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Community Learning Disability Teams – National Survey
Debra MooreManaging Director
Debra Moore Associateswww.debramooreassociates.com
01723 37144607950 333884
Busy landscape
• Lots of health related policy and guidance impacting on the role and function of CTLD’s
• CTLD’s the ‘frontline’ of provision• Feeling the need to respond to a range of
initiatives such as Mansell 2, Michaels Report, DRC etc etc
Mission impossible?
Background to the research
• Development programme for Community Learning Disability Teams based around the 6C’s Model
• Revealed information about current ‘state of play’ and raised questions about future role and modernising the workforce
Background to the research …what people were saying….
• Need to reduce health inequalities and supporting the delivery of VP objectives e.g. HAP’s etc
• Need to support mainstream NHS including mental health• Reducing out of area placements• ‘Personalisation’ • Safeguarding• Changes in demography• ‘Boundaries’ between teams e.g. children & older people• Supporting criminal justice system• Workforce issues • Financial pressures • Some concerns about choice and quality of provision
Pressure to ‘rescue’• In some localities the
community based team are increasingly ‘rescuing’ situations created by ‘specialist’ social care providers (often ‘importers’)
• Also ‘recovering’ problems created by changes in other parts of the system e.g. day services - the ‘buck stops here’ position
• Safeguarding
‘Being painted into a corner’
Background to the research ‘old chestnuts’
• Issues raised about time spent on health related activities and social work activities as opposed to ‘care management’
• Questions about the content of the work of individual CTLD members & blurring of roles within the team
• Concern about capacity for ‘face to face’ contact and time spent on admin/IT and in meetings
• Concern to make sure that the CTLD is part of a wider care pathway
Methodology• A brief electronic survey• A number of key questions generated
by emergent themes from work with CTLD’s
• Self selecting participants• Survey link posted on various
professional websites and out via networking groups etc
• 500+ responses• Gleaned information about social work
but today focus on health professionals and in particular nurses
What percentage of your working week is spent across the following 4 areas?
• Care Management• Admin & IT• Face to face contact
with service users• Review meetings
Other questions
• If A&T service in locality or behavioural support team
• If strategic health facilitator in locality
Will be ‘mapping’ provision onto survey findings
What percentage of your working week is spent on care management?
0-25% 25-50% 50-75% 75-100%
Nurse 75% 15% 8% 2%
Social Worker
34% 48% 13% 5%
AHP 91% 7% 2% 0%
Care Management - nurses
• Most nurses who responded (75%) said they spent up to a quarter of their working week on care management activities
• 10% nurses who responded spent over 50% of their working week undertaking care management activities
What percentage of your working week is spent on face to face contact with service users?
0-25% 25-50% 50-75% 75-100%
Nurse 38% 43% 17% 2%
Social Worker 80% 14% 5% 1%
AHP 27% 49% 21% 3%
Face to face contact - nurses
• Most nurses who responded (43%) said they spent between 25-50% of their working week in face to face contact with people who use services
• 38% of nurses said they spent up to a quarter of their working week in face to face contact with service users
• Around 19% spent over half of their working week in face to face contact
What percentage of your working week is spent on administration and IT?
0-25% 25-50% 50-75% 75-100%
Nurse 38% 47% 14% 1%
Social Worker 12% 34% 45% 9%
AHP 44% 48% 8% 0%
Admin & IT - Nurses
• Nearly half of the nurses who responded said they spent between 25-50% of their working week undertaking admin and IT duties
• Not clear how much of this is related to inputting client information into electronic care planning systems etc
• Not sure how much time is due to a ‘poor fit’ with IT system or how much due to poor ‘technical’ skills
What percentage of your working week is spent in review meetings?
0-25% 25-50% 50-75% 75-100%
Nurse 81% 17% 1.5% 0.5%
Social Worker
74% 23% 3% 0%
AHP 92% 8% 0% 0%
Health professionals – what percentage of your working week spent on health action planning &
health facilitation?
Less than 10%
10-25%
25-50%
50-75%
75-100%
Nurse 29% 32% 25% 12% 2%
AHP 56% 30% 9% 4.5% 1.5%
Health professionals – what percentage of your working week spent on training and supporting
mainstream health professionals?
Less than 10%
10-25% 25-50%
50-75%
75-100%
Nurse 49.5% 36% 11% 3% 0.5%
AHP 57% 28% 15% 0% 0%
Regional variations – face to face contact - nursesLess than 10%
10-25% 25-50% 50-75% 75-100%
North East 0% 0% 75% 25% 0%
Y&H 0% 39% 44% 14% 3%
North West 10% 35% 40% 15% 0%
East Mids 3% 24% 41% 29% 3%
West Mids 0% 47% 35% 12% 6%
Eastern 22% 33% 45% 0% 0%
South West 32% 42% 16% 10% 0%
London 5% 50% 35% 10% 0%
South East 3% 19% 56% 22% 0%
Some regional variations Face to face contact
• In the SW region 74% of nurse respondents said they spend less than a quarter of their working week in face to face contact with service users
• In Yorkshire and Humber it was 39%• In the North East the answer was 0%
• Need to investigate why
Some regional variations Care Management
• In the Eastern Region over a third of nurse respondents spend between 50-75% of their working week undertaking care management work
• In the East Midlands Region more than two thirds of nurses spend less than 25% of their working week undertaking care management work
Integrated teams – what difference did it make in relation to the 4 key
areas?• No discernable difference across care management,
face to face contact and reviews • However the amount of time spent on administration
and IT was higher for those who were in an integrated team
Probably raised as many questions as answers
• Why are there such big variations between regions and how does this effect outcomes?
• What does admin & IT consist of?• If health professionals reduce care
management activity what will be the implications?
• If health professionals focus on ‘health related activity as a first priority’ what will be the outcomes?
Next steps• More detailed analysis of survey• Drilling down on emergent
themes• Examine patterns of provision
e.g. A&T, Out of Area placements etc
• Consider how we map against outcomes such as health checks, numbers of HAPs etc
• Discussion with commissioners• Inform CTLD Development
Programme• Publish findings
For further information
www.debramooreassociates.com
07950 333884
01723 371446
