Using Research to Shape Management Decisionmaking Services for Older People with Mental Health Probl

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Using Research to Shape Management
Decision-makingServices for Older People with
Mental Health Problems in Cumbria

PSSRU at the University of Manchester David
Challis, Jane Hughes, Sue Tucker and Alistair
Burns
PSSRU Personal Social Services Research Unit
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Using Research to Shape Management
Decision-makingServices for Older People with
Mental Health Problems in Cumbria

North Cumbria Primary Care Trusts - Vernon
Watson North Cumbria Mental Health and Learning
Disabilities Trust Daniel Scheffer Cumbria
Social Services Department Nick Marcangelo and
Jean McGrath
PSSRU Personal Social Services Research Unit
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Origins

• Lack of rational structure to services
• Reprovision of local hospital
• NSFOP
• Unclear roles of care homes specialist/non-speci
  alist

PSSRU Personal Social Services Research Unit
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Goals of Integration

• Demolish Berlin Wall
• Increase range and scope of community based
  services
• Reduce excess reliance on institutional care
• Achieve greater territorial justice in service
  provision
• Change the local balance of care

PSSRU Personal Social Services Research Unit
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Balance of Care

• Central to community based care policies both at
  a
• local, national and international level
• Shift pattern of care towards community based
  support
• Ensure care home places provided for the most
  vulnerable
• Ensure sufficient mix of community based services
  to offer substitution at the margin between
  institution and community

PSSRU Personal Social Services Research Unit
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Balance of Care in practice

• Adjusting the mix of services between community
  and institutional facilities in order to optimise
  the appropriate care of vulnerable older people
• Four factors are influential Dependency Living
  arrangements Availability of family carers
  Range and level of community based services

PSSRU Personal Social Services Research Unit
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Research and Service Development in Old Age
Mental Health Services in North Cumbria
Aim To evaluate the current balance of provision
and inform future service configuration

• Method
• Identify current pattern of provision (what
  exists?)
• Identify patterns of service allocation (who gets
  what?)
• Identify possible changes in balance of care and
  cost (what if?)
• Option evaluation/consultation (what next?)

PSSRU Personal Social Services Research Unit
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Study Design

• 4 Stages
• Map local service provision and benchmark against
  national data
• Examine patterns of admission to residential,
  nursing homes and hospital
• Explore the feasibility of community provision
  for different types of case currently admitted to
  hospital and care homes
• Review and cost possible service options with key
  stakeholders and make recommendations to service
  commissioners

PSSRU Personal Social Services Research Unit
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Involvement in the Research Process - Staff Groups

• General Practitioners
• Consultant Psychiatrists
• Nurses in CMHTs for Older People
• Hospital Based Nurses
• Service Managers Health and Social Services
• Social Workers
• Independent Sector Providers

PSSRU Personal Social Services Research Unit
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Simulation Exercise The Feasibility of Downward
Substitution

• Case vignettes of most prevalent cases in
• Hospital admissions
• Care home admissions
• Review by expert panels to ascertain
  alternative care packages (and their costs)
• Expert Panels include Consultants, Admission Ward
  nurses, community nurses and social workers
• Package review by carers

PSSRU Personal Social Services Research Unit
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User and Carers Involvement in the Research
Process

• Reference Group
• Stakeholder Meetings
• Service Priorities Questionnaire (all
  stakeholders)
• Contribute to Simulation Exercise
• Participate in Service Review

PSSRU Personal Social Services Research Unit
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Project Management Arrangements

• Research managed by PSSRU
• Local data collection
• Key contact people in health and social care
  agencies locally
• Timely meetings to review progress and plan next
  steps
• Principal researcher well-known to key staff
  frequent contact with local agencies

PSSRU Personal Social Services Research Unit
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Opportunities

• Evidence-based approach
• Involvement of practitioners, managers, users and
  carers in strategic redesign
• Promote integrated health and social care
  provision for older people with mental health
  problems
• Challenges practitioners to take a holistic
  approach to assessing and meeting patient/user
  need and promotes the use of standardised measures

PSSRU Personal Social Services Research Unit
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Challenges

• Applying the methodology across the health and
  social care interface
• Identifying the population of interest within
  social care provision (old age MH)
• Multiple stakeholders
• Including user and carer perspectives
• Scale and pace of organisational change in health
  and social care locally

PSSRU Personal Social Services Research Unit
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Systematic Collection and Analysis of Data can

• Address policy issues in advance of
  implementation
• Facilitate evidence-based planning
• Inform the budget setting process by reducing the
  parameters of uncertainty
• Feed into the commissioning process
• Address Best Value and NHS Improvement Plan
  criteria
• Have utility in briefing stakeholders and partner
  agencies of the likely impact of change

PSSRU Personal Social Services Research Unit