Community Learning Disability Teams – National Survey

1. Community Learning Disability Teams – National Survey Debra Moore Managing Director Debra Moore Associates www.debramooreassociates.com 01723 371446 07950 333884 debra@debramooreassociates.com

2. Busy landscape • Lots of health related policy and guidance impacting on the role and function of CTLD’s • CTLD’s the ‘frontline’ of provision • Feeling the need to respond to a range of initiatives such as Mansell 2, Michaels Report, DRC etc etc

3. Mission impossible?

4. Background to the research • Development programme for Community Learning Disability Teams based around the 6C’s Model • Revealed information about current ‘state of play’ and raised questions about future role and modernising the workforce

5. Background to the research …what people were saying…. • Need to reduce health inequalities and supporting the delivery of VP objectives e.g. HAP’s etc • Need to support mainstream NHS including mental health • Reducing out of area placements • ‘Personalisation’ • Safeguarding • Changes in demography • ‘Boundaries’ between teams e.g. children & older people • Supporting criminal justice system • Workforce issues • Financial pressures • Some concerns about choice and quality of provision

6. Pressure to ‘rescue’ • In some localities the community based team are increasingly ‘rescuing’ situations created by ‘specialist’ social care providers (often ‘importers’) • Also ‘recovering’ problems created by changes in other parts of the system e.g. day services - the ‘buck stops here’ position • Safeguarding

7. ‘Being painted into a corner’

8. Background to the research ‘old chestnuts’ • Issues raised about time spent on health related activities and social work activities as opposed to ‘care management’ • Questions about the content of the work of individual CTLD members & blurring of roles within the team • Concern about capacity for ‘face to face’ contact and time spent on admin/IT and in meetings • Concern to make sure that the CTLD is part of a wider care pathway

9. Methodology • A brief electronic survey • A number of key questions generated by emergent themes from work with CTLD’s • Self selecting participants • Survey link posted on various professional websites and out via networking groups etc • Information was collected over a x week period • 500+ responses • Gleaned information about social work but today focus on health professionals and in particular nurses

10. What percentage of your working week is spent across the following 4 areas? • Care Management • Admin & IT • Face to face contact with service users • Review meetings

11. Other questions • If A&T service in locality or behavioural support team • If strategic health facilitator in locality Will be ‘mapping’ provision onto survey findings

12. What percentage of your working week is spent on care management?

13. Care Management - nurses • Most nurses who responded (75%) said they spent up to a quarterof their working week on care management activities • 10% nurses who responded spent over 50% of their working week undertaking care management activities

14. What percentage of your working week is spent on face to face contact with service users?

15. Face to face contact - nurses • Most nurses who responded (43%) said they spent between 25-50% of their working week in face to face contact with people who use services • 38% of nurses said they spent up to a quarter of their working week in face to face contact with service users • Around 19% spent over half of their working week in face to face contact

16. What percentage of your working week is spent on administration and IT?

17. Admin & IT - Nurses • Nearly half of the nurses who responded said they spent between 25-50% of their working week undertaking admin and IT duties • Not clear how much of this is related to inputting client information into electronic care planning systems etc • Not sure how much time is due to a ‘poor fit’ with IT system or how much due to poor ‘technical’ skills

18. What percentage of your working week is spent in review meetings?

19. Health professionals – what percentage of your working week spent on health action planning & health facilitation?

20. Health Action Planning and Health Facilitation

21. Health professionals – what percentage of your working week spent on training and supporting mainstream health professionals?

22. Regional variations – face to face contact - nurses

23. Some regional variations Face to face contact • In the SW region 74% of nurse respondents said they spend less than a quarter of their working week in face to face contact with service users • In Yorkshire and Humber it was 39% • In the North East the answer was 0% • Need to investigate why

24. Some regional variations Care Management • In the Eastern Region over a third of nurse respondents spend between 50-75% of their working week undertaking care management work • In the East Midlands Region more than two thirds of nurses spend less than 25% of their working week undertaking care management work

25. Integrated teams – what difference did it make in relation to the 4 key areas? • No discernable difference across care management, face to face contact and reviews • However the amount of time spent on administration and IT was higher for those who were in an integrated team

26. Probably raised as many questions as answers • Why are there such big variations between regions and how does this effect outcomes? • What does admin & IT consist of? • If health professionals reduce care management activity what will be the implications? • If health professionals focus on ‘health related activity as a first priority’ what will be the outcomes?

27. Being bold

28. Next steps • More detailed analysis of survey • Drilling down on emergent themes • Examine patterns of provision e.g. A&T, Out of Area placements etc • Consider how we map against outcomes such as health checks, numbers of HAPs etc • Discussion with commissioners • Inform CTLD Development Programme • Publish findings