SAP Implementation Learning from Experience

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Birmingham 29th June
2004
SAP Implementation Learning from Experience
Professor Keith Wilson
Director Whole System Strategies
Sheffield Centre for Healthy Ageing
THE UNIVERSITY OF SHEFFIELD
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Single Assessment Process What its for

• Identify the right people
• To have a standard (useful) assessment
• By a competent assessor
• At the right time
• In the right circumstances
• Sharing the right information with the right
  services at the right time
• To give the best outcome for the older person

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Im Knackered Ive been trying to do this for two
years
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Structure of this Presentation

• Why its all been so difficult
• Issues with the policy
• Issues for staff
• Issues for organisations
• Specific Issues
• Standardised Assessment Instruments
• IT strategy (NPfIT) SAP strategy
• GP involvement

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Issues for Staff

• May be concerned that older peoples assessment
  of their own needs is safe
• May be concerned that it will involve more time
  than is saved
• May have to be convinced they can assess in
  unknown territory - issues of clinical governance
• May have to rely on the judgement of colleagues
  in different disciplines
• May not be convinced that they dont already
  practice patient focussed assessment

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Issues for Staff (2)

• Need to learn to use a standardised assessment
  tool and perhaps give up some cherished practices
  
• Need to agree thresholds for referral or inaction
  . irrespective of attitudes to risk
• Need to follow some pre-determined care pathways
  that can be audited
• May have to improve their computer and become
  confident in the use of hand held technology
  (eventually)

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Person Centred Assessment Record
FINAL COMMENTS Alf said as he got older his main
concern was the trouble he was having with his
joints. But I suggested his priority was for him
to eat more fruit
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Issues for Organisations

• Senior management space on the agenda for SAP
• Leadership across whole systems
• Realistic approach to resources needed for SAP
  implementation
• Share common IT systems
• Accept shared accountability
• NPfIT out of synch NHS focussed
• GPs not yet engaged

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Standardised Assessment tools
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Extract from Ombudsmans Report

• Social Services requested an assessment to
  determine whether trained nurse input was
  required or whether a carer could provide care.
  This assessment was carried out by a member of
  the District Nursing Team. She concluded that
  there was a requirement for carers with
  experience of looking after people with
  challenging behaviour, but qualified nursing
  input was not required.
• an occupational therapy assessment identified
  that for effective and appropriate care to be
  provided to deal with Mr Pointons challenging
  behaviour, more help was required from staff
  experienced in the management of dementia.
• the independent medical assessment report
  concluded that Mr Pointon could not be in a more
  severe condition and that he met the criteria for
  100 continuing care as his needs were entirely
  health related.

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Collaboration Convergence
RD Canterbury Kent University Senectus
Programme (MDS) Sheffield University Centre for
Healthy Ageing (EASY-Care) FACE
Software collaboration AIS/MDS Liquidlogic F
ACE
Big Picture Links Care Home assessment/DATA/RUGS
FAMEOP,mental health, children Assessment
Children MH
SAP Training WSS
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Non standardised assessments will be open to
challenge in the future
Elderly wrongly charged for carenews.bbc.co.uk
20th February 2003Thousands of elderly and
disabled people may be able to claim compensation
because they have been wrongly charged for long
term care.
A report by the independent Health Service
Ombudsman has found evidence to suggest officials
are wrongly making people meet the costs of
nursing home care.
But charities and opposition politicians say the
report is just the "tip of the iceberg" and that
thousands more could be entitled to money back.
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• IT strategy (NPfIT)
• SAP strategy

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A simple scenario
GP (contact assessment)
Advise
Refer to housing services (specialist assessment)
Assessor
Overview assessment using Tool/scales
Professional Judgement
Identify needs
Agree any action
some means of timely transfer of information
Patient
Report action
Take action with patient
Refer to Social Services(Specialist Assessment)
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INFORMATION ISSUES

• Patient held records
• Hardware
• Mobile working
• Social services access ..or integration
• Other than social services and NHS .when if
  ever?
• Changes to the instrument at what level ?
• Benchmarking
• Management reporting
• SAP data for planning older peoples services
• Value for money, Audit Commission, NAO

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• SAP
• G.P.s and Primary Care

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SAP in primary care are there any hangers in
the wardrobe?

• Awareness
• Many GPs have not heard of SAP
• Perceived as a labour intensive bureaucratic
• Operational
• Which of their older patients included in SAP
• Need to understand detailed operational
  arrangements
• SAP leads trying to engage GPs ahead of NPfIT
• Clinical frameworks GMS2
• Currently no fit for SAP, no definition, no code
• Possibility of locally agreed frameworks

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Summary Key implementation issues

• Whole System management
• Staff training in SAP - before they get to the
  software
• Clinical Governance
• Standardised Assessment Instruments
• Links between overview and in-depth assessments
• Managing SAP NPfIT strategies
• Realistic strategy for engaging GPs