Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

1. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

2. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund Jean MacLellan OBE Head of Adult Care and Support Division

3. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

4. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund Ruth Forbes Carer VOCAL Midlothian

5. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

6. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund Michael Matheson MSP Minister for Public Health

7. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

8. A Step Change for CarersReshaping Care Change Funddirect and indirect support 12 March 2013 Thistle Hotel, Glasgow Moira Oliphant Carers Policy, Scottish Government

9. Manifesto Commitment/Guidance • …we will ensure that from 2012-13 onwards at least 20% of the Change Fund spend is dedicated to supporting carers to continue to care • The optimum way of supporting carers is through a planned combination of direct carer support and support for the cared-for person

10. Why it matters • Direct support to carers recognises their role as care providers and ensures that they have the resources to enable them to continue in their caring role • Indirect support focuses primarily on the needs of the older person; direct support improves wellbeing

11. Not one or the other • Good quality, timely and reliable services for the cared-for person indirectly support the carer, often leading to a reduction in stress • Carers still require an assessment of their own needs – appropriate and timely intervention

12. Indirect support • Not all older people have carers • Degree of interpretation • Examples: - aids and adaptations; specialist palliative nurses for end-of-life care; re-ablement services; telecare • Additionality

13. Direct support • Provided directly to the carer, often following a carer’s assessment

14. Calculations: Indirect Spend • % older people who have carers • The impact the project will have for carers: determine the % that supports older people and the % that supports carers

15. Calculations: Indirect Spend A service or intervention where the carer is not the main recipient but the service or intervention aims to have a significant and measurable positive impact for the carer in their caring role. Projects are included where 25% or above of the project is directed to have a significant and measurable impact on carers. Criteria for considering the degree of benefit for carers: - proximity of the carer to the intervention; time benefit for the carer; degree of involvement of the carer in the design and planning of the service/intervention; service/intervention helps raise staff awareness of the needs of carers.

16. Outcomes • The extent to which carers are better supported and the difference made to their lives and to the lives of the person or people they care for and the wider family/community

17. Thank you! Moira Oliphant Carers Policy St Andrew’s House Edinburgh moira.oliphant@scotland.gsi.gov.uk Tel: 0131 244 3503

18. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

19. Carers of East Lothian Short Breaks Servicefor Older People and their Carers Time well spent!

20. Aim To support people in a caring situation to arrange breaks that are as beneficial as possible for both the carer and the older person they care for

21. Background Pilot Project Dec 2011-May 2012 Short Breaks Service began June 2012 Officially launched at the COEL AGM September 2012

22. The Short Breaks Service • Supportive discussions where both the carer and the person they care for can think about their needs • Research into short break opportunities • Negotiations with short break providers • Advice re social work provision • Grant applications • Referrals to other services • Transport options • Mobility equipment Also… Support with the emotional issues around organising breaks

23. The Short Breaks Service More time apart… Could the older person be left on their own safely for a short period of time? Would the older person benefit from spending some time with other people e.g. at a day service or with a support worker? Would the older person prefer to be cared for at home or away from home while their carer has a longer break? Quality time together… Would the carer and the person they care for like to have a break together but with other people undertaking the caring responsibilities?

24. Outcomes • Carers will find their caring roles more manageable • Older people in need of care will be able to stay in their own homes for a longer time • Carers and the people they care for will maintain a happier and healthier relationship • Carers and older people will feel valued and supported

25. Features Plus Points Challenges No budget for breaks Not a one-stop shop, some assessments and services still accessed through social work Small scale – one worker with administrative support • Continuity for people using the service • A holistic approach • A supportive environment where caring issues are understood • Easy access, quick response times • A dedicated service

26. Work in Progress • Ongoing evaluation of the service to respond to older people and their carers’ comments and requests. • Support for people managing their SDS individual budgets for short breaks/respite • A streamlined service to inform carers about spare capacity/short break opportunities in care homes • A growing membership with increased power to negotiate favourable rates with holiday providers • Involvement in shaping future short break provision • Organised days out for carers as a break from caring

27. The Short Breaks Service Thank you for your time Any questions?

28. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

29. Pharmacy Service role in supporting informal carers Inverclyde Pharmacy Change Plan Natalie O’Gorman

30. Background • The predicted change in demographics will place a significant strain on health, social care and support services. • Polypharmacy in the elderly is increasingly being recognised as a major issue with over 40% of over 65 year olds now on >5 medications. • Drug-drug interactions, medication errors, non compliance and adverse drug reactions are all consequences of polypharmacy. • Adverse drug reactions have been implicated in 5-17% of all hospital admissions. • In 2009, NICE reported that approximately 50% of all medicines prescribed for long term conditions are not taken as recommended.

31. Background • Previous local work has shown that medication review supports high quality, safe, clinically effective and cost effective prescribing. • Follows a previous local audit of medication reconciliation at the primary/secondary care interface showing that improving communication helps reduce discrepancies. • Assisting patients with managing their medications is now a significant part of the role of an informal carer. • There is a need to support informal carers by providing them with information and advice on the use and administration of medication.

32. Pharmacy Service • 0.8 WTE Prescribing Support Pharmacist • Medication Review as a domiciliary visit • For patients over 65 years on polypharmacy/ high risk medicines to reduce avoidable medication–related issues in primary care and hospital admissions for avoidable medication-related issues • 0.6 WTE Prescribing Support Technician • Medicine Reconciliation. • Compliance needs assessment. • Face-to-face medicine concordance and medicines reconciliation reviews for recently discharged patients over 65 years and to liaise with other services to ensure changes during admission are implemented in community and to support elderly patients to manage their medicines in their own home. • Based within the Prescribing Team, Port Glasgow Health Centre.

33. How does the service support informal carers? • Gives carers the opportunity to ask questions about the conditions and medicines of the individual they care for. • Assists carers at the point of discharge by communicating with the hospital ward, GP practice and community pharmacy to ensure correct and timely follow on prescriptions and supply. • Reduces polypharmacy and improves medicines safety through medication reviews to ensure that each medication has a current and valid indication, all monitoring is up to date and where appropriate, reduce the dose or dosing frequency of the medication.

34. …. • Reduces confusion and potential harm through the isolation of expired, discontinued and stockpiled medications for return to a community pharmacy. • Aids compliance with medication by recommending formulation changes. The service can review all the medications in a patient with a swallowing difficulty and where possible recommend changes to a licensed soluble or liquid preparation or give guidance on what medications can be crushed and how to correctly administer them. • Supplies and provides counselling for a variety of compliance aids e.g. reminder charts, dosette boxes, eye dropper aids and inhaler aids which promote independence in the patients they care for.

35. …. • Links with and sign posts carers to other services e.g. community pharmacy collection and delivery services, social work, community alert alarms, sensory impairment. • ?? Offer medication review to carers themselves.

36. Example Case 1 • 72 year old female. • Lives with husband. • 6 week admission (HDU). • 11 changes to medications. • Significant changes to antidepressant and anxiolytic medication. • Discharged with one week supply of medication in a dosette box. • Discharge Rx posted to GP from ward.

37. Case 1 contd. • Husband normally fills dosette box. • Husband also been unwell (admission to hospital). • No copy of discharge summary at GP surgery. • Copy of discharge summary taken to GP for amendments to electronic record and prescription generation. • Discontinued medication removed from home. • Communication with community pharmacy re new dosette box and delivery. • Counselling provided on medication indications and administration. • Follow up visits / phone calls to patient. PHARMACY TECHNICIAN

38. Example Case 2 • 83 year old male • Lives with wife. • PMHx – Insulin dependent diabetes, Angina, Osteoarthritis • On 14 repeat prescription medications. • Neuropathy in hands. • Finding it difficult to access medication. • Can’t drive now and has difficulty getting on and off public transport so wife walking to get medication. • Dosette box arranged with local pharmacy. • Medications will be delivered.

39. Summary • Change Fund Pharmacy Service – medication review and medicines reconciliation to support patients and carers in managing medicines • Aim to reduce avoidable medicines-related issues in primary care and avoidable medicines-related hospital admissions • Challenges – to focus medication review on patients/carers who benefit most and developing referrals to new medicines reconciliation service • Pharmacy Input/Presentation to Carer’s Network – in line with CHCP Carer’s strategy and innovative Pharmacy service • Assessment – intervention database and working with CHCP to assess impact

40. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

41. A Step Change for Carers Developing Best Practice through the Change Fund12 March 2013Julie Somers, Aberdeen City CouncilSandy Reid, Aberdeen Community Health Partnership/Aberdeen City Council

42. What have Carers Told Us? • 2010 Carer Survey (148 responses). • Most carers live with person they care for & want to remain at home with good quality of life. • We didn’t realise that “Shared/Active” Respite was a high priority for carers.

46. What Challenges Did We Face? • Services were traditionally for carers or clients/patients – but not for both! • Carers didn’t think it was for them • Staff scepticism (so they didn’t “refer” their client/patients). • Overcoming Stigma (can’t do/too frail/they’ve got dementia etc). So… we invited them to join us! …. We got media interest to ‘spread the word’ e.g. Care Home “Globetrotters” coverage in Evening Express (3 pages); Take On Life, 7 March.

47. How Will We Evidence Impact for Carers? • February 2013 City Voice Survey • Keep listening to carers. • How much did they value it e.g. turning up in December 2012 in the snow to “Musical Memories”.

48. Reshaping Care Improvement Network A Step Change for Carers: Developing Best Practice for Carers through the Change Fund

49. Dementia Support Service March 2013

50. Dementia Support Service – Why do it? • Fear of dementia means that people delay in coming forward for diagnosis and support. • Information and support after diagnosis for those with dementia and their carers has been poor or non-existent. • Services do not always understand how to respond to people with dementia and their carers, leading to poor outcomes. • People with dementia and their carers are not always treated with dignity and respect. • Family members and people who support and care for people with dementia do not always receive the help to protect their own welfare and to enable them to go on caring safely and effectively. • Dementia diagnosis is increasing.