Meeting the needs a social care perspective

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Meeting the needs - a social care perspective

• Jenny Garber
• Brain Injury Social Work Group

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CARER changes in knowledge and level of
awareness, realisation of longterm nature of
problems decisions about future roles
CLIENT changes in level of awareness constant
need for re-adjustment
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Needs identified

• Brain injury creates specific social need
• Profound life changes to a social unit
• Social re-integration
• preventable social exclusion
• Extensive research literature on carer stress
• Complex care pathway - re-access with life
  changes
• Successive reports call for integrated
  health/social care approach
• SSI A Hidden Disability 1996
• HAS Review 1997
• Health Select Committee 2001

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Social Care after brain injury - core tasks

• Direct work with individuals
• integrated with interdisciplinary
  rehabilitation/support teams
• maintaining rehabilitation gains
• Direct work with families/significant others
• regardless of client engagement
• support to facilitate rehabilitation outcomes
• practical, enabling and emotional support
• Assessment of need - timely, appropriate process
• Care management / facilitating community support
• Information delivery
• Advocacy

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Service Provision 2001

• Headway survey April 2001
• 215 local authorities across Great Britain - 88
  responses
• 24.1 have a written plan for brain injury
  services
• 51 have no specific contact point for brain
  injury
• 72.2 report no specialist service /worker
• over reporting of specialist workers possible
• 83 have no specific day care provision
• 50 of specialist day care provided by voluntary
  sector
• 52.4 unable to identify specific
  residential/nursing homes
• The wrong box problem
• No national statistics - a.b.i. not a client
  category

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Social Care - the reality

• Assessment fails to recognise subtle problems
• insight and awareness problems under reporting
• Fair Access to Care criteria excluding a.b.i.
• Social work counselling role reduced or absent
• Hospital social work driven by discharge
  penalties
• Care managers becoming finance managers
• Reviewing systems losing continuity for
  users/carers
• Social care commissioning
• Where are the specialist providers ?
• Who monitors quality of workers/management ?
• Are they affordable ?

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Problems for Social Care provision

• Hidden disability
• Assessment process/ Facilitating service
  delivery/Carers
• Hidden client group - not a category, no register
• Low volume, high intensity, life time recurrent
  need
• Service boundaries
• Learning Disability, Mental Health, Physical
  Disability
• Specialist knowledge/training
• Community access to specialist clinical advice

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Barriers and constraints

• Service boundaries and criteria
• No lead manager, champion
• No national priority drivers
• Unquantified population
• Lack of performance indicators
• Activity monitoring not reflecting a.b.i. tasks
• Lack of skilled workforce - workers/supervisors
• Budget management

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Good practice

• Integrated health and social care - clear roles
  protocols - strategic and operational partnership
• POOLED BUDGETS ?
• Social care delivered across the a.b.i. pathway
• For injured individuals
• Family/carer support regardless of injured person
  engaging
• Brain injury as a client category - data base
• Brain injury informed needs assessment
• Assured access to brain injury informed/experience
  d social care services
• social work, care management, respite,
  residential,day care, support work, supported
  housing, benefits advice

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Health Select Committee 2001 - Head Injury
Rehabilitation

• Recommendation (viii)
• The lack of community support and care networks
  to provide ongoing rehabilitative care is the
  problem area that has emerged most strongly in
  the written evidence
• Recommendation (xvii)
• That social service departments use an
  additional classification of user group..which
  explicitly includes ..problems such as those
  resulting from head injury
• Recommendation (xxii)
• .. that named managers are identified within
  both health and social services departments..
  That health and social services departments
  collaborate locally to map out care pathways

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Where Now?

• DoH response - National Service Framework for
  Long Term Conditions Standards
• Implementation 2005 - 2015 - a long wait
• Preparation can begin now - any Early Wins?

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Service improvement - strategy planning

• Identify Lead Officer
• Create strategic forum within the planning
  process
• Construct care pathway Service Level Agreement
• Involve service user/carer reference groups
• Involve Health partners
• Identify capacity, gaps and barriers
• Joint health/social care development planning
• Work force planning priority
• Client/carer involvement in service design

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Action changes - Early Wins

• Establish single point of contact
• Initiate data base
• Information strategy
• Improved assessment processes
• Maximum use of existing specialist knowledge
• actual or virtual a.b.i. social care specialist
  teams
• robust links with health care teams
• Joint health/social care training
• delivering bad news

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Getting the best from social services - a users
guide

• Provide a discharge statement from most recent
  rehabilitation service
• Provide a what works document
• Request a carer interview as part of the first
  assessment
• Give social care providers any general
  information you have - Headway booklets