Health and Social Care Integration
Health & Social Care – The Occupational Therapy Contribution
On the 1st November I joined around 90 Occupational Therapists and Managers in Dunblane to hear about the contribution they are making to the National Health and Wellbeing outcomes in relation to Health and Social Care Integration.
Participants shared their experiences and progress within their own Partnerships and heard about approaches and models being used in different parts of the country. This included presentations from the Glasgow Partnership on their review of OT services with the key aim of “Making Occupational Therapy Services better for the people of Glasgow”. Other presenters included Tim Eltringham Chief Officer of the South Ayrshire Partnership who talked about the challenges and opportunities for OTs in an integrated world.
You can view all the presentations from the day on the Scottish Housing Network’s website.
“In a time of scarcity OTs need to be assertive… What is your unique role and how does it contribute within multi- disciplinary team working?”
Alison Keir, Policy Officer for the College of Occupational Therapists in Scotland also talked about the important role of OTs, and the College’s campaign Occupational Therapy – Improving Lives Saving Money.
“Occupational Therapists are a limited resource. They can be more effective in addressing the needs of the local population by training and supervising others to be competent to deliver on aspects of traditional practice – minor adaptations, practising skills in activities of daily living e.g. Trusted Assessors, Health & Work Champions.”
Their report Reducing the Pressure on Hospitals: A report on the value of occupational therapy in Scotland highlights the value that occupational therapists are bringing to improving people’s outcomes and maintain the flow of patients in and out of hospital. The report is based on service examples collected over a 12 month period, and is one of a range of reports the college has published during their campaign. All the reports are available on their website.
The report includes a number of good practice examples from across Scotland showing where OTs are contributing to reducing admissions to hospital, reducing time spent in hospital and successful transition and discharge planning.
Good Practice Examples
- Reducing hospital admissions: Safe Home – Occupational Therapists within NHS Lothian A&E. Three occupational therapists provide seven-day cover, 12 hours a day, 365 days a year in A&E. The service provides systematic discharge planning and direct discharge from A&E, navigating across health and social care systems and managing risk of complex and challenging presentation. They commission care packages, and provide rehabilitation, equipment and follow-up. The occupational therapy service prevents 100 admissions per month. Given the average hospital stay in Scotland is 3.2 days (and higher for people over 65) even using this lower value, the savings are estimated as £864,000 per annum.
- Reducing hospital length of stay: Seven-day services improving flow, Aberdeen Royal Infirmary. The redesigned acute geriatric assessment service based at Aberdeen Royal Infirmary is a seven-day service. The multidisciplinary team takes a comprehensive approach to geriatric assessment following admission to the emergency care centre. Data gathered indicated that the average length of hospital stay, calculated on whole admission, was 22.5 days prior to the service being redesigned. This is compared with 7.9 days average length of hospital stay, calculated on whole admission, for the acute geriatric service.
- Discharge Planning: iPad’s for secure discharge with amputees. Occupational therapists within NHS Grampian’s acute amputee assessment team introduced iPad’s to improve efficiency and communication during discharge planning. Using iPads for home environment assessments improved communication and saved an average of three days of clinical time and hospital inpatient stay per patient. This equates to a potential saving of £2,319 for each patient.
Watch the COT video showing how occupational therapists help people to live, not just exist.
Adapting for Change & Housing Solutions Training Modules
In 2014, in response to the report from the Adapting for Change Working Group, the Scottish Government established a Test of Change Programme with 5 demonstration sites – Aberdeen, Borders, Falkirk, Fife and Lochaber.
The sites tested a wide range of improvements over a 2 year period, and a series of ‘Practice Examples’ (available through site links above) were published. The Adapting for Change programme officially ended in March 2017, but the sites continue to work on sustainability plans and embedding improvements locally.
Another key output of the AfC Programme is the development of the Housing Solutions Training Modules which are available for use across agencies within local Partnerships.
The training programme has been designed to be delivered in localities by inter-agency (Housing, Health & Social Care) trainers. The format is classroom based and uses case-studies (Service user stories) and demonstration areas where possible (e.g. Stairlifts, bathrooms, Telecare etc…) to help with the assessment element of the modules.
There are 3 levels of Training Module within the programme. The first level (Module 1) encompasses the key principles and aims of the AFC programme, and sets the tone for the overall approach in terms of ‘acting early’ and having ‘the right (housing) conversations’. This can be delivered to all staff who come in contact with people who need timely and effective advice about a range of Housing based solutions. Modules 2 & 3 is for those staff who have a designated assessing role for the provision of adaptation and technology solutions.
And finally, the Improvement Hub has also developed a Digital Story highlighting the benefits of OT intervention. Mrs R’s story describes the effectiveness of a service intervention, where one occupational therapist is able to provide an integrated role, avoiding duplication in the service pathways, and delivering effective, enabling, person-centred outcomes. This was based on a case-study from East Ayrshire ‘OT job swop’ and further information on this and other case studies is available in the Eat Ayrshire section of the Partnership Developments page on the SHN website.
If you have any other case studies, or examples of good practice you would like to share then please get in touch!