NHS Lothian Self-directed Support Test Site Allie Cherry Project Manager

1. NHS Lothian Self-directed Support Test SiteAllie CherryProject Manager

2. Re-ablement / Self-management Aspect AimTo protect individuals’ health through a time limited, health promotion / preventative approach

3. Outcomes led process Co-production between individual & health professional Health outcomes and interventions agreed following needs led clinical assessment 6-12 months with regular review

4. MS 17 participants Stroke 5 participants ABI 13 participants • Package range £182.50 - £650 • Equal packages requesting equipment or services

5. Impact on service users & carers Improved physical and mental health and wellbeing Reduced burden Improved family relationships Improved independence Benefits for carers and families Benefits for service users Improved ability to manage health conditions independently Reduced need for health services in some cases Reduced social isolation

6. Impact on service users & carers Improved mental health and wellbeing Reduced social isolation Improved ability to manage health conditions independently

7. Impact on service users & carers Improved physical health Reduced burden on carers & family members Improved family relationships Improved independence

8. Impact on Services • Fewer occupational therapist visits less regularly as a result of exercising at the gym • no longer receiving occupational therapist and physiotherapist visits because he is exercising at the gym • less need for visits to his Day Centre as a result of taking part in horse riding

9. Impact on Services • taking part in gardening has led to a reduced need for physiotherapy for one service user • less need for occupational therapist services having received adapted kitchen equipment through SDS

10. Mary’s Story

12. Allie CherryProject Manager - SDS Test Site 0131 465 5556 allie.cherry@luht.scot.nhs.uk

13. NHS Fife Council Self Directed Support (SDS) Test Site Grace MacDonald, Self Directed Support Project Manager, Fife Council (grace.macdonald@fife.gov.uk)

14. NHS Fife Council SDS Test SiteOverview • Timescale September 2010 – May 2012 • At outset NHS Fife and Fife Council agreed: • Focus on Adults with Acquired Brain Injury receiving service from Fife Rehabilitation Service (FRS) • To use Fife Council’s Direct Payments System/Processes and evolving SDS governance structures • No upper financial limit set for each package • Other potential funding sources to be considered

15. NHS Fife Council SDS Test SiteParticipants • 10 individuals proceeded with SDS Plans • Additional 5 withdrew – 3 alternative funding/support found, 2 changed personal circumstances • Total Expenditure on Packages £11389 • Range: £240 to £4684

16. NHS Fife Council SDS Test SiteItems Funded • Personal Assistant (3) • Computer Equipment (2) • Gym Equipment/ Membership(2) • Transport (2) • Art Materials (1) • University Course (1) Meet People Confidence Get back to Work Self-Esteem Get Fitter Take up a Hobby

17. NHS Fife Council SDS Test SiteJoint Health and Social Care SDS • 2 individuals received SDS through Health Test Site and through Fife Council’s Social Care SDS Test Sites • Importance of reviews, joint working and information sharing to maximise impact of SDS for individual • Kevin (Transition) • Health SDS (Time Limited)– PA support (close liaison with OT) to develop electric wheel chair skills, physical mobility thereby promoting independence e.g. at college • Social Care SDS (Ongoing) – homecare (agency) and PA to develop social/leisure activities in community.

18. NHS Fife Council SDS Test SiteChallenges for Individual, Carers and Workers • Kevin’s Case Study • Changing circumstances e.g. fluctuating condition (ABI), house move, college timetable, first PA moving job • Key worker joint working e.g. Time implications, cultural differences • Additional financial and administrative responsibilities for carers • Risk management e.g. wheelchair, college, activities • Additional paperwork, streamlining processes but retaining governance.

19. NHS Fife Council SDS Test SiteBenefits to Individual, Carers and Workers • Kevin’s Case Study • Increased confidence, independence and feeling of being more in-control • Improved social life and leisure activities with peer group • Fewer physical demands and less dependence on family carers • Dad considering returning to work • Continuity of PA support over transition • Shared knowledge, expertise and practice ( OT, Social Worker, Direct Payment support staff) “Everyone wanted it to succeed”

20. NHS Fife Council SDS Test SiteCollaborative Working Key Learning • Different working cultures but shared values • Co-terminus boundaries of NHS Fife and Fife Council • Importance of staff training and time • Synergies and benefits of SDS with Rehabilitation Model – timing, focus, principles • Common platform for joint working - SDS person centred principles and outcome focus • “..We have our boxes and we fit people into them, we have lost our way. SDS has helped get back to basics..” Stakeholder. • Potential for SDS process for future joint working?

21. Pamela’s Story