Ruth Lake Director of Adult Social Care and Safeguarding

Leicester City Council

To share a view

To explore 2 initiatives

To consider future opportunities though the integration agenda

Closely linked to the sub-region though NHS provider trust arrangements

A challenged health and social care economy

Long history of joint work on acute care agenda – focus on ‘flow’

Low social care delays from acute settings

Lots and lots of actions; no sustained improvements

Integrated Crisis Response Service (ICRS)

Social care and health services providing 24/7 rapid response to crisis

2 hours response time

Cases held up to 72 hrs

Hand over if ongoing need

Virtual integration social care provider staff, community health services including OPMH, AT, handypersons, community alarms

Focus on community cases, A&E diversion

Provider –led initiative Developed in response to operational

challenges Addresses service gap noted by users / carers

and professionals 10pm to 7am gap; weekend ‘assessment

capacity’ gap Coordinated provider-led bids for funding Use of reablement monies initially Future funding via BCF / health transfers to

LA

Operational since November 2012

2 813 referrals – majority seen within 1 hour

Main referrals source community alarms (80%) with others spread across acute, community health, primary care, EDT

Top 3 issues: ◦ Falls

◦ Personal care

◦ Inability to transfer

470 packages provided during the72 hour period

26% requiring no further services

36% referred into reablement

24% requiring maintenance package (at same or higher level)

Routine follow up by DN

Medication review

Falls assessment

Community equipment

OPMH involvement

Very high levels of satisfaction

Falls – evident reduction in ambulance call outs and reduced conveyances

Resultant comprehensive assessment has preventative benefit - independence

Ability to respond to 7 day services agenda

Route for hospital diversion that didn’t previously exist

Reduced duplication and improved flow

Systems savings

‘Super weekends’

Proof of concept event

Whole system step up to business as usual on Saturday and Sunday

2 weekends in January 2014

Sponsored by the Urgent Care Board to test a theory on reducing acute pressures

Well-established additional working days to support peak / holiday periods

Existing provider led response (ICRS / Reablement) for simple discharges

Social worker assessment capacity usually limited

Input of small care management team on super weekend dates

Full duties – new referrals, action on existing discharge notifications

The whole system did step up

Busy 1st weekend with work that could be progressed

Focus on known discharge cases rather than newly referred

Flushed out gaps – pharmacy, equipment, independent sector preparedness, knowing what is available

If one part is missing, overall impact is lost

Maintaining Saturday working

ICRS a keystone in Better Care Fund plans

Links to new primary care Clinical Response Service

Good early outcomes

BCF to build ICRS and assessment capacity to support acute to community shift and 7 day services