Change Fund 6-Month Evaluation Report December 2013

Purpose of report

This report provides an update on the progress of the Edinburgh Change Fund to date.

Background

The Scottish Government established a Change Fund for 2011-15 to enable health and social care partners to implement local plans for making better use of their combined resources for older people’s services.

Edinburgh’s share of the national fund was £6.013m in 2011/12, £6.872m in 2012/13 and 2013/14, and £6.013m in 2014/15. National funding ends in March 2015. In addition to the national allocation, the City of Edinburgh Council has committed £1.774m as part of the 2012/13 budget, £1.770m for 2013/14 and £2.648m for 2014/15.

Summary

The Change Fund Evaluation Group undertakes 6 monthly monitoring of all Change Fund investments. This report gives an update for each project/ work stream including:

recurring projects, most of which had funding agreed in 2011 are now well established

a range of one-off projects, totalling approx £1m, which were agreed from slippage in October 2012 and are at various stages of implementation.

Recommendations

It is recommended that the group:

note the progress made in implementing the Change Fund in Edinburgh

Table of ContentsIntermediate Care Service 1

Edinburgh Community Stroke Service 2

Enhanced Physiotherapy in the Community 3

Dietetics 4

Community Nursing and Case finding, identification and management of patients 5

Domiciliary Care 6

Overnight Home Care Service 7

Telecare 8

Equipment and Adaptations 10

Day Services 12

Medication Review 14

Medication Procedures 15

TeleHealth 16

Making it CLEAR 17

Edinburgh Behaviour Support Service 18

Community Connecting 20

Carer Support Hospital Discharge Service 23

Step Down 23

Community Transport 24

Innovation Fund 25

Communication and Engagement 25

One-off Projects 27

Intermediate Care Service 2013/14 allocation: £742,067 2013/14 projected spend: £632,830

Intermediate Care is a service that facilitates discharge from hospital with rehabilitation and prevents admission to hospital by providing physiotherapy and occupational therapy assessment and treatment with community therapy assistants and assistant practitioners providing additional support.

18 FTE were funded through the Change Fund, 3 FTE of which are Falls Assistant Practitioners (in post from July 2013).

The Change Fund has enabled the service to achieve the following:

7 day service – launched in Nov 2012. An average of 4 urgent assessments are undertaken every weekend to prevent unnecessary hospital admission.

Hospital discharges - increased from 4 to 10-12 per week (in line with target from 200 per year to 600 per year). Direct discharges are being supported from acute beds as well as targeted rehab beds.

Admission prevention - average of 14 per week so far in 2013/14 (slightly below target of 800 per year, but this is likely to be seasonal) (referrals inc GPs, SAS, falls pathway)

Extended in-reach – early identification and discharge of people who can receive rehabilitation at home

Falls prevention - new referrals are immediately appointed rather than placed on waiting list. Referrals from Scottish Ambulance Service are seen within 24 hrs.

Feedback from service users illustrates how the service aims to improve people’s confidence, mobility and independence:

‘The team really helped me get used to being back at home and I went from being frightened of doing things to being happy to give things ago. My confidence is so much better now and I think I just needed time. I think people forget that older people need more time.’

‘absolutely great, doing exercises every day, showering on own, able to put myself to bed’

‘[the service has made a] very big difference; if I didn’t have the team I think I’d be in hospital or a home by now’.

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Edinburgh Community Stroke Service 2013/14 allocation: £191,984 2013/14 projected spend: £192,487

ECSS is a community based multi-disciplinary stroke service, delivered from 2 community bases: Firrhill and Craighall Centres. Each Centre has 2 stroke specific rehabilitation days per week, and clients are also visited in their own homes, or workplaces as appropriate.

The Change Fund has funded 2 WTE OTs, 2 WTE PT's, 0.5 SLT, 2 WTE support workers.

Key performance information:

Total referrals Oct 12 – March 13: 93 referrals

o 53% hospital discharges

o 19% Intermediate Care Service

o 30% community practitioners

64% of clients are over 65 years. This is a 10% increase from last year.

46% North (Craighall) / 54% South (Firrhill)

All referrals are screened within 2/3 days

Hospital discharges are seen within a week, all others within 2 weeks

Av length of time in ECSS is 3 months, but some complex cases upto 12 months.

ECSS is often the last rehabilitation service in the stroke pathway and return to independence in self-care, domestic tasks, community mobility and community inclusion is facilitated. Where on-going maintenance support is required referral to many other agencies is made, mainly 3rd sector eg community connecting, CHSS, Edinburgh Leisure. This aims to prevent further stroke episodes and potential hospital readmission.

Outcomes include:

19 (21%) of people sought employment advice:

o 5 returned to work

o 3 obtained a voluntary post

o 1 enrolled in further education

o 3 joined a community based project

o 7 required advice on welfare rights/employment law & were medically retired.

Feedback from service users is gathered using the CARE measure, examples include:

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“Since day one the service I have received has been second to none, staff have been fantastic and have helped me to develop my confidence “

“Really good, didn’t realise I would get so much help as I’ve had.”

“Staff understood what I said”

Enhanced Physiotherapy in the Community 2013/14 allocation: £116,236 2013/14 projected spend: £110,465

The Change Fund has funded 3 WTE Physiotherapists (1 x Band 6 and 2 x Band 5) and 0.6 WTE Physiotherapy Assistant.

649 new patients have been seen by the service since April 2012, with a total of 3,154 visits delivered. 569 hospital discharges have been supported and 38 people have been readmitted to hospital whilst receiving the EPIC service.

Patient feedback is positive, with

91% of patients feeling EPIC to be beneficial.

100% of referring physiotherapists felt that patients were seen by the service quick enough on discharge from hospital.

Qualitative feedback from referrers suggests that the EPIC service has reduced patients’ length of stay in hospital eg

“We have had many patients that we have referred to EPIC that may not have been able to be discharged without the service due to the longer waiting times / slower ability to respond of standard domi services. These are patients who although are safe to go may not be quite at their previous mobility baseline so if there was a longer wait for community input would have stayed in hospital for rehab.”

“My colleague spoke to one of the EPIC team recently who was happy to accept a referral for a man in a homeless shelter so I think the location may be more flexible than with other services which also helps.”

“We have had some patients who have benefited from prompt assessment of outdoor mobility once home which we may have kept in for longer if the service was not in place.”

Speech and Language Therapy 2013/14 allocation: £51,918 2013/14 projected spend: £47,962

The Community Speech and Language Therapy service provides highly specialist speech and language therapy to adults with communication and/or swallowing problems associated with acquired neurological conditions in the community.

Additional funding from the Change Fund has enabled the service to increase the SLT staffing capacity (by 1.5 WTE) and has supported the local redesign of the speech and language therapy model delivered to people living with stroke.

Achievements against the key objectives for the project include:

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Objective PerformanceTo facilitate timely and more responsive access to SLT Early Supported Discharge service by reducing waiting times, facilitating discharge and enabling improved seamless transitions between hospital and community SLT services for people with a Stroke.

Early Supported Discharge Team waiting timesBaseline: 6 weeksTarget: 1 weekPerformance: 5-10 days

Develop an integrated and collaborative model of service delivery with SLT resources aligned to Edinburgh Community Stroke Service (ECSS) and work in collaboration to provide MDT early supported discharge and rehabilitation for people with Stroke living in the community.

ECSS referral to SLTBaseline: 12 weeks (priority dependent)Target: 1 weekPerformance: 1-2 weeks

Develop and streamline an enhanced partnership working model with Intermediate Care Services to deliver a more integrated service for Stroke patients with on-going physiotherapy and occupational therapy needs aligned to SLT intervention delivered by SLT Early Supported discharge Team.

SLT Therapy supported by Intermediate Care workersBaseline: NilTarget 100% of all referrals with SLT needsPerformance: 90% achieved

Other achievements highlighted include:

improved communication and knowledge transfer, including the introduction of shadowing and rotational opportunities between hospital and community SLT services

SLT Community Service Lead and SLT Stroke Clinical Lead are now leading a programme of redesign of the Stroke Pathway across NHS Lothian

In-reach pilot - A 6 month feasibility pilot for RIE in-reach. Evaluation report is available. Key findings include heightened awareness of hospital SLT staff regarding range of community services available to support clients. Patients and families report being better informed and having more manageable expectations on discharge.

SLT staff within Acute and rehabilitation sites are providing increased outreach and follow up to selected patients where continuity of care provided by hospital staff would avoid unnecessary wait and referral onwards to community services. The % of patients and impact of this pathway development is currently being evaluated.

Staff morale is high due to increased investment in SLT and opportunities this has enabled in terms of NHS Lothian Wide Stroke Pathway development.

Dietetics 2013/14 allocation: £20,666 2013/14 projected spend: £18,222

No return was received for this service.

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Community Nursing and Case finding, identification and management of patients 2013/14 allocation: £187,917 2013/14 projected spend: £136,526

The Community Nursing IMPACT (Improving Anticipatory Care and Treatment) team support people with long term conditions in the community. The Change Fund has been used to increase the capacity of the IMPACT team by 3 full time nurses and has provided an additional 1 full time District Nurse Discharge Facilitator to ‘case find’ ie identify patients at greatest risk of admission and readmission to hospital and provide additional support.

The additional investment has supported the reconfiguration of the IMPACT service to provide a city wide, 7 day per week, responsive service. The capacity of the team has increased as follows:

Number of patients on caseload has increased from 289 in January 2013 to 360 in Sept 2013 (20% increase)

Number of referrals has increased from 326 in 2012-13, with a projection of 368 for 2013-14 based on the first 6 months performance.

Increased capacity within the IMPACT team has allowed for significant links to be developed with nursing and medical colleagues in the acute sector within specialist areas of Respiratory, Cardiology and Medicine of the Elderly. The team also link closely with social care services, particularly homecare and Intermediate Care Services. The IMPACT team have been involved in the development of the COMPASS models in South East and North-West Edinburgh and will have a key role in the further development of a hospital at home model.

The IMPACT team have been reviewing SPARRA data to assist with pro-active case finding, all GPs have been contacted and the team have offered to meet with practices to discuss patients with increased SPARRA scores who are at risk of hospital admission.

An evaluation report of patients’ views upon the IMPACT service has recently been conducted. The major findings are that approaching 95% of patients report being more confident and able to manage their symptoms through the use of the service, even where their condition is not improving. In patients’ own views, this has led to less need to escalate their care supports through admission to hospital. In this way, IMPACT is achieving one of its main aims of avoiding hospital admissions for patients with persistent, long term conditions.

The following barriers have been identified by the team, along with remedial actions:

Challenge Remedial actionGP engagement is an ongoing challenge New GP contract may help to ensure ongoing

GP engagement

Telehealth – use of multi-condition monitoring to support patients and increase capacity has stalled due to provider (02) withdrawing from contract

See telehealth update

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COMPASS is an additional work stream that was not in the initial work plan for this service and there has been no additional resource to support this work to date

An enhanced staffing model is being developed by the COMPASS Steering Group

The IMPACT service has demonstrated a contribution to the following high level outcomes:

Outcome ContributionShifting the balance of care and increase the number of patients being cared for in the community

New service supporting patients to self manage using an anticipatory case management approach

Reduce the length of hospital stay & delayed discharge

Working with colleagues across primary secondary & social care to provide alternatives to admission and support early discharge (COMPASS, COPD & Heart Failure) Close links with intermediate care team

Reduce the number of patients admitted as emergency twice or more to acute specialties

Pro-active case finding – SPARRA, engagement with primary care colleagues to identify patients most at risk. Contribute to development of alternatives to hospital admission ( Compass , Hospital at home)

Domiciliary Care 2013/14 allocation: £3,645,060 2013/14 projected spend: £3,645,060

Additional Social Care Workers have been recruited to expand the capacity of the Reablement Service. Funding allows for 36 Whole Time Equivalents (WTE). The first additional worker came into post on 5 May 2011. There are currently 36 WTE funded by Change Fund money.

The Reablement Service is a short term service that helps people regain skills to live as independently as possible. Surveys of people who have recently finished receiving a service. Some of the feedback is given below:

“I have been very happy with the care I have received and am glad that I have improved sufficiently to carry on without this support.”

“As time has passed I have become stronger and [am] now able to do things for myself, but all the time they were here, my carers were most thoughtful and helpful, and encouraged me to make steady progress. Home care Reablement service is a splendid help, especially to someone on their own. Thank you.”

Money from the Change Fund was also used to continue the Reablement Service capacity developed as part of the Phased Implementation of New Model of Care for Orthopaedic and Stroke Rehabilitation Pathways.

Additional money has also been made available through the Change Fund to expand Care at Home provision.

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During 2012/13 total provision for older people across all domiciliary care services increased from 32,625 hours per week at the beginning of April 2012 to 37,068 hours per week at the end of March 2013. This is an increase of 13.6%. This can be seen in the graph below.

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Delivered hours of domiciliary care to people aged 65+ 2012-13

During 2013 total provision for older people across all domiciliary care services increased from 37,068 hours per week at the end of March 2013 to 38,628 hours per week at the end of September 2013. This is an increase of 4.2%. This can be seen in the graph below.

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Delivered hours of domiciliary care to people aged 65+April - September 2013

Overnight Home Care Service 2013/14 allocation: £300,000 2013/14 projected spend: £300,000

Money from the Change Fund is being used to expand the service. Prior to the additional funding three teams operated in the city. The extra funding allows the recruitment of staff for a further three teams to operate overnight. The fourth and fifth teams commenced operation in November 2011 and February 2012 respectively. The sixth team started work in September 2013.

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The Overnight Home Care Service often plays a pivotal role in facilitating the support of people at home. The visits overnight may be short in duration but they do secure the sustainability of the entire package by ensuring that people receive appropriate care in their own home 24 hours a day, thereby avoiding an admission to long term nursing or residential care.

The number of visits made by the service per night has increased from 65 visits in October 2011 to 131 visits in September 2013. The number of services users supported has also increased, but more slowly. This suggests that the number of people requiring more than one visit is increasing reflecting the expectation that people with higher levels of need are supported in the community.

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Telecare 2013/14 allocation: £285,228 2013/14 projected spend: £285,228

Additional funding for telecare services and equipment was made to support people with health and social care needs in the community. The money is being used to fund:

6 FTE Call handlers

1 FTE Equipment Technician

3 FTE Mobile Support Workers

1 FTE Assessment Officer

1 FTE Project Officer

These posts are ensuring calls are managed appropriately, the service continues to offer same day installation for hospital discharges or prevent hospital admissions,

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offers complex assessments and reviews where required, offers clients a timely response to emergency calls and continues to offer support and supervision to staff groups.

This workstream has been working closely with Home Care and Reablement services, with the aim of releasing Home Care hours through the use of telecare technology, enabling Homecare to reprovision these hours to support further clients. The funding is also being used to:

Maintain and enhance the existing service, (with regards to provision of equipment, response and installations) to support people to live at home and increase independence and safety.

Facilitate an annual 10% increase in complex packages for people aged 75+.

The service is continuing to work with the Scottish Ambulance Service to develop a rapid installation process to decrease unnecessary hospital admissions. It is helping to support the delayed discharge team and the Step-Down project and also linking in with Step-Down to provide technology for trialling prior to discharge in to community. A Telecare Dementia Resource Manual has been developed as part of the wider Dementia Strategy to help support people with dementia and their carers. The workstream is developing links to provide technology to support Falls Management. The service is offering development training to other people/teams which again will raise awareness with the aim to increase the number of people supported in the community.

Telecare continues to be fundamental to the preventative strategy. The service continues to support customers to remain at home following an alarm call. 63% of all Telecare customers are aged over 75 years. 85% of all emergency response visits were to people aged 65 and over.

The additional funding has met targets by helping to support 1200 extra people through Telecare since 2010/11, from 8492 to 9692 in 2012/13 (a 12.4% increase). At the end of September 2013 there were 6334 people aged 65 and over supported through Telecare.

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Incoming alarm calls (all ages) and installations of complex packages (75+)

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As displayed in the chart above, the number of incoming alarm calls has shown an increasing trend since April 2011. The number of installations of complex packages for people aged 75 and over follows a similar increasing pattern and has exceeded the 10% target by facilitating a 13% annual increase from 267 in 2011/12 to 308 in 2012/13.

There have been two telephone surveys conducted with approximately 500 service users in 2011/12 and 2012/13. In both surveys 99% of people interviewed were satisfied with the quality of the service.

The following case study helps to evidence some of the outcomes for the service users and how this has helped carers.

“David’s son stated the Community Alarm Service had had a huge impact on David and his family. The equipment gave them piece of mind that their father was safe and allowed him to stay at home.

The equipment has alerted staff to falls and has also allowed for improvements to David’s medication compliance. Prompts have ensured that medication is taken at regular intervals, which is particularly important in relation to Parkinson’s medication, and have also allowed for improved monitoring during transition to different medications. David is now stabilized on his medication and this has lead to improved mobility and reducing the number of falls that David was having.

David is now looking to join the gym and build on this with more activities outside the home.

The family stated that if CAS had not been put in place David would be in a care home and not looking forward to a new sense of freedom thanks to equipment and staff from the Community Alarm Service.”

Equipment and Adaptations 2013/14 allocation: £206,715 2013/14 projected spend: £206,715

Allocations were made to meet the increased demand for equipment and adaptations in people’s homes to support the shift to more community based services and to increase the number and reduce the waiting time for bathing/toileting assessments. Recruitment has taken place and all positions have been filled.

The number of people on the books in Edinburgh have increased by approximately 4,021 people since April 2011 (a 12% increase). The number of people over 65 that have received equipment each month displays an increasing trend over the last three and a half years, as shown in the graph below.

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Number of people who received equipment in the period (65+) (also incl. East & Midlothian)

The number of bathing/toileting assessments completed for people aged 65 and over has increased from 953 in 2010/11 to 985 in 2011/12 to 1302 in 2012/13.

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The service has met the target by facilitating a significant drop in waiting times since June 2012. The funding has allowed the service to take on Priority A assessments (to be completed within 14 days). The graph below helps display how these assessment types are being completed within timescales (excepting Priority B assessments from July onwards). Due to the low number of staff who carry out these assessments (four CCAs), assessment times are easily affected, e.g. there were three CCAs off on long term sick leave over the period of February 2013 – October 2013 bringing the waiting time up. Despite this, Priority A assessments have continued to be completed within the target timescale.

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Priority A (14 days) Priority B (28 days)

The evaluation has highlighted issues with IT support. There is only one IT system administrator for ELMS, the service ordering/delivery database.  This service funds this position.  The administrator is currently off on long term sick leave so there is nobody with the same level of knowledge who is able to support the high workload for ELMS.  Knowledge loss is a major problem.  It would be useful to have central support for this database, similar to Swift and the Swift team, as the demand for this service increases (to spread the knowledge and workload).

Day Services 2013/14 allocation: £134,000 2013/14 projected spend: £51,189

The investment is being used to develop a re-ablement approach within day care services and to extend the opening of Drumbrae day service to weekends, to provide more preventative, re-ablement based services to older people, in particular, with dementia.

Four Occupational Therapists (OTs) have been recruited to work throughout both council and registered voluntary sector day services in Edinburgh, working with staff to develop a Reablement approach. Two started in July 2012 initially working with council services and following their success another OT was recruited in August 2013 with one more due to start in October 2013 to help extend the work into the voluntary sector. The Assistant Unit Manager has been recruited in October 2013 for the new Saturday service. The four Social Care workers have yet to be advertised. The planned opening is 1st February 2014. This Saturday service will run Cognitive Stimulation Therapy courses and provide 15 short term places for older people with dementia on a Saturday in the North West sector of the city.

Since July 2012 the OTs have been working in a focused way with individual service users (109 so far) dealing with assessments such as manual handling, mobility, feeding, access and equipment. The approach has shown immediate, positive effects. There has been instant improvement in service user’s abilities and staff skills, for example the mobilising of seven people who were in wheelchairs. They have been working closely with social care staff to help change the culture in day service to a Reablement style approach. These results will continue to produce short, medium and long term results for the service and the outcomes of the service users. A longer term objective is the anticipated increase in throughput to

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preventative services due to the Reablement approach and plans are underway to facilitate this.

The OTs carried out two training sessions for 10 volunteers in Reablement and two volunteer coordinators.

Since March 2013, the OTs have also been training social care staff from the centres and have been running 14 week Cognitive Stimulation Therapy (CST) programmes working with service users with mild to moderate levels of dementia in small groups. Seven training courses have been delivered, including three to the voluntary sector, where 21 staff have been trained so far. This is being rolled out across the city. Seven CST groups have been implemented in 6 day centres so far.

CST has been shown to stimulate and improve memory and cognition therefore strengthening people’s resources and allowing them to function at the maximum capacity. This fits with the ethos of Reablement. It is believed that this programme can help to reduce carer stress by supporting older people to live as independent a life in the community for longer. Appendix 3 provides feedback on two CST groups from group members, carers and staff. One group participant stated:

“Helps with my confidence, I’m a lot cleverer than I thought!”

Feedback from family members/carers has also been very positive. Two comments included:

“I am very happy that my mum is doing this type of group as it is something that I am trying to do with my mum at home. I see that she is brighter in mood and says that she has enjoyed the group.”

“I have very much seen a difference in my mum since the group started, she is mentally brighter and her mood is brighter as well. When I speak to my mum on a Tuesday she is able to put a conversation together better. My mum has not spoken much about going to the centre before but she is now saying that she likes it and has met some nice people which is definite progress.”

This workstream has seen improved partnership working as connections and close working relationships have had to be made with Health, voluntary sector, other teams and worker types within the department, as well as service users and carers, in order to facilitate this shift in the way this service is being delivered.

These activities mentioned are just some of the activities that are being progressed by the OTs and staff in the day centres.

An outcome evaluation tool is currently being piloted at one council day centre. Once fully implemented, this will help measure service user outcomes across the council day services. Research into outcome evaluation for the Reablement approach is also being conducted by the OTs.

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Medication Review 2013/14 allocation: £60,130 2013/14 projected spend: £48,024

The investment provides additional capacity within community pharmacy to review medication packages, targeting older people who receive regular home visits to dispense medication.

The project pharmacist took up post in late September 2012. He has continued to develop extensive working relationships with the range of care providers engaged in providing care to people (including home care and reablement, Compass, GPs and Scottish Care). These continue to be developed through regular attendance at a range of team meetings, the provision of staff training and support and through being available for queries from staff.

Activity levels have increased markedly: by 25 March 2013, 57 medication reviews had been completed; over the six months ending 30 September 2013, this had increased to 560. The actions resulting are shown below. The most common was to reduce unnecessary drug therapy, followed by reduction of ineffective drug usage:

Indicator Performance CommentsNumber of referrals received for medication reviews

TOTAL = 560 217 (From other services) 343 (Current Level 3 list)

Reduced unnecessary drug therapy

456 (81%)

Identifying additional drug need for patients

41 (7%)

Reduction of ineffective drug usage

377 (67%)

Adjustments to dosage 103 (18%)Reduction in adverse drug reactions

NA (Limited as difficult to follow up on patient symptoms)

Reduction in inappropriate compliance with drug regime

168 (30%)

Feedback from colleagues has included:

‘I would like to say that I have found your help to be invaluable. Having yourself as a contact for advice and support allows people to ask the questions needed. The benefit to the clients can’t be overstated.’ Home care organiser, City of Edinburgh Council

‘The impact of having a Community Pharmacist associated with Compass has been a key contributor to its success. The Community Pharmacy input into the community multidisciplinary input has been excellent. Polypharmacy reviews are an absolutely integral part of the Compass process in the provision of Comprehensive Geriatric assessment.’ Clinical Director, Royal Infirmary of Edinburgh, NHS Lothian

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Recent initiatives to improve practice have included close working with two homecare and reablement teams to review, audit and implement changes in current practice by supporting co-ordinators with their routine audits of charts completed by homecare workers, as per regulatory guidance.

Further development requirements include: engagement with hospital pharmacy dispensing sites; addressing the variation in assessing the medication level (which indicates the level of support the person requires) between different staff groups (e.g. OT, charge nurses and social workers); and addressing the variation in MAR charts supplied by a number of pharmacy contractors which has led to to marked inconsistencies, potential confusion and error. The post holder has made recommendations to resolve these and other outstanding issues.

Medication Procedures 2013/14 allocation: £120,000 2013/14 projected spend: £60,000

The objective of this workstream is to have a robust procedure on the administration of medicine to people living at home, and staff who are well trained and confident in using it. This is a requirement of the Care Commission.

The review of existing procedures has been completed. The review involved large-scale engagement with stakeholders, and prior to the re-launch of the procedures a comprehensive programme of training was implemented for staff groups within hospitals and the community across a range of health, social care and independent agencies. The revised procedures were approved by the Integrated Management Team in January 2013 and were published on 15th April 2013. They will be reviewed after one year.

An ‘Expert Group’ consisting of representatives from primary care, acute hospitals, the CHP, the independent sector and CEC has been established to meet quarterly to oversee the implementation of the revised Medication Procedures. During the first two meetings of this group it has become clear that there are complexities relating to managing medication at the point of admission and discharge which require resolution. Without improved knowledge and communication, unresolved issues regarding people’s medication will continue to delay and disrupt transfer back home from hospital.

Further Change Fund monies (a total of £120k allocated for 2013/14) will be used to resource work across the hospital and community interface in Edinburgh to embed the revised CEC Medication Procedures within acute and community settings. This will enhance service quality across care pathways through ensuring rigorous admission and discharge processes are in place and improving knowledge and awareness of the requirements of the CEC Medication Procedures within staff groups working both in hospitals and in the community. A band seven pharmacy clinician will be recruited for a period of twelve months to support this work.

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TeleHealth 2013/14 allocation: £183,260 2013/14 projected spend: £111,940 (TBC)

There has been a significant changes to the proposed Telehealth developments supported by the Change Fund since the last reporting period in March 2013. NHS Lothian was served notice that the national contract provider and telecommunications developer, O2, were withdrawing from the UK Telehealth market in July 2013. This significantly impacted the main Telehealth Workstream – Daily Remote Monitoring for COPD, Heart Failure and Multiple Conditions. At the time the withdrawal was announced, the Daily Remote Monitoring had been a success with 42 active patients: 20 monitoring their COPD, 5 monitoring their Heart Failure and 17 monitoring Multiple Conditions.

There were three community healthcare professional teams utilising telehealth home monitoring: The Heart Failure Team, The Community Respiratory Team (CRT) to monitor COPD patients and the IMPACT nursing team for multiple-conditions.

The Heart Failure team had 5 patients on home monitoring and have feedback that these patients found the system easy to use and provided addition support for their condition. A few patients felt there were too many telephone calls from NHS24 to check on their condition which did not provide extra support. Heart Failure team staff felt there would be greater benefit to patients whom lived rurally rather than in a large city where geography was not a barrier.

All 10 of the IMPACT nursing team were trained to set-up and monitor patients with a combination of long term conditions being Diabetes/Heart Failure/COPD. Within the IMPACT team a total of 22 patients were offered telehealth home monitoring of which 20 accepted. 3 patients had their kit removed due to anxiety reasons and 2 patients died while their telehealth monitoring was still in use. There was very positive feedback from patients using the system who felt more supported, more frequently contacted by nurses and better empowered to self-manage their condition(s). Patients generally liked the system and some expressed their regret that it was removed. The IMPACT staff also found the use of the system a good learning experience which capitalised on their telephone triage skills and with increased contact, felt there were more opportunities to get to know their patients better. There were some issues encountered with transmitting/technical difficulties and some inaccuracies with recordings either through patient technique or the sensitivity of the technology. The IMPACT staff found it was time consuming initially to carry out the monitoring, but over time as confidence and knowledge grew, this decreased. Some staff felt it increased patient dependency although overall felt the benefits outweighed.

Within the Community Respiratory Team (CRT) a total of 20 patients used Telehealth Home Monitoring to better self manage their condition at home. Feedback from patients and staff were similar to the other teams – mainly positive with patients feeling better supported.

All Telehealth Home Monitoring units were removed from patient use over a phased period between September and November with the final unit being dissembled on 21st November. Patients using Telehealth Home Monitoring were offered the opportunity to migrate onto a LiteTouch system instead.

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The cost implication of O2 withdrawing from the UK market has been neutral as the development was in early stages funded fully by the supplier O2. Change Fund allocations: £39,000 was allocated for future equipment costs for COPD, £23,400 for Heart Failure and £23,400 for Multiple conditions. In addition £21,600 was allocated for future eHealth support beyond the initial development stage. These costs will not be realised resulting in an underspend of £107,400.

In addition, there has been a significant delay in implementing Simple Telehealth - SMS text reminder service – this has been due to data management issues with the supplier. Currently NHS Lothian Caldicott Guardian sign off is awaited before this development can progress. It is anticipated that the full allocated budget to deliver Simple Telehealth will be utilised in Quarter 1 of next financial year, £36,940.

The deployment of LiteTouch telehealth interventions has proven extremely successful. Currently 183 patients are supported with the management of their COPD (158 patients), Heart Failure (17) and Diabetes (8). The IMPACT nursing team have developed a LiteTouch Multiple Condition care plan and these are currently in trial. Oxygen Saturation probes, glucometres and scales are utilised as peripherals to the system. It is intended to rapidly upscale the use of LiteTouch to support further patients aiming for 200 by the end of this current financial year.

There were some challenges to carefully manage the patient expectation when migrating patients from telehealth home monitoring to LiteTouch, however, these were overcome by the building close working links between the IMPACT and Community Respiratory Team (CRT) in conjunction with eHealth ensuring patients received their new devices promptly and the data transitions ran smoothly. LiteTouch is now fully embedded in clinical practise of both the IMPACT and CRT teams.

Next steps are to continue the upscale of LiteTouch and ensure Telehealth and Telecare are fully aligned with the integration of Health and Social Care.

Making it CLEAR2013/14 allocation: £135,000 2013/14 spend: £135,000

‘Making it CLEAR - community living, enablement and resilience', is a 3 year project between City of Edinburgh Council, NHS Lothian, third sector services and Queen Margaret University. The aim is to enable older people to live well within their communities by better understanding what supports them to remain resilient. By having more resilient communities we will support the ‘Live Well in Later Life’ principle of ‘shifting the balance of care to the community’.

Two key workstreams have been undertaken so far: a review of the literature on resilience and, using the evidence from the literature, the development of a tool to determine older people’s resilience.

The literature review revealed that there are no appropriate assessment tools to determine older people’s resilience. However it also highlighted which community factors support older people to overcome adversity and remain resilient. Based on these findings, the project team continue to be engaged in the development of a specific self-report resilience tool which assessed both individual character assets

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and the presence or absence of associated community factors. Creating and validating this tool is a key element of the wider Making it CLEAR project. This will provide us with an objective tool which we can use to measure the outcomes of project work.

At a practical level developing a scale which is able to assess both individual character assets and the presence or absence of associated community factors may be particularly useful for health and social care professionals. Information generated from the use of such a scale could inform the development of interventions which aim to support older people to continue to live meaningful and quality lives despite the increased likelihood of encountering adverse events which come with ageing.

Targeting community engagement or individual assets which have lower scores on the Making it Clear (MiC) assessment tool provides a very specific and targeted approach to improving resilience. This is being supported through:

Development of a ‘MiC short form’ that will be used to identify those at risk of poor outcomes associated with low resilience is underway. The short form will be used to trigger a full MiC assessment to identify which areas should be targeted for support or intervention.

Development of a resilience intervention package with options derived from items within the MiC assessment.

The next stage of Making it CLEAR will be to pilot the tool and intervention manual in a specified neighbourhood in the NE sector of Edinburgh, specifically from Constitution Street to the top of Leith Walk. This will be done through joint working using an action research approach, in collaboration with a range of stakeholders including GP practices, hospital teams, reablement, homecare, intermediate care, other Change Fund initiatives, third sector organisations, private and independent sectors (including local businesses), housing and community resources (e.g. libraries).

This project is unique in bringing clarity and consistency to the concept of resilience and in establishing its relationship with ageing well. The project is being promoted through various national and international conferences, including:

JIT Co-production and Capacity Building Conference in February 2013

AHP International Conference in October 2013.

Edinburgh Behaviour Support Service 2013/14 allocation: £409,865 2013/14 projected spend: £341,688

The Edinburgh Behaviour Support Service is a multi-professional integrated service which works to increase the understanding of formal and informal carers about the needs of people with dementia or cognitive impairment with behavioural problems to improve their quality of life.

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The service was launched in February 2013. The multidisciplinary team includes Clinical Psychologist, Consultant Psychiatrist, Nurse Team Leader, Mental Health Nurses, Occupational Therapists, Dieticians, Speech and Language Therapists and Physiotherapists. Carer Peer Support Workers, with lived experience of mental health challenges.

270 referrals were received between Jan-Oct 2013, with a significant majority of these (90%) made by care homes, 5% inpatients in the Royal Edinburgh Hospital and 5% in their own homes. Five referrals were not taken by the service, 2 were transferred to the hospital-based Bridging Team, 1 person went into NHS long term care, and input was no longer required for 2 people who had settled. Full year projections are for 330 referrals for year 1. It is anticipated that the number of referrals will further increase in year 2 as awareness of the service continues to grow, and the impact of the national dementia strategy and media spotlight on quality of dementia care in care homes. These projections are higher than anticipated, based on a similar service in Newcastle which receives approx 240 referrals per annum.

The following feedback from formal and informal carers has been collated about the psychological formulation process used by the service:

A great deal A fair amount A little Not at all

Helped the client feel listened to 86% 14% 0% 0%

Was helpful in better understanding the person’s needs in a holistic way

70% 30% 0% 0%

Made them feel more optimistic about the person’s quality of life

59.5% 32% 6% 2.5%

Made them feel they had collaborated in a shared process to develop a holistic intervention plan to better meet the person’s needs

81% 18% 0% 1%

(Info on respondents (N = 84); 51 formal care staff; 22 family or friends; 26 social work and other professionals)

The service can demonstrate a contribution to the following high level outcomes:

High level outcome Contribution

Carers feel supported and able to continue their caring role for as long as they wish

Peer carer support is providing essential emotional and practical support to carers of people with dementia/ or cognitive impairment with behavioural difficulties.

Clients are remaining in the place they consider home without being moved unnecessarily due to behavioural problems

Our multi-professional health service, in collaboration with Edinburgh social work teams, is enabling this culture change.

Clients are living with less behavioural distress and mental health problems

Generic multidisciplinary team workers provide evidence based assessments & a psychological intervention and generate a holistic intervention

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plan which addresses client’s unmet needs and works with both formal and informal carers to support the client to improve their quality of life. Specialist uni-professional AHP, Nursing, Psychiatric and Psychological assessments add to this when required on a case by case basis.

The use of antipsychotics for the treatment of behavioural symptoms in dementia is decreasing for those referred to the service

Consultant Psychiatrists in the team are liaising with the GP’s of clients to advise on the decrease of such medications where appropriate.

A detailed case study has been provided, the outcome of the intervention is summarised below:

“Ellen did not move out of her home due to having behavioural issues which were initially reported as extremely disruptive to care staff. She was no longer clinically distressed and her quality of life was richer given her unique holistic intervention plan to address her unmet needs. Her behavioural symptoms diminished considerably as a result. She put on weight. Her sleep improved. Care staff no longer felt she was a burden in terms of increased time needing to be spent addressing behavioural problems or giving reassurance.”

A number of issues have been highlighted by the evaluation:

Demand for the service is outstripping the current level of staffing resource. This has been exacerbated by the reduction of two dementia nurse posts through the Older People’s Mental Health Service re-design that supported care homes.

Office accommodation where the team are based in North Edinburgh is noisy, cramped and staff feel that the environment does not allow then to optimally undertake their jobs.

The team require one more pool car, two more computers and the patient information system is being reconfigured to hold outcome focussed data.

A project Steering Group with Heads of Service has been established to help address these issues and support the project’s aims.

Community Connecting 2013/14 allocation: £400,000 2013/14 projected spend: £380,371

A city wide Community Connecting service has been in place since September 2012. The service helps older people to connect to local community activities and opportunities, regain skills, confidence and prevent social isolation.

The service is provided by the following organisations:

Pilmeny Development Project (North East)

Health in Mind (South West)

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Places for People, in partnership with Volunteer Centre Edinburgh (North West and South East)

Between September 2012 – October 2013

Total number of service users supported

317

Total number of volunteers trained 156

The target set out within the Service Specification is for a total of 720 older people to be supported per year (180 per sector). This is a challenging target which relies on sufficient numbers of volunteers being recruited and retained and appropriate referrals being made to the service. Providers continue to develop and promote their services and the number of older people supported is expected to increase in year 2 of the service. The target will be reviewed as part of the forthcoming annual contract monitoring arrangements.

The following examples demonstrate the improved outcomes for the older people that have received a service.

Outcome Example of support/ activity

Older people feel less isolated

Kevin was referred to Community Connecting following the sudden death of his wife in April. Kevin and his wife did everything together and all of his interests and activities were based around her. Kevin has now been attending the Eric Liddell Lunch club for over two months, initially with support from his volunteer, then independently. Kevin has also been supported to join his local library. Kevin loves audio books and told us it feels like having someone else in the house again when he is listening to the story.

Older people feel able to maintain interaction in activity/ opportunities following the end of the service

“Last week I walked to the church with May and she watched the class and I picked her up afterwards & walked her home. I have just spoken to May on the phone and she went to the class on her own this morning and participated and she told me that she enjoyed the class very much although she doesn't know every step yet!”

Older people have improved health and wellbeing

“I have put on 2 pounds over the last month. It’s good to put on weight. I am moving in the right direction. Since my illness I have not many clothes to fit me. The Doctor is taking me off anti-depressants as they weren’t helping me. I go to the hairdressers every week by myself now. I am just using the taxi (Taxicard) just now as am not ready to walk by myself yet. I am teaching myself to relax more now. I am doing less rushing about the house tiring myself out.”

Older people feel more confident

A volunteer arranged for a service user to visit a Lothian Bus depot to practice using her electric wheelchair on a stationary, empty bus. That same afternoon, the service user cancelled the taxi she and her sister were going to use to go shopping in favour of using the bus.

Older people feel safe living at home

Gina was referred by a Community Police Officer following a break in at her home. Gina did not feel safe at home and Community Connecting have been working closely with the Community Police team around safety in her home. Gina has been supported to travel on the bus again and to rebuild her confidence in her local area. For exampleGina is supported to go out to the bank and post office which is something she was very reluctant to do since her break in.

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Carers feel supported and able to continue their caring role

Alice is a older person who was experiencing dementia and this was worsening. She lives next door to her daughter who is her carer. We were able to provide a volunteer for a period of 4 weeks to accompany Alice out on trips on the bus. The staff member also contacted the Ripple Project Lunch Club for older people with dementia who were able to accept her on the service. The carer was incredibly grateful for this intervention in giving her a “breather” as well as linking her mother in to a new weekly service that suited her needs. “I can’t thank you enough for all your help. I sometimes feel like I am at my wits end with Mum, this has given her something positive to do during the week that gives me a break”.

Community Connecting also provides opportunities for volunteers through increasing confidence and skills and making social connections.

Outcome Example of support/ activity

Volunteers are well supported and feel positive about the service

Elizabeth moved to Currie following the death of her husband. Although this meant she was closer to her family it meant that she did not know what was going on in the area. Joan was a volunteer who had also recently moved to the area and she was very keen to get to know the area more too. Elizabeth and Joan explored the area together and when they met up excitedly shared all they’d learned about the area during their time apart. Elizabeth and Joan visited various community groups together and also enrolled in a local crafting group.

Tom is a 26 year old Scottish male volunteer with us who has recently emerged from a challenging period in his life involving homelessness, anxiety and an alcohol addiction. Tom is naturally good interacting with older people but needed some support to be able to do this regularly and with confidence. Tom is now our most experienced Community Connecting volunteer and an invaluable supporter of our service!

Referral routes:

23%

25%

40%

12%

Direct from NHSDirect from H&SCReferral & Resource GroupsOther

Significant issues have been highlighted by all three providers in relation to referrals. The main issue is that a high number of referrals coming through the Referral and

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Resource Groups do not result in a service being provided. This is due to the older person understanding that they have been referred for day centre place and they reject the Community Connecting service, either at first point of contact or at the assessment stage. This is resulting in a large amount of additional work for the Community Connecting providers. Work is required to educate referrers and the public as to the range of day opportunities available and that a ‘day centre’ is not the only option. A meeting has been arranged to consider referral routes and other issues raised in relation to the referral process.

Carer Support Hospital Discharge Service 2013/14 allocation: £100,000 2013/14 projected spend: £74,717

The Carer Support Hospital Discharge service will work alongside unpaid carers of older people and older carers aged 65+, in pre hospital discharge planning to inform care package decisions and provide better outcomes to carers.

The funding allowed for the recruitment of three staff including two carer support workers and one admin worker. However, there were staffing difficulties after both carer support workers left within a few months of each other. Both carer support worker positions have now been filled there are two FTEs working in post at present. New management of these posts has been put in place.

The service has worked with and helped to support 26 carers since Oct 12. Historic staffing difficulties have resulted in a reduction in referrals currently being received. This is being addressed through increased promotion of the service and building links with hospital professionals. A new Steering Group has greatly improved management and partnership working which is now providing a new drive to the project.

Plans are progressing well and new processes have been put in place to record activity more effectively. This work stream is working closely with the Swift Team to set up a new referral process.

Step Down 2013/14 allocation: £1,400,000 2013/14 projected spend: £1,400,000

Step Down is intended to provide intensive rehabilitation and a period of extended assessment for people who were in hospital and were being considered for a care home place. The objective is to support people to return home, where possible, by enhancing their level of independence.

The phased implementation of Step Down facilities began in October 2013. The total capacity will be 42 beds. A monitoring and evaluation framework is in place, and routine high level reporting will begin at the end of November 2013. Weekly project implementation meetings continue.

Comments from some of the first people to use the Step Down service have been positive, including:

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“I’ve enjoyed being here, It’s very comfortable here, much nicer than the last place”

“This place is amazing, out of this world, I never knew anywhere like this existed. I’ve got my own room and the set up is marvellous. The size of this place is good, not too big and it’s homely. The staff are very friendly, should get a medal!”

“I’ve got a freedom here that you wouldn’t get in the hospital but I’m still getting my therapy. I’m building my energy levels back up and I’m going home next week with the therapists to see how I get on. It will be a big thing going home but I’m more confident now. Everything is more rushed in hospital, whereas here you have time.”

Community Transport 2013/14 allocation: £150,000 2013/14 spend: £0

Accessible community based transport is essential to support the aims of the Change Fund and the increasing numbers of frail older people living at home. Transport is consistently noted as a priority by older people and voluntary sector service providers.

Edinburgh Voluntary Organisations Council (EVOC) led discussions on how best to allocate the funding to meet these aims. The Change Fund Core Group agreed to use part of the Change Fund allocation (£225,000) for capital investment for 5 replacement vehicles, with one vehicle allocated to each of the five community transport operators forming part of ECTOG (Edinburgh Community Transport Operators’ Group), with a minimum of 10% match funding from each provider. This funding was allocated in January 2013.

The above funding was agreed with a recommendation that any further funding should be used to support the development of a sustainable community transport strategy for the city. A symposium was held in June 2012 which brought together a wide range of stakeholders which preceded the initiation of a formal Review of Community and Accessible Transport in April 2013. The review is progressing with engagement from transport providers. The allocation of any further funding will be discussed by the Change Fund Core Group in light of recommendations emerging from the review.

ECTOG has also worked with Evaluation Support Scotland to develop a logic model and a summary of evidence to demonstrate the contribution that community transport makes to the Reshaping Care agenda.

Innovation Fund 2013/14 allocation: £552,600 2013/14 projected spend: £528,670* * + transfer of £23,930 to Voluntary Sector Resilience Fund (see below)

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The delivery of the 21 funded projects commenced from April 2012. The projects are wide ranging and include the following areas of focus:

Evaluation and monitoring arrangements are in place against project outputs and outcomes, using the same reporting framework for evaluation of the wider programme. EVOC continues to work with projects to build-in evaluation arrangements that best demonstrate wider benefits. A full Evaluation Review took place on 2 December to update the Change Fund Core Group on the evaluation of all 21 projects to date.

Related work includes the ‘A Stitch in Time’ programme, sponsored by John Swinney MSP and focused in Lothian, to demonstrate the Scottish third sector contribution to care for older people. Additional funding has been made available to EVOC by the Scottish Government to undertake local community mapping work. EVOC are also working with the Council to develop local forums to consider and influence day services and opportunities available for older people at a local level and to cascade learning from the Innovation Fund projects.

Communication and Engagement 2013/14 allocation: £150,000 2013/14 projected spend: £54,230

An overarching Communications and Engagement Strategy has been developed to incorporate three major transformational programmes: Personalisation, Integration and Reshaping Care for Older People.

A Communications Officer is now in post to lead the ‘Life Planning Campaign’. This campaign aims to raise awareness of services and support available, encourage people to consider and plan for the future, and prevent the need for more intensive services. The Dementia Campaign will be launched in January 2014.

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Following the success of Live Well in Later Life Information Days held in November 2012, a series of local events are planned, and a second successful event took place in the west of the city on 23 April 2013.

To assist clinical and social work professional staff, a directory of services has been widely distributed to raise awareness of the wider range of services available, particularly those that focus on prevention and rehabilitation and that are based in the community. Work to expand the availability of information about services for service users and carers is also ongoing with partners who deliver public information services.

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One-off Projects

Post Diagnostic Support for DementiaOne-off allocation: £530,636 (for 2 years) Projected spend: £535,114

Six Link Workers will be employed by Alzheimer Scotland. A contract is in place, six workers have been recruited and final PVG checks are taking place, with an expected start date of early December 2013. A Planning and Commissioning Officer for Older People has also been recruited to support this work.

AHP Enhancement in Orthopaedic Rehabilitation ServicesOne-off allocation: £150,879 Projected spend: £141,276

Project fully operationalised on 2 September 2013. Further information will be provided in March 2014.

Life Planning CampaignOne-off allocation: £60,000 (for 2 years) Projected spend: £60,000

A Communications Officer has been recruited for two years from April 2013. Planning for the Dementia Campaign is well advanced and a launch date is planned for January 2014.

Community Connecting in the Royal Victoria BuildingOne-off allocation: £100,000 Projected spend: £91,886

A service model has been developed and agreed with key stakeholders. Places for People are currently recruiting a 0.8 FTE worker to be based at the RVB.

Care Home Liaison ServiceOne-off allocation: £199,294 Projected spend: £199,294

The service will be piloted in the North West of the city. 2.5 WTE nurses are currently being recruited. Five care homes have agreed to take part in the initial stage of the pilot.

Equipment for registered voluntary sector day services2013/14 allocation: £141,440 2013/14 projected spend:£141,440

Funding has been provided for moving and handling equipment to support registered voluntary sector day services to work with increasingly frail service users. Maintenance of equipment and training for staff is also being considered. This aims to work towards:

Supporting older people to live independently within the community for longer

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Improving service user experience and quality of care within voluntary sector day services

Improving staff safety and skill levels.

Detailed assessments have been carried out by the two Day Service OTs in each of the registered voluntary sector registered day centres to find out what equipment is required and what is appropriate to the environment in each centre in order to work with increasingly frail service users. A report of the equipment required has been submitted to Health & Social Care Senior Managers. A formal agreement has been sent out to the day centres for them to sign, after which, steps will be put in place for purchasing required equipment.

Follow up visits to the centres once the equipment and resources have arrived will be carried out which will help evaluate what difference has been made.

Voluntary sector investment in trainingOne-off allocation: £20,000 Projected spend: £20,000

Edinburgh Voluntary Organisations' Council (EVOC) has been allocated this investment to provide free at the point of delivery essential training for staff and volunteers working with older people. Courses delivered thus far:

Date Course No. Cost

14/02/2013 Manual Handling 10 150.00

20/02/2013 Emergency First Aid in the Workplace for Appointed Person 12 288.00

26/03/2013 Emergency First Aid Awareness 7 150.00

22/04/2013 Accredited Passenger Assistant Training Scheme (PATS) 5 175.00

23/05/2013 Emergency First Aid Awareness 8 237.00

28/05/2013 An Introduction to Reminiscence Work 6 360.00

17/06/2013 Accredited Passenger Assistant Training Scheme (PATS) 8 280.00

24/06/2013 Depression Awareness 8 150.0027/06/2013 REHIS Elementary Food Hygiene 4 382.0009/09/2013 Passenger Assistant Training Scheme (PATS) 9 378.0024/09/2013 Emergency First Aid Awareness 11 262.00

02/10/2013 Living Life to the Full - taster session 5 393.20

10/10/2013 REHIS Elementary Food Hygiene 13 450.80

15/10/2013 Boundaries and Confidentiality 10 350.00*

23/10/2013 Scotland's Mental Health First Aid (SMHFA) 2 days 12 900.00*

28/10/2013 Manual Handling 9 150.00

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TOTAL £3,806* estimate

Voluntary sector resilience fundOne-off allocation: £175,000 (+£23,930 from Innovation Fund) Projected spend: £198,930

A total of £163,930 was allocated in July 2013 to 23 voluntary organisations across the city:

Edinburgh Art Therapy Centre £9,960Milan £8,807Edinburgh Citizens Advice Bureau £7,282NKS Health £6,375Dove Centre £9,252Ripple Project £6,784Broomhouse Centre £9,723Third Age Computer Fun £9,958Dunedin Canmore £9,963ACE IT £9,721Pilmeny Development Project £9,288Almond Mains Initiative £4,000Health All Round £8,620LifeCare £9,995Care for Carers £4,700Saheliya £4,906The Open Door £6,536Eric Liddell Ca(I)re Programme £8,565South Edinburgh Day Centre Volunteers Forum

£5,500

Corstorphine Youth & Community Centre £3,998Health in Mind £9,997

Successful organisations will report during winter/spring 2014 to account for their allocation and how their project delivery contributes to the outcomes of the Change Fund.

The remaining £35,000 is allocated to the Participatory Budgeting project ‘Canny wi’ Cash’ which is an innovative funding stream for the smallest community groups whereby recognition is given to their preventative work with older people. Decision making on successful applications shall be conducted by older people who use services through a facilitated voting process across Edinburgh in November 2013.

Research project on older people with substance misuseOne-off allocation: £40,000 Projected spend: £40,000

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Findings suggest that there is an increasing proportion of older people who have substance misuse problems, and there has been little research into the extent of this problem.

In order to work towards increasing the proportion of older people living independently and safely at home, whilst being healthier for longer, funding was provided to enable a research scoping exercise to identify the extent of the issues around older people’s substance misuse will be carried out.

The purpose of the scoping exercise was to research the numbers of older people affected by both illicit and prescribed drug use, the needs of staff, (development of skills and/or increased knowledge base of substance misuse), and how to manage it.

One FTE support worker was funded to work on the research project from May to October 2013.

Information gathering took the form of questionnaires (by email), Telephone interviews, face-to-face meetings/interviews, attending meetings, statistics gathering via dedicated requests from ISD, NHS and The City of Edinburgh Council.

The areas that were approached were:

Care Homes (Private and City of Edinburgh Council (CEC))

Care at Home (Private) and Homecare (CEC)

Day services (CEC and Voluntary)

Various volunteer groups as advised by CEC and EVOC.

Community Mental Health (NHS)

Community Nursing (NHS)

GPs (NHS)

Intermediate Care (CEC)

The Access Point (CEC)

Although it was already known that, in Edinburgh, alcohol consumption is above the recommended limits, the report provided previously unknown information about consumption rates in older people. Invaluable information was also gathered about other substances, e.g. gas sniffing and prescription drugs. The report highlighted gaps in service provision for older people and the difficulties care staff have in managing substance misuse.

The main recommendation from the report was a requirement to upskill the staff group which will lead to a building of confidence, knowledge and abilities in the staff group to enable them in future to broach substance misuse with service users and to manage the effects of substance misuse.

A training programme is now being developed based on findings and recommendations of the research scoping project with help from Workforce Planning and Development (WPD). The training will be combined with existing e-learning

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about substance misuse and funding is being sought to mainstream the training when the Change Fund monies are used. This training will be available to care staff both in the public and private sectors.

In the longer term, the project will contribute to the workforce development in the private and public sectors and will inform and prepare care staff for dealing with issues of substance misuse. It will also assist in monitoring of the situation of older people and substance misuse and will highlight any unknown issues/service development requirements.

The funding provided by the Change Fund has enabled a valuable piece of work to be carried out which will have positive, long-term effects in terms of workforce development and improvement in service provision for older people who have substance misuse problems.

Dementia training in care homesOne-off allocation: £124,293 Projected spend: £124,293

A working group has been established to progress this work, with membership from Scottish Care, CEC Workforce Planning and Development, Planning and Commissioning, NHS and EVOC. The NES/ SSSC Appreciative Inquiry tool has been used with Porthaven and Letham Park care homes in the first instance to understand existing dementia skills and further training requirements. Suggested amendments have been made to the SSSC in relation to the tool to make it more appropriate for use in care homes.

A letter has been sent to all care homes along with a survey to find out further details about existing dementia training and further training needs.

Jackie Sloan and Rene Rigby attended the SSSC event in September, and led a workshop presentation on the work they are leading in Edinburgh.

My Home LifeOne-off allocation: £73,800 Projected spend: £73,800

My Home Life aims to improve the quality of life and relationships for everyone living, dying, visiting or working in the Care Home. It is an evidence informed programme that seeks to create a positing culture and develop a workforce fit for purpose through relationship-centred care. Pre Programme Discussion with professor Belinda Dewar ensured that ‘Talking Points’ (Personal Outcomes Approach) was threaded throughout the My Home Life Programme.

The Edinburgh My Home Life programme started with four days leadership support workshops in May and June 2013. The programme continues through a programme of regular action learning sets between August 2013 and June 2014. The programme promotes an appreciative and collaborative approach to practice development so that everyone has a part to play in change including residents, staff, relatives and others. Between the meetings of the action sets, the participants are expected to identify and support practice developments in their homes.

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The programme is in its earliest stages. Feedback from the initial workshops has been very positive and suggests that the programme provides both the strong motivation and practical approaches to supporting change. The action learning sets provide a space and time for managers to reflect on their efforts and encouragement to go further as they grow in confidence. Over time it is anticipated that the sets will identify a ‘community development’ strand that reflects the issues that are shared across the homes. Managers from both Edinburgh sets will work together to identify important issues that require a wider, systemic response to enhance and support the sustainability of the changes in individual homes.

Feedback from one participant including the following comments:

“My Home Life is an exciting and liberating programme to be involved with”

“It gives permission to ‘press the pause button’”

“My Home Life encourages and enables us to look at introducing changes but not change for the sake of change, these changes make a real difference to how staff see themselves and others.”

Care Homes Small Investment FundOne-off allocation: £175,000 Projected spend: £140,189

The Change Fund Partnership agreed to create a one-off investment fund. The fund was open to all care homes in Edinburgh for small investments of up to £10k for projects aligned with the Change Fund objectives and that could demonstrate that quality of life for people living in care homes would be improved.

23 care homes in Edinburgh responded and 2 applications were assessed as not meeting the criteria for the fund. The successful applications were grouped into the following themes:

Reminiscence work

Gardens

Art, Music and activities,

Technology and My Life Software.

A strong focus on evaluation of the projects has been incorporated. All care homes are asked to complete a six-monthly evaluation template. Of 21 successful projects, 9 of these were for My Life Software. These projects will complete an initial evaluation form in the New Year following delays with implementation due to supplier issues (see below). Of the other 12 projects, 12 returns have now been received. A number of projects are still at an early stage of implementation and are subject to external factors eg weather for the garden projects. Further detail of projects that are underway and have provided a good level of detail in their evaluation form is provided below.

Erskine Edinburgh Home - Café Culture, Creative Community, Boxes and Books

The Erskine Edinburgh Home received £9,000 for a range of activities including:

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Acting and movement sessions with Honeysuckle Swing

Reminiscence Boxes

Life Story Books

Dementia Café.

A programme of 34 Honeysuckle Swing sessions are underway, providing “fun, therapy and melody for the soul”. An average of 25 residents attend each session, including residents from nursing and dementia units. The residents will perform in their own Swing Show in April 2014.

Feedback from residents includes:

“It’s magic, superb”

“I think it brings everyone together with shaking their instruments, it’s great”

“Absolutely wonderful, not only for myself but watching other people enjoying it so much”

“It’s a great place to come, I think it’s great”

“Oh I wouldn’t miss it, I love it!”

Haugh St Care Home (Bield) – Extra Time

Haugh St Care Home received £5,235 to develop a football reminiscence project. The project includes the use of football memorabilia and resources to support residents to share their memories of football. The project is also developing links with youth team, promoting intergenerational work. Links are being made with the local community and other care homes. Volunteers are also supporting residents to attend football games.

“We had a lady, for example, who’s been in the care home for 19 years, who didn’t even have an interest in football. All of a sudden, she could remember the names of all the members of a team from the 1940s. And, of course, the conversation goes in different directions – songs they might have heard on the street when they were kids, food they used to eat: it’s amazing how it takes different routes.”

Other updates include:

Viewpoint opened a Dementia Craft Cafe at Lennox House in September, building on their award winning project at St Raphaels’.

Building of a sensory garden is well underway at The Elms Care Home, with paths and raised beds having been built and planting underway ready for the spring.

Tor Christian Nursing Home is also underway with plans for an accessible and dementia friendly garden. Consultation with residents and families has been done and plans developed. Tree surveys and consultation with the Planning Department has been required as the building is listed. It is hoped that work will be complete by March 2014.

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Dementia Reminiscence SoftwareOne-off allocation: £13,602 Projected spend: £10,053

The Change Fund Core group at a meeting on the 23rd April 2013 agreed funding applications made as part of the Care Homes Small Investment Fund for the total of fourteen My Life Software units.

My Life Software provides communication support and interactive games for older people and people living with dementia. The touch screen technology is comparable with using a large iPad.

Outcomes

Improve communication and engagement with people with dementia

Develop meaningful activities for people with dementia and their families and carers

Improve wellbeing of care home residents.

An evaluation form and guidance has been issued to care homes. These will be returned in the new Year once the units have been used more fully within the homes. Evaluation questions include:

How have you used the My Life Software - how many people has it reached, type of activities etc ?

What difference has it made-outcomes for residents/families and visitors/staff?

Any issues or challenges you had in using the My Life Software units?

A number of issues related to the supplier have delayed implementation. It is disappointing that arrangements made with My Life Software for care home staff to receive training on utilising the equipment had to date not been undertaken. However a training plan is now in place and will have been completed by 7th December 2013

IPads for volunteers in care homesOne-off allocation: £5,600 Projected spend: £981

Funding provided 3 iPads for the Moose in the Hoose project which supports volunteers to work with residents in CEC and Four Seasons care homes to use technology for a range of activities including:

Taking photos

Word games

Painting and drawing

Interactive games such e.g. playing the piano

Accessing videos and music

Looking up works of art

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Emails

Following an evaluation report provided in May 2013, a further 4 iPads were provided.

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