Archived decisions

Hampshire County Council

Social Care Policy Review Committee Item 11

30 March 2005

Hampshire's Innovation Forum Project

Report of the Director of Social Services

Contacts: Claire Foreman, Ext 7127 mailto:[email protected]

David Browning, 07795 180248 email: [email protected]

1. Summary

1.1 The Policy Review Committee received a paper describing the Innovation Forum Project on 12 November 2004. The project is being developed jointly between the NHS and the County Council, and its purpose is to promote the well-being of frail older people and reduce their need for emergency services - especially emergency hospital stays. It supports Aim Number One of the Corporate Strategy (maximising life opportunities) by contributing to the Cabinet Priority for Older People. It also contributes to the achievement of key milestones and targets in the National Service Framework for Older People, and both national and local Public Service Agreements.

1.2 The project is being undertaken as part of the work of the Innovation Forum of `excellent' local authorities. The project involves deploying nurses and social workers within specific primary care practices to work proactively with older people who are most at risk. The aim is to work with the older people and their families to reduce these risks and promote independence.

1.3 This report brings the Committee up to date with the project and some of the issues emerging.

2. Progress with the Project

2.1 Four primary care trusts (PCTs) are taking part in the scheme with the County Council. They are East Hants, Fareham and Gosport, Eastleigh and Test Valley South and the New Forest PCTs. Teams have now been established in all four PCTs and the social workers and nurses are building up their case loads.

2.2 Fareham and Gosport PCT was the earliest to start, providing support in two practices from April 2004 by two full-time nurses and a social worker. A six month review in October, audited by a community geriatrician, concluded that the scheme definitely prevented 17 hospital admissions, probably prevented a further 10, and could have prevented a further 5 with greater experience. These savings have already more than covered the cost of the scheme. The PCT is now recruiting additional staff to roll out a similar proactive approach with nurses across all 21 practices in the PCT (although there are no funds to increase the number of social workers).

2.3 East Hants PCT already has a network of health care co-ordinators who work directly with primary care practices to help support vulnerable older people. For the Innovation Forum Project, one of these co-ordinators has been paired with a part-time social worker across two linked practices. The extra workload has been difficult to manage for the co-ordinator, and the PCT has made additional funds available for extra nursing support for the co-ordinator.

2.4 In both the New Forest and Eastleigh PCTs, a part-time nurse has been matched with a part-time social worker in a primary care practice. It has taken slightly longer to get these schemes going, mainly because of recruitment difficulties, but both are now up and running, and the staff are working with considerable enthusiasm.

2 Development of the Methodology

3.1 Since the start of the project, staff have been developing the approach. A number of key steps have been identified:

· Case finding

· Assessment and case planning

· Intervention

· Caseload management

· Monitoring and recording

· Assessement of cost-effectiveness

3.2 `Case finding' involves identifying the people who are at risk but not yet in crisis. This has proved to be more difficult than first thought. Initial scans of the files were not very successful. Currently staff rely on two main methods: first, practice staff nominate people that they are concerned about; and second certain `trigger events' are used to identify people. Triggers include attendance at A&E without admission, a rise in the frequency of attendance at the surgery, and calls to a GP at night.

3.3 After identifying that someone is at risk, a full and intensive assessment process follows - to gain the person's trust and uncover an often complex situation, that requires a care plan, drawn up with the person's full involvement.

3.4 The interventions included in the plan involve voluntary and community resources wherever possible, rather than statutory services. The social workers in particular are identifying needs for services and support and are beginning to work with their communities to develop additional services - such as carers' support groups. The aim is increasingly to involve independent agencies as partners in the project.

3.5 Staff are gradually building caseloads of people who need support, and principles for managing these caseloads will need to be developed. They will need to work out how many people they can support actively, and when it is safe to reduce their involvement, making contact less frequently to make space in their workload for new people.

3.6 Monitoring and recording are key to identifying the impact of the scheme. Social workers and nurses are recording information about the use of emergency services both before and after involvement in the scheme. It is too early to come to any firm conclusions, but initial indications from the first 30 people to have been supported for six months are encouraging (Table 1).

Table 1

Average use of emergency services for individuals before and after inclusion on the Innovation Forum Scheme.

Notes: sample of 30 people who have completed a six month review - excluding outliers with excessive values in the period before inclusion.

Rates have been converted to an `annual rate' so that the figures are comparable.

3.7 With a sample size of only 30, the improvements are certainly not statistically conclusive, but encouraging patterns are beginning to emerge. Once someone is included on the scheme, their need to keep attending the surgery reduces significantly, although for many people (10 of the 30), the numbers of GP home visits increases - prompted in some cases by the nurse on the IF Team. But overall, the workload of hard-pressed GPs is reduced, and bed-days per year for the 30 people was reduced from just over 500 to 70.

3.8 In addition to recording by social workers and nurses, ways of assessing well-being and quality of life are being explored. The London School of Economics is advising on possible approaches. The hope is that well-being and quality of life improve significantly for people involved in the scheme.

3.9 Overall emergency admission rates and bed days for people 75 and over from practices included in the scheme will be compared with practices outside the scheme, once it has been running for sufficient time.

3.10 The costs of providing the extra support are being recorded. In due course, any effects on emergency admissions and bed days and on GP time will be estimated, and the cost-effectiveness of the scheme will then be assessed. The hope is that there will be major efficiency gains - with the costs of providing proactive care in the community significantly lower than the costs of providing hospital care. If this proves to be the case and well-being measures also show gains, then the project will be improving well-being while reducing the overall cost of care.

3 Funding

4.1 The project is due to run for three years initially, and the first year is nearing completion. Funding for the second year (2005 / 06) has been secured as follows:

· Social Services Department (£50,000 plus management support)

· PCTs (full cost of nursing staff and their accommodation and support)

· Chief Executive's Department management, funding and co-ordination support.

An application has also been made to Hampshire County Council (Community Development and Regeneration) Fund for a further £50,000.

4.2 The Department of Health has announced (3^rd March 2005) a major new fund for supporting `Partnerships for Older People Projects' (POPPs), and the learning from the Innovation Forum Project will be used to help formulate Hampshire's grant application for additional funding.

4 Conclusion

Developments of both methodology and results have so far been encouraging after one year of the project. A further report will be made to the Committee in the autumn.

Recommendation: that the report be received.