Hospital Liaison Team

1. Hospital Liaison Team JULIE MATTHEWS, SENIOR NURSE MANAGER MAGZ SMITH, SUPPORT WORKER

2. PRIMARY ROLE TO PROVIDE : - • ASSESSMENT • SUPPORT • ADVICE • LIAISON FOR PEOPLE WITH A LEARNING DISABILITY WHO NEED TO ACCESS ACUTE GENERAL HOSPITALS FOR : - • ADMSISSION • INVESTIGATION’ S • TREATMENT FOLLOWING THE PATIENT JOURNEY THROUGH TO THEIR DISCHARGE

3. BACKGROUND / WHY WE ARE NEEDED/EVIDENCE • Health inequalities. • Access to care. • Unmet health needs. (DH 2001, Mencap 2007, DRC, 2007)

4. TREAT ME RIGHT • Mencap • 2004 • Poor treatment • Views of medical profession (Mencap; 2004)

5. DEATH BY INDIFFERENCE • Mencap • 2007 • Ombudsman • Independent enquiry • Awaiting Government response (Mencap; 2004, 2007)

6. Female 65yrs Hospital 2 weeks Informed by Clinical Case Managers Choking episodes/aspirate event/chest infection History of : - Gall Stones Constipation Aspiration Weight Loss Requested urgent Case Conference Patient died P.M Concluded cause of death perforated bowel and Cerebral Palsy CASE STUDY

7. EDUCATION(ESTABLISH TRAINING NEEDS) • Provision of a training needs analysis • Audit to be undertaken • To partake in the induction training programme for all new WWL staff • Provision of training for Social Care, Voluntary and Private Provider Services

8. PATHWAY • Determine if referred client meets criteria/eligibility • Accept or decline referral • Complete 2 minute risk assessment • Look at capacity • Collate client history • Make any onward referrals (psychology/SALT) • Pre-Operative work (accessible format for planned surgery) • Desensitisation if required

9. PATHWAY • Complete Hospital document with client and or carer • Liaise with ward staff regarding planned admissions • Visit client on ward/Clinical decision unit if team is notified of an emergency admission • Ensure an appropriate advocate is in attendance at ward rounds • IMCA representation if capacity to retain information is lacking and no family or friends involved with patient

10. CONTINUED • Access medical notes when needed • Ensure staff have access to patient hospital document • Attend any needed MDT’S, case conferences and discharge planning meetings • Ensure referrals to other LD nurses are made in advance if staff training is required to support client on discharge

11. ROLES AND RESPONSIBILITIES • Attendance at discharge planning meetings for all people with a learning disability who are regarded as requiring complex care. • To request additional meetings for those people who’s needs have changed and thus future care package may be affected. • To work jointly when required with the other Nurses within Learning Disability Services if a client held on their case load is admitted to hospital

12. AIMS AND OBJECTIVES • Establish good links with Pharmacy around medication prescribing/ stock issues • To look at Acute Service Nursing Admissions Assessment and discharge process • Identify funding streams for extra support for patients with complex health needs. • To develop a care pathway/protocol with hospital SALT colleagues to minimise the risks that dysphagic patients experience

13. CONTINUED • To inform the Divisional Chair within medicine of the teams role and plan to attend the consultants monthly meetings to present the teams role and function. • To meet with the Head of Nursing within medicine. • To establish a steering group to help in the development process of the team • To have training and access to WWL Trusts Electronic Patient Record System (EPR) and Patient Administration System (PAS) system.

14. INVOLVE OUR PATIENTS/CLIENTSTHE PATIENT EXPERIENCE • Establish local views around hospital admissions for people with learning disabilities through the LD partnership board • Hospital document to be placed on partnership board website and accessed by anyone. Feedback around its use to be sought through the sites chat room forum • Feedback into the Trusts patient focus groups and PPI group.

15. END OF LIFEPREFERRED PLACE OF CARE • To ensure that clients who are at the End Of Life have a Care Of The Dying Pathway in place, and their needs and wishes are adhered to during the end stages of life. • To ensure that any DNAR orders are discussed and recorded with relevant people and are reviewed according to policy

16. DEVELOPMENTS TO DATE • Provision of a hand held Patient Document which details health and social needs, and addresses safety whilst the person is in hospital • Forged links with the Director Of Nursing within Acute Services. • Building of relationships with Clinical Case Managers, Specialist Teams, Ward Managers, Clinical Governance Leads • Liaison with other Professionals to establish future working relationships and Care Pathway Development. • Liaised with the LD IMCA around capacity issues and future working. (Looking into planning joint training for professionals and our care-pathway approach for people requiring serious medical interventions)

17. CONTINUED • Presented at Ward Managers Meetings. • Invited to The Acute Trust Patient Focus Forum. • Verbal and written agreement between WWL’s Director Of Nursing and the PCT for the Senior Nurse to write in patients Medical Notes. • Development and piloting of a capacity assessment

18. CONTINUED • Met with the communications/patient safety rep (Talking with Patients). • Arranged to meet with the head of unscheduled care • Requested to have membership on the PPI group • Meeting held with Clinical Governance Facilitators Surgical and musculoskeletal Directorate) • Planned meeting with IT to look at a flagging up system within triage to identify people with a LD who are admitted in an emergency

19. PAPERWORK • Draft eligibility tool • Draft Operational Policy. • Draft Criteria For Referral. • Draft Patient and Professional Leaflets completed. • Accessible hospital document. • Draft capacity assessment tool.

20. PROMOTING THE TEAM • Stall held at the hospital during health week • Email sent to communications department regarding the team • Flyer designed and submitted to the hospitals monthly focus magazine • Posters designed for all consultation rooms, out-patients department A and E, Wards and the Walk-in-centre. • Met with the GP Quality Group, and leaflets about the team to be sent to practices once ratified. • Article to be written and placed in GP news letter and practice nurses news letter

21. AWARDS • Entered the team for a PCT award • We are invited to the awards presentation this evening

22. FUTURE DEVELOPMENTS AHEAD……. (SIX TO TWELVE MONTHS TIME) • A review of client data base to look at the types of admissions, times of year, ages, demographics etc, feedback to Public Health • A robust Care Pathway for planned and emergency admissions that will be agreed by all Stakeholders. • A qualitative piece of research with Edge Hill University around hospital admissions for people who have a LD. Process in the very early stages

23. ANTICIPATED PROBLEMS • No one in post as a clinical governance lead within medicine • More problems within general medicine than within surgery • Staff too busy • Many difficulties due to working in separate Trusts • Staff ignorance, lack of training and releasing to have training.

24. CONCLUSION • The teams roles and responsibilities will be adjusted according to developments. • We will review the approach in April 2008 • We would appreciate any positive comments or constructive advice during the development stage.

25. THIS IS THE END……..But to us this is only the beginning THANK-YOU FOR LISTENING ANY QUESTONS?