Community Learning Disability Teams – National Survey

Debra MooreManaging Director

Debra Moore Associateswww.debramooreassociates.com

01723 37144607950 333884

debra@debramooreassociates.com

Busy landscape

• Lots of health related policy and guidance impacting on the role and function of CTLD’s

• CTLD’s the ‘frontline’ of provision• Feeling the need to respond to a range of

initiatives such as Mansell 2, Michaels Report, DRC etc etc

Mission impossible?

Background to the research

• Development programme for Community Learning Disability Teams based around the 6C’s Model

• Revealed information about current ‘state of play’ and raised questions about future role and modernising the workforce

Background to the research …what people were saying….

• Need to reduce health inequalities and supporting the delivery of VP objectives e.g. HAP’s etc

• Need to support mainstream NHS including mental health• Reducing out of area placements• ‘Personalisation’ • Safeguarding• Changes in demography• ‘Boundaries’ between teams e.g. children & older people• Supporting criminal justice system• Workforce issues • Financial pressures • Some concerns about choice and quality of provision

Pressure to ‘rescue’• In some localities the

community based team are increasingly ‘rescuing’ situations created by ‘specialist’ social care providers (often ‘importers’)

• Also ‘recovering’ problems created by changes in other parts of the system e.g. day services - the ‘buck stops here’ position

• Safeguarding

‘Being painted into a corner’

Background to the research ‘old chestnuts’

• Issues raised about time spent on health related activities and social work activities as opposed to ‘care management’

• Questions about the content of the work of individual CTLD members & blurring of roles within the team

• Concern about capacity for ‘face to face’ contact and time spent on admin/IT and in meetings

• Concern to make sure that the CTLD is part of a wider care pathway

Methodology• A brief electronic survey• A number of key questions generated by

emergent themes from work with CTLD’s • Self selecting participants• Survey link posted on various professional

websites and out via networking groups etc• Information was collected over a x week

period• 500+ responses• Gleaned information about social work but

today focus on health professionals and in particular nurses

What percentage of your working week is spent across the following 4 areas?

• Care Management• Admin & IT• Face to face contact

with service users• Review meetings

Other questions

• If A&T service in locality or behavioural support team

• If strategic health facilitator in locality

Will be ‘mapping’ provision onto survey findings

What percentage of your working week is spent on care management?

0-25% 25-50% 50-75% 75-100%

Nurse 75% 15% 8% 2%

Social Worker

34% 48% 13% 5%

AHP 91% 7% 2% 0%

Care Management - nurses

• Most nurses who responded (75%) said they spent up to a quarter of their working week on care management activities

• 10% nurses who responded spent over 50% of their working week undertaking care management activities

What percentage of your working week is spent on face to face contact with service users?

0-25% 25-50% 50-75% 75-100%

Nurse 38% 43% 17% 2%

Social Worker 80% 14% 5% 1%

AHP 27% 49% 21% 3%

Face to face contact - nurses

• Most nurses who responded (43%) said they spent between 25-50% of their working week in face to face contact with people who use services

• 38% of nurses said they spent up to a quarter of their working week in face to face contact with service users

• Around 19% spent over half of their working week in face to face contact

What percentage of your working week is spent on administration and IT?

0-25% 25-50% 50-75% 75-100%

Nurse 38% 47% 14% 1%

Social Worker 12% 34% 45% 9%

AHP 44% 48% 8% 0%

Admin & IT - Nurses

• Nearly half of the nurses who responded said they spent between 25-50% of their working week undertaking admin and IT duties

• Not clear how much of this is related to inputting client information into electronic care planning systems etc

• Not sure how much time is due to a ‘poor fit’ with IT system or how much due to poor ‘technical’ skills

What percentage of your working week is spent in review meetings?

0-25% 25-50% 50-75% 75-100%

Nurse 81% 17% 1.5% 0.5%

Social Worker

74% 23% 3% 0%

AHP 92% 8% 0% 0%

Health professionals – what percentage of your working week spent on health action planning &

health facilitation?

Less than 10%

10-25%

25-50%

50-75%

75-100%

Nurse 29% 32% 25% 12% 2%

AHP 56% 30% 9% 4.5% 1.5%

Health Action Planning and Health Facilitation

Health professionals – what percentage of your working week spent on training and supporting

mainstream health professionals?

Less than 10%

10-25% 25-50%

50-75%

75-100%

Nurse 49.5% 36% 11% 3% 0.5%

AHP 57% 28% 15% 0% 0%

Regional variations – face to face contact - nursesLess than 10%

10-25% 25-50% 50-75% 75-100%

North East 0% 0% 75% 25% 0%

Y&H 0% 39% 44% 14% 3%

North West 10% 35% 40% 15% 0%

East Mids 3% 24% 41% 29% 3%

West Mids 0% 47% 35% 12% 6%

Eastern 22% 33% 45% 0% 0%

South West 32% 42% 16% 10% 0%

London 5% 50% 35% 10% 0%

South East 3% 19% 56% 22% 0%

Some regional variations Face to face contact

• In the SW region 74% of nurse respondents said they spend less than a quarter of their working week in face to face contact with service users

• In Yorkshire and Humber it was 39%• In the North East the answer was 0%

• Need to investigate why

Some regional variations Care Management

• In the Eastern Region over a third of nurse respondents spend between 50-75% of their working week undertaking care management work

• In the East Midlands Region more than two thirds of nurses spend less than 25% of their working week undertaking care management work

Integrated teams – what difference did it make in relation to the 4 key

areas?• No discernable difference across care management,

face to face contact and reviews • However the amount of time spent on administration

and IT was higher for those who were in an integrated team

Probably raised as many questions as answers

• Why are there such big variations between regions and how does this effect outcomes?

• What does admin & IT consist of?• If health professionals reduce care

management activity what will be the implications?

• If health professionals focus on ‘health related activity as a first priority’ what will be the outcomes?

Being bold

Next steps• More detailed analysis of survey• Drilling down on emergent

themes• Examine patterns of provision

e.g. A&T, Out of Area placements etc

• Consider how we map against outcomes such as health checks, numbers of HAPs etc

• Discussion with commissioners• Inform CTLD Development

Programme• Publish findings