Community Learning Disability TeamsDebra Moore

Managing DirectorDebra Moore Associates

www.debramooreassociates.com01723 37144607950 333884

debra@debramooreassociates.com

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

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

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%

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%

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%

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%

Integrated teams – what difference does it make?

• 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?

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

Lessons for nurses

• Health related activity as a first priority• Outcomes • Person experience• Universal and mainstream services• Look after one another• Don’t give up• Use an appreciative eye – what do you want more

of?

Don’t get the Dibley’s!

• Strong leadership• Earn your place at the

table• Ensure people who use

services and their families are at the table

• No piccalilli and tuna sandwiches!

FinallyKeeping the message simple -

ensuring the ‘me and mine’ test is passed

• http://www.youtube.com/watch?v=LYPIxHzXAJY