1 single assessment process and the involvement of the voluntary sector a project commissioned by...
TRANSCRIPT
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Single Assessment Process and the Involvement of the Voluntary Sector
A project commissioned by Leeds Older People’s Forum on behalf of the City-wide SAPImplementation Group
Jean Townsend & Jeanette Moore
Health and Social Care Group
Institute of Health Sciences and Public Health Research
University of Leeds
March 2005
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Single Assessment Process and the Involvement of the voluntary sector
Purpose of single assessment process
Understanding the older person as an individual with a whole range of needs
Linking wide range of elements/services in the system to provide an appropriate response to individual’s needs
Making the system better for older people and their families
Everyone we spoke to shared this vision, so how does it become a reality?
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Scoping the size and diversity of voluntary sector in Leeds
Very substantial sector: eg Older People’s Forum has 100 member groups
Diversity of organisation: eg individual group; branch of national organisation
Capacity of organisation: volunteer run – single paid staff – large-scale organisation
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Key variations in voluntary organisations relevant to involvement in SAP
City-wide locally based services General community support support to
specific groups and/or high level needs Short-term interventions long-term
relationships Paid staff run by volunteers Activities of normal life provision of care
and support
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Our sample
City wide organisations
voice of older people 2
service providers 9
support to specific groups 2(Black & Ethnic Minority communities)
Locally based organisations
service providers 5
community based groups 12
Plus 6 key informants from the statutory sector
PCT, SSD Modernisation Team, Mental Health Trust
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What is going on outside Leeds Contacts with people working on this nationally
Most areas are struggling with how they can involve the voluntary sector. We need to share what is going on.
Not aware of guidance from national voluntary organisations to their members re SAP noted by Leeds vol organisations
Examples from Internet search, followed up by requests forinformation e.g.
North Tyneside information days contact: [email protected]
Northamptonshire information-sharing protocol - see: Appendix 3 at http://www.northamptonshire.nhs.uk/pdf/sap/sharingprotocol.pdf
Hertfordshire voluntary sector briefing days contact: [email protected]
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What is meant by involvement
Ladder of involvement Information Consultation Deciding together Acting together
We aimed to explore current situation andaspirations at these different levels of involvement strategically and operationally
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Attitudes to SAP in practice Enthusiastic
It helps you work with the older person to make sure they get quality care. I’m actually very for it…SAP is communication between agencies and you all go in at the same level and can find out who else is working there and contact then if necessary.
Open to possibilities
It has not been set up enough to know the advantages. We’ve not been involved. We’d like to know more about it to give it a fair chance.
Puzzled and cautious
It is difficult, knowing the process is struggling around the city to get my head round where we can fit into the loop.
Dismissive
I’ve barely given it a thought. There is no coherent and up-to-date information.
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Current sources of information about SAP
Most common source Older Peoples’ Forum – talks by Sally Mayfield, SAP Project Manager & City-wide Lead, mainly about concept and plans, but little about day-to-day implementation. In questionnaires, only one person ticked box saying ‘familiar with way SAP working in their locality’
Local Neighbourhood schemes meetings with commissioners – familiarised people with forms etc.
Day-to-day local front-line staff give their (often negative) views of SAP
Registered service providers had most acquaintance with forms
A number of interviewees said they had not seen the SAP folder in people’s homes
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Good practice examples
West Area Neighbourhood Network Schemes attended basic training on SAP and found that very useful
Social Isolation Group (Standard 8 Lead, Health Promotion & NNS) have developed a programme with Cheryl Guest, SAP Training Officer, for SAP assessors to relate to the Wellbeing section of the Overview Assessment
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Consultation and planning about SAP
Involvement of voluntary sector on SAP Implementation Group from early days but only one representative.
Lack of voluntary sector involvement in sub-groups such as development of specialist assessment forms.
Local consultation in PCT areas but patchy across the five PCTs. Locality forums can be problem for city-wide agencies.
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Perceptions from voluntary sector
It is down to partnership working. What we want is to be recognised as equal partners. It can be hard work getting thatrecognition.
We are an after-thought.
Different relationships with different agencies – SSD more familiar with voluntary sector than Health
Differences across the five PCTs
Mental Health Trust more advanced in partnership with voluntary sector through Volition and CPA than Acute Trust
Can be both excellent working relationships and barriers with individual staff at grass-roots.
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Perceptions from statutory agencies
We have managed to get system in place across the whole city involving SSD, 5 PCTs, Acute and mental health hospital BUT:
Enormity of task has meant that voluntary sector involvement has been deferred until sorted our own staff.
Huge area for attention is involvement of Primary Care – GPs. This is taking up much attention at present.
Still developing, evolving and revising forms and procedures as the system rolls out.
Important to include voluntary sector groups but need to be clear about how and at what level.
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What strengths/attributes could the voluntary sector organisations bring to the SAP process?
Person-centred, holistic, flexible approach, often less constrained by bureaucracy than statutory agencies
Identifying unmet need in the community
Advocacy for older people in contacts with statutory agencies
Maintaining long-term, on-going contacts
Providing flexible quality care
Providing care for groups who are less easy to reach or provide for in mainstream services
Monitoring quality of assessments.
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What concerns/problems have been raised about voluntary sector involvement?
SAP depends on trust in professionalism and competence of assessors – this presents a barrier for some statutory staff re voluntary sector.
Drawing the voluntary sector, especially community based groups too far into the statutory mould – loss of distinctiveness from statutory agencies.
Extent of information sharing – importance of understanding boundaries/ retaining privileged information
Too time consuming for small agencies.
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Assessment and Care Management Pathway
Service user needs additional support
Identify needs Referrers into system
Assess-ment of needs
Deciding how to meet needs
Providers of
services
Review and reassess- ment of needs
Therefore voluntary sector agencies may be involved at two distinct points in the pathway; some agencies in one only, many at both points.
Point1 Point 2
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Voluntary sector contacts at point 1 Assessment of new members to their organisations by voluntary
agency
Identification of unmet needs e.g.
People beginning to struggle
Self-referrals to voluntary agency
Those who have fallen through net on discharge from hospital
Winter warmth visits
Referral to statutory agencies – variable practice
Occasionally act as advocates/companions during assessments
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Issues re involvement in SAP Prevent duplication of assessments of new
members/sharing information
Voluntary organisations want statutory assessors to be more aware/have information about their services
Need a smooth route to make referral for assessment
For some agencies, especially where they know older person well, they could fill in contact assessment, provided training, protocols and guidance, resources available.
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Voluntary sector contacts at point 2
Care manager/District nurse make referrals – variable documentation used
Voluntary sector providers undertake their own assessments to enable them to provide a service
NB some voluntary sector agencies are registered under CSCI – legal requirements like those of home care
Variable involvement in care planning and review
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Issues re involvement in SAP
Quality of assessment documentation/ care plan
Logistics re documentation
Concerns re documentation in older people’s homes
Better involvement in care planning and review
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Voluntary Sector Involvement in SAP
The graph on the following slide illustrates the different levels of voluntary sector involvement:
The axes represent Intensity and complexity of needs (horizontal) Likelihood of contacts with different specialist services (vertical)
Many older people at the bottom left hand corner will be supported in local communities and by voluntary sector agencies without formal assessments of needs (e.g. bowls clubs, leisure activities, neighbourhoods networks, faith groups). Voluntary/community sector role here is often signposting and advocacy.
Voluntary sector may be directly involved in SAP At contact level, for clients who need support from formal services In some cases, especially with hard-to-reach groups, at overview
assessment For voluntary agencies which provide specialised services – e.g. early
dementia services, homeless older people, sensory impairment – there may be direct involvement in specialist assessments.
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Voluntary Sector Involvement in SAP
Signposting
NEEDS
SPECIALISMS
Contact
Overview
Comprehensive
Specialist
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Conclusions
Voluntary organisations want to be involved in developing systems to improve person-centred care, at a strategic and individual level, though the level of involvement will differ with the nature of the agency.
Strategically, the voluntary sector would like to have more than one representative on the SAP group and to be involved in sub-groups on development of tools and procedures. More regular contacts between the reference group and SAP Implementation Manager were suggested as a possible avenue to explore, as this would provide a conduit for the agencies to feedback the reality of the situation at operational level.
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Conclusions (cont)
Voluntary organisations need more and consistently up-dated information about the day-to-day running of the system. Involvement in initial training about SAP would offer this opportunity and should be offered to all agencies who have an SLA with statutory agencies or substantial grant funding.
Voluntary organisations want statutory staff who are assessing and managing care to be aware of and have information about the services they offer. Engaging voluntary organisations as trainers in SAP modules, as in the Social Isolation group is a good model already in progress.
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Conclusions (cont) There needs to be more emphasis on the care management
and review aspects of the SAP process and involvement of the voluntary sector in this. Work on CPA which is on-going in the Mental Health Trust may offer lessons and good practice.
Because of the diversity of the voluntary sector, agencies will be involved at different levels in SAP. Where staff already have good relationships with older people and identify unmet needs, for example, the contact assessment could be completed by them as a referral route. In specific circumstances, based on individual needs, this maybe extended to overview assessments or these could be undertaken jointly. Some agencies will conduct specialist assessments. Levels need to be agreed with individual agencies and appropriate training and information sharing protocol agreed.
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Conclusions (cont)
Information is required by all those who are providing services about
who and what can be recorded in the SAP documentationissues around consent and the extent of information sharingclarity about expectations on how to undertake an assessment.
When discussions take place about communication routes, including IT developments, the voluntary sector should be seen as a partner in the process.
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Contact Information
Jean Townsend e-mail [email protected] Moore e-mail [email protected]
Health and Social Care Group
Institute of Health Sciences and Public Health Research
(formerly Nuffield Institute for Health)
University of Leeds
71-75 Clarendon Road
Leeds
LS2 9PL
Tel. 0113 343 6993Fax. 0113 343 6880