INTEGRATED CARE NETWORK NORTH WEST REGION 8 FEBRUARY 2005 INTEGRATED DAY SERVICES

1. INTEGRATED CARE NETWORKNORTH WEST REGION 8 FEBRUARY 2005INTEGRATED DAY SERVICES

2. INTEGRATED DAY SERVICES - CONTEXT • Morecambe Bay PCT is a Mental Health Trust • It straddles Cumbria Social Services (South Lakeland) and Lancashire Social Services (Morecambe/Lancaster) • The remainder of Lancashire has a Lancashire-wide Mental Health Trust with a total of 8 PCTs across Lancashire • Population of Lancaster/Morecambe is 135,000, with a PCT total of approximately 270,000 • A local Lancaster Health Group – Modernisation of Older Peoples Services (MOPs) oversees Health/Social Care Developments

3. INTEGRATED DAY SERVICES - DRIVERS • District Audit Report 99/00 identified good range of services but inequity of access and inconsistencies in approach in deciding if day care or day hospital is provided • Audit commissions “Forget Me Not” Report • PCT commissioned a review which confirmed that services were not meeting people’s needs • Lancaster Health Group undertook a further detailed needs assessment which triggered the project to transform existing services into a new integrated enhanced model of day time support

4. INTEGRATED DAY SERVICES - NEEDS ANALYSIS • Audit of current users in both systems against a dementia scoring continuum • Postcode analysis for locations • Demographics • Transport issues • Partnership sites

5. INTEGRATED DAY SERVICES – NEEDS ANALYSIS FINDINGS • Mismatch of client need, resources used and skills available • People attending SSD care with no diagnosis • Some users getting unnecessary CPA and consultant input purely because they are in a Health System • Day care and day hospital not working together – no sharing of skills, training etc • Poor knowledge of each others skills/roles • Clients attending both day care and day hospital – no co-ordination of care

6. INTEGRATED DAY SERVICES – NEEDS ANALYSIS FINDINGS • Gaps for functionally ill and physically dependent • Lack of “space” for Health to develop proper therapeutic interventions e.g. Memory Assessment Clinics (MAC) • No one offering an appropriate service for dementia sufferers under 65 • Current SSD day care unsuitable environment for dementia care and physical dependency

7. INTEGRATED DAY SERVICES – EXISTING PROVISION – MENTAL HEALTH SERVICES

8. INTEGRATED DAY SERVICES – PROPOSED MODEL

9. INTEGRATED DAY SERVICES – PROPOSED MODEL

10. INTEGRATED DAY SERVICES – MODEL PRINCIPLES Social Day Care Service: • Re-integration and re-introduction • Use of Mainstream facilities • Role for voluntary organisations Service Level Agreements • Use of Domiciliary Rehabilitation service • Transport • Input of personal care support

11. INTEGRATED DAY SERVICES – MODEL PRINCIPLES Physical Dependency Day Care • Fit for purpose environment • Rehabilitation focus • Higher staffing levels

12. INTEGRATED DAY SERVICES – MODEL PRINCIPLES Enhanced Day Care for People with Dementia • Support for those unable to cope without specialist support • Support with incontinence, eating and assistance with other daily activities • Assistance with communication, mobilisation • Support/guidance with therapeutic activities • Manage difficult behaviours (with support from Mental Health Services) • Medium to long term support • Specialist staff Health and Social Services (with Dementia Care Training) • Carer respite

13. INTEGRATED DAY SERVICES – FRAMEWORK FOR PROJECT DELIVERY • Project Group supported by discrete Project Manager • Sub Groups chaired by most appropriate agency (Social Services, PCT Commissioner, PCT Provider) • Transitional Arrangements • Transport • Enhanced Day Care Model • Finance • Joint reports to PCT Board/Cabinet Portfolio Holder and joint 3 month consultation

14. INTEGRATED DAY SERVICES – PCT CONTRIBUTION • 2 Enhanced Day Care premises • Health Support Worker for each enhanced Unit – providing link back into day hospital and extra support • Ongoing joint training and support for staff working in these services

15. INTEGRATED DAY SERVICES – PCT OPPORTUNITIES • Capacity to provide memory clinic and better service for older people with functional ill health • Capacity to provide outreach support to primary care • Better targeting of older people’s specialist mental health service

16. INTEGRATED DAY SERVICES SOCIAL SERVICES CONTRIBUTION • Management of care and support • Provision of existing residential site for third day service • Provision of transport with better co-ordination • Provision of meals SOCIAL SERVICES OPPORTUNITIES • Better access for service users to specialist services when needed • More outcome focussed day services with improved links into community networks

17. INTEGRATED DAY SERVICES – CHALLENGES • “Leap of faith” required by both partners • Budget implications of moving to specialist provision – whilst developing model in parallel • Consultants – letting go • Integrated transport arrangements • Charging • Consultation- User and Family expectation

18. INTEGRATED DAY SERVICES – LEARNING • Different LA and PCT decision making processes can hamper progress • Tension between PCT commissioners and providers • Allow more time for consultation, engage with advocacy organisations at earliest opportunity • Identify and use key players/champions who will drive it through • Engage with frontline staff regarding both the model and their role within it • Make use of Workforce Advisory Groups to develop roles • Keep Users as the central focus and this will dismantle some barriers