BOARD of ORKNEY HEALTH and CARE: 9 FEBRUARY 2011

ITEM 8

ORKNEY HEALTH AND CARE COMMITTEE MEETING: 24TH JUNE 2011

CHANGE FUND – RESHAPING CARE FOR OLDER PEOPLE – ALLOCATION OF ORKNEY FUND FOR 2011/12

1. PURPOSE OF REPORT This report presents the proposed initiatives to be funded from the Orkney Change Fund for 2011/12 and seeks the Committee’s endorsement of the proposed allocations. The Committee are then asked to make a recommendation to the Orkney Health and Care Partnership Board on the allocation of this funding for 2011/12.

2. INTRODUCTION 2.1 Orkney has been successful in securing its £321,000 share of the £70 million set aside from the Scottish Government Change Fund for reshaping care for older people for 2011/12.

2.2 This funding is for one year only and any investment provided in 2011/2012 needs to demonstrate change and efficiencies in year to the following key performance measures as outlined in the Orkney Change Fund bid:

1) Increased proportion of older people living at home 2) Improved support for unpaid carers 3) Reduction in unplanned or emergency bed days in the over 75 population 4) Reduction in bed days lost to delayed discharges 5) Reconfigured use of care/residential home resources 6) Increase in housing related support 7) Creation of 20 care apprenticeship opportunities 8) Talking Points qualitative outcomes

2.3 A stakeholder event took place on 21st March 2011 to discuss the leads for each of the workstreams and to agree an indicative allocation for each of the key themes, namely: £

Prevention and early 6 intervention Building capacity in the 1 community (Third Sector £80k, Care Apprenticeships £80k) Facilitating early discharge 6

1 Strengthening our local 4 infrastructure 3

2.4 Each of the workstream leads have been tasked with forming working groups and implementation plans with funding to be released pending an agreed implementation plan.

2.5 Representatives from the Joint Improvement Team (JIT) visited Orkney on 12th and 13th April 2011 to feed back on the Orkney Change Plan at a time-out session. The feedback was that Orkney has a strong plan which demonstrates good progress and engagement to prepare the plan. JIT have offered to continue to work with Orkney to ensure that we have robust systems in place for governance; programme management and service redesign; decommissioning/shifting core budgets; and to prepare the 2012 Change Plan.

3. PROPOSED AREAS HIGLIGHTED FOR INVESTMENT 3.1 The proposed areas highlighted for investment are outlined below. Each of the proposed areas indicates how they link to delivering the key performance measures listed in section 2.2.

3.1.1 Prevention and Early Intervention

Work Action Lead(s) Timescale Fun Link to performance Stream ding measures Heading Allo cati on 1. Access 1a) Care and Repair Mike Training £300 Delivers quicker, direct to Care staff to be trained to Cooper & programme (allo access to service for and Repair undertake simple Pam developed and cate people. Reduces risk to Housing assessment for basic Marwick supporting d individuals and supports Support equipment (eg hand documentation from carers in managing at rails) and subsequent prepared end Third home. Frees direct installation May 2011 Sect professionally qualified without need for or staff to focus on work referral to Occupational Training delivered fundi that only they can do. Therapy. end June 2011 ng Makes better use of Care and Repair to be secti partnership working. provided with Scheme active on More straightforward

2 documentation and July 2011 3.1.2 pathways of care for checklist to support a) individuals. them to undertake this Links to measures function. 1, 2, 3, 4, and 6

1b) Care and Repair Mike Training and £800 Extending range of Small Repairs Officer Cooper Accreditation (allo services that can be to be trained and complete end cate offered by Care and accredited to undertake September 2011 d Repair. Enhancing PAT testing for (date is from opportunities for effective electrical devices and dependant on Third joint working. More provided with when course is Sect straightforward pathways appropriate equipment running) or of care for individuals. to undertake PAT fundi Links to measures testing work (links to Scheme active ng 1, 2, 4, and 6 item 2g). October 2011 secti on 3.1.2 a) 1c) Extend pilot of Caroline For duration of £1,0 Simplifies adaptation ‘Idapt’ adaptation Sinclair 2011 – 2012, can 00 planning process and planning software for be implemented reduces waiting times, to use by partners immediately the benefit of service involved in building users and carers. adaptation work for 1 Links to measures year. Idapt system to 1, 2, 3, 4, and 6 be ‘hosted’ by Care and Repair. Link to Idapt web site IDAPT PLANNING for more info 1d) Support for Mike In place by £3,0 Improves access to establishment of Care Cooper August 2011 00 information for service and Repair ‘Housing (allo users and carers and Options’ service to cate improves pathway deliver the Scheme of d through complex repair Assistance (including from and adaptation

3 Housing support, Third processes. Housing Options and Sect Links to measures Home Safe Home or 1, 2, 3, 4, and 6 schemes) to the fundi general public, ng targeting elderly and secti disabled home owners on and private tenants. 3.1.2 Link to HOME a) SAFETY SCOTLAND report, Home Safe Home, for more info 1e) Support for Care Mike In place by £4,0 Improve accuracy of and repair to develop Cooper September 2011 00 information, support appropriate systems to (allo business continuity, record and share cate improve communication service delivery d between partner information with from agencies, promote particular emphasis on Third efficient working practies. adaptations, hospital Sect More straightforward discharge, repairs and or pathways of care for prevention of accidents fundi individuals. at home. Link to ng Links to measures HOME SAFETY secti 1, 2, 3, 4, and 6 SCOTLAND report, on Home Safe Home, for 3.1.2 more info a) 1f) Promote easy drop Mike In place by £4,0 Improves access to in access for the public Cooper September 2011 00 information for service to Housing Advice and (allo users, carers and staff, Assistance for elderly cate and improves pathway and disabled d right through from advice homeowners, with a from services, to complex broader goal of Third repair and adaptation achieving a multi Sect processes. agency one stop shop or Links to measures facility for housing fundi 1, 2, 3, 4, and 6

4 needs. ng secti on 3.1.2 a) 1g) Improve access to Caroline September 2011 £500 Shared work space for equipment for Sinclair & (allo Council, NHS and 3rd installation, Mike cate sector services reflecting maintenance and Cooper d modern partnership recycling for Care and from approach to joint Repair through Third working. Increased establishment of work Sect presence at Selbro to space / hot desk at or support expanded drop Selbro joint equipment fundi in service. Better able to store. ng sign post visitors secti between services. on Streamlined care 3.1.2 pathway for service a) users and carers. Links to measure 6 2. 2 a) Purchase of Caroline June 2011 £20, Improve availability of Additional equipment to achieve a Sinclair 000 equipment, establish equipment base line core stock core stock level for the and a level for the newly new service, support process to established Community people to live at home, recycle Equipment Service. Support carers to equipment manage at home, avoid using the admissions and facilitate current discharges joint store Links to measures arrangeme 1, 2, 3, 4, and 6 nts 2 b) Piloting of Keith September 2011 £4,0 Support people to live additional telehealth Farrer/Jud 00 independently and input for targeted y Sinclair reduce risk through groups based on good targeted approach to practice examples from telehealth service for

5 other areas and people at risk in their making use of own homes SPARRA data, where Links to measures appropriate, to identify 1, 2, 3, and 4 target groups.

6 2 c) Extend pilot of Caroline April 2011 £3,0 Inform assessments for ‘Quietcare’ lifestyle Sinclair 00 individual services users. monitoring system to Make best use of service inform assessments for capacity. Support people service users enabling to live independently and better tailoring of reduce risk through service to meet needs targeted approach and in the home. One off better tailored and purchase covers three personalised service year period. Link to interventions Quietcare web site GE Links to measures HEALTHCARE- 1, 2, 3, and 4 PRODUCT FEATURES- QUIETCARE PROACTIVE ELDER CARE TECHNOLOGY for more info 2 d) Raise awareness Pam September 2011 £2,0 Return as much stock to of need to recycle, and Marwick 00 store for recycling as maximise recycling rate possible. Maximise stock through ‘equipment levels for re use. Raise amnesty’ event(s) in community and staff the community awareness of this area. including the isles with Links to measures media (press and 1, 2, 3, 4, and 6 radio) coverage and arrangements for uplift, and information for service users, carers and staff 2 e) Improve recycling Pam August 2011 £2,0 Maximise stock levels for practice to ensure Marwick 00 re use. Promote and maximum appropriate ensure safe, efficient, recycling levels and effective practice in this effective, safe area.

7 procedures through Links to 1, 2, 3 and 4 review of existing decontamination facilities and resulting improvement actions. Provision of additional or upgrade of storage, disposal and drying equipment and review of work space.

8 2 f) Introduce an Caroline Sept 2011 £9,0 Effective, efficient and electronic asset Sinclair 00 accurate system for management system management of stock for community including maximisation of equipment and telecare uplift and health and stock to ensure safety compliance, effective stock contributes to safe, management, tracking, effective, timely modern health and safety service. Reduces staff compliance, time spent on installation, uplift and administrative functions recycle by providing automated reports Links to measures 1, 2, 3, and 4 2 g) Care and Repair Mike Training and £1,0 Extending range of Small Repairs Officer Cooper Accreditation 00 services that can be to be trained and complete end (allo offered by Care and accredited to Minor September 2011 cate Repair. Enhancing Electrical Works (date is d opportunities for effective Certification (links to dependant on from joint working. Promoting item 1b) when course is Third use of telecare and running) Sect telehealth by increasing or avenues for installation Scheme active fundi and maintenance. More October 2011 ng straightforward pathways secti of care for individuals. on Links to measures 3.1.2 1, 2, 3, 4, and 6 a) 3. Roll out 3 a) Roll out of national Shauna Agree the £10, Improved falls prevention of our Good Practice Stockan assessment 000 awareness and application of current Resource on managing approach - Stand timely, locally delivered, falls falls and fractures in alone preventative intervention in care manageme care homes for older assessment homes and community settings nt work to people to include which could has significant evidence to

9 residential implementation of easily be support the reduction in falls, homes timely interventions – incorporated/add resulting in reduced unplanned and Very to include a medication ed into one single hospital admissions and Sheltered audit. assessment at a increasing the proportion of Housing. later date. April older people living at home. Increase Basic training and 2011 fall’s awareness raising for The external champion training prevention all Care Home and Scope the will enable an exercise awareness ward staff training Aug 2011 programme to be run in each . Falls assessment facility, improving/maintaining training for selected Specialist training ability and general health for all staff in Care Homes bought in for residents. Champions Later Life training for Group by later life (£2,8 A medication audit will ensure Care Home training ? 80 that all residents are on the ‘Champions Group’ inc appropriate bone health Deliver the in VAT medication, again reducing Improve awareness house training by min fracture and falls risk. and response to falls end March 2012 8 and risk of falls in the Note, this is a peop The in-patient staff training and community through large staff group le @ ward interventions will aim to falls assessment training £300 reduce unplanned bed days due training for programme + to a reduction of in patient falls. targeted staff groups therefore VAT Links to measures (responders, ICT, timescales are pp) 1, 3, 4 and 5 community nursing, longer to allow for potentially home-care) full implementation 4. Oral 4 a) Roll out of national Karyn Tait Scope the £5,0 Raise awareness of the health ‘Caring for Smiles’ training May 2011 00 importance of good oral programme to services health and oral health provided in the Deliver the care amongst dependent community via Home training Start Oct older people. The Care and unpaid carers 2012, finish by training promotes good via Crossroads. end March 2012 practice in this Note, this is a preventative and early large staff group intervention area, linked

10 training to issues of nutrition programme which impact on health therefore and wellbeing. The timescales are training supports early longer to allow for identification of oral full health problems, implementation, providing clear referral which may extend pathways and into the year procedures into dental 2012/2013 care in support of, and in line with, Anticipatory Care Planning programme. Links to measures 1, 2, and 3 5. Better 5 a) The structures and Barbara Throughout the nil Identifies those most use of processes to support Graham year, up to March likely to benefit from SPARRA this are delivered within 2012 anticipatory care in the data NHSO therefore work community to prevent here focuses on raising admission or awareness of the value readmission to hospital; of this approach and may benefit those with promoting its use LTCs most. Should help through focussed visits reduce 75+ readmission to GP practices and rates and all unplanned teams that work in the admission rates. community plus an Links to measures awareness-raising 1, 2, 3 and 4 event for Practices, together with the extended use of ACPs. (6a) 6. Ongoing 6 a) The structures and Barbara By end Sept 2011 £2,0 Should be done in roll out of processes to support Graham 00 combination with anticipator this are delivered within SPARRA data y care NHSO therefore work Links to measures planning here focuses on raising 1, 2, 3, 4, 5 and 6

11 (ACP) awareness of the value of this and promoting use of this approach through an ACP/SPAARA event with guest speaker and relevant presentations

Contingency fund to Caroline As required £2,0 Not specifically linked to cover unforeseen Sinclair 00 performance measures overspend or growing but relevant to sound costs in action plan financial management areas. Considered practices and overall appropriate as planned achievement of change costs are based on plan goals best calculations available at the time of writing, rather than confirmed costs. Total £60, *Note – Overall total 000 £73,600 but £13,600 to be funded from Third Sector Allocation

3.1.1 Building Capacity in the Community

3.1.2a Third Sector

Workstrea Action Organis Timescale Fund Link to m Heading ation ing performance and Alloc measures contact ation person

12 Prevention Access to Care and Care Immediate start £13,6 1,2,3,4,6 and Early Repair and 00 Interventio housing support Repair (detai n (Mike l in Cooper) secti on 3.1.1 ) Prevention Age4Age – a living Age September £10,0 1,3,5,6,8 and Early well, ageing well peer Concern 2011 00 Interventio support network for (Sue (out n older people Ward) of bid and specifically aimed at for Building improving and £19,8 Capacity maintaining physical 17) in the well being and Communit reducing the incidence y of accidental injury and unplanned hospital admissions Building Short respite breaks Crossro Immediate start £18,0 1,2,3,4,5 Capacity with a sleep in ads 00 in the overnight and four (Olivia (pen Communit visits through the day. Tait) ding y a rewor ked prop osal base d on respit e to carer s and these 3

13 initial prop osals

Building Provide full day respite Crossro Immediate start 1,2,3,4,5 Capacity to carers on the outer ads in the isles allowing them to (Olivia Communit come to mainland for a Tait) y whole day Building Full day breaks to Crossro Immediate start 1,2,3,4,5 Capacity cares who are under ads in the stress with high (Olivia Communit dependency Tait) y dependants. Building Increase capacity in VAO August 2011 £19,9 1,2,4,6 Capacity befriending service (Gaynor 93 in the Jones) (supp Communit orted y pendi ng an exit strate gy) Building Development of out of Red Immediate start £4,37 1,2,3,4 Capacity hours patient transport Cross 6 in the service (Anna Communit Johnsto y n) Early Increase capacity of Age August 2011 £6,70 1,3,4,6,8 Facilitated Domiciliary support Concern 0 Discharge services (Sue and Ward) Prevention and Early Interventio n

14 Prevention Safe at Home and Falls Age October 2011 £2,30 1,3,6,8 and Early Awareness roadshow Concern – March 2012 0 Interventio (Sue n Ward) Additional VAO lead relevant third £5,00 element sector services and 0 work with partners/ stakeholders to scope out changes to current day care provision with the view of submitting a full proposal to next year’s Change Fund Total £80,0 00

3.1.2b Care Apprenticeships

Workstream Action Lead(s) Timescale Fund Link to Heading ing performance Alloc measures ation Creation of 20 20 generic worker Karen By end of £80,0 1, 2, 3, 4, 5, 7 apprenticeship roles to be developed Crichton March 2012 00 opportunities across Orkney. Cindy Target: Westray 4, Clark Hoy 4, Sanday 4, Marie Stronsay 4, Mainland O’Sulliv

15 4 an Lynda Bradford Sylvia Campbe ll Total £80,0 00

3.1.1 Facilitating Early Discharge

Workstream Action Lead(s) Timescale Fund Link to Heading ing performance Alloc measures ation 1. Reablement To link with data IRF Cindy By end of £15,0 1, 2, 3,5 through data and Clark December 00 Homecare pilot a small Lynda 2011 geographical area to Bradford train staff with a 3 day Sylvia recognised Campbe programme ll ACTION; Lynda Bradford to discuss with Alex Davidson JIT 2. To access a Sylvia By the end of £2,00 1, 2, 3, 4, 5 Development programme that Campbe December 0 of staff roles would be suitable to ll 2011 and capability be delivered by an Robert to work across external source Allan an integrated model of care 04.06.11 – this will and now be delivered community internally; programme capacity to be compiled and

16 delivered to Senior Managers and Team Leads in year 1 3. OOH Review out of hours Cindy By the end of Year 1, 2, 4 Provision for night time Clark September 2 provision for 2011 mone overnight y will social/support needs be to decrease length of requi stay in hospital red if avail 04.06.11 – audit to be able completed in all in- patient hospital areas for 3 months to establish accuracy and baseline for future service provision

4. Develop Using LEAN Carolyn By the end of £2,00 1, 3, 4 integrated methodology, focus Chalmer August 2011 0 working that on AHP input in s minimises hospital and transition Sylvia duplication of to community Campbe effort, ll inefficiencies and maximises efficiency and quality

5. Pilot 1-2 Intermediate Cindy Year 1, 2, 3, 4, 5 Reconfigured Care beds (step Clark 2 use of up/step down) in a Lynda mone residential residential care Bradford y will

17 home setting Sylvia be resources - Campbe requi Support ll red if shifting the avail balance of able care agenda to enable community developments to progress

6. MSK 5 hours of physio time Peter By the end of £4,50 1, 3 developments to work with national McKellar July 2012 0 and pathways colleagues to further Sylvia develop service Campbe ll 7. Discharge Ensure that Sylvia See attached £25,5 1, 4, 5 Planning developments that Campbe action 00 developments have been revisited ll plan/appendice from hospital from rapid Carolyn 7 improvement event Chalmer can be completed s

8. Pharmacy To support pharmacy Chris See attached £10,0 1, 2, 3 developments/ developments Nicolson plan from Chris 00 training through bid submitted Nicholson from Chris Nicholson – cost divided up between work streams

10.06.11 – this work will be incorporated in

18 this work stream

9. To support three Karen End of June £1,00 1, 2, 3, 4, 5, 6, 7 Rehabilitation months extension of Crichton 2011 0 Co-ordination Rehabilitation Co- ordination post to support all high impact changes until Sep 2010

Total £60,0 00

3.1.1 Strengthening our local infrastructure

Workstrea Action Lead(s) Timescale Fund Link to m Heading ing performance Alloc measures ation 1. IRF post Demonstrating B Apr 2011-Mar £41K Inform OH&C on measurable changes in Graham 2012 progress and help the Key Performance to ensure robust measures across all decision making in workstreams; ensuring future change fund that all workstream years. actions are explicitly Links to all linked to one or more measures performance measure. 1,2,3,4,5,6,7,and 8 Link outcomes with the JIT Reshaping Care Core Measures (draft) (Appendix 1) to develop and support methodology around

19 outcome measurement.

Provide co-ordination and support in outcome measurement for all workstreams (see Appendix 2)

Link the IRF data with the Change Plan Key Performance Measures.

2. Telecare Enhanced use of Caroline December £500 Support people to telecare input for Sinclair 2011 0 live independently targeted groups and B from and reduce risk possibly around the Graham Prev through targeted Fife falls pilot, or GPS entio approach to for dementia sufferers n & telecare service for as for ‘Prevention & Early people at risk in Early Intervention’. Interv their own homes Possibly in combination entio Links to measures with SPARRA data as n 1, 2, 3, and 4 in NHS Fife 3. Better The structures and Barbara To March 2012 nil Identifies those use of processes to support Graham and ongoing most likely to SPARRA this are delivered within benefit from data NHSO therefore work anticipatory care in here focuses on raising the community to awareness of the value prevent admission of this approach and or readmission to promoting its use hospital; may through focussed visits benefit those with to GP practices and LTCs most. Should teams that work in the help reduce 75+ community plus an readmission rates

20 awareness-raising and all unplanned event for Practices, admission rates. together with the Links to measures extended use of ACPs. 1, 2, 3 and 4

4. Ongoing The structures and Barbara To March 2012 £200 Should be done in roll out of processes to support Graham and ongoing 0 combination with anticipator this are delivered within Event due in from SPARRA data y care NHSO therefore work PLT Sept 2011 ‘Prev Links to measures planning here focuses on raising entio 1, 2, 3, 4, 5 and 6 (ACP) awareness of the value n & of this and promoting Early use of this approach Interv through an entio ACP/SPAARA event n’ with guest speaker and relevant presentations

Total £41,0 00

Ove £321, rall 000 tota l to be allo cat ed

4. RECOMMENDATIONS

4.1 The Orkney Health & Care Committee is invited to:-

4.1.1 note the progress made in taking forward the Change Fund submission; 4.1.2 note the initiatives that are being proposed to be funded in 2011/12 from the overall £321,000 allocation;

21 4.1.3 make recommendations to the Orkney Health and Care Partnership Board on the distribution of this funding in 2011/12 based on the approval of each of the above proposed areas for investment.

Karen Crichton 21st June 2011