Physiotherapists and Occupational Therapists work with reablement staff, social services and discharge facilitators. The team works over 7 days from 08:30-16:30 and 8.00- 16.00 at a weekend, with patients of any age, but predominantly frail older people. The team covers: Acute Medical Unit (AMU - 56 beds), Clinical Decision Unit (CDU - 12 beds) the Emergency Department. Part of the AHPs working differently case study series.
Tools & Resources
Occupational Therapists and Community Assessment Officers (CAO) as part of their role in the Contact Team spend regular time rotating into the Social Services Contact Centre on a monthly basis. The team are employing an innovative approach to integration looking at creating links between all of the community services in Salford (all now under the umbrella of Salford Royal Foundation Trust including social services) to look where they can link up and reduce duplication.Part of the AHPs working differently case study series.
The Countess of Chester's radiology team's development of a new community ultrasound service.The community U/S service was a joint project with CCG to improve the service for rural GP’s.Part of the AHPs working differently case study series.
Integrated Community Care Teams are based in localities aligned with General Practitioner practice clusters. The multi-professional teams are based within GP premises where possible and monthly MDT meetings occur to discuss patients with the whole team and GPs.
The team has 4 functions:Rapid Response Plus: This is a 72h service linked with Social Services. They provide early supported discharge from hospital or in community placement and reablement.Rapid Response: This is an up to 14 day service. The aim is to facilitate discharge from a ward or step up in community. Early Supported Discharge for COPD patients.Community IV Service: Managed by nursing staff.Part of the AHPs working differently case study series.
The project at Blackpool Fylde and Wyre Hospital NHS Trust aimed to use teleswallowing to link to and provide input to nursing homes remotely. Secondary aim was to provide SLT communication therapy using computer technology, using iPads, laptops and video as a service (VaaS) technology Speech & Language Therapy assessments / interventions for dysphagia are provided remotely into 8 selected nursing homes.
The introduction of the Aintree at Home (A@H) Community Therapy led Service in December 2012 was in response the Trust needing to increase the number of medical discharges. This was achieved by facilitating more timely and effective safe discharges and contributing to an improved patient experience by providing continuation of their functional rehabilitation and short term care support in their own/family home. This new model presented an innovative solution to supporting bed capacity management at Aintree.
The Healthy Minds Improving Access to Psychological Therapies (IAPT) service at Pennine Care NHS Foundation Trust has developed a pilot project to improve attendance at group therapy sessions by using Florence telehealth application (FLO) to text patients with reminders and prompts to help them manage their recovery. FLO is a text messaging service which uses a protocol that can be tailored to the specific needs and requirements of patients.
Salford Royal NHS Foundation Trust (SRFT) is committed to the development and implementation of a process of managing individual employee contribution, which will lead to the creation of a performance-driven culture. Therefore, as part of the Trust’s overarching plans for organisational development, with accountability, performance and leadership as key components, the Trust is implementing a Performance Framework and associated Reward Strategy.
In October 2010 a proposal was made by a multiagency group of Cheshire and Wirral Partnership NHS Foundation Trust (CWP), the Countess of Chester Hospital NHS Foundation Trust and Cheshire West and Chester Council, to place a specialist practitioner in mental health into an integrated discharge team.The aim of introducing this role was to facilitate the timely, safe discharge of patients over 65 years of age with possible dementia, delirium, or mental health issues, who would otherwise experience increased length of stay or delayed discharge from hospital.