Looking at needs can help to open up the theme of delivering care in different ways and in different places, but it does not work for all stakeholders. A range of different workshop formats may be needed to engage people in discussions about new ways of working.
The two-day ‘whole system’ events run by the King’s Fund in nine care communities were very successful in eliciting the views of older service users. Participants were led through a process that encouraged them to comment on existing patterns of care and to consider changes that might meet older people’s needs in ways that are more acceptable. A sample programme is shown in the box below/opposite.
TWO-DAY PROGRAMME FOR DEVELOPING REHABILITATION OPPORTUNITIES FOR OLDER PEOPLE
Day one
■ workshop overview and procedures (15 minutes)
■ mapping services (75 minutes)
■ present trends/what’s good (90 minutes)
■ values/principles (30 minutes)
■ focus on the future (100 minutes) Day two
■ plan for the day (10 minutes)
■ identifying common ground (50 minutes)
■ negotiate priorities (60 minutes)
■ action planning (90 minutes)
■ feedback (30 minutes)
■ next steps (40 minutes)
Adapted from Northumberland Health Action Zone Person Centred Care Programme (2000).
Show me the way to go home! Developing rehabilitation opportunities for older people in Northumberland. Whole systems event report.Morpeth: Northumberland HAZ.
Day one began with everyone exploring the patterns of local services that have the potential to deliver or support rehabilitation. Older people brought a different perspective to this exercise, often suggesting rehabilitation opportunities unrecognised by professionals, e.g. tea dances, swimming clubs, exercise groups. The contribution of the professionals was often restricted to naming services run or commissioned by the NHS or social services.
By identifying what was done well and what was done less well by current services, the participants were able to move on to setting possible agendas for change. Thus, in almost every case, people recognised the need to integrate care, through closer partnership working across agency and professional boundaries. Older participants frequently emphasised the lack of rehabilitation opportunities in the community.
Day two began by getting people to imagine how, in an ideal world, they would like to see rehabilitation opportunities improved in three years’ time, using the ideas generated in earlier sessions. Various themes emerged, including objectives for systems and individuals, ideas for
Case study 1 Northumberland Health Action Zone
new services or reshaping existing ones, and changes in individual working practices. Groups of participants then selected a theme and developed an action plan for bringing about the desired changes.
At a workshop held by mid-Hants Primary Care Trust in November 2001, small groups of participants representing all stakeholders in the care community were given brief case notes. Some examples are shown below:
Case 1
planned admission for hip replacement. Relatively fit and well. Lives with husband, who is in good health. Retired 10 years ago. From home and back to home
Case 2
planned admission for heart bypass operation. Well and in good spirits. Lives alone. Has close friends and relatives. Retired. Played golf until recently. From home and back to home
Case 3
planned admission for hip operation. Severe depression, pain. Grown-up son who has mental health problems. Has small home care package. Both have community psychiatric nurse. From home and back to home
Case 4
person behaving out of character. Confused. Services contacted by worried neighbours. Lives alone. Managed at home up until now with no problems. From home and back to home Case 5
sufferer from Parkinson’s disease, fiercely independent. Lives in sheltered accommodation. Falls over and is found. What happens next?
Case 6
person is self-funded in dual-registered nursing home. Falls over in the village while out shopping. Has non-insulin dependent, stable diabetes. What happens next?
The cases chosen were based on a mixture of planned and unplanned events, and were prescriptive enough to get the discussion started. Each group was asked to map the likely journey of the client in the existing service system. They then recorded where choice (or a lack of choice) existed, and noted any gaps in services that might affect the care provided. People were encouraged to ‘think out of the box’, without constraint. Key points from the discussions were fed back to the whole group.
The second session involved each group listing the components of care and support which they would like to see in a redesigned local intermediate care system, including both new services and new ways of working. Each group was given one of the following specific constraints within which to work:
1. New model should be closely aligned with primary care. 2. New model should be closely aligned with secondary care. 3. New model should be closely aligned with the independent sector. 4. No expense spared in developing a new model.
5. New model must be resourced from existing finance.
6. All the staff in the new model will be employed by a single agency.
Case Study 2 Mid-Hants Primary Care Trust
They reported back to the whole group by drawing a picture of how their new model would work for service users and for staff. The outputs from this workshop informed the development of a new strategy for intermediate care in mid-Hants.
At a workshop run by Nuffield Institute for Health, Leeds University, participants were asked to consider how the rehabilitation needs of older people in a sample area (‘Careshire’) could be met in ways more closely aligned to the values and principles that ideally underlie care provision. They were given a set of guiding principles, as well as information about current resources in the care community and about the categories of rehabilitation need that the redesigned service model should meet.
As well as shifting the balance of care away from a heavy reliance on institutional settings and towards the community, they were encouraged to make more imaginative use of voluntary and private sector services and to consider changing current ways of working for statutory sector staff.
The task was presented as follows:
To consider the possible service models needed in this community to provide care for a given range of rehabilitation needs.
■ Discuss how best to use existing resources.
■ Decide what new care models could be developed.
■ Discuss what is involved at both strategic and operational levels.
■ Identify barriers to change and suggest ways to overcome them.
■ Feed key points back to the full group.
Adapted from Nuffield Institute for Health (2001). Accompanying papers, Policy into Practice Seminar Series: ‘Intermediate care: rehabilitation, recuperation or warehousing’. West Yorkshire Playhouse, 22 February.
Participants were given information about existing services and resources in the local community (Careshire), details of eight programmes of care that must be provided (Enderby & Stevenson 2000), an outline of the NSF Implementation Framework (Department of Health, 2001b), and the principles that should underpin service. The notes for participants in the workshops are reproduced below: