Health and Social Care

Peter Knight discusses the Indicator of Relative Need (IoRN) tool

January 22, 2015 by Linda White No Comments | Category Uncategorized

Interview Profile: Peter Knight, Lead Information Specialist (Joint Improvement Team)

One of Scotland’s foremost information professionals, Peter is a catalyst for the better use of data across the integrating health and social care landscape in Scotland.

 

Formerly ISD’s Head of Statistics, Peter applies his extensive knowledge, vision and flair in the use of information to support local and national partners directly or through the Joint Improvement Team. He has consistently supported the Indicator of Relative Need (IoRN), identifying it as an important resource for Scotland’s integrated future.

1.  Can you tell us about the IoRN tool?

The IoRN tool is a practical, nationally supported tool which can be used to gather information about the relative dependency levels of people.

In a nutshell, it’s a succinct, standardised questionnaire and algorithm tool that groups people according to the degree of their functional independence, summarising the key characteristics of people who use health and care services. A community IoRN is available for people who live at home, while a version is also available for people living in care homes or who are in hospital.

2. So, how will this tool help users to better understand the key characteristics of people?

The IoRN tool is person-centred. Information collected concerns the person as opposed to services. It captures how the individual is at this moment in time and can be repeated to show if and how they have changed. This is very relevant when discussing outcome-focused plans and reviewing a person’s wellbeing.

This information is essential in helping us to begin to understand the characteristics of the people we support, but more generally: to ensure we are delivering the right kinds of care and support to people that is reflective of their needs. The range of options (e.g. step-down, step-up, reablement, budgets) is much wider now than before – and this information is essential in helping us plan for future services.

3. So, is the IoRN just for capturing data about older people?  What about other age groups?

There is no rigid age barrier. While the IoRN was originally developed to support older people, some teams have successfully used the IoRN more widely to capture information from other age groups.

4. So what’s the benefits for patients and service-users? What difference will they see?

The IoRN provides supporting information that can help inform plans that are personal and outcomes-focused. It is a by-product of a good assessment: person-centred, balancing realism with ambition, and with a focus on independence or maintenance, wherever possible. For example in a residential setting, it is vital that caring staff understand the changing needs of the people they care for. Good decisions and good information make excellent joined-up service provision.

5. As the integration of health and social care gathers pace, who would benefit from using this tool and how will this support integrated working?

We are developing IoRN tools for the community, the care home and for the hospital. The challenge is to introduce and share IoRN information within and across all relevant services. This could encompass social care, community health, intermediate care, care home, hospital and the general practitioner.

6. What’s next? Are you currently testing the tool ‘out there’ in the real world?  If so, how is that going?

We’ve been testing an improved version of the IoRN in a number of community-based services across Scotland, with pretty positive results. Examples are within the intermediate care service in Fife, and Falkirk. In Dumfries and Galloway, the Short Term Augmented Response Service (STARS) team are now using it as part of their routine monitoring and clinical support, while in East Dunbartonshire and Midlothian, it’s being  used by reablement staff.

NHS Lothian is actively considering using the IoRN across all of its hospitals, and it doesn’t stop there. We’re keen to roll out IoRN to many more areas and partnerships and we are determined to get the IoRN tools into best shape, with plans for further testing in a range of different settings.

7. How do you access IoRN?

A range of resources are already available, including guidance, questionnaires and practitioner training on the use of the IoRN. Material will be added here to the JIT website over the next few months.

The care home version of the IoRN is already part of a staffing model, which is on the ISD website, free of charge!

Alternatively just give me a call or drop me an email and I will be happy to chat to you about the benefits of getting involved.

Email: Peter.Knight@scotland.gsi.gov.uk Tel: 0131 244 3610

Feedback from the field:

Following assessment and completion of IoRN I feel that we can identify and quantify the areas of a client’s activities of daily living that we can work towards enabling optimal independence. IoRN can quantify the improvements made at each review.

IoRN can indicate mental well-being influences on a client’s ability and therefore influences the approach to enablement and strategies for improving independence within these confines”.

Janet Fell (SCN STARS, Stranraer)

____

“The IoRN2 is quantitative measurement that enhances the outcome-focused qualitative assessment that we undertake in the Housing with Care Reablement Service (HWCRS) in Falkirk.

“The assessment tool we use prior to transferring service users from the acute hospital service or the community to the HWCRS and again prior to discharge home from the HWCRS considers quality of life, change and process outcomes that encompass mental and physical well-being. The IoRN2 offers an excellent before and after comparative quantitative score that augments the qualitative assessment.

“Service users (frail older people) transferring to the HWCRS often lack awareness, confidence or motivation, thus we have found that the IoRN2 is an excellent tool that highlights if these factors are influencing or preventing the service user’s pathway to independence and their return home fully reabled”.

Dr Gail MacNamara, Professional Doctorate Health & Social Care; MCC; BSc (Hons). (OT) Team Manager Housing with Care (HWC) & HWC Reablement)

____

“I have found using the IoRN tool a more fair, equitable and accurate way of assessing a person’s independence and dependence of their needs. Initially thought it would be ‘another time consuming’ paper exercise, but it only takes a few minutes to complete and the benefits are time well spent. It focuses on the individual and not the service, allowing us to signpost to relevant place or focus on a specific task.

Coming from a Nursing background that did not use such a tool, it has shown me that using IoRN within a multidisciplinary team we can all focus on what’s best for our service users.”

Senior Charge Nurse (NHS Dumfries & Galloway)

____

I find using IoRN really helpful within reablement as you are able to demonstrate improvements in a measurable way. We have had team discussions when there is areas of uncertainty to gain clarity which have been very helpful. I look forward to addition of medication as this is an area where improvements can be achieved but not recognised. It can be frustrating when small improvements can’t always be demonstrated within IoRN but that is the nature of the beast.”

Jacqueline Geddes,Senior Charge Nurse (NHS Dumfries & Galloway)

Tags: IoRN, Joint Improvement Team, Pete Knight

Comments