Category: Scheme best supporting New Ways of Working and Training
Name: Janet Toynton
Job Title: Service Manager
Organisation: Lincolnshire Partnership NHS Trust
Email: Janet.Toynton@lpt.nhs.uk
Telephone: 01788 423154
Key team: Mark Chalinor - Team Manager, Rachel Wright - Care Coordinator, Jill Sage-Carim - Crisis Intervention Nurse, Paul Bagstaff - Crisis Intervention Social Worker, Mohamed Kaptoul - Salem Consultant
Title: Welland - model of care
Services for Older People had been traditional in approach with little alternative to in-patient admission. Generally these admissions were service led with most older people and their carers preferring the choice of staying at home. Once admitted the close bond between carer and patient was often tested and together with a reduction in self independence of the patient this often necessitated the need for admission to long-term care.
Following these admissions a pattern was emerging of Care homes unable to manage the complex needs of Older People with Dementia or Mental Health needs and a vicious circle was created with demands for re-admission to in-patient services.
The aim of the new service model was to:-
- provide an individualised patient and carer-focussed service
- respond within two hours at time of crisis
- provide a multi-disciplinary assessment
- Pool local resources between health and social services
- work positively with voluntary services
- develop formal links and training to care homes
- develop liaison with general acute wards.
- develop a service model that could be implemented across Lincolnshire.
- modernise services in line with recommendations from NSF Older People and NHS Plan
As part of the service development patients and carers were included in the project, together with the Community Health Council. Ideas were sought and carers who had previously received a more traditional service were asked what would have made a difference to them at the time of their crisis and avoided in-patient admission.
The repeating themes in carers admission were:
1] Timely admission
2] Advice and support
3] Extensive support at home and
4] A single assessment process for a health and social care assessment.
The service model provides: -
- Crisis Intervention by a 'G' Grade CPN and Social Worker within two hours Monday - Friday
- Home treatment through a community team that carry on the follow-up on crisis work and planned/urgent CPN referrals
- A home treatment team comprising of qualified RMN's and unqualified community health workers
- Advice and support to general acute in-patient services
- Day hospital that provides time limited assessment and treatment intervention
- Support to carers through voluntary agencies Alzheimer's Society and Rethink.
- Existing staff team
- Primary Care Trust
- Senior Managers Lincolnshire Partnership NHS Trust
- Social Services
- Community Health Council
- Patients
- Carers
An Audit from the NHS Plan have now identified the Welland Resource Centre as an area of 'Good Practice for Older People with Mental Health Needs'.
The results of a questionnaire with GP's, key stakeholders, patients and carers re: satisfaction was completed at twelve months and they reported that they found the service very good. There has also been a reduction in the requests for both in-patient and long term nursing and residential care.
Our main challenge was to create a service that nationally was currently not available and as such this meant learning by results. This obviously necessitated ongoing reviews to reshape the services, as ideas were fed into the implementation phase.
Another challenge was to introduce the new service at the same time as closing nine in-patient beds which provided the staff pool for the new service model.
These staff although excellent were skilled in in-patient care, but had little community experience. To overcome this all staff received a four week intensive training programme, which developed and shaped their existing skills and knowledge.
Part of the closure of beds created space that could be utilised by a range of health and social care partners.
A large ex-dormitory is now housing the Intermediate Care Team that provides services for Older People with Physical Care Needs. The co-location provided easier access for referrals and a positive relationship is allowing patients who have Dementia or Mental Healths as a secondary needs are now able to access these mainstream services. [Previously our patient group had been excluded, as their needs were considered too complex to be managed through Intermediate Care].
We are currently building on our strengths and have recently implemented the first Lithium Clinic for Older People and our next target is a Memory Assessment Unit.
As previously mentioned the Unit was identified as an area of 'Good Practice' and as a result of this is part of the Mental Health Foundation website.
The model within our Trust is considered as a 'blue print' for services for Older People and we are already working up proposals for two more centres.
Within our Primary Care Trust staff have visited and recently a Director from Wales Mental Health Services visited and was provided with up to date information and audits.
Within the Trent area the Welland model was also part of the NIHME Bring and Share Day.
