case study: north yorkshire preparing services for future generations: becky nightingale, sap...
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Case study: North Yorkshire
Preparing Services for Future Generations:
Becky Nightingale, SAP Project Co-ordinator
Introduction
SAP in North Yorkshire: backgroundIT projectsPerson Held Records Working with the National NHS IT
Programme (Connecting for Health)Research into user/carer views on SAP
SAP in North Yorkshire: the background
Long standing commitment to SAP from senior management team and appointment of SAP project manager in 2000-2002
Development of SAP IT solution with Liquid Logic
Appointment of SHA SAP Partnership Manager
SHA wide commitment to adopting EasyCare Project set up for 250 users in four sites
across North Yorkshire Further project management support in place
from 2004-current position
SAP Assessment Types and NEYNL choice of tool
TYPE ACCREDITED TOOL
Contact EasyCare
Overview EasyCare
Specialist Locally Configured
Comprehensive MDS
IT PROJECTS AND PARTNERS
IT Projects
Electronic SAP solution developed using a web-based product which enabled staff to dial up to the database from a variety of health and social care settings. (Liquid Logic)
Local ownership and championing of SAP by managers and practitioners
Building on existing networks of good inter-agency working e.g. intermediate care
Negotiations ongoing around API (Application Product Interface) with social services system (SWIFT) and SAP
NPfIT programme rolled out through Accenture providing an e-SAP solution.
IT projects: cont’d
Range of organisations involved includes voluntary sector, housing, mental health trusts, 4 PCTs and 4 Acute Trusts.
Staff training supplemented by local staff attending “train the trainer” e-SAP courses and central IT services providing ongoing “floorwalking”
Provision of SAP training commissioned by local Workforce Development Confederation and provided by local Universities.
Outcomes:
After one year the four projects are still up and running, one has doubled in size and another has adopted NPfIT technology.
Between Nov 04 and Nov 05 the 250 staff involved in the project have completed 3251 assessments and 1146 referrals. Of the assessments 1795 were contact assessments (40%) and 41% were Overview assessments.
By the end of 2006 a further 350 NHS and social care staff to join the SAP programme through NPfIT
Care planning software and other functionality now available.
Ongoing issues:
Shortage of IT skills/confidence of staff Culture change from paper to laptops Culture change around information sharing Problems with individual teams dropping out due
to staff shortages System training and support for staff is much
more intensive than originally expected. Engaging with voluntary sector, housing, home-
care Establishing roles and responsibilities
Next steps:Establishing base-line IT competency for
all social care staffCustomised training materials suitable for
individual staff groups.Ongoing staff liaison groups to feedback
issues/problems with the system.Staff feeling confident to use more detailed
functionality within the systemReview of mobile working e.g. digital pens
Issues that we cannot blame on IT
Local staff teams do not always meet up regularly to look at person centred care and IT is not always top of the agenda!
Complete system redesign/business change is required to “embed” SAP in day to day business.
“Group think” can be a positive influence but can also be negative where staff groups feel they are the only ones participating and others are less committed.
Joint project planning and delivery of services requires a large amount of joined up working which can test anyone’s project management skills!
Person Held Records
Person Held Records: background
Due to local situation within one region of North Yorkshire the local health community were unwilling to look at using the e-SAP solution.
Therefore needed to look at other ways of sharing information.
Trialled use of a person held record with EasyCare documentation.
Discovered Bradford had an excellent model and used their design/printers to supply North Yorkshire.
750 folders have already been issued and a further 950 printed ready for distribution across at least 4 different sites (including teams already using the IT software.)
Constituents of SAP Folder
Person Held Records: pros Can be a very positive way to incorporate
person centred care into services as there is an immediate benefit to service users and carers rather than a “back-office” tool.
Folders are a simple cost effective way to encourage staff in the use of an accredited SAP tool which might not normally meet their expectations of an assessment.
Out of hours services can access information more easily
Carers/Family can access copies of assessments/record sheets from the multi agency team
Person Held Records: cons
Difficult to leave a copy in the clients home and take one back to the office. Time delays are fairly inevitable.
home care and district nurses still need to keep their records separately within the folder, so that they can be removed at a later date for audit purposes.
Does not allow professionals to access information until they are in the clients home e.g. where risks have been identified around visiting or access.
Working with NPfIT
By Sept 2005 2000 users of SAP completed over 30,000 assessments across the North and NE clusters (managed by Accenture).
SAP Clinical Reference Group set up for the NE and Eastern Cluster by the NPfIT programme board.
As a core member of the Clinical Reference Group, I am able to report back staff concerns and priorities for upgrades to the software.
Through this network it is possible to influence the development of interfaces between different NPfIT systems e.g. mental health, community nursing, acute trusts.
Also part of a consultation on the bigger picture e.g. types of functionality that are considered important by different staff groups.
Start
Develop Idea
Implement
Monitor and control the project
Plan and Organise the
Change
Define Scope Test the solutionEnd
Build the ongoing support
Communicate
time
Design
Why evaluate the project’s success?
Research into user/carer views of being “SAPed”
Survey sent out to 500 service-users who had recently undergone a “SAP” assessment and we also included a small sample of people who had been assessed through social care only. We had 147 replies (29% response rate) and some comments from carers on a free-text section, which asked how well they thought NHS and social care worked together locally.
Out of the 12 questions, there were 6 that had over 55% response rate from the service users and therefore provided slightly clearer messages.
There was quite a lot of variation of opinion across the different SAP projects but no marked difference between the site that we used as a “control” which included only service users who had been visited by social care staff.
Results of the survey
78% of respondents agreed that they would prefer the first professional who visits to write down relevant details, and then share with others
In the event of the service user having to go to hospital, nearly 69% would like a professional to tell the hospital what has been happening at home.
More than 63% of respondents are happy for details recorded by professionals to be kept in a folder in their own home so that other professionals can read it.
Survey results:
Nearly 58% of respondents are happy for details recorded by professionals to be kept on a computer so that other professionals can read it.
Information most commonly asked for by professionals was ‘How is your health’, How well do you manage to look after yourself’, ‘Who helps look after you at home’ & ‘Name & address’
When asked if there was anything that they would prefer professionals not to share with each other, the most common response was ‘How well they manage their money’
Unexpected outcomes:
Using the technology does not automatically reduce the number of visits made.
Intermediate care teams and other MDT teams particularly received high praise.
The number of professionals visiting a client was not necessarily reduced.
The same type of information was likely to be gathered by all agencies. E.g. personal details, personal care, home situation, general health
Comments on how NHS/Social Care could work better together:
“I understand Health and Social Services are legally obliged to work together and they do the best they can under the strict financial controls that apply”
“Unless I contact Social Services or doctor they do not make any contact at all. As I am 92 a phone call or visit would be appreciated.”
Comments:
“Unfortunately communication between individual people is so poor, in spite of “modern aids” that I doubt if any help can ever by gained by reports such as these!”
“Should keep same case worker, once contact has been made. And not re-allocated to different case worker if needs comes up again. Old people get to know one person and then it can be changed to someone they don’t know.”
Comments:
“The help that has been given to me up to now has been good and the health and social services team worked well together to give me the help I needed at home after coming out of hospital.”
“From personal experience excellent- if it hadn’t been for NHS and Social Services Rehab/Rapid Response Services working together I don’t believe I would be filling in this form today. A very grateful patient”
National/Regional Networks
Regional “Lessons Learnt” event in Newcastle which was extremely helpful for implementation of SAP through NPfIT
Do once and Share programme being established to look at best practice around SAP, care pathways etc.
CPA website has a useful discussion forum and library of resources set up by the DOH.
Contact details:
Social Services, Pick’s Lane, Thirsk, YO7 1PF
07984 74226901845 521425