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Access to Health Services for
people with learning disabilities
or mental health problems
The Anticipatory Care Calendar introduces a number of benefits, such as:
• Ensuring that health is tracked and changes are noted so action can be taken before symptoms get worse or are even missed. • The ability to plan health care and
provide anticipatory care rather than crisis management.
• To help people access appropriate health services when they need to.
• To assist health professionals by providing a visual picture of the person’s health.
The introduction of the Anticipatory Care Calendar means that a client’s behaviour will no longer be an excuse for missing clinical health problems.
Tracie Keats
ACC Director
Introduction
Our key priority is to ensure the people in our communities receive the highest quality health care, delivered by the best health services. Not everyone is able to access health services as easily as others, but we’re working very hard to change this, ensuring health care is equal for all. Improving services for people with learning disabilities is very important and by using the highly rated Anticipatory Care Calendar you’ll be able to monitor the health of the people you support more effectively.
Studies published by Mencap in 2006 highlighted the death of six people who they believe died unnecessarily as the disability was seen and not the person. Sadly these cases are not in isolation. The recently produced report also by Mencap - 74 and counting (2012), highlights that we are still not getting it right.
The development of the calendar began several years ago following the revelations of ‘Robert’s Story’ another harsh example of health inequalities.
In light of ‘Robert’s Story’, we made a genuine commitment to improve our services.
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Find out more
Learn more about our E-Learning programme
User Comments
Case Study 1
Case Study 2
Case Study 3
Useful websites
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Merseyside and Cheshire
Cancer Network
Suite 4
Woodcourt, Riverside Park Southwood Road Bromborough Wirral CH62 3QX Main telephone: 0151 201 4150 Fax: 0151 201 4151
Contents
Useful Contacts
1Tracie Keats
ACC Director
Email: Tracie.keats@mccn.nhs.ukPaul Mackenzie
Associate Director Health Inequalities
Email: Paul.mackenzie@mccn.nhs.ukHow can I find out more information about the
Anticipatory Care Calendar?
The Anticipatory Care Calendar has its own website which allows organisations to find out further details about the tool and the implementation process.
The website will allow you to register your general interest in the programme, obtain sample documentation for information or register for places on the train the trainer workshops that are being run throughout the year.
The process for implementation is as follows:
• A nominated lead should be identified within your organisation.
• The lead should then access the website completing all required fields and book places on the train the trainer workshop. The workshops are aimed at managers and seniors.
• (All remaining staff will complete their training via the e-learning training programme details of which can be found below).
• Places will be confirmed via an email. If a chosen session is full, an alternative session will be offered.
• Following attendance at the train the trainer workshop, all remaining staff names will need to be forwarded to enable accounts for login to be created.
• Following all staff completing the training, all documentation will be released for use. • Timescales for this to be complete will be agreed beforehand.
The registration process is completed online via the new website; this can be found at
www.anticipatorycarecalendar.org
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Learn more about our
E-Learning programme
The on line e-learning programme has been developed in partnership with Edge Hill University and is accessed free of charge for any organisation within the North West area. Organisations external to the North West are able to access the programme for a small fee. Log in details to access the programme will be available following attendance at the train the trainer workshop. For further details regarding the e-learning programme, please contactTracie.keats@mccn.nhs.uk
The online training programme covers: • Introduction and background to the ACC • Roberts’ Story & Who Matters
• How to complete the ACC
• Interactive questions and answers
• Scenarios to watch and the ACC to complete To ensure all staff have a full understanding of the tool, 100% compliance must be reached for each section of the training programme.
3 The programme should take no longer than 90 minutes to complete and access to the help desk is available at all times should anyone experience any problems.
On successful completion of the Anticipatory Care Calendar online E-Learning Programme you will be able to enquire about a negotiated learning module with Edge Hill University, Faculty of Health & Social Care, to allow you to receive academic credits for your work. You will be able to get 20 academic credits. These modules are available at all academic levels to meet your individual needs. There are a range of full awards from certificate to masters level that you can use these credits towards. For a list of possible awards visit www.edgehill.ac.uk/health/cpd. The faculty provides education and training for all health and social care workers.
There is an additional charge for the negotiated learning module. There may be opportunities for help towards these funded studies via The Merseyside & Cheshire Cancer Network.
User Comments
“I think t
he ACC has r
eally helped f
ocus car
e staffs minds
on healt
h gener
ally and t
he tool empo
wers st
aff to be
able to r
aise their concer
ns re someone
’s health wit
h
health car
e professionals confident
ly because t
hey hav
e
the evidence t
here to b
ack up what t
hey are sa
ying”
Michele Bering – Nurse Consult
ant
“The Care Calendar is a v
ery useful t
ool, we
have enjoyed w
orking with it, it is v
ery easy
to use and quic
kly identifies an
y problems”
Jackie, Blac
kpool
“All staff say it is easy t
o use and t
he action sheet gives them the confidence t
o do what t
he action is telling t
hem i.e. call t
he GP without ha
ving to discuss it wit
h their manager first”
Dr Sandr
a Rodwell – Orkney Isles
“You can instant
ly see if there is a
problem. The inf
o is instant so y
ou’re not
eams of diary entries.”
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Case Study 1
Diagnosis of Oesophageal Cancer
In September 2008, an independent care provider in Cheshire introduced the Anticipatory Care Calendar (ACC) within their group homes as a part of a six month pilot project. One of these group homes, which shall be referred to as House A was an enthusiastic participant in the pilot and completed the calendar well.During December 2008, staff at House A had become increasingly concerned about one of the residents (client F) who had demonstrated evidence of a sore throat and an increasing number of coughing/choking episodes during meal times. Because of the persistent complaints of a sore throat, an appointment was made with the GP. The staff team returned from the appointment still very concerned about F
and as a result of following the ACC actions (in the event of coughing/choking when eating), the staff contacted the Specialist Community Health Team (Learning Disability). The Health Facilitator praised the team leader and his staff at House A for their conscientiousness and supported them in facilitating a referral to the Speech & Language Therapy (SLT). The assessment by the SLT led to a referral to a Consultant Physician who initiated a number of diagnostic investigations including a full body scan and a gastroscopy. These investigations then confirmed that F had a tumour of the oesophagus.
A more detailed scan was performed at Christie Hospital to identify whether the cancer had spread. The scan showed that this was not the case but it did highlight evidence that F had previously suffered a heart attack which had not been diagnosed. As a result of the investigations, client F is now receiving palliative care. A Macmillan nurse is closely involved and is co-ordinating the appropriate care to meet F’s needs in collaboration with the staff team and primary care. It is also worth noting that as a result of staff observations - a pattern of hesitancy and urgency in respect of urinary output - F was also diagnosed as having an enlarged prostate gland. Because of the issues associated with palliative care it was not appropriate to start a surgical intervention although the introduction of a permanent catheter has been effective in alleviating the symptoms.
Whilst discussing F with the Service Manager at House A, I was given the following statement about the ACC from the house manager:
“It has been fantastic and a real bonus in highlighting health issues associated with the clients that we support. Without the Anticipatory Care Calendar it is very unlikely that we would have picked up F’s symptoms anywhere near as quickly. The staff here at the house were all devastated by the news about F, but I can assure you that we are working very hard as a team to ensure that F has the very best in terms of quality of life in the time that remains for him. We are now really focused on health issues regarding ALL of the clients that we provide a service for. Even the slightest concerns are checked out thoroughly. The calendar has really proved its value to us, and all the staff at the house would very much like it to continue.”
Andy Worth: RGN /RNMH / BSc (Honours) Health Facilitator
Case Study 2
Diagnosis of renal failure
September 2011In September 2011, an independent care provider within Trafford introduced the Anticipatory Care Calendar (ACC) within a group home.
As a result of completing the ACC diligently on a daily basis, it was noted by staff that one of the residents was urinating and defecating far more than usual. They followed the ACC guidance for actions relating to increased bowel and bladder movements. An appointment was
made with the Client’s GP. The GP conducted a thorough examination of the client taking into account the details provided by the staff based on recordings in the ACC. On
seeing the ACC the GP agreed that a blood test should be done. Blood tests were taken and as a result of this it was established that the client was suffering with Stage 3 renal failure.
Following this diagnosis, the client is now being monitored by staff at the house who ensure she follows the GPs recommended care plan. Staff also ensure that she regularly attends appointments and has monthly blood tests to assess the progress of her condition. This enables her to continue to maintain a level of health where she is able to delay any deterioration in her kidney function and therefore have a positive impact on her general health and well-being.
The House Manager has stated that whilst the staff were initially sceptical of the introduction of the ACC as ‘just being another lot of paperwork to fill in’ they quickly realised the value of the document as a tool to help monitor and assist in the management of the clients health needs.
The House Manager and Staff have continued with the use of the ACC as part of their daily routine for all the house residents and will being utilising it fully when another client with complex health needs returns to the property following an extended hospital stay. This particular client has been diagnosed as having Stage 4 renal failure and will need to be managed with palliative care and end of life.
Carol Stephens Health Facilitator
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Case Study 3
Diagnosis of bowel cancer
December 2011I must admit on first seeing the care calendar I was very
impressed, the staff however were a little reluctant to the extra paperwork. As with anything new you expect the usual criticism on time factors etc.
Within the first month of our home implementing the calendar we had our unannounced inspection by C.Q.C. we showed the inspector the new care calendar and he was impressed, by the ease of use and the clarity for staff to quickly see any problem areas for all the residents.So that was an immediate positive for us.
After 2 months using the calendar, we had a resident who had been feeling off colour for a couple of days, no vomiting and looked her normal self, but may be a little pale if anything. But out of character the lady informed us she didn’t feel well, didn’t want to do anything, said she felt sick. As this was not a normal response for this resident the calendar quickly showed something was not right, the GP was called after two days and after examination and a visit to Blackpool Victoria Hospital, it showed that this resident had a Hiatus Hernia, which was treated and the resident soon felt a lot brighter, however the tests went on to show the Resident had Bowel Cancer.
As this lady was beyond the age of screening, this would possibly have not been picked up for a long time, six months into the calendar the Lady is still showing no symptoms, or sign of the Cancer, these problems could have both gone on for some considerable time, worsening to the point were treatment could have been to late.
To our home the Care Calendar has been one of the most worthwhile tools we have come across in many years. It has enabled us to give quality care and a quality of life that could have easily been missed, all members of the team find the calendar very easy to use and understand, the simplicity of the tool, and the ease in which problems stand out , makes it a valuable asset
All the care workers have quickly seen the benefits of completing the calendar, the complaints about it being too much paperwork and time consuming quickly stopped,
I’m sure every home that has the opportunity of using the calendar, wont have the instant benefits that we have experienced, we have been the fortunate ones in being able to see immediately the impact the calendar has had to the home.
Even today we had a 98 year old who has bee a little breathless when laughing at the activities or whilst singing, over the Christmas period, the calendar again quickly picked this up, the GP was called and the lady had fluid on the lung, for which she has been prescribed water tablets for 2 weeks, again this could have gone unnoticed for a while longer, and could have resulted in pneumonia, or worse.
Our home will definitely be using the calendar
Mrs Jackie Nutter Manager
