Module Code: HSCF001-20
860-1492254657725000
Module Code: HSCF001-20
Module Title: The Health and Social Care Professional.
Assignment: S1: Health and Social Care Standards A Case Study Report
Word Count: S1: 1500 words
Contribution to Module Mark: S1: 50%
Deadline: 24-Apr-24
Before 5pm
Assessment outline (from the Module specification): S1: Case Study Report
Learning outcome assessed: LO1: Identify and explain health and social care standards.
LO2: Demonstrate an understanding of behavioural theory.
Assessment Brief
Section 1: Health and Social Care Standards A Case Study Report
This assessment will require you to present a case study report (LO1) outlining the organisational role as stipulated by the health and social care standards with examples on how these are met within the UK, based on the case studies provided in the appendix section. You will also be expected to demonstrate an understanding of the behavioural theory through the Health Belief Model (LO2) using your chosen case study or a given practical example.
The provided case studies are practical examples and shows how a health and social care organization meets UK regulatory standards. You are required to select one case study from the three provided options in the assignment brief.
The case study has four (4) parts: (LO1)
1. Identify one (1) organisation from the case studies provided and describe the services
it provides.
2. Identify the health and social care standards including relevant legislation that apply
to your chosen organisation.
3. Identify the ways in which the organisation meets or fails to meet the relevant
standards
4. A Harvard referenced bibliography (not included in the word count)
Section 2: Behavioural Theories - Health Belief Model
You will be expected to demonstrate an understanding of the behavioural through The Health Belief Model (LO2) using your chosen case study or a given practical example.
An analysis of the Health Belief Model as a preventative health behaviour using examples either from the case study/or relevant real life practical examples to show your understanding. (LO2)
Use the Northumberland report provided (please see in the appendix section) to choose a relevant case study to construct your response and to justify your views on all aspects of HSC standards and legislation and to support your stance on what is considered as best practice.
* Case Study Report (S1) will be graded according to the following criteria; please also consult the marking criteria from Table 1 below.
Ability to understand clearly key HSC standards and behavioural theories (30%)
Ability to explain legislation underpinning HSC professional roles, standards and best practice (20%)
Amount of research and range of sources used (25%)
Written communication skills: structure (including word count) & appearance (15%)
Written communication skills: spelling, punctuation, grammar and paragraphing (10%)
For all policies regarding submission of your work please refer to the Programme and Student Handbooks.
center-914399Appendix section
00Appendix section
Approaches to integrated housing, health and social care services: case studies from North Tyneside Council and Northumbria Healthcare
The Care Act 2014 places a duty on local authorities to integrate services, including housing, where this could improve wellbeing by preventing, reducing and/or delaying care needs (LGA 2015). Despite calls for greater collaborative working between housing and health professionals, there are limited examples of live projects taking an integrated approach to service delivery.
1015196-39764393024020Case Study Report
Case Study Report
30240210236603 Housing Learning & Improvement Network
www.housinglin.org.uk
Housing Learning & Improvement Network
www.housinglin.org.uk
This case study report presents three case studies of innovative approaches to integrated working across housing, health and adult social care from North Tyneside Council and Northumbria Healthcare Foundation Trust. The case studies highlight the relevance of understanding access processes within different services, the role of workforce development in aligning referral and access pathways, targeted and more cost-effective health intervention delivery via housing services, and the potential for achieving health outcomes through housing improvement. Understanding of these issues informed the approach that was developed for the co-ordination of services and departments to work together across organization and sector boundaries.
Written for the Housing Learning and Improvement Network by Professor Glenda Cook, Dr Dominic Aitken and Dr Philip Hodgson at Northumbria University and Roy Marston, Eleanor Binks, Robert Peach, Christine McMillan, Linda Herman and Wendy Burke at North Tyneside Council, and Karen Park, Shirley Conway, Helen Graham, Gail Blood, Paula Cossar and Debora McKinnon at Northumbria Healthcare
December 2016
Introduction
The report Integration across government by the UK National Audit Office (2013) suggests that integration offers the opportunity for the co-ordination of working arrangements where multiple departments or public sector organisations work together for the delivery of a public service or programme. Whilst the European Foundation for the Improvement of Living and Working Conditions (2013) has highlighted the impact that the economic crisis across Europe has had on every aspect of life since 2008, this is only one key factor that has focused attention on the imperative to develop integrated approaches not only for services and teams, but also across housing, health and social care sectors. Other important drivers for the current transformation of public services include improvement through integrated services that promote wellbeing of communities and provide care and treatment in the community rather than through hospital-centric services (Health and Social Care Act, 2012; Care Act, 2014; LGA, 2015; NHSE, 2016).
Figure 1: State-of-the-art accommodation for older people
In England, the Care Act 2014 placed a duty on local authorities to integrate services, including housing, where this could improve wellbeing through prevention, joined-up support, early intervention, reduction and/or delay of care needs (LGA 2015). A key aim of integration is to ensure that services and resources can be better used to meet need. For too long silos in public services have existed resulting in duplication and gaps in provision. In the context of substantial pressure on public finances there is recognition that transformation of the whole system is all-important, yet difficulties remain in practice of how to cross boundaries of knowledge, organization and understanding.
This policy framework is grounded in the substantial evidence of the interrelationship between housing and wellbeing, and the health impact of poor housing (Marmot, 2010; Thomson and Thomas, 2015). Whilst this is applicable to all sectors of society, the interrelationship between housing and wellbeing is particularly evident in later life. Hence, another key driver for integration and partnership working is the expectation that greater burden will be placed on public services as the number of people who live to an advanced age with high levels of multi-morbidity will increase.
The older population and those with complex health problems often require prolonged treatment and care from a range of professionals and carers, services and agencies at the same time. When so many staff, services, sectors and agencies are involved it is all too easy for gaps in care, fragmentation of care, lack of co-ordination between services, or duplication of services to occur. These problems have been well documented.
In a literature review of integrated care, Reed et al. (2005) identified that these outcomes were attributed to the following factors:
demarcation of professional responsibilities and the turf wars that exist in the boundaries between professionals
reneging and shunting of responsibilities across the boundary of health and social care
weak channels of communication between and within health, social care and housing organizations
information is shared within a service sector, however this does not occur across sectors
that there are multiple points where older people access housing, health and social care systems with no centralised systems to co-ordinate what / when older people access services
older people are routinely, systematically assessed and reassessed by multiple agencies and different professionals with minimal or no sharing of this data
gate keeping mechanisms inhibit the smooth transfer of patients from one care sector to another
budgetary controls in the UK are divisive and constrain the integration of services, although recent policy has promoted shared budgets and joint funding.
In the decade that followed this review there has been a continual call for joining up of services, yet integrated provision of services remains a vision rather than a reality (Yaxley, 2015). The barriers to integrating housing, health and social care systems are immense. Different governance arrangements, funding streams, regulatory regimes and professional cultures present a range of challenges and layers of complexity that make working together incredibly difficult. Yet this is not preventing determined local leaders from developing small scale, bottom-up initiatives to address local problems and cost-effective sustainable solutions (NHF, 2010; LGA, 2015).
This paper presents three case studies from the North East of England of approaches to integrated working across housing, health and adult social care. The case studies highlight the relevance of understanding access processes within different services, the role of workforce development in aligning referral and access pathways, targeted health interventions delivered in housing services, and health outcomes achieved through housing interventions. Taken together these case studies present illustrations of integration in action.
Case study 1:
Direct referral from North Tyneside Living sheltered housing officers to
Northumbria Healthcare Emergency Care Practitioners and Admission Avoidance Resource Teams
North Tyneside Living (NTL), the local authoritys sheltered housing service, has placed emphasis on integrated working with adult social care and health services. Since 2013, this has included an innovative referral pathway between NTL and Northumbria Healthcare NHS Foundation Trusts Emergency Care Practitioners (ECPs) and the Admission Avoidance Resource Team (AART) (Marston et al., 2014). These teams are responsible for delivering urgent assessments for North Tyneside residents in health or social crisis, to help them remain in their own home and prevent them attending hospital unnecessarily.
ECPs are nurse specialists in providing diagnostic tests and healthcare for older people, including treating minor injuries and illness (such as following a fall or chest / urine infections), and can refer patients directly into hospital. AART are a multi-disciplinary team who work with people to prevent unplanned admissions into hospital and reduce hospital stays, particularly for patients with declining mobility and frailty. Existing Sheltered Housing Officers (SHOs) (previously wardens) were skilled-up to make direct referrals on behalf of tenants to ECP and AART services. ECPs respond to a referral from SHOs within two hours and the AART professionals respond within 24 hours. Referral from North Tyneside Living has been included in health service referral pathways since the reorganisation of these services, and within social services pathways since 2013. Figure 2 provides a diagrammatic representation of the referral pathway that SHOs follow to refer tenants to ECP and AART services.
Figure 2: Referral pathway from NTL to ECP and AART services
However, in order to meet the aim of supporting NTL tenants to remain safely within their own home and avoid unnecessary hospital admissions, it was important to recognise the importance of the role of the SHOs. Although not previously included within the health referral pathways for this population, they now provide an invaluable resource to health care teams through sharing their understanding of the needs of the tenants and supporting access to appropriate services. Accordingly, the development of skills for recognition of the early signs of disease or changes in health status, and understanding of health pathways, these workers have contributed to the success of this approach to housing and health services working collaboratively.
Sheltered Housing Officers were initially skilled-up to make direct referrals to ECP and AART services, whilst also being able to access telephone advice from these health services, on behalf of tenants. The SHOs role leads to regular contact with tenants and understanding their needs, which facilitates an early knowledge of any arising health issues. Following identification of health issues, access to ECP and AART services provides early intervention for older tenants with injury not requiring immediate treatment by emergency services, acute illness or an exacerbation in chronic disease. Simultaneously, this improved access further developed collaborative working by allowing the ECP and AART team greater knowledge of tenants in an efficient and timely manner.
During the period January 2013 to the end of December 2015, 161 referrals were made to ECP/AART from NTL. Three of these referrals were not accepted because the service was not operational at the time of referral. 60 per cent (n=97) were dealt with by ECP or AART services alone. The remainder required other treatment from other professionals and services, such as ambulance, GP, district nurse, hospital staff, social workers and telecare services.
The predominantly recorded cause of the referral to ECP and AART were falls (32 per cent), and contact was also made on symptoms such as pain (16 per cent), respiratory illness (16 per cent), swelling (12 per cent) and injury (11 per cent) (multiple causes were recorded). In many instances, assessment and treatment was provided, although in other situations advice, medication administration and referral to other services were carried out. Tenants reported that they were pleased with the overall service given, particularly the speed of delivery. Some also highlighted their satisfaction of care and treatment being provided in their own home and at not having to consult their GP or go to hospital.
Example: Early intervention through assessment and treatment at home
An example of the success of this service included an 80-year old tenant with Chronic Obstructive Pulmonary Disease who was on continuous oxygen therapy and inhalers. During a routine visit from the SHO, it was noticed that this tenant was coughing constantly and, on further investigation, it was confirmed this had produced discoloured mucus. However, the tenant had been unwilling to contact her GP. The SHO then explained the new ECP service to the tenant and the fact that a home visit could be made by a specialist nurse. This was agreed, and following a visit from an ECP, within two hours, steroids and antibiotics were prescribed, a full assessment was carried out and it was decided that a hospital admission was unnecessary. The tenant expressed her gratitude for care and treatment being provided in the comfort of her own home, and confirmed she would be happy to use the service again in the future.
During the operational period of this service, SHOs, ECP and AART professionals were also asked to estimate what services would have been required if ECP and AART services were not available. Of the 135 cases where this was recorded, contacting a GP was recorded for 84 (62 per cent), 22 listed calling an ambulance (16 per cent) and 14 listed contacting a district nurse (10 per cent) (some SHOs recorded more than one). Other services that would have been used included Accident and Emergency, and a NHS walk-in centre. Critically for commissioners within the local health and social care economy, each of these episodes of avoidance to emergency and primary care services offered a considerable financial saving to the respective services, with each visit from ECP and AART having an estimated cost of 50-60. This is considerably less than the use of ambulance and Accident and Emergency services.
Case study 2:
North Tyneside sheltered housing Healthy Living pilot programme.
The sheltered housing tenant population has a high risk of falls and general deterioration in health. The majority of tenants live with one or more chronic diseases, and nearly half of this population experience a spell in hospital each year (Cook et al., 2016). Whilst this is the profile of this population, preventative healthcare can support individuals to age well and maintain their health and wellbeing. Common problems such as falls, and general deconditioning can also be reduced if positive action is taken to address problems and slow down deterioration.
The National Institute of Clinical Excellence (NICE) guidelines (2016) recommend that any older person with recurrent falls or assessed as having an increased risk of falls should be considered for individualised multi-factorial intervention (COT, 2006; 2015). Components to this are strength and balance training, home hazard assessment and intervention, visual assessment and medication review. NICE guidelines also include encouragement for participation in falls prevention programmes, with specialist assessment from the appropriate healthcare professionals. To be effective in falls prevention the exercise programme has to be of sufficient intensity, progressive and practised regularly (Barnett et al., 2003: Tiffany and Schubert, 2011).
Stevens et al. (2014) found that an effective intervention for falls prevention was an in-home safety assessment visit completed by an occupational therapist. This allows an evaluation of the individuals ability to complete activities of daily living. Occupational therapists have significant skills and expertise in the delivery of home hazards assessment and safety interventions, taking into consideration the visual impairments of patients. Environmental assessment must be conceived as greater than a checklist determination of home hazards. It is essential that the assessment explores how the actual use of the environment influences the individuals risk of falling.
Physiotherapy is another integral part of the multifactorial approach to falls education and intervention. Age UK (2014) advise that it is important to exercise as you get older to maintain strength, flexibility and energy levels. Aiming to improve posture, co-ordination and balance that will in turn reduce the risk of falling. Activities that promote strength, co-ordination and balance are particularly valuable for older people to help them perform daily activities and reduce the risk of falling and being seriously injured (DoH, 2004). For exercise to be most effective in falls prevention it has to be targeted to those who are most vulnerable and that it addresses key risk factors. These are:
Strength
Balance
Muscle power
Endurance
Joint flexibility
Co-ordination
Reaction time
The nursing components include monitoring of medication, monitoring blood pressure and consideration of long-term condition on falls risk. Patients should have a medication check at least every 6-12 months if taking more than four different types of medication (NICE, 2016). Falls can be caused by almost any drug that acts on the brain or circulation. Monitoring of blood pressure is valid in checking for hypotension. Also considered are a review for adequate nutritional intake and dehydration.
In late 2015 professionals from NTL (North Tyneside Living) sheltered housing service and Northumbria Healthcare, and researchers from Northumbria University explored options for a Healthy Living programme that addressed common problems encountered by older tenants, including risk of falls. The programme selected was a healthy living, balance and gait programme. This was adapted from an existing training programme, previously developed for use at Walkergate hospital in Newcastle upon Tyne.
The programme ran over six weeks and combined structured exercise with educational elements. It was agreed to run the programme in one sheltered scheme to investigate feasibility, acceptability and outcomes. The sessions were delivered by a senior occupational therapist, physiotherapy technical instructor and nurse from AART (Admission Avoidance Resource Team). The six, weekly two hour sessions included an educational element, followed by an exercise class. The educational elements were:
Session 1 Exercise and What to do if you have a Fall.
Session 2 Environmental Hazards (OT focus)
Session 3 Medicines (Led by Nurse)
Session 4 Food and Nutrition
Session 5 Vision
Session 6 Footwear and Foot care
The exercise programme was an adaption of Age UKs Preventing falls, strength and balance exercises for healthy ageing (2014), Staying Steady (2016) and the Otago exercise programme (Campbell and Robertson, 2003). This adapted programme was a structured and progressive exercise intervention with key components of warm up, balance and gait training, including exercises that target strength (knee extension and flexion, hip abduction, standing squats, chair raises, toe/heel raises), balance (single leg stand, side stepping), and walking performance (heel/toe walk, walking challenges). Static and dynamic activities included group-based games utilising equipment such as gym balls, bean bags, quoits and sticks to promote co-ordination and strength.
Fifteen tenants participated in the programme during February to April 2016. They agreed to the completion of the following assessments prior to and following the programme. The methodology applied was:
The HOMEFAST (Home Falls and Accidents Screening Tool)
The Tinetti assessment of balance
The Tinetti assessment of gait
The HADS (Hospital Anxiety and Depression Scale)
The FES-I (Falls Efficacy Scale International)
Due to 3 individuals not completing the follow-up assessment, paired data for 12 participants was analysed. The mean before and after scores are shown in Table 1 below. Reductions in scores represent improvements in all assessments. Of particular interest, all measures showed a positive reduction in mean score following the class, with the exception of Tinetti gait (in which participations all maintained a highest possible level of ability with a score of 9).
Before (Mean)After (Mean)
Tinnetti Gait scores 9.00 9.00
Tinnetti Balance scores 18.00 14.50
FES -I Scores 32.58 31.75
HOMEFAST 1.00 0.42
Had Anxiety 4.42 4.17
Had depression2.832.17
Table 1: Mean scores before and after the Healthy Living programme
In order to assess the statistical significance of these results, a Wilcoxon signed rank test was carried out for paired data for each measure. This analysis showed that changes were statistically significant for Tinetti balance (z = -2.814, r=-0.57), p = .005, and FES-I (z = -2.060, r=-0.42), p = .039. This suggests that participants were significantly more likely to have improved balance after attending sessions than before and that they were also significantly less concerned about falling.
Importantly the participants enjoyed taking part in the programme.
Keeping fit helps wellbeing and happiness; singing gives confidence and helps breathing. Getting together helps everyone.
Enjoyed the group, had a good laugh, feel a lot better.
Best thing ever. I feel it has been really beneficial and will continue with the exercises myself.
I enjoyed the weekly keep fit. It gave me ideas of what I can do in my own home.
These older people indicated that they intended to continue with the exercises they had completed during the programme. This is so important for longer term benefits.
Figure 3: NTL tenants enjoying the outdoor space of their new homes whilst engaging in physical and mentally stimulating activities.
This case study demonstrates the positive outcomes and impact on service user wellbeing that can be achieved through housing and health professionals working together. The programme is now being piloted in two other sheltered schemes in order to continue to test feasibility and assess outcomes. The intention is to scale-up this intervention and develop approaches to sustain tenant engagement in regular exercise. However, rolling out this programme across the whole service will require substantial resources from health services therefore the implementation team are working together to consider options for skilling-up other members of the workforce such as housing-based occupational therapists. Sustainable and cost-effective options for facilitating regular exercise to support maintenance of the health gains, such as volunteer exercise champions and walk leaders are also being considered.
Case study 3:
Safe and Healthy Homes in North Tyneside
Nationally, the Building Research Establishment (BRE) estimate that the cost of poor housing to the NHS today is between 1.4bn and 2.5bn (Nicol et al. 2015).
01933950In 2013, North Tyneside Council (NTC) completed a Joint Strategic Needs Assessment (JSNA) which recognised that the health and well-being of a population is greatly shaped by a wide variety of social, economic and environmental factors and identified housing as one of the key wider determinates of overall public health in our area. North Tynesides Director of Public Health and the Health and Wellbeing Board decided that a specific project was needed to address the health impacts of poor housing in the borough. Utilising BRE data relating to the condition of the housing stock in North Tyneside and its impact on health, the Safe and Healthy Homes (SHH) initiative was developed to reduce poor housing conditions in the private sector. Working in the private sector, SHH recognises the responsibility of the homeowner (including landlords) to maintain their property.
The SHH team has now been in place
Figure 4: Team member Rob helped solve heating and electrical problems at Mr Pagdens home who was suffering from Parkinsons disease and making regular calls to the ambulance service due to respiratory problems
for two years. SHH officers are trained to identify hazards in the home which affect health. The officers visit all individuals in their home, conduct an assessment of the property, complete a health survey with clients and engage in an in-depth discussion with occupants about the services which may be able to support them. Residents are eligible to receive the service if they live in private sector accommodation with problems which are causing or exacerbating health conditions or have the potential to do so. The team thus focus attention on a population outside of the social housing sector, who may have fewer obvious sources of support and guidance available to them yet may live in accommodation which does not meet Decent Homes standards.
The SHH team provides advice and information to clients about services that can address their housing issues and can refer them to a variety of teams and organisations including:
Age UK - free draught proofing, energy efficiency advice, carbon monoxide detectors and benefit maximisation;
Warmzones affordable warmth partner for free and subsidised heating;
NPower Health Through Warmth scheme provider;
Fire service - smoke detectors and fire safety advice;
Mears Home Improvement Agency for assistance with repairs and falls hazards;
Trusted Traders;
NTCs Care and Connect team for help with social isolation;
NTCs Select and Direct service which installs minor home adaptations free of charge;
and Environmental Health which can enforce property standards.
Figure 5: Adult Social Care and Health Service Referrals to and from the Safe and Healthy Homes Service
The SHH team has received over 960 referrals, resulting in over 700 visits to clients homes since commencement in 2013. SHH receive referrals from residents and other professional teams, including adult social care services, community and hospital NHS services, voluntary sector organisations such as Age UK, and the emergency services. Figure 5 above shows the referral pathways both into and outgoing from the Safe and Healthy Homes team, for both adult social care and health services. These referral pathways have been developed via a series of information sharing sessions with services to explore whether SHH could assist other teams existing patients or customers and/or if they could fulfill any unmet needs of SHH clients. Integrating services in this manner has enhanced both the offer of SHH and its referral partners.
Due to a low number of contacts from GP surgeries (13 patients in 13 months) an innovative referral pilot was implemented. Registered patient data is held on a practices clinical information system and patients with particular clinical or long term conditions are identified on registers. As a result, data from the following registers were included in the pilot referral programme: patients on the COPD, asthma, depression, falls and high risk registers. In partnership with the surgery, we developed a flagging system that provides a pop-up alert on the computer screen when patients on these registers next attended the surgery for an appointment with the GP or practice nurse. This alert prompts the practitioner to discuss with the patient whether they would benefit from assistance from the SHH service. If the patient wants a referral the pop-up alert can be used to make a direct electronic referral. To protect patient confidentiality SHH staff did not view the registers and only received patient details if they had consented to a referral being made. To date there have been a total of 33 referrals from this GP surgery to the SHH service since the referral pathway was established.
Example: A life saving intervention
Client F was one client to have been referred to the Safe and Healthy Homes Team by a local medical practice. Client F was terminally ill, suffering from a number of health issues including angina, diabetes, COPD, osteoporosis and as a result had mobility problems and was being cared for by her partner. When Client F attended her surgery, the practice nurse read the flag on the system and offered her a referral to the SHH team.
Upon visiting the property, the SHH officers main concern was around ensuring slips/ trips/falls risks were reduced given Client Fs mobility issues. The officer made referrals to North Tyneside Councils Select and Direct Service which was able to install a second banister on the stairs and a referral to an occupational therapist led to the installation of bathing equipment in the bathroom. Concerned about the temperature in the property, the team also organised a service for the clients boiler and organised draught proofing of the property at no cost to Client F. Social isolation was also an issue and so the client was referred to the councils Care and Connect service who have since been involved in helping connect Client F with local exercise classes, potentially allowing her to improve her mobility and meet new people.
Ms Fs concerns about falls and cold have been reduced, and she now has more opportunity to engage in the community and become more active. In her review questionnaire the client claimed that she had felt suicidal before the teams involvement and stated that her Safe and Healthy Homes Officer saved her life.
Discussion and Conclusion
At the heart of the principle of service integration is the acceptance that no one profession or team can fully meet the demands of citizens. This means that all services cannot meet all the needs of service users in isolation and gaps exist. Recognizing these gaps, how they might be filled and, critically, what service currently in existence is able to meet that need is central to the process of integration. Furthermore, service users needs are varied and complex and only through integrated working by several services will the best outcomes be achieved.
All three case studies demonstrated how professionals reflected upon the services provided, whether there were gaps in service provision, and how the needs of service users could be addressed differently through collaboration with other services. This involved consideration of the existence of other services and the associated workforce; an understanding of its role; and the potential the service has for meeting service-user needs (see table 2 below).
Case Study 1 Case Study 2 Case Study 3
Learner Service NTL Health Services Health and Adult
Social Care
Services
Gap SHOs unable
to provide rapid medical assistance in situ Appropriate delivery sites for preventative service delivery Unable to tackle housing issues affecting health and wellbeing
Awareness Gained The existence of
ECP/AART The existence of NTL schemes around the borough The existence of
Safe and Healthy
Homes
Role Multidisciplinary rapid response team to prevent admission to hospital Provision of rental accommodation
specifically for those aged 60+ Information, advice and guidance service for those in private sector accommodation which is impacting on their health and wellbeing
Potential Delivery of medical attention in-situ without GP visit or admission to hospital Well-placed conduit for delivery of preventative services to older population Tackling housing issues and other wider social determinants of health
Table 2: Gaps in service provision and potential for an integrated response to address the gap
The case studies highlighted different approaches to integration across departments, services and sectors.
Case study 1 pointed to workforce development being instrumental in enabling professionals to build competencies to fulfil roles required of new referral pathways between housing and health services. By utilising the knowledge and understanding of the health needs of tenants within a workforce usually excluded from health and social care pathways, this allows the targeted services to work more efficiently and effectively.
Case study 2 presented an innovative intervention developed and delivered by health service teams in NTL sheltered housing. This intervention supported NTLs preventative agenda of optimizing older tenants health and wellbeing and allows health professionals access to a population well situated for receipt of an intervention to prevent falls. Housing, leisure and health teams continue to work together to explore sustainable options for building upon achievements through this six-week programme. For example, older tenants may be invited to volunteer as walk leaders. This approach draws on the social capital that exists within these sheltered housing communities and supports active living in later life (Mohnen et al. 2012). Without housing, leisure and health professionals working together to develop innovative approaches, whilst addressing the inherent risk in the vulnerable sheltered housing population this programme would not have been possible.
Case study 3 presents a housing service that delivers interventions specifically designed to address health issues. One of the referral pathways to this service is direct referral of individuals with specific health problems directly from their General Practitioner or practice nurse. This process increases the likelihood that individuals with unmet housing needs that directly affect their health can be identified. Identifying potential SHH service users in this way required general practice and housing service teams to work together to develop a computer programme within the practices sophisticated clinical information system, EMIS web, that alerted the GP or nurse to the presence of particular types of patients and a referral mechanism that required minimal time commitment. Hence this is potentially a cost-effective, reliable whole population based approach for housing services to work with general practice.
The case studies draw attention to several themes. These include:
Co-operation and partnership between individuals and teams were critical to the successful implementation of each of these innovative services. For example, in case study three, the initial attempt to programme the general practice clinical information system led to over 150 discussions but only 6 referrals to the SHH team. Analysis of the initial pilot data led to rewriting the programme and targeting of different patient groups. This required commitment and cooperation of housing and health professionals to develop a successful referral process that worked well in both organisations. In this instance decision making occurred at the local level between service leaders rather than having to overcome the complexities that exist in housing and healthcare organisations. More importantly, the outcome led to individuals with specific health and housing problems being supported with relevant interventions.
Prevention and early intervention is a key aspect of all the case studies. Whilst the focus in each of the developments discussed in this paper is different, the focus is on supporting people in their communities and providing services that have the potential to optimize wellbeing and not just preventing hospital or care home admission. The Chartered Institute of Housing has argued that there is too much emphasis on commissioning for higher level need at the expense of lower level preventative services (CIH, 2012). Our case studies demonstrate that service outcomes can be achieved through the implementation of preventative strategies that aim to improve wellbeing through addressing health problems and optimizing the capabilities of service users. While such preventative strategies may appear to be difficult to identify or implement, each of these case studies illustrates that the necessary information and understanding may already exist within other teams which sit outside of existing silos.
Lessons can also be learnt about what works and does not work from these case studies that aimed to develop integrated services where this could improve individual and community wellbeing through prevention, joined-up support and early intervention.
In addition to the commitment of professional leaders locally, the aspects of the services and interventions that worked well required service and system transformation of housing, health and social care systems. This was achieved through linking systems and referral pathways. Skilling-up the workforce is essential to make these linkages work. For example, in case study 1 the SHOs required knowledge of NHS services and the competence to assess when older tenants required referral to the ECP and AART teams. This suggests that the integration of systems required skilling-up a workforce and placing individuals and roles in a position where they can facilitate navigation of service users through systems and across health, housing and social care sector boundaries. The demonstration that this is an effective approach to integration rests in the evidence of whether it allows each contact with the system by a service user to occur in a context that links the service user to the appropriate service or professional and bridges gaps within and between services.
And lastly, the key question is how to scale up these types of small local successes so they become a consistent feature of mainstream services. The Local Government Association (2015) suggested that this is one of the major future challenges for all services:
Currently innovative developments led by the housing sector tend to be developed largely as one-off projects, rather than the adoption of large scale institutional change (p.12).
All of the case studies discussed in this report, highlight the need for local leaders who are committed and are flexible in their approach to design services around local need that can be implemented and sustained within local contexts. Some of the solutions were quite straightforward to develop and others required complex transformation of the way that services work together. The overriding message from these innovative approaches is that they do work, the service can be adopted at-scale, and they do provide a better quality of service to the user.
References
Age UK (2014) Preventing falls, strength and balance exercises for healthy ageing. London: Age UK.
Age UK (2016) Staying Steady Keep active and reduce your risk of falling. London: Age UK.
Barnett A., Smith, B., Lord S.R., Williams M., Baumand A. (2003) Community based group exercise improves balance and reduces falls in at-risk older people: A Randomised control trial. Age and Aging, 32(4), 407-414.
Burgess M., Rowson R. (2010) Housing for health: worlds aligned: A tool for local influencing.
National Housing Federation, London. Retrieved on 19.10.16 from: www.housinglin.org.uk/_library/Resources/Housing/Support_materials/Other_reports_and_ guidance/HousingForHealth.pdf
Campbell A.J., Robertson, C. (2003) OTAGO Exercise Programme To prevent falls in older adults. Accident Compensation Corporation. Wellington: Accident Compensation Corporation
Care Act (2014) Retrieved on 10.11.16 from: www.legislation.gov.uk/ukpga/2014/23/contents/enacted
Chartered Institute of Housing (2012) Consultation on the integration of adult health and social care: joint statement from the key representative housing organisations in Scotland. Chartered Institute of Housing, Scotland. Retrieved on 19.10.16 from:
www.cih.org/resources/PDF/Scotland%20Policy%20Pdfs/Housing,%20Health%20and%20 Social%20Care/JointHousingStatement%20Final.pdf
Cook G., Bailey C., Hodgson P., Gray J., Barron E., McMillan C., Marston, R., Binks E., Rose J. (2016) Sheltered housing tenants perceptions of wellbeing and their usage of hospital services. Health and Social Care in the Community. doi: 10.1111/hsc.12398.
College of Occupational Therapists (2006) Occupational Therapy in the prevention and management of falls in older adults. Practice Guidelines. Specialist section older people. College of Occupational Therapists.
College of Occupational Therapists (2015) Occupational Therapy in the prevention and management of falls in older adults. Practice Guidelines. Specialist section older people.
Retrieved on 11.11.16 from: https://www.cot.co.uk/sites/default/files/general/public/Falls-guidelines.pdf
DoH, (2004). Preventing Falls. Managing the risk and effect of falls among older people in care homes. Retrieved on 17/08/2016 from: www.educasante.org/img/helptheageduk.pdf
European Foundation for the Improvement of Living and Working Conditions (2013) Quality of life, public services and the crisis. Foundation Focus (Issue 13). Dublin: Author. Retrieved on
21.10.2016 from: http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1308&context=intl
Field A. (2009) Discovering Statistics using SPSS. 3rd Edition. London: SAGE.
Health and Social Care Act (2012) Retrieved on 20.10.2016 from:
www.legislation.gov.uk/ukpga/2012/7/contents/enacted
Land, S and Dinan, S (2014) Preventing Falls Strength and balance exercises for healthy ageing. London: Age UK.
Local Government Association (2015) A home is much more than a house: Integrated approaches for the housing, health and care needs of vulnerable adults. Local Government Association, London. Retrieved on 19.10.16 from:
www.local.gov.uk/documents/10180/6869714/L15-435+A+home+is+much+more+than+a+ho use/df3048c6-63b8-4419-8dcb-afee2a275f69
Marmot, M., 2010. Fair society, healthy lives. The Marmot Review, London.
Marston R., McMillan C., Binks E., Herman L., Cook G., Bailey C., Barron E., Rose J. (2014) North Tyneside Living: an integrated housing, health and social care model to deliver preventative and enabling sheltered housing services. Housing LIN Case study 98. Retrieved on 21.10.2016 from:
www.housinglin.org.uk/_library/Resources/Housing/Practice_examples/Housing_LIN_case_ studies/HLIN_CaseStudy98_NorthTynesideLiving.pdf
Mohnen SM., Vlker B., Flap H., Subramanian SV., Groenewegen P.P. (2012) You have to be there to enjoy it? Neighbourhood social capital and health. European Journal of Public Health. 23(1), 3339.
National Audit Office (2013) Integration across government. London: The Stationary Office.
Retrieved on 21.10.2016 from:
https://www.nao.org.uk/wp-content/uploads/2013/03/10091-001_Integration-acrossgovernment.pdf
National Institute for Clinical Excellence (2016) Falls in older people overview. Retrieved on
18/09/2016 from: http:pathways.nice.org.uk/pathways/falls-in-older-people
NHS England (2016) General practice forward view. Retrieved on 20.10.2016 from: https://www.england.nhs.uk/ourwork/gpfv/
Nicol S., Roys M., and Garrett H. (2015) The cost of poor housing to the NHS. Watford, Herts: BRE Trust.
Reed J., Cook G., Childs S. and McCormack B. (2005) A literature review to explore integrated care for older people. International Journal of Integrated Care, 5.
Stevens J.A., Mahoney J.E., Ehrenreich H. (2014) Circumstances and outcomes of falls in community-dwelling older adults. Injury Epidemiology, 1(5), 71-76.
Thomson H., Thomas S., (2015) Developing empirically supported theories of change for housing investment and health. Social Science & Medicine. 124, 205-214.
Tiffany E., Schubert M.P.T. (2011) EvidenceBased Prescription for Balance and Falls Prevention:
A Current Review of the Literature. Journal of Geriatric Physical Therapy, 34(3), 100-108 Yaxley, N. (2015) Going Round the Houses. Clore Social Leadership, London.
Other Resources
Video on Supporting Independence and Improving Health and Wellbeing for Older Tenants:
https://www.youtube.com/watch?v=_212Z8V6ehI
Acknowledgement
We would like to express our recognition that there are many professionals who have contributed to the services discussed in this report. We want to acknowledge that without their efforts the developments and outcomes that have been achieved would not have been possible.
Note
The views expressed in this paper are those of the authors and not necessarily those of the Housing Learning and Improvement Network.
About the Housing LIN
The Housing LIN is a sophisticated network bringing together over 40,000 housing, health and social care professionals in England and Wales to exemplify innovative housing solutions for an ageing population.
Recognised by government and industry as a leading knowledge hub on specialist housing, our online and regional networked activities:
30240210236610 Housing Learning & Improvement Network www.housinglin.org.uk
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Housing Learning & Improvement Network
www.housinglin.org.uk
Housing Learning & Improvement Network www.housinglin.org.uk
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Housing Learning & Improvement Network
www.housinglin.org.uk
connect people, ideas and resources to inform and improve the range of housing choices that enable older and disabled people to live independently
provide intelligence on latest funding, research, policy and practice developments, and
raise the profile of specialist housing with developers, commissioners and providers to plan, design and deliver aspirational housing for an ageing population
To access further information and resources on the links between health and housing, visit the Housing LINs dedicated online Health Intel pages at: www.housinglin.org.uk/ Topics/browse/HealthandHousing/
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Housing Learning & Improvement Network c/o EAC, 3rd Floor, 89 Albert Embankment
London SE1 7TP
Tel: 020 7820 8077
Email: info@housinglin.org.uk
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Table 1: Case Study Report (S1):
Elements of Criteria Fail 0-39
Poor Quality D. 40-49
Satisfactory Quality (Low Pass) C. 50-59
Sound Quality
(High Pass) B. 60-69
Good quality
(Low Merit) A. 70-79
Excellent quality
(High Merit) A. 80-100
Outstanding quality
(Distinction)
Ability to explain key HSC standards and behavioural theories 30% Key concepts are misunderstood.
Explanations are confusing.
Mostly adequate explanations and coverage of the key questions. Some minor misunderstandings or confusing explanations Demonstrates a sound grasp of all themes implied by the key questions.
Good understanding of the literature read with examples. Clearly explains the concepts implied by the key questions.
Very good understanding of the literature read with example with justification. Excellent grasp of all the concepts implied by the key questions.
Excellent understanding of the literature read; ability to digest complex ideas and arguments. Outstanding engagement with main concepts and beyond. Outstanding insight into a wider literature, which has lead to an inspirational level of engagement of complex ideas and arguments.
Ability to depict how HSC standards, legislation improve HSC professional roles 20% No clear understanding for example all authors ideas and opinions are taken at face value and are simply described.
There are major misunderstandings of key concepts. Some attempts to understand clearly although sometimes the arguments may be unclear.
Identified minimum one relevant legislation.
Some of the understanding in the work is derived from other sources it is not the students own thinking.
The work appears as a collection of separate pieces obvious connections are missed between key concepts. Clear evidence of critical judgement in selecting, ordering and analysing content and tries to construct a sound argument.
Identified and describe relevant legislation.
The work attempts to integrate all the key questions as part of a whole piece.
Clear evidence of critical judgement in selecting, ordering and analysing content to construct a sound argument which reveals occasional insight and/or originality. Work experience/real life example provided to show in depth understanding.
Evidence of an attempt to evaluate the relevant legislation.
There is a flow to the work and discussion of all the key questions fits together. There is some excellent evidence of originality and insight with current health and social care challenges included and an ability to sustain an argument based on critical analysis and/or provide recommendation.
There is an outstanding ability to synthesise material effectively and the potential for skilled innovation in thinking and practice is to be evident.
Amount of research and range of sources used
To deliver explanation of health social care standards and best practice
25% No, or little evidence, of reading from Reading Group articles
No or little evidence of reading outside the sources provided. Inappropriate sources used, i.e. no connection to key literature. Clear evidence of reading from the articles provided.
Some additional reading of health and social care standards.
There may be some limitations in ability to select appropriate material.
Little evidence of using real life examples to illustrate theoretical concepts.
Clear evidence of reading from the articles provided, appropriately used.
Additional reading appropriately used.
Some evidence of using case study examples to illustrate theoretical concepts, legislation and standards. Clear evidence of thorough reading from articles provided, appropriately used.
Very good breadth and depth of reading from outside those sources provided.
Uses real life examples to analyse the best practice.
An excellent reach of important literature and an excellent critical engagement with these sources.
Advantages of disadvantages of current practice discussed and recommendation. An outstanding reach of important literature way beyond the given reading list on theories, concepts and principles - and an outstanding ability to critical engage with these sources to find solutions for real life challenges from health and social care.
Written communication skills: structure (including word count) & appearance
Of case study illustrating HSC standards and behavioural theories 15% The work is poorly organised. The structure is confusing. The visual appearance is poor. The structure is fairly clear.
Although rather standard, there are no problems with the visual appearance. The structure is clear.
The work is well presented. The structure is very clear. Care and thought has gone into visual presentation of the work The structure is very clear. The work is beautifully presented - real care and thought has gone into it. An innovative presentation of ideas in the context of health and social care practice.
Written communication skills: spelling, punctuation, grammar and paragraphing 10% Major improvement needed in more than one of the following: spelling, grammar, punctuation & paragraphing. High number of errors. Major improvement need to be made to one of these 4 areas: spelling, grammar, punctuation or paragraphing. There are a small number of minor errors in spelling, grammar, punctuation and paragraphing. There are hardly any errors in spelling, grammar, punctuation and paragraphing. There are no noticeable errors in spelling, grammar, punctuation and paragraphing. The assignment is flawless also in terms the absence of any errors of grammar, spelling etc.
