in paper use / wastage gained from completion of e- forms as opposed to paper forms (and then e- forms in CEC) Reduction in size of carbon footprint related to areas such as need for fixed desk space / office usage / paper usage. More easily auditable process QA / ID of problem areas Reduction in lead times gained from real time processing (no time wasted in waiting for faxes / letters / other professionals assessments) Improved experience for the client related to data collection time being reduced (affirmation rather than re-asking) and questions such as why don t you talk to each other, I ve given my consent for you to they ve already asked me that once? Reduction in duplication of data across different forms required at different parts of the assessment and care & support provision journey in social care Better experience for the assessor completing the assessment and a greater Yes Yes No Not measureable In part In part Yes SMART staff in CEC - new form much shorter than MDS. Not shorter than CECCA but gives better outcome. Easier to complete on laptop. More meaningful to client and assessor. Less paper used in printing as only print domains assessed not whole form. CECCA is 19 pages and MDS Overview is 25 pages. HaSCAN 21 pages in entirety. More likely to start recording on ShareCare rather than paper and then transfer. Workers report do not like recording direct to laptop at patient bedside. Not measureable in timescale. This would only be realisable if a) interface to EMIS Web so assessments could be shared or b) with MDNA if you really had multi-professional input. To be measured formally by PSSRU as part of external DH evaluation. Informally service users on CAF programme said HaSCAN better format / content (than CECCA). CECCA & MDS replaced with 1 form. Some direct mapping to proposed Support Plan. The form pulls through data from domain assessments to the assessment summary which cuts out duplication. Feedback from Hospital and SMART staff in CEC suggests
sense of pride / achievement / fulfilment in their work. Reduction in time (to zero) spent copying and pasting data from ShareCare to Paris this has been realised. No Integration was not achievable in timescale. Costs The costs of the HaSCAN development and implementation have been approximated further to information from Esprit that the HaSCAN represented approximately 30% of the development time of the suite of forms (in addition ICT, CHC and hospital discharge). To note: They include only programme costs and do not take account of the time contributed by working group members. Development costs only apply as Cheshire East was the first site to work with Esprit to develop the portal, and on-going and for other sites there would only be running costs. This information is confidential and has been removed Conclusions and Recommendations for future developments: The HaSCAN has been viewed as step forward in the assessment process in CEC and the adoption of it in the wider CEC social care teams is recommended The HaSCAN needs to be part of an iterative development process to take account of future developments in legislation and policy. However, before any amendments / tinkering happen a full evaluation needs to happen of the requirements The HaSCAN can stand alone from any future developments in the RAS based approach to allocation of resources to meet care & support needs Any future developments in forms / processes within social care needs to include social care employees on the design group to ensure that their needs are met and views taken in to account
Appendices: Appendix 1 Design group members Appendix 2 Evaluation Criteria
Appendix 1 Design group members This information is personal and confidential and has been removed. Appendix 2 Evaluation Criteria Involvement & Process o Was the range of stakeholders adequately represented? o Was co-production an effective way of working (e.g. delivered on time, in line with user requirements)? HaSCAN Solution o Did the HaSCAN and IT solution deliver the full scope of the vision? o Were changes required to the content of the HaSCAN identified? o Was the HaSCAN sufficiently easy to use? Benefits (early days, so may only be anticipated or anecdotal, not measured) Costs/Resources o What benefits were anticipated from the CAF developments? o How far have they been realised? How can the benefits be measured? o Costs of IT solution (system, networks, etc. for PDS, new forms, portal, RD) o Resource costs (programme team, business lead, staff and user/carer input)