Local Authority services

The Local Authority spending in site 1 for Adult Social Care was in the band of 70-80 million in 2007/8 compared to site 3 which was in the band of 130-140 million. It was not possible to disaggregate the County Council

spending into the areas covered by Site 2. The provision of Local Authority provided support to older adults varied considerably between the three sites (table 21). Site 1 provided services to more people aged over 65 per 1000

than the other two sites. Only site 2 achieved a performance level of the top 25 percent of Local Authorities on one measure.

Table 21. Comparison of selected Best Value Performance indicators relevant to older adults 2007/2008

Best Value Performance Indicators 2007/2008

Site 1 Site 2 Site 3 Average of national top 25% performing Local Authorities 2006/07 Number of households

receiving intensive home care per 1000 pop. aged 65 or over

29 7 14 17

Older people helped to live at home per 1000 population aged 65 or over

124 80 97 101

Number of adults and older people receiving direct payments per 100,000 population

127 90 94 127

% of items of equipment delivered and adaptations made within 7 working days

90 85 85 93

% of assessments of Older People completed within acceptable waiting times (5)

81 85 83 88

% meeting acceptable waiting time for care packages following assessment for new older clients

92 93 90 93

Sources: Council Annual Reports 2007/2008

The key events in each site over the period of the study are summarised in table 22 below. Chapters 5,6,7,8,9,10 present the findings of the case studies.

Table 22. Key Events in each PCT over the study period

Date Site 1 Site 2 Site 3

2005 Creation of Community Matron

service – 6 posts initially, planned for 12 after 18 months, primarily recruited from Band 7 District Nurse Team Leaders 2006 Creation of a team of 4 community

matron posts and 1 community matron team leader. Most recruited from Band 7 district nurse team leaders.

8 district nursing teams. Band 7 district nurse team leader vacancies replaced with Band 6 District nurse team leader change in job description to become team leader.

Practice based commissioning locality groups established Creation of 6 Community Matron posts mainly recruited from band 7 and 8 local district nurses.

Later in year, 5 new CM posts established as team is developed.

Practice based commissioning locality groups established Review of Community nursing services – increased focus on District Nurses providing specialist services and holistic assessment

Consolidation of DN teams to form 16 larger teams with 160 WTE staff

Increase of CM teams to 12 staff National Autumn

2006

Restructuring of PCTS and SHAs nationally. Patricia Hewitt’s announcement that the NHS would be in financial balance by March 2007

Spring 2007 Practice based commissioning consortia established across the PCT Commissioners initiated review of district nursing service, community specialist nurses and community matrons

Provider arm of PCT establishes its own arm’s length organisation with a chief operating officer from the

District Nursing review in progress District Nursing review

Comprehensive internal review of all nursing services initiated Evaluation of organisational change

Date Site 1 Site 2 Site 3 commissioning arm of the PCT

National Summer 2007

The NHS Next Stage Review announced. Annual rise in NHS funding falls to 4% from 7.2%

Summer 2007 District nurse teams are configured to cover practice based commissioning consortia

Restructuring of local adult social care services

Community provider services re-organised.

Plans go ahead to restructure DN service increasing Day time DN working hours and contracting out of hours service to new provider

Autumn 2007 ENCAM Recruitment Starts Amalgamation of district nursing teams across the PCTs, 1 large team formed by joining 2 together to make 4 in total

ENCAM Recruitment Starts Plans to restructure DN teams in place

ENCAM Recruitment Starts

Spring 2008 Remaining 3 community matrons moved into the DN teams to give clinical support but also continue with own caseload.

Introduction of Band 8A team coordinator to manage the DN team, and the CM. 50% clinical supervision and 50% screening of new patients.

Evening and night community nursing service changed to a service covering from 8-10pm as part of main district nursing service.

DN teams restructured, Staff reapply for jobs.

CM teams moved from central base to community clinics to be closer to caseload

National Summer 2008

The NHS Next Stage Review : final Report and Vision for Primary Care Published

Date Site 1 Site 2 Site 3

Summer 2008 Early plans for consolidation of DN

teams with CMs

DN team hours extended, out of hours DN service contracted out.

Autumn 2008 ENCAM data collection ends ENCAM data collection ends CM team leader appointed.

ENCAM data collection ends

5 The nurses’ experience of case management

5.1 Introduction

This chapter addresses the following study questions from the perspective of the nurse case managers:

What are the factors that enable nurse case managers to contribute most effectively to successful outcomes of care?

What are the factors that sustain the models of nurse case management over time?

What is the team structure the nurse is within, and how does it function?

What contributions are nurses making to the structure, process and outcomes of care?

In what ways are nurses working collaboratively with expert patient and user/carer groups?

What are the experiences of nurses?

What factors inhibit and facilitate the full participation of nurses?

The chapter commences with a description of the nurses who participated in this study and considers how they represented their involvement in the different elements of case management. The chapter concludes by examining the extent to which the nurses were able to embed a case management function within their work, and exploring the factors that supported, sustained, and inhibited this process.