Agenda item

Proposal to develop a Specialist Older Adults Home Treatment Team

Paper

6.1  Zoë Reed Executive; Director of Strategy and Business Development and Cha Power; Deputy Director MHOA Clinical Academic Group presented. The Deputy Director explained that the proposal to develop a Specialist Older Adults Home Treatment Team is aimed at both reducing costs, and moving more towards community care and home treatment. He said that they want to improve the service by providing home treatment to older people.

6.2  The Deputy Director reported that they have been discussing this model with Lambeth and Southwark commissioners and now MHOA want to develop a pilot. He explained that before the service could not offer support at the weekend and evenings, which meant the only option was for staff to bring older people needing care into hospital, and consequently many older people then became institutionalised. He reported that similar projects in other hospitals have reduced demand for beds by 30 %. He went on to emphasise the project intends to work with people who want this services. He explained that for this to work the initiative needs family and clients engagement.

6.3  The Deputy Director explained that the teams will be made up of nursing and social work care staff, and that these staff members will act as a bridge between different services.

6.4  He went on to explain that the pilot has a number of stakeholders involved in its development and there will be a user involvement group. A member asked if these groups have been set up and the Deputy Director confirmed that they have, and that they will be meeting shortly. He reported that the proposal has been taken to the older people’s partnership board and to staff.

6.5  The chair invited questions and a member asked how intense the care would be. The Deputy Director said that this could be high intensity care, with three to four visits a day for up to an hour, however usually twice day initially. He said that medication is a big part of home treatment.

6.6  A member asked if the project is proposing nobody would be admitted. The response was no,  and that a 30% reduction to inpatient care could be expected in inner city areas. He explained that the service often depends on social support. He reported that there is additional spare capacity in Bethlam Hospital, Ladywell Unit at University Hospital Lewisham and at other locations. He added that availability could depend on the sex of the client and provision available.

6.7  Members asked how the project will be evaluated and manage risks. The Deputy Director assured members that if they were seriously concerned then the service would continue to bring people into hospital. He reported that this is a proven practice, which is in use with adults and used in Australia with older adults .

6.8  The Deputy Director reported that the Equality Impact Assessment (EQI)  is to be developed, and  a work in progress, to which a member commented that he considered it good practice for an EQI to be  imbedded right from the start. The Deputy Director  responded that this is a developing document that being updated with relevant data. A member commented that he hoped that they are now collecting data across all protected characteristics. He went on to comment that this is not supposed to be a retrospective exercise and that it would appear that the pilot had been designed before the EQI had been completed. He pointed out that the Trust has a duty to comply with legislation. The chair requested that an updated EQI be sent to the committee.

6.9  A member asked why there is separate work being done with a user involvement group and Nuala Conlan, MHOA lead for older people’s involvement, commented that this group is working at a slower pace and feeding into the stakeholder group. The member  enquired as to why there was no direct user representation on the stakeholder group and the chair requested that a user representative attend the next committee meeting.

6.10  Members asked about risk management and commented that have been some incidents of concern where older adults have come to harm in the community. The Deputy Director assured members that there would be risk assessment done with senior practitioners, psychiatrists and community social work team. He commented that there are risks factors in hospital with a greater chance of suicide due to depression. He said that he saw this  initiative as positive risk taking, however he went on to assure member that if clients went down hill then the service would bring people in.

6.11  The Deputy Director was asked to confirm that there are two processes going on – one providing home care and the other bed reduction. He responded that this pilot is not taking beds taking away as MHOA agreed with commissioners to do a pilot. The member asked if there was an agenda to reduce beds and the Deputy Director responded that home treatment would lead to a reduction, not an obliteration, of the need for beds and that practice in other areas had shown that there will be a reduction. The member asked for clarification that during the pilot there will be no reduction in beds and the Deputy Director assured the sub-committee that there would not be. .

6.12  A member asked why the service had taken so long to introduce this initiative if the clinical evidence was that it was beneficial, and asked if this was to save money or improve care. The Deputy Director explained that there was extra money available for adult’s services to do the initial investment. The Director of Strategy and Business Development explained that ultimately they do anticipate financial savings, which are needed at this time. She went on to explain that a while a couple of beds will not make much difference a whole ward is significant because this can cost a million pound a year to run but a  team is half that cost.

6.13  Members asked if there will be equal access to beds from Lambeth and Southwark residents and the committee was assured the sub-committee that there would be. A member asked if there were complex cases that need to stay in hospital and the Deputy Director replied that 40% of older people who come in do not return home. He explained if admission can be prevented then this number would be reduced, and noted that if people come into hospital then they deskill.

6.14  A member commented that she liked the home treatment model, however she commented that if people who live alone there needs to be contact with neighbours and housing managers. She also voiced concerns that people are heavily drugged. The Deputy Director responded that if they get permission then they will contact wider social networks of family and neighbours, and added that staff  try to give appropriate medication not over drug 

6.15   MHOA staff were asked about older people with an acute need for both  physical and mental health needs and the sub committee was told that the service are  developing  services in partnership . They said that they do provide a mix and agreed that sometimes both are needed.

6.16  A representative of LINKs Southwark commented that people in wards get care, and went on to query the care burden on carers and social workers. The chair requested that SlaM respond to this in writing.

RESOLVED

Officers were requested to send the committee the:

• Draft Equalities Impact Assessment
• Draft risk register

The committee requested a quarterly update of statistics on the:

• Number of people being seen by home treatment team
• Number of home visits
• Number of hospital admissions
• Number of emergency weekend hospital admissions

Officers were requested to attend the next meeting with a user representative.

A written answer was requested by the LINk on the care people receive in wards and the potential care burden on families and social services if the home treatment model is adopted.