Intermediate Care Services in Sheffield
Improving access and improving the experiences of patients and carers

Final Issue, No. 7 - Spring 2011

Welcome

Welcome to the seventh and final newsletter. In this issue we’d like to summarise some of the successful developments of intermediate care services in Sheffield over the past three years. We’d also like to highlight the achievements by staff for patients in delivering a community intermediate care service – redesigned and fit for purpose – and let you know about future plans.

The Intermediate Care Programme has been my main focus for the last three years. Taking a programme approach to redesigning services has to be flexible, and also capable of accommodating changes in circumstances. Programmes also must have a defined beginning and end. With this in mind, the final Intermediate Care Joint Commissioning Board met on 28 February 2011. The Board approved the ending of the Intermediate Care programme and the transfer of any outstanding work to a city-wide programme for Transforming Unscheduled Care. This new programme will cover all services that patients may need to use in an unplanned for way, like Walk-in services, A&E and Out-of-Hours care.

I’d like to thank Sheffield staff and our partners, who all have much to be proud of in your efforts to help support improvements and provision of intermediate care services for patients. I’d also like to thank patients, carers and members of the public, who have helped to shape the vision for Intermediate Care services in the city. Each newsletter has illustrated how far staff and services have come on this journey. Whilst this is the official end of the Intermediate Care Programme, patients will continue to benefit from your efforts for many years to come and work will continue through the city-wide programme for Transforming Unscheduled Care.

With thanks and best wishes,

Margaret
Margaret Gibson Intermediate Care Programme Manager

Our legacy for the future – the Intermediate Care programme

In May 2008 the NHS Sheffield Board approved a programme of work intended to establish a new model of intermediate care for Sheffield. The aims were to improve patient choice and recovery, reduce hospital stays and give as many people as possible the chance to live independently.

The model incorporated three clinical pathways – step down Stroke; Orthomedical / frail elderly; and, admissions avoidance. All providing care at home wherever possible and all requiring existing services to change or be provided in a different way. Partners, staff, patients, carers and members of the public who have been involved in this process have much to be proud of. Together achievements have included:

Using a Programme Management approach to deliver change. Setting a vision and using a route map (or programme plan) of how to achieve the best outcomes for patients.
The award of the ‘Care in your own bed’ contract to a consortium of NHS and independent sector providers, led by Sheffield PCT Provider Services, in November 2009. The contract value is £37.5m for the 5 years from 2010 to 2015.
The community intermediate care (Care in your own bed) service now provides rehabilitation for patients across the city so they can quickly regain their independence. Changes for patients include being allocated a personal ‘key worker’ to develop and coordinate an individual treatment programme. Patients also receive treatment from a team of different healthcare specialists, who work closely together to provide assessments and referrals. They provide a more seamless service for patients and offer treatment in a patient’s own home.
A community rehabilitation facility (prototype) based at Beech Hill in Norfolk Park. The unit provides 24 hour nursing care for a short period of time for individuals who are unable to manage at home as a result of an orthopaedic condition or following a stroke. Care is provided by nursing staff, a Consultant Geriatrician and General Practitioners (GPs). Patients can also receive treatment from Speech and Language Therapists, Physiotherapists, Occupational Therapists and Dieticians. The team work closely together and develop a tailored care plan to rehabilitate patients so they can regain their independence.
Work at Beech Hill confirms the continuing appropriateness of the original case to deliver a 120 bedded single-site unit. Extensive clinical involvement has taken place and work with Community First on the functionality and design of the intended building.
Successful peer reviews from the external National Clinical Assessment Team and Office of Government Commence Gateway. These reviews confirm the Department of Health could be confident in our plans to deliver these city-wide service changes.

Community Intermediate Care – a patient’s story

Sheffield’s Community Intermediate Care Service (CICS) knows that independence is important to everyone. For Phil Scarpa, their care meant the freedom to live the life that she wanted, and to live it her way.

Phil’s short stay in Beech Hill, the service’s residential rehabilitation unit, helped her to recover and regain her independence following a hip fracture. The service’s multi-disciplinary team worked with Phil to draw up an appropriate package of care and rehabilitative treatment. Phil’s care was tailored around her goal to go to Italy – an aim she realised through confidence-building exercises:

“When you looked at [the exercises] you thought, ‘oh, I’ll not be able to do that’. And, of course, once you had done them you felt good about it because you’d actually managed it.

“The next time you came back to the gym you had no fear of that particular exercise. It helped me because [the service] treats you as an individual and not just one of a ward full of people.”

The Community Intermediate Care Service is delivered in partnership by Sheffield Primary Care Trust (Provider Services), Sheffield Health and Social Care NHS Foundation Trust, Sheffield Teaching Hospital NHS Foundation Trust and Serco Health.

Improving health and wellbeing

As reported in the last newsletter, I am pleased to announce that Agewell & Lunch Clubs launched their First Point of Contact on 14 February – and they have already received a number of referrals from the Community Intermediate Care Service (CICS).

Agewell have already negotiated and arranged support for patients through the voluntary and community sector. This has included helping one patient to be accompanied on gentle walks and helping the partner of another patient to be able to go swimming. The service is also helping to find support for another patient so they can remain involved in their local community, as well as providing information and welfare benefits advice.

In addition, Agewell have been able to offer the option of lunch clubs and Agewell groups that older people can attend. The Agewell database of voluntary and community sector organisations that they are able to contact to arrange support, continues to increase.

It will be important to ensure that this scheme is monitored and evaluated to illustrate the benefits volunteers are able to bring to the health and wellbeing of patients referred by nurses, occupational therapists, physiotherapists, assistant therapists and social workers in the CICS team. Two student Occupational Therapists are currently on placement with Agewell and are keen to get involved with this project, and are currently looking at the outcomes and evaluation of this scheme.

Next steps – the future of Intermediate Care services

As we move into a future where NHS services will be commissioned through our GP colleagues, we must ensure we can support these national changes locally. This means working differently and working towards a different future than was envisaged when the Intermediate Care programme was originally set-up.

The Intermediate Care programme will officially come to an end on 25 March 2011 and any outstanding work will be transferred to a city-wide programme for Transforming Unscheduled Care. This new programme is a real opportunity to do something in Sheffield, which we believe is unique. Our GP colleagues, NHS and Local Authority partners and others will all be involved in this new programme – and together they will look at how all Unscheduled Care services can be shaped for the future. We still believe that the original case for a 120-bedded single unit is appropriate and we will be asking the programme board to take into account all you have told us, and all we know and have learnt through this process. It is our recommendation to this new city-wide programme that this final piece in the jigsaw for improving Intermediate Care Services in Sheffield, continues to be explored. If you’re interested in finding out more about the new city-wide work programme please let me know.