| Single Assessment Process - training materials long term conditions The following listing is subject to ongoing review and revision... Happy ever after [Unique Care, an alternative to Evercare] [author: Ann Dix] (9 December 2004) Article in: Health Service Journal, vol 114, no 5935, pp 28-31. Unique Care, which is based on case management (itself a US model of care) is now being promoted by the National Primary Care Development Team (NPDT) as a more viable alternative to the Evercare model for managing people with long-term conditions. This article describes how the Castlefields health centre in Runcorn, run by national primary care director Dr David Colin-Thomé, has been using this form of managed care for more than four years. Those over 65s who are likely to become high users of hospital services are identifIed, and their conditions are managed in ways that reduce hospital admissions. This work involves a half-time nurse and full-time social worker case manager. The practice has also extended case management to mental health. Case management of cancer patients is also being piloted in 9 PCTs, including Halton, Castlefields' local PCT. Contact Details: Tel: | Fax: E–mail: | Web links: http://www.hsj.co.uk | Target group: LA/HA | Type / Format: article Availability / Price: | ISBN/ISSN: 0952-2271 Notes: National Primary Care Development Team: http:// www.npdt.org On the case [critique of case management based on US-style Evercare] (11 January 2005) Article in: Care and Health Magazine, issue 96, pp16-18. This article considers whether too much emphasis is placed in the Evercare model for the UK on health at the expense of social care. Evercare, is part of the United Healthcare Group based in Minnesota, USA. The Kaiser Permanente programme is briefly considered as an alternative model. The author reviews the progress of Evercare providing two pilot programmes, Halton PCT and Bexley Care Trust as case studies. The views of the Long Term Medical Conditions Alliance, Age Concern, Help the Aged, and those within the Department of Health are amongst those quoted. The article urges readers to consider the recent report by the King's Fund, "Case managing long-term conditions: what impact does it have in the treatment of older people?" (King's Fund, November 2004) Contact Details: Mike George Tel: | Fax: E–mail: | Web links: http://www.careandhealth.com | Target group: LA/HAs | Type / Format: article Availability / Price: | ISBN/ISSN: 14779994 Notes: Sea change or quick fix? Policy on long-term conditions in England [author: Bob Hudson] (July 2005) Article in: Health and Social Care in the Community, vol 13, no 4 pp 378-385. Long-term conditions is a policy area that has risen rapidly up the political agenda in England, culminating in the development of the National Health Service and Social Care Model in 2005, which is to be implemented over the following 2 years. The Model draws heavily upon US ideas of case management and proposes the creation of 3000 community matrons to undertake this role with the most vulnerable patients. Although welcomed in principle, the specific proposals in the Model have been subject to some criticism, and these issues are explored in this paper. The problematic areas include patient identification, transplanting US models to England, the role of case management, workforce and funding issues and the mix of medical and social models. The author concludes that there is a danger of long-term care policy developing an unduly health-focused approach at a time when the thrust of partnership working is towards an inclusive, whole-system model. Contact Details: Tel: | Fax: E–mail: bob.hudson@durham.ac.uk | Web links: | Target group: | Type / Format: article Availability / Price: | ISBN/ISSN: 09660410 Notes: The STEP assessment system Cumbria Health Community [author: Idris Williams] (Sept 2006) As a result of experience and further field testing, the STEP Assessment System has been refined and brought up to date to conform with new thinking. It now consists of an assessment instrument which can be used reactively in acute situations, or proactively (e.g. in management of long-term conditions programme). It has a self administered version which has the same framework of domains and questions. A section is included in this assessment which allows an assessor to review it on completion and to produce a summary and care plan. As a further refinement, there is a "stand alone" contact assessment with can be used reactively. It allows an assessor to proceed to STEP overview, or deal with the situation by direct referrals. A training assessment instrument is being developed and field tested. This short paper (2 pp) outlines some key attributes of the STEP System. See also: STEP (Standardised Assessment of Elderly People in Primary Care in Europe), E I Williams et al, 2002. Contact Details: Prof Idris Williams, Barn Howe, Lyth, Kendal, Cumbria LA8 8DF. Tel: 01539 568666 | Fax: E–mail: idrisandkate@ktdbroadband.com | Web links: | Target group: | Type / Format: briefing Availability / Price: On application to Prof Idris Williams | ISBN/ISSN: Notes: Prof Williams was formerly Board Chair, Morecambe Bay Hospital NHS Trust Use of community matrons for care of long-term conditions [author: Mandy Bowler] (15 August 2006) Journal article in Nursing Times, 15 August 2006, vol 102, no 33, pp31-33. Improving care for people with long-term conditions has become a national priority and has led to many new - and often challenging - roles for nurses. This article describes the appointment of 12 community matrons to act as key workers and the use of their advanced clinical skills to improve the care offered to vulnerable patients with multiple long-term conditions. This article also makes reference to the June 2005 conference "Developing the Role of the Community Matron in Case Management : A Practical Guide" - the programme of which can be viewed at the website given below. Reference is also made to the Department of Health's policy guidance document, Supporting People with Long Term Conditions : an NHS and Social Care Model to Support Local Innovation and Integration (2005) - click on link below: View document Contact Details: Tel: | Fax: E–mail: | Web links: http://www.nursingtimes.net | http://www.ukhcc.com/event/rcm.html Target group: HAs | Type / Format: article Availability / Price: | ISBN/ISSN: 09547762 Notes: Department of Health, Supporting people with long term conditions liberating the talents of nurses who care for people with long term conditions [author: Department of Health - DH] (1 February 2005) Nurses play a central role in caring for people with long-term conditions. This paper (30pp) describes some of these roles, paying particular attention to the new clinical function of community matron. It presents examples in practice of experiences in implementing case management, including Evercare and Unique Care. Contact Details: Department of Health, PO Box 777, London SE1 6XH. Tel: 08701 555 455 | Fax: E–mail: dh@prolog.uk.com | Web links: http://www.dh.gov.uk/assetRoot/04/10/24/98/04102498.pdf | Target group: Nurses | Type / Format: book Availability / Price: FOC from the above address, or as download. | ISBN/ISSN: Notes: Other contact details: Professional Leadership Team, Room 5W06, Quarry House, Quarry Hill, Leeds LS2 7UE. Tel 0113 254 6057. Department of Health, Supporting people with long term conditions an NHS and social care model to support local innovation and integration [author: Department of Health - DH] (5 January 2005) The NHS and social care model is a blueprint to support local NHS and social care organisations in improving local services to people with long-term conditions. It draws on existing successes and innovations for the NHS and social care and international experience, to help local health communities to develop a more integrated systematic approach. This "Improving care, improving lives" document (44pp) includes examples of case management and disease-specific care management to illustrate how the model should work. View document Contact Details: Department of Health, PO Box 777, London SE1 6XH. Tel: 08701 555 455 | Fax: E–mail: dh@prolog.uk.com | Web links: | Target group: Nurses | Type / Format: book Availability / Price: FOC from the above address, or as download. | ISBN/ISSN: Notes: Other contact details: Long Term Conditions Team, Room 4N26, Quarry House, Quarry Hill, Leeds LS2 7UE. Tel 0113 254 6070 Department of Health The national service framework for long-term conditions [author: Department of Health - DH] (March 2005) This national service framework (NSF) sets eleven quality requirements for health and social care services for people with long-term neurological conditions to live as independently as possible. Much of the guidance in this document (107pp) can also apply to anyone living with a long-term condition. The quality requirements are: a person-centred service; early recognition, prompt diagnosis and treatment; emergency and acute management; early and specialist rehabilitation; community rehabilitation and support; vocational rehabilitation; providing equipment and accommodation; providing personal care and support; palliative care; supporting family and carers; and caring for people with neurological conditions in hospital or other health and social care settings. This NSF is supported by a web-based NSF good practice guide, an NSF information strategy, a leaflet for the public and glossary of terms (see www.dh.gov.uk/longtermnsf). Contact Details: DH Publications Orderline, PO Box 777, London SE1 6XH. Tel: 08701 555 455 | Fax: E–mail: dh@prolog.uk.com | Web links: www.dh.gov.uk/longtermnsf | Target group: All staff | Type / Format: book; guidance Availability / Price: Web link as above, or FOC from the above address. Also available in Braille, audio cassette tape, disk and large print (ref 265109). | ISBN/ISSN: Notes: Other contact details: Older People and Disability Policy Management Unit, Care Services Division, Department of Health, Room 8E30 Quarry House, Quarry Hill, Leeds LS2 7UE. Department of Health - DH Launch of 11 pilot schemes to test self-assessment for people with long-term needs [author: Department of Health - DH] (4 August 2006) People with long term health and social care needs will be able to assess their own support needs and apply directly for services to help them, due to 11 new pilots announced by Care Services Minister Ivan Lewis on 4 August. Annotated press release given below. The ground-breaking new projects will explore the scope for enabling people to self assess their need for support from a range of services, such as equipment, home care, standard housing adaptations and low-level preventative services. The successful councils are: - London Borough of Barnet - Birmingham City Council - Bristol City Council - Croydon Council - Derby City Council - East Riding of Yorkshire County Council - London Borough of Hammersmith and Fulham - Kingston Upon Hull City Council - Royal Borough of Kingston Upon Thames - Nottinghamshire County Council - St. Helens Metropolitan Borough Council Some pilots involve a focus on people arranging their own care, as well as those in receipt of formal health and social care. There is also a focus, in a number of pilots, on groups in the community whose needs can be difficult to meet, including minority ethnic groups, carers and people living in rural areas. In all cases, self-assessment will be introduced as an additional point of access for local services, rather than a replacement for traditional ways of accessing services. The pilots will launch in October 2006 and run until 30 September 2007. View press release Contact Details: Tel: | Fax: E–mail: | Web links: http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=218918&NewsAreaID=2&NavigatedFromDepartment=False | http://www.gnn.gov.uk/environment/mediaDetail.asp?MediaDetailsID=172936&NewsAreaID=2&ClientID=46&LocaleID=2 Target group: LA/HAs | Type / Format: Availability / Price: | ISBN/ISSN: Notes: The full press release can be read at the first above website link. The second website link is to a download file on the pilot scheme. Department of Health - DH The national service framework for long-term neurological conditions national support for local implementation 2008 [author: Beverley Hopcutt] (6 May 2008) This document (21 pp) is the product of collaboration between the Department of Health (DH), the Care Service Improvement Partnership (CSIP) and the Third sector. It is a summary of resources, tools and guidance available to local commissioners and service providers to support local delivery of the national service framework for long-term neurological conditions (NSF) since its publication in 2005. It includes: an outline of the DH's NSF programme including work still in progress and other relevant resources from key broader programmes; tools and awareness raising activities developed by CSIP; resources developed by the Third sector; and a programme of future actions. Contact Details: Helen Wiggins, Social Care, Local Government & Care Partnership, Room 8E25, Quarry House, Quarry Hill, Leeds LS2 7UE. Tel: 0113 254 6486 | Fax: E–mail: | Web links: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_084579 | Target group: HA staff | Type / Format: guidance Availability / Price: Electronic PDF format only | ISBN/ISSN: Notes: Beverley Hopcutt is is Clinical Adviser, Long-term (Neurological) Conditions Disabled Living Foundation - DLF AskSARA Helpline [Disabled Living Foundation] (October 2007) AskSARA is an online self assessment tool developed by the DLF to help a person make adjustments to their life to improve it, and involves the person going through a self assessment process. AskSARA is an innovative way for older and disabled people and their families to obtain advice about equipment that can help them in their daily lives. It is also possible to do an assessment on behalf of someone else. The products and the information that are suggested are designed to give small pieces of advice, suggest minor adaptations around the home, simple changes, ‘low level’ equipment. The advice and information has been updated with the help of Occupational Therapists, who have used their expertise to ensure AskSARA contains the most up-to-date and relevant information. It might be AskSARA does not meet a person’s needs if they are more complex. For those cases, other sources of assistance will be suggested that could include referral to the main DLF Helpline. DLF have been funded for a pilot project of AskSARA for people aged 60 years+ from London. Services include an impartial and confidential helpline and outreach services. Contact Details: Hugh Dobie, Marketing Officer - 020 7289 6111 ext 211 Disabled Living Foundation 380-384 Harrow Road London W9 2HU Tel: AskSARA helpline: 0845 470 7272 - Opening hours: 10am-4pm, M-F. | Fax: E–mail: hugh.dobie@dlf.org.uk | Web links: http://www.asksara.org.uk. | Target group: | Type / Format: assessment tools Availability / Price: | ISBN/ISSN: Notes: Health Care Conferences, Managing Long Term Conditions A one day conference on 5 April 2006 at London Hilton Metropole. A big event for all those involved in supporting people with long term conditions, with 7 conference streams and 39 sessions from policy makers, leading clinicians, managers and healthcare professionals offering services in the most innovative ways. Over 50 companies and organisations exhibiting. Contact Details: Compton Business Centre, Compton Abdale, Nr Cheltenham, Gloucestershire GL54 4DL Tel: +44 (0)870 2500 368 | Fax: +44 (0)870 2500 369 E–mail: enquiries@ukhcc.com | Web links: http://www.ukhcc.com/event/cm.html | Target group: HAs | Type / Format: conference Availability / Price: £232.65 to £408.90 VAT inclusive. | ISBN/ISSN: Notes: HSJ Conferences, Managing Long Term Conditions Developing models of integrated working to reduce admissions and deliver patient-led services A one day conference on 12 October 2006 at The Oval, London SE11. Opening remarks from the Chair: David A Peat, Chief Executive at Burnley, Pendle & Rossendale PCT. Speakers on main topics: Understanding the changing landscape; Collaborative working - engagement within and beyond health; and, Reducing Pressure on Acute Services. Contact Details: Managing Long Term Conditions Registration Ground Floor, 33-39 Bowling Green Lane, London EC1R 0DA Tel: +44 (0)845 056 8299 | Fax: +44 (0)20 7505 6001 E–mail: HSJconferences@emap.com | Web links: http://www.hsj-longtermconditions.co.uk | Target group: HAs | Type / Format: conference Availability / Price: £440.63 to £675.63 VAT inclusive. | ISBN/ISSN: Notes: King's Fund Case-managing long-term conditions : what impact does it have in the treatment of older people? [Ruth Hutt, Rebecca Rosen, Janet McCauley] (November 2004) 24 page document, to download from website. Contact Details: Tel: | Fax: E–mail: | Web links: http://www.kingsfund.org.uk | Target group: LA/HAs | Type / Format: book Availability / Price: | ISBN/ISSN: Notes: Matrix Research and Consultancy, on behalf of the former NHS Modernisation Agency Good care planning for people with long-term conditions updated version [author: Matrix Research and Consultancy] (September 2005) Following publication of the National Service Framework for People with Long-Term Conditions (NSF), the NHS Modernisation Agency commissioned Matrix to identify and report on the key elements of good care planning for people with long-term conditions. This document (26 pp) is intended to contribute to and link with other initiatives such as the Single Assessment Process (SAP). It outlines the potential benefits of care planning and barriers to its implementation. Appendices include a self-assessment toolkit, and three case studies illustrating how care planning approaches have been successfully implemented: Shared Care Plan, Hounslow; Nottingham City PCT integrated rehabilitation and intermediate care service; and general practice in Hexham, Northumberland, for people living with diabetes. The key objective has been to produce user-friendly guidance and tools to assist local health and social service providers to implement evidence-based, person-centred care planning for people with long-term conditions. Replaces a previous version (June 2005). View report. Contact Details: Tel: | Fax: E–mail: | Web links: http://www.diabetes.nhs.uk/downloads/Matrix_Care_planning_report.pdf | http://www.matrixrcl.co.uk Target group: All staff | Type / Format: toolkit Availability / Price: Web link as above | ISBN/ISSN: Notes: The NHS Modernisation Agency has been dissolved and superseded by the NHS Institute for Innovation and Improvement Morecambe Bay University Hospitals NHS Trust. The STEP assessment system a synopisis [author: Idris Williams] (May 2005) This document (19 pp) gives a brief description of the STEP Assessment System. It is in 2 forms: a reactive Single Assessment Instrument, which is used in acute situations where direct help is needed; and a proactive Single Assessment Instrument, which is used in the management of long term conditions and is essentially a case finding exercise. Both have been developed from a generic instrument constructed by STEP (Standardised Assessment of Elderly People in Primary Care in Europe)., an international group commissioned by the European Union to examine assessment of older people, and published as the Royal College of General Practitioners Occasional Paper No 82 The long standing illness assessment instrument is congruent with the Department of Health accredited Single Assessment Instrument. Electronic versions of both are available. The Instruments were developed in the NHS and are not commercial. See also: STEP (Standardised Assessment of Elderly People in Primary Care in Europe), E I Williams et al, 2002. Contact Details: Prof Idris Williams, Barn Howe, Lyth, Kendal, Cumbria LA8 8DF. Tel: 01539 568666 | Fax: E–mail: idrisandkate@ktdbroadband.com | Web links: | Target group: | Type / Format: guide Availability / Price: On application to Prof Idris Williams | ISBN/ISSN: Notes: Prof Williams was formerly Board Chair, Morecambe Bay Hospital NHS Trust Pavilion The Castlefields integrated care model the evidence summarised [authors: David Lyon, Julia Miller, Kirsty Pine] (February 2006) Article in: Journal of Integrated Care, vol 14, issue 1, pp 7-12. This article presents and reviews the evidence from a pilot project run by Halton Primary Care Trust at Castlefields Health Centre in Runcorn, where a social worker was based and worked proactively with a district nurse to introduce an integrated case management approach for patients. The practice had noticed that social interventions were at least as valuable as mmedical ones for older people. Indeed, an important element of this model was the identification of high-risk people aged 65+ not already known about, and for whom anticipatory assessments and care packages could be arranged. Decision-making was noticeably simplified and speeded up, with most assessments completed in a single day. The authors recommend that PCTs should consider the benefits of social care input to case management, especially when planning new services and new roles such as that of community matron. Contact Details: Tel: 01273 623222 | Fax: 01273 625526 E–mail: info@pavpub.com | Web links: http://www.pavpub.com | Target group: LA/HA | Type / Format: article Availability / Price: | ISBN/ISSN: 14769018 Notes: Skills for Care Common core principles for self-care out for national consultation [author: Skills for Care] (16 January 2007) "Have we got it right?" That is the question being posed in a major consultation drive being launched across the country in January until March 2007. Comments are invited from across the health and social sector on a set of five "common core principles" that have been drawn up in order to address the self-care agenda highlighted in the Government's White Paper, Our Health, Our Care, Our Say. A deadline for responses is: 28 February 2007. http://www.skillsforcare.org.uk/view.asp?id=861 The above website link will introduce this consultation and a hyperlink will allow the consultation document to be downloaded in pdf format. Contact Details: Karen Walker Tel: | Fax: E–mail: Karen.walker@skillsforhealth.org.uk | Web links: http://www.skillsforcare.org.uk | http://www.skillsforhealth.org.uk Target group: | Type / Format: strategies Availability / Price: downloads | ISBN/ISSN: Notes: Social Care Services, Department of Health Self Assessment Pilots The Department of Health is supporting 11 pilots to explore self-assessment for people with long-term needs.The pilots will launch in October 2006 and run until 30 September 2007. People with long term health and social care needs will be able to assess their own support needs and apply directly for services to help them. The projects will explore the scope for enabling people to self assess their need for support from a range of services, such as equipment, home care, standard housing adaptations and low-level preventative services. A number of the pilots will also focus on groups in the community whose needs can be difficult to meet, such as minority ethnic groups and people living in rural areas. The pilots are sited at the London Borough of Barnet; Birmingham City Council; Bristol City Council; Croydon Council; Derby City Council;, East Riding of Yorkshire County Council ; London Borough of Hammersmith and Fulham ; Kingston Upon Hull City Council; Royal Borough of Kingston Upon Thames; Nottinghamshire County Council; and St. Helens Metropolitan Borough Council. The purpose of the pilots will be to determine if self-assessment is feasible and to identify the risks and benefits of self-assessment. An independent evaluation will be commissioned to underpin the pilots. Contact Details: Tel: | Fax: E–mail: | Web links: http://www.dh.gov.uk | Target group: | Type / Format: pilot; policy Availability / Price: | ISBN/ISSN: Notes: Social Care Workforce Research Unit, King's College London Assessing the mental health needs of older people systematic review on the use of standardised measures to improve assessment practice [author: Jo Moriarty] (November 2002) The introduction of the Single Assessment Process (SAP) highlights the importance of summarising current knowledge in the use of standardised measures to improve the identification of mental health problems in older people and their carers, as in Standard Seven of the National Service Framework for Older People (NSF). This systematic review (115 pp) presents evidence on the use of such standardised tools and scales. It is primarily aimed at supporting the assessment practice of social workers and staff in community and long-term settings with no professional background in mental health. It outlines some of the reasons for using standardised measures and the criteria for selecting between different measures. It provides information on different mental health problems (dementia, cognitive impairment, depression, anxiety, and alcohol or substance abuse) and the screening measures available to assist in their identification. It covers the assessment of carers' needs, and looks at the wider assessment context. The review cites 199 articles, books and reports, which are presented as tables of useful sources by topic or name of measure. View report Contact Details: Janet Robinson, Unit Administrator, Social Care Workforce Research Unit, King's College London. Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH. Tel: 020 7848 3752 | Fax: 020 7848 3700 E–mail: scwru@kcl.ac.uk | janet.j.robinson@kcl.ac.uk Web links: http://www.scwru.kcl.ac.uk/ | Target group: Social workers, Residential care staff | Type / Format: book Availability / Price: Also available as hard copy from the Unit. | ISBN/ISSN: 0954648129 Notes: |