Argyll & Bute Council

1. Argyll & Bute Council Realising our potential together Patricia Trehan Joint Planning & Performance Officer

2. Where is Argyll & Bute?

3. What is it like? • 2nd largest geographical area of any Scottish Local Authority • 7,000 square kilometres, stretching from Helensburgh westwards to Tiree & Coll and from Mull of Kintyre in the south to the edge of Glencoe in the north. • There are 6 towns, many remote and rural communities and 25 inhabited islands. • The economy is mainly service based, with 85% of jobs in the service sector. • The population aged 65+ and life expectancy are higher than the Scottish average.

4. Population

5. Life Expectancy

6. Utilising IoRN • Our aim is to shift our Balance of Care to maintain more people, for longer, in their own homes and communities. • We needed to achieve a cultural shift for staff, service users and families. • The nature of the area means a lot of workers have close friends and relatives in the areas where they work. • We needed an objective and fair way to inform care decisions.

7. Matching IoRN to Care Options • IoRN Categories A, B and D • ADL Score • Personal Care Score • SSA-IoRN Score • Care Options • 1 • Low ADL. Total ADL Score = 3 • Low personal care/food/drink prep. Total personal care/food/drink score = 7 to 14 • SSA-IoRN Group A • Delivered frozen meals; Meals on Wheels; Telecare; Care & Repair: equipment & adaptations • 2 • Low ADL. Total ADL Score = 3 • Medium personal care/food/drink prep. Total personal care/food/drink prep. Score = 15 to 27 • SSA-IoRN Group B • Delivered frozen meals; Meals on Wheels; Telecare; Care & Repair: equipment & adaptations • 3 • Low ADL. Total ADL Score = 3 • High personal care/food/drink prep. Total personal care/food/drink prep. Score = 28 to 35 • SSA- IoRN Group D • Homecare less than 10 hours; personal care; podiatry; falls prevention; Argyll Active

8. IoRN Categories C, E and G • 4 • Medium ADL. Total ADL Score = 4 • No/Low mental well-being. • Total mental well-being score = 6 • SSA – IoRN Group C • Any service from rows 1 to 3 PLUS referral to GP practice • 5 • Medium ADL. Total ADL Score = 4 • Medium mental well-being. • Total mental well-being score = 7 to 9 • SSA – IoRN Group E • Any service from rows 1 to 4 PLUS Telehealth home pod; Occupational Therapy input; Dementia day care; respite for carer; Voluntary sector social activity e.g. lunch club. • 6 • Medium ADL. Total ADL Score = 4 • High mental well-being. • Total mental well-being score = 10 to 12 • SSA – IoRN Group G • Any service from rows 1 to 5 PLUS Homecare 7 hours upward; ICT; Referral for community nursing care e.g. District Nurse; Frail Elderly Day Care; Referral to hospital; use of Telecare packages to monitor ADLs

9. IoRN Categories F, H and I • 7 • High ADL . • Total ADL Score = 5 to 9 • No/low mental well-being. Total mental well-being score = 6 to 7  • Low bowel management. • Response to Q12 = A • SSA- IoRN Group F • Any service from rows 1 to 6 PLUS Homecare more than 10 hours; Single Care; ICT • 8 • High ADL . • Total ADL Score = 5 to 9 • High mental well-being. • Total mental well-being score = 8 to 12  • Low bowel management. • Response to Q12 = A • SSA =- IoRN Group H • Any service from rows 1 to 7 PLUS Residential Care; Enhanced Residential Care; Progressive Care • 9 • High ADL . • Total ADL Score = 5 to 9 • High bowel management. • Response to Q12 - B • SSA-IoRN Group I • Any service from rows 1 to 8 PLUS Nursing Care

10. Exception Reporting • CARE DECISION: EXCEPTION REPORT • Service User Name: ………………………………………………………………. .. • Date of Birth: ………………………………………………………………………. • CareFirst Number: ………………………………………………………………….. • IoRN Score: ………………………………………………………………………..... • Proposed Care Option: ……………………………………………………………… • The service user has additional needs, not reflected in the IoRN score, but relative to my proposed care option. Describe below: • The proposed care option is required to take account of carer’s needs. The Carers’ Assessment was completed on (insert date): • 2) Support already available to carer (tick) • Respite  • Day care  • Personal care for client  • Other  • Provide a clear summary of the carer’s needs below. (e.g. the carer has serious health problems and give details, but NOT things like ‘the carer says home is no longer an option.’ ) • Assessor name: …………………………………………………………………… • Date: …………………………………………………………………………….... • Area Manager: …………………………………………………………………… • NB: Recommendations for levels of care that exceed the needs of the service user/carer will be refused by the Area Manager/Service Manager.

11. Implementation • We set a definite date 1.10. 2009 • We circulated the paperwork to all staff • Our Head of Service made a clear statement that there would be no exceptions to using the system • Area Managers followed this up in Supervision • We run regular Business Objects reports on CareFirst • I carry out file auditing to ensure compliance • Our Service Managers query exceptions and can/will refuse funding if they are not in agreement

12. Outcomes so far…. • We are seeing a small but consistent shift in our Balance of Care • We have more care home vacancies than we have ever seen before (67 in February 2011) • We are seeing increasing numbers of people with IoRN categories H&I being supported at home and we plan to increase this through our developing Model of Care, overnight teams and Extra Care Housing. • The work is on-going

13. Oban Bay

14. Rothesay, Isle of Bute

15. Dunstaffnage