The Public Health priorities reflect the recent funding awards made under the Public Health Project Grants scheme. A total of 18 bids were received, collectively bidding for £214k. Funding was agreed in the case of 9 projects with a total amount of £93,200 awarded. The successful bids came from all four council directorates and are aimed at improving the health and well-being of a range of groups, including older people, children, people with learning disabilities and the Nepali community. Key themes include increasing children's physical activity, reducing social isolation, improving self-care and the prevention of cardiovascular disease:
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1. Holistic Health and Social Inclusion in Vulnerable Older People £15000
Aimed at encouraging more effective self-care among older people. Methods include an action research approach to identifying socially excluded older people, in addition to the production of self-help resources and delivery of workshops aimed at these vulnerable older residents. Supported by BA CCG.
Project Leads: Dave Rossiter & Phillip Ellis Martin (ASC)
2. Work Based NHS Health Checks £8200
Aimed at making comprehensive NHS Health Checks available free of charge to employees aged 40 to 74 years old, this project brings a service only previously available in General Practice into a setting more convenient and accessible for many people. The health checks can provide feedback on cardiovascular and other risk factors, as well as incorporate expert advice on health improvement. .The funding will enable a pilot with BF Council Staff, from which lessons can be learned for future roll out with other employers.
Project Leads: Kim Stevens & Tony Madden (Corp Services with ECC)
3. Beat the Streets' Schools Challenge £15000
An active travel school competition motivating children to walk, cycle or scoot to school or on other regular journeys. The project utilises e+ smartcards along with 'Beat Box' sensors installed across the local area that measures and log active journeys. Schools compete with others both locally and across the world.
Project Lead: Phillip Burke (ECC)
4. Family Health & Learning Project £15000
Focussing on children with low levels of physical activity - this project aims to engage whole families in a more active lifestyle and healthy eating. Regular sessions will aim to improve knowledge and confidence, as well as deliver measureable reductions in child obesity levels.
Project Lead: Sue Pike (CYP&L)
5. Healthy Voices £10000
A programme aimed at improving health and well-being among the local Nepali community. Building on previous work the project will utilise NHS Health Checks, Health Trainers and work aimed at Language Skills development to provide a comprehensive vehicle for sustainable improvement in the health inequalities often experienced by local Nepali people.
Project Lead: Abby Thomas (Corp Services)
6. NHS Health Checks in Leisure Centres £8000
This project brings an NHS Service only previously available in General Practice settings into a setting that is more accessible and in immediate proximity to facilities that can facilitate health improvement. Evaluations will explore the extent to which the work can become financially cost neutral for leisure services by encouraging new membership.
Project Lead: Chris Vaal & Mark Rose (ECC)
7. Healthy Lifestyles in People with Learning Disabilities £3000
Aimed at improving healthy lifestyle awareness among people with LD. The project will deliver a series of targeted sessions delivered by qualified health and nutrition specialists. Tailored (easy read) resources will be developed.
Project Lead: Mark Sanders (ASCHH)
8. Raising Food Hygiene in Poor Performing Premises £4000
This project will go beyond usual enforcement work to actively engage and educate premises rated lowest against Food Hygiene Rating Scheme. Intensive work will result in agreed action plans from which measureable and sustained improvement will be achieved.
Project Lead: Maria Griffin (ECC)
9. Supported Discharge & Falls Assistance via Forestcare £15000
Aimed at preventing hospital readmission or unnecessary ambulance attendances via the provision of a remote 'life line' and key holding service By providing a free trial of these services this project will encourage more people to actively evaluate them and consider long-term use - thereby increasing the overall number of local users. The positive impact of this increase will be significant on both individual well-being and health services resources.
Project Lead: Claire Bennett (ASCHH)
Total funding initially agreed £93200
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Short Description |
Previous Figure Q4 2012/13 |
Current figure Q1 2013/14 |
Current Target |
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ASCHH All Sections - Quarterly |
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NI132 |
Waiting times for assessments (Quarterly) |
92.1% |
91.5% |
90.0% |
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NI133 |
Waiting times for services (Quarterly) |
90.0% |
95.3% |
90.0% |
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NI135 |
Carers receiving needs assessment or review and a specific carer's service, or advice and information (Quarterly) |
45.2% |
10.6% |
9.3% |
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OF2a.1 |
Permanent admissions to residential or nursing care per 100,000 population 18-64 (Quarterly) |
5.50 |
1.40 |
To be confirmed |
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OF1C.1 |
Proportion of social care clients receiving Self Directed Support (Quarterly) |
49.1% |
52.8% |
Target not set |
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OF1C.2 |
Proportion of social care clients receiving Direct Payments (Quarterly) |
14% |
11.1% |
Target not set |
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OF2a.2 |
Permanent admissions to residential or nursing care per 100,000 population 65 or over (Quarterly) |
785.00 |
210.30 |
To be confirmed |
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L137 |
Number in residential care (quarterly) |
164.00 |
168.00 |
Target not set |
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L138 |
Number in nursing care (Quarterly) |
119.00 |
136.00 |
Target not set |
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L159 |
People receiving Self-Directed Support as a percentage of Eligible People (Quarterly) |
97.6% |
97.5% |
98.0% |
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L172 |
Timeliness of financial assessments (Quarterly) |
74.30% |
96.80% |
95.00% |
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Community Mental Health Team - Quarterly |
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OF1f |
Adults receiving secondary mental health services in employment (Quarterly) |
18.6% |
15.9% |
13.0% |
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OF1h |
Adults receiving secondary mental health services in settled accommodation (Quarterly) |
82.9% |
75.9% |
84.0% |
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Community Response and Reablement - Quarterly |
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OF2c.1 |
Delayed transfers of care - total delayed transfers per 100,000 population (Quarterly) |
3.4 |
2.3 |
10.0 |
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OF2c.2 |
Delayed transfers of care - delayed transfers attributable to social care per 100,000 population (Quarterly) |
1.7 |
0.0 |
7.0 |
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L135.1 |
Percentage of Intermediate Care Referrals seen with 2 hours (quarterly) |
99.30 |
100.00 |
97.00 |
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L135.2 |
Waiting time for OT support (Quarterly) |
91.60 |
88.4 |
90.00 |
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Community Support & Wellbeing - Quarterly |
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L136.1 |
Number in receipt of direct payments (Quarterly) |
265.00 |
187.00 |
Target not set |
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L136.2 |
Number in receipt of community support excluding direct payments (Quarterly) |
1,152.00 |
1,130.00 |
Target not set |
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Community Team for People with Learning Difficulties - Quarterly |
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OF1e |
Adults with learning disabilities in employment (Quarterly) |
16.9% |
16.4% |
15.0% |
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OF1g |
Adults with learning disabilities in settled accommodation (Quarterly) |
86.8% |
84.9% |
86.0% |
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Integrated working in Bracknell
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Integrated working has been key to successful service delivery in Bracknell for many years. This is illustrated in the diagram below which details the organisations and personnel who support this across secondary and primary care, the Local Authority and the third sector. Each aspect of integrated is summarised below.
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SECONDARY CARE |
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Consultant COPD° Heart Failure° |
Ward OT° Nurse° Doctor |
Discharge Team° |
A&E OT° Nurse Doctor Consultant |
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PRIMARY HEALTHCARE FUNDED |
JOINT FUNDED |
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Health Consultant |
Lead GPs |
Nursing |
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SCAS
Falls Dr Behuman
Community Dr G
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◊Heart Failure Nurse
◊COPD Team clinic based
◊Community Matrons Telehealth
◊District Nursing
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Intermediate Care ◊Single Point Access ◊SW – Hospital Team Therapy Community Support 25 bed IC Centre
Falls OT Nurse
Integrated Working 3 Clusters
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° = Outreach ◊ = In reach
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SOCIAL CARE FUNDED |
THIRD SECTOR FUNDED BY LA |
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Care Management Individualised Budget POC Residential Nursing Home Day Care Telecare
Forestcare Alarms Care Call Service
Public Health Life Style Choices Education
I-Hub
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Carers Emergency Respite Carer Support Carers’ Grants
BFVA Befriending Service
Support with Confidence Personal Assistants Domestic Tasks
Charities British Heart Foundation
St John/Red Cross First Aid Training
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PRIVATE |
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Leisure Fitness Checks
Pharmacy
Organisations/Companies On I-Hub
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Bracknell Forest Council has a well established Intermediate Care Service. It is joint funded by health and the Local Authority with a section 75 agreement. The service is fully integrated and includes:
· Social work
· Physiotherapy
· Occupational Therapy
· Community support work
· Residential support work
· In reach nursing
· In reach medical cover
· In reach dietician
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Bracknell Forest Council Model of Whole System Support
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Process |
Outcomes for the whole system |
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Contact |
· Contact assessment · Information gathering · Eligibility criteria · Signposting to other services |
· Easier access for referrers as only one number for health and social care needs · More inclusive service as accept referrals from all sources · More proactive approach to responding to need as people screened in on eligibility for intermediate care / reablement rather than just FACS criteria |
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Assessment |
· Triage · Assessment of needs and choices · Monitoring of hospital admissions / discharge planning / delays · Identification of services to suit needs and choices · Allocation of cases for intermediate care / reablement · Packages of care or placements straight in if not intermediate care / reablement |
· Timely response based on person’s need (2 hours for prevention of admission) · Less duplication as needs can be assessed jointly · Person centred approach as focus on needs and choices rather than services available · Low number of hospital delays due to proactive monitoring and discharge planning and joint approach to hospital delays · More efficient discharge planning as in-reach model used for complex cases |
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Services |
· Domiciliary intermediate care · Bridgewell intermediate care beds · End of life care at home · Falls clinic and programme · Packages of care at home · Nursing home / residential home placements · Eligibility / assessment and planning of ongoing needs if any (SSAQ) |
· More effective use of available services and resources as all managed under one team · More flexibility to meet people’s needs by utilising more than one service · Better management of capacity as all services reviewed as a whole system · Reduced length of stay in services · Less duplication as intermediate care / reablement provided at the same time · Financial savings as care ‘right-sized’ during intermediate care / reablement |
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Ongoing |
· Review of ongoing care needs and assessment · Work with complex cases |
· Less duplication and better joint working as intermediate care / reablement will relook at a case if there is a change in needs · Less delay in whole system due to joint working around safeguarding concerns particularly with hospital social work · Proactive management of problem cases through integrated care meetings with health |
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SUMMARY
· Intermediate care in Bracknell Forest is a joint integrated health and social care team funded by Ascot and Bracknell CCG and Bracknell Forest Council. It is hosted by Bracknell Forest Council and the team is co- located in Time Square Bracknell.
· The service operates an integrated model of health and social care that provides a seamless well coordinated health and social care experience for the individual
· It promotes faster recovery from illness, unnecessary acute hospital admissions, support for timely discharge and maximises independent living
· Improves the health and well being, confidence, quality of life and functional abilities of people so that they can stay at home or return home fo0llowing hospitalisation or a health crisis at home.
· The service provides end of life care
· The multi disciplinary approach provides time limited multi disciplinary rehabilitation and social care reablement
· The team provides physio therapy, occupational therapy, social work.
· There is a directly provided community based service delivered by Community Support Workers
· Bed based Intermediate Care is provided by the Bridgewell centre which has nursing cover provided in a contract by BHFT.
· Triage through Single Point of Referral and access
· Initial assessment – screening, care management, community based rehabilitation, rapid multi disciplinary assessment, active rehabilitation and reablement
· Service operates 24/7 with out of hours management provided by an Emergency Duty service – providing emergency duty social work and enhanced therapy
· Pro active work in 3 acute trusts with social workers providing in reach through information gathering, critical analysis of delays - working jointly with ward staff to facilitate early timely discharge
· Provides support for prevention of hospital admissions through 2 hour rapid response with in reach if required
· Provided tailored individual support with on going re assessment throughout period of Intermediate Care
Key drivers for the service are:
· Prevention of avoidable hospital admission
· Maximising independence
The service has a 2 hours crisis response time and operates 7 days a week including outside office hours.
INTEGRATED SUPPORT FOR PEOPLE WITH A LONG TERM CONDITION
An integrated way of working between health and social care has been developed in 2013 to further prevent avoidable hospital admission and support frail people living in the community. The work revolves around 3 clusters of GP surgeries in the Bracknell and Ascot Clinical Commissioning Group.
· Meetings are held fortnightly and are attended by GPs, District Nurses, Community Matrons and Social workers.
· People selected for discussion are identified through their number of A & E attendances, GP appointments, number of periods of Intermediate Care, high cost care packages and frequency in increasing care packages.
· Every person discussed has given their consent for this prior to the meeting.
The project has only been operational since February and is undergoing evaluation. Anecdotal evidence shows that numbers of attendances at A & E have fallen due to active case management for a number of people and crisis calls to Duty Social work decreased for a small number of people as a result of proactive and person centred assessment.
BRIDGEWELL FALLS SERVICE
The falls service operates out of the Bridgewell Centre. There is a full day of assessment for up to 3 people a week. This is supported by a 6 week rolling programmes of interventions for people who have been assessed in the clinic and who would benefit from attending the sessions. These are held weekly in the afternoon and are for up to 8 people. Their carers can attend too if they wish to.
Sessions include:
· Physiotherapy – balance and strength sessions including stepping, unstable ground, gym ball etc
· Dietician – advice on healthy eating
· Medicines management – managing your medication, medication and the risk of falls
· Occupational therapy – getting up from a fall, home safety
· Fire safety
· Sensory needs service
· Ostepporosis
· Foot care
· Support available
· Blue badge/over 75’s check
Each session gives people an oportunity to discuss any issues they may have regarding the topic of the afternoon.
FRIMLEY TRANSFORMATION
There has been ongoing work with Frimley Park Hospital on their Transformation Programme which was originally co ordinated by The King’s Fund. The aim of the work is to make the whole sytem around Frimley Park work efficeintly and effectively together. There are now 3 dsitinct workstreams with associate subgroups. Summary of this work is as follows:
· Reducing the number of emergency hospital admissions for patients in the local health social care system
o Reducing the number of patients who reach Frimley Park Hospital when they become unwell
o The workstream agreed to focus on the COPD and Heart Failure pathway because of the national evidence on the success of admissions avoidance measures. Business intelligence has started to quantify local activity and is looking to identify the next pathways for possible review. The workstream has agreed an approach which begins by documenting the current pathways across the system and the health and social care services (capacity and capability) that support these pathways. This will underpin agreement and promotion of best proactive models of care.
· Reducing the number of patients who are admitted from A & E
o This workstream is focusing on better partnership working, builidng capability and capacity to avoid admissions from A & E.
· Public and patient education about prevention and appropriate use of health and social care services
o The workstream is developing and implmenting a programme of public and patient eductaion on better self-care and making more appropriate use of health and social care services.
EAST BERKSHIRE HEALTH AND SOCIAL CARE URGENT CARE PROGRAMME
· Early supported discharge service for stroke patients.
o The aim is to provide ESD to acute stroke patients and to promote interagency working. A project group is overseeing the implementation of this service
· General Rehabilitation Wards
o The shaping the future business case highlited that the people admitted to Ward 8 could be discharged home 2 weeks earlier. This led to the proposal to close ward 8 and develop community based services. A project group oversees the implementation of this service.
· A&E Recovery Plan
o A bid has been prepared by HWP for funding to deliver on improvments in A&E. It is unkown at this stage how the UA’s fit into these proposals.