North East Non-Residential Provider Forum 15 th January 2019 1 pm to 4 pm

1. North East Non-Residential Provider Forum 15th January 2019 1pmto 4pm

2. Visit the Marketstalls IRN and Bed Finder System Health in Mind Single point of access with St Helena Community Winter Packs

3. Introductions Patrick Higgs Director for Local Delivery North Patrick.Higgs@essex.gov.uk

4. Agenda 13:00 – 13:30 Refreshments and Marketstalls 13:30 – 13:40 Introductions & Issues 13:40 – 14:00 Winter update 14:00 – 14:15 Community Winter Plan 14:15 – 14:50 End of life and palliative care 14:50 – 15:10 Trusted Assessor model update 15:10 – 15:25 Improving independence of clients 15:25 – 15:50 ECA training opportunities 15:50 – 16:00 Closing

5. Winter update Lauren Rochat, Service Manager Lauren.Rochat@essex.gov.uk

6. Winter & Capacity Updates Delayed Transfers of Care Reablement changes Soft launch of Home to Assess 17th December Discharge to Assess block beds Winter Acceptance payment Bridging service Dom in Lieu of reablement Additional contingency / emergency beds

8. Additional initiatives Residential reablement Single referral form Reciprocal assessment with Ipswich Sourcing challenges – SPT heat map

9. Discussion: Looking ahead Major incidents such as weather pressures, norovirus etc • Emergency planning - How can we work as a system together to respond to this and support each other? • Mobilising staff as a system

10. Community Winter Plan Louise Willsher Business Development Manger bdm2@community360.org.uk

11. One ColchesterWinter Resilience www.community360.org.uk

12. Stay Warm, Stay Well, Stay Connected One Colchester is a partnership of public, voluntary and commercial organisations who have come together to address topics which can affect the whole community, in this case staying warm and well. The group has been funded by North East Essex Clinical Commissioning Group and Essex County Council, as well as supported by donations in kind from Colchester Borough Homes, Metro Bank, Waitrose, Wilko and Lidl to offer resources to local residents. www.community360.org.uk

13. Targets • One Colchester Shop - reach at least 1500 people and establish a partnership programme of at least 12 targeted activities within the Winter campaign • Winter Packs - supplying 300 packs to vulnerable residents containing vital resources to stay warm, free warm clothing obtained through donations and connecting people to local support services and amenities.  • Outreach - conducting outreach in at least six locations across the Borough which are identified as at risk during the winter period (i.e. fuel poverty).  The intention will be to reach at least 1800 households.   Also facilitate six roadshows with at risk groups and align projects with collaborative programmes • VCS Bursary - Issue at least £15,000 to Voluntary sector projects reaching at risk groups • Community Response Plan - Develop a Plan to target key issues – i.e. volunteer recruitment, transport • Training - recruit at least 6 Winter Resilience ambassadors in key partner organisations who can cascade and train teams within their own organisations • Communications - complete a co-ordinated communications campaign to reach households in Colchester (intention for full coverage of Borough)    www.community360.org.uk

14. Key activities… • Winter Packs – supplies include. Bag, Neck Warmer, Fleece Hat, Gloves, Thermal Socks, Hot Water Bottle, Fleece Blanket, Torch, Flask, Tea, Biscuits and Long Life Milk • Other resources – Winter clothing (coats, trousers etc.), Uniform for families, Slippers for people at risk of falls, Clothing Vouchers • Outreach– Promotional and engagement events across Colchester – i.e. flu jab day, Community Day • Community Response Plan – Transport by 4x4 in bad weather, Community Transport www.community360.org.uk

15. One Colchester Shop • Open Monday to Friday 10 am to 3 pm • Regular programme of activities including: • i-tea sessions (twice a week) • Women’s Group • My Weight Matters • Time Together social group • Work Club • Plus… • Hygiene Bank • Winter Clothing (including children’s coats and clothes) • Slipper Exchange • Uniform Exchange (launch January) • Winter Packs • Information and Guidance • Upcoming • Carers First • Essex Dementia Day • Homelessness Drop In • Big Energy Saving Week • St Helena www.community360.org.uk

16. Community360 • Community Development (core area of operation Braintree and Colchester) • Support for voluntary and community groups – i.e. fundraising, charity registration, networking, policy development • Volunteering – i.e. promoting opportunities or placing people in them – via Volunteer Centre and Time Bank • My Social Prescription – connecting individuals to community groups and volunteer roles that will help to maintain or improve health and wellbeing (Colchester and Tendring) • Support for people from Black, Asian or Minority Ethnic Communities – i.e. Seniors Group, IAG • Shopmobility – hiring electric scooters and wheelchairs to people to use in Colchester town or on holiday (Colchester) • Training/Workshops – various courses ranging from conversational ESOL, Employability and Volunteering to How to Social Prescribe and Evaluation techniques www.community360.org.uk

17. Community360 • Community Development (core area of operation Braintree and Colchester) • Events– i.e. Lunch and Learn, conferences, Fundraisers Network Group meetings • News and Information – i.e. weekly email newsflashes and monthly magazines, outreach and online presence • Stakeholders – supporting voluntary organisations under our umbrella with support services • Representation – i.e. role on over 60 committees, working groups and multi-disciplinary teams (Essex wide) • Room Hire – hiring space in our main office on Colchester High Street, including hot-desking • Online Database of Voluntary and Community Groups – www.essexconnects.org.uk holds over 1600 voluntary activities covering North Essex and Basildon – new social prescribing interface www.connectwellessex.org.uk for direct referral • Spot projects – i.e. Winter Warmth roadshows www.community360.org.uk

18. Community360 • Community Transport (Colchester and Maldon) • Social Car trips – volunteer drivers taking people to and from venues of their choice • Minibus hire – wheelchair accessible minibuses available • Excursions – befriending trips (bespoke and a calendar) every week • Bus routes – for example, Mill Road therapy centre and Boxted • Community Accounts Service (Essex Wide) • Independent Examinations – review of charity accounts • Management Accounts – on site secondments of staff • Payroll • Training • Business Bank – pro bono and in kind support for community projects (Colchester/Braintree) www.community360.org.uk

19. Winsley’s House High Street Colchester Essex CO1 1UG T: 01206 505250 E: information@community360.org.uk www.community360.org.uk community360org @community360org

20. Dr Karen Chumbley Clinical Director St Helena kchumbley@sthelena.org.uk

22. Advance Care Planning in Care Homes • Improves quality of end of life care • Increased the chance of being cared for in preferred place at the end of life • Improves carer satisfaction • Increases the provision of care in line with the resident’s wishes • Decreases unnecessary admissions to hospital

24. Who can see My Care Choices? GPs Hospital Anglian Community Enterprise St Helena Out of Hours GPs Ambulance services

25. What do we know about people on My Care Choices? Over 3000 people have choices currently recorded 1 in 3 people in North East Essex in the last year of life have an entry in the register People on My Care Choices usually prefer to be cared for in their usual place of residence at the end of life and only a minority choose hospital as a preferred place of care People on My Care Choices are much less likely to die in hospital than people who are not on the register

26. How can your resident’s access My Care Choices?

27. Palliative and End of Life Care

28. What is Palliative Care? Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

29. What is End of Life Care ? GMC Guidance: Patients are ‘approaching the end of life’ when they are likely to die within the next 12 months. This includes patients whose death is imminent (expected within a few hours or days) and those with: advanced, progressive, incurable conditions general frailty and co-existing conditions that mean they are expected to die within 12 months existing conditions if they are at risk of dying from a sudden acute crisis in their condition life-threatening acute conditions caused by sudden catastrophic events

30. End of life Care Palliative Care

31. Palliative Care Prevention and relief of suffering by: 1. Early identification 2. Impeccable assessment 3. Treatment of pain and other problems; Physical Psychosocial Spiritual

32. Early Identification Suitable approach for all residents? Gold Standard Framework – prognostic indicator guidance

34. Impeccable Assessment

35. Treatment of pain and other physical problems

36. Psychosocial Needs Spiritual Needs

37. When do you refer to St Helena? How do you refer? 01206 890360

38. St Helena Services SinglePoint 01206 890360 24 hour triage and rapid response service Rapid response is for people in the last 3 months of life Not in replacement of primary care

39. St Helena Services Clinical Nurse Specialist Team For when a resident’s needs are not met by primary care

40. St Helena Services Inpatient beds Medical Team Breathlessness Team Chaplaincy Family Support team Bereavement support

41. Training and Education Opportunities Gold Standard Framework Care Homes Programme Foundations of Palliative and End of Life Care Communication skills Holistic Assessment in Palliative care Introduction to end of life care Promoting patient centred care at the end of life Nurse verification of expected death Symptom management Syringe driver training for registered nurses Understanding loss and bereavement

42. Trusted Assessor Dawn Taylor – Project Lead dawn.taylor13@nhs.net

43. Background: The principle of a Trusted Assessor is one profession or service, trusting the assessment of another profession or service and acting on it. Feedback from local domiciliary and care home providers reports variable reliability and quality of information received on discharge from the acute provider and the sense of ‘hand-off’ once the patient has returned to a community setting. What would work in NEE?

44. Background: Initial engagement with care home providers and domiciliary care providers. In NEE we have approx. 202 care homes, varying in size and care remit. Of these 76 provide care to over 65’s caring for up to 3000 people. The other 126 are a combination of learning disability and mental health homes, caring for roughly 1300 people. Numbers of domiciliary care agencies vary and numbers of people receiving care unobtainable.

45. The Red Bag initiative has been adopted by the North East Essex Clinical Commissioning Group (NEECCG) as part of the national Vanguard programme (an NHS England New Care Models programme) to improve the quality of care for the frail, elderly and vulnerable residents in our care homes, as well as to better support communication between our local care homes, ambulance service and hospitals.

46. What is the Red Bag Scheme: • The “Red Bag Scheme”is a simple initiative to help people living in care homes receive quick and effective treatment should they need to go into Colchester hospital in an emergency. • The "Red Bag" keeps important information about a care home resident's health in one place and easily accessible to ambulance and hospital staff. • The “Red Bag” contains standardised information about the resident's general health, any existing medical conditions they have, medication they are taking, as well as highlighting the current health concern.  This means that ambulance and hospital staff can determine the treatment a resident needs more effectively.

47. Red Bag Feedback: • We obtain valuable feedback from across the system (patients, carers, care homes, ambulance, hospital) around what is working well and how we can improve. • Feedback from our care homes identified issues around the reliability and quality of the information received on discharge. • Poor discharge information • Missing medications • Transport issues • Referral to community services • Poor communication to relatives and providers • The sense of ‘hand-off’ once the patient has returned to a community setting. • Consequence there are anxieties around accepting discharges from the acute providers without individually assessing the patient first. • This leads to a poor patient experience and delayed transfers of care. • The experience of domiciliary providers is similar

48. Trusted Assessor Model • One of the processes to address this is via a Trusted Assessor Model. • The principle of a Trusted Assessor is one profession or service, trusting the assessment of another profession or service and acting on it. • The use of a Trusted Assessor Scheme can reduce the numbers and waiting times of people awaiting discharge from hospital through comprehensive assessment and discharge planning, together with an effective wrap around package once established back into the community to reduce the likelihood of readmission (NHS England). • Since January 2018 the CCG has extensively scoped the implementation of Trusted Assessor Schemes adopted nationally and heralded as exemplars.

49. Trusted Assessor in NEE • NEE acknowledges that there isn’t a ‘one size fits all’ Model. • First Steps • Standardised Red Bag process/contents • Based on local engagement with stakeholders, initially agreed standardised assessment paperwork that offers a comprehensive needs assessment to improve reliability of information flow. • The aspiration is for care homes and domiciliary providers to accept patients based on this paperwork, trusting the assessment of colleagues in our local hospital, coastal beds, CHC team & Hospice . • Lessons learnt from ‘test and learn’ will help the inform the next steps to rolling out this aspect of the project.

50. Busting the myths • A provider cannot be forced to take a patient based on ‘trusted assessment’ • Should be cost neutral – using existing resources • Not about changing outcome – but speed it up • Not about denying people a full assessment • If it’s slowing the transfer process, it is being done wrong • Not about moving people from hospital without correct support or consent/best interests • Not about discharge before they are clinically ready