THE CFWI CARE PATHWAYS TOOLKIT:

An introduction to the tool and its benefits

IHWC conference – May 2013Meena MahilThe CfWI produces quality intelligence to inform better workforce planning that improves people’s lives

The complex needs of the ageing population are amongst the greatest challenges facing the health and social care system.

The Later Life Project focuses on identifying and analysing the workforce implications of this scenario. We have developed a toolkit to assist workforce and service planners in planning across an integrated care pathway.

What is the Later Life Project?The population of the UK is ageing. In thirty years time, a quarter of the population is projected to be aged 65 and over.

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The later life project was developed to help improve the care received by the elderly. It consists of six phases.

What is the Later Life Project?

Interim report identified the scale of potential benefits and the broad implementation themes

Report documenting potential benefits in more detail, and provided narrative around the workforce

Intelligence report

Draft online care pathway toolkit

Guidance for NHS planners

Interim care pathway toolkit

Toolkit testing and refining

Develop case study

User acceptance testing and benefits evaluation

Public launch of care pathway toolkit

Ongoing benefits evaluation

PHASE 1 PHASE 2 PHASE 3 PHASE 4 PHASE 5 PHASE 6

SEP 2010 – DEC 2010

JAN 2011 FEB 2011 – JUN 2011

JUL 2011 -NOV 2011

DEC 2011 – MAR 2012

APR 2012 - ONWARDS

CAMBRIDGESHIRE

LINCOLNSHIRE

SOUTH LONDON

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The project has produced three main outputs:

What is the Later Life Project?

Jun 2011

Report exploring the workforce that

supports care for older people. Focus on

integrated models of care.

Nov 2011

Report detailing the testing of CfWI toolkit in the Cambridgeshire health and social care

system.

Nov 2011

Online toolkit built on eight stage care

pathway workforce planning approach. Final version to be released Mar 2012.

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The care pathways toolkit is an online resource designed to support workforce planning across organisational boundaries.

The toolkit consists of eight stages composing of19 individual steps.

Each stage contains a series of tools and templates designed to identify the care pathway, the workforce skills required, and how these might be deployed differently to remove blockages impeding better care.

What is the care pathways toolkit?

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The tools and templates within the toolkit are simple to use.

What is the care pathways toolkit?

We have also produced an illustrative guide to the toolkit, which sets out what each stage tries to achieve and what tools and templates are required to be completed.

It is recommended that the eight stages are carried out in order. However, the stages have been designed so that it is possible to complete them independently of each other, as might suit the specific needs of a site.

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The toolkit was originally developed to improve older people’s services. However, it can be applied to any pathway.

What is the care pathways toolkit

An integrated discharge care pathway was chosen because it relies heavily on integration between health, social care and the third sector. Complex discharges are also often seen in later life care.

We developed and tested the toolkit in Cambridgeshire, and it is currently being implemented in South London and Lincolnshire.

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The toolkit aims to improve the standard care pathways approach by taking into consideration the skills, competencies and requirements of the workforce.

How can the toolkit help?

It helps organisations to: map and analyse workforce

along a care pathway identify workforce

blockages conduct gap analyses model different pathway

scenarios.

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How can the toolkit help?In Cambridgeshire, we identified that the assessment process was a significant reason for delays. Following the toolkit, it was found that some assessments could be done in the community. This would improve patient flow in the acute setting, and remove duplication.

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From this, the toolkit has evidenced potential savings, purely from workforce cost. Other savings are also likely to be made, from reduced administration and reduced length of stay.

How can the toolkit help?

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“The toolkit is useful as whole system, reviewing the pathways and interfaces between them. This has given us a wealth of information from all partners’ perspectives.”

Catherine Mitchell, Director of Integrated Commissioning, NHS Cambridgeshire“We are confident the CfWI’s toolkit will help us to

develop our new integrated community teams and reduce duplication in activity across organisations.”

Sarah Button, Service Improvement Manager, NHS Lincolnshire

Examples from Cambridgeshire

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Priorities

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Priorities Weighting

Reduce number of delayed discharges 1-5

Increase patient/service user satisfaction of the discharge process

1-5

Make cost savings by making better use of resources 1-5

Increase cross organisational working 1-5

Reduce the average length of stay, especially for complex, longer stays

1-5

Increase staff satisfaction 1-5

The weightings have been chosen by CFWI based on knowledge of the discharge planning team obtained from reading background information, speaking to staff and understanding the different priorities

Main workforce bottlenecks

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To-take-out medicationThis is a bottleneck due to problems with the process for requesting medication and last minute changes to prescriptions

TransportThis is a perceived bottleneck due to last minute referrals from wards and limited availability at the weekend

Completing assessments in a timely fashionThis is the main reason for delayed discharges and comes from difficulties in coordinating MDT input into assessments

Communicating with out-of-counties and external organisationsThis bottleneck exists due to different processes in different counties, and a lack of compatibility between the technology systems used

Patients / families not wanting to leave acute settingThis is an ongoing problem due to patients / families thinking they have the ‘right’ to remain in a hospital bed

Availability of community resourcesThis is a perceived bottleneck, although it has yet to be established whether resources

are limited or whether they are being used in a sub-optimal way

Priorities vs bottlenecks

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Example - Assessments

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Current issues

xx of people interviewed from DPT said assessment forms still take a long time to complete and are bureucratic.

XX% of DTOCs in Feb 2011 were due to people ‘awaiting assessments’.

All assessments are completed in the acute setting, which increases the number of unproductive bed days.

Legislation - an NHS body “must carry out such an assessment as it considers appropriate or as the individuals needs for continuing care…” (The Delayed Discharges (Continuing Care) Directions 2004).

Options for consideration

Legislation - “If the Checklist is used at the point of discharge…a decision should be made, and recorded, to undertake a full consideration of eligibility once all treatment and rehabilitation has been completed. This full consideration should be completed in the most appropriate setting….” (The National Framework for Continuing Healthcare and NHS-funded nursing care).

Some areas carry out CHC assessments following discharge in the communty e.g. NHS Rotherham..

Is a full SAP assessment required when referring to the re-ablement service - assessed in the community within 24hrs?