« Previous | Contents | Next »
Listen
Integrated Care for drug users: Principles and practice
ANNEX 2B
ABERDEEN CITY DAT INTEGRATED CARE MODEL
Background
In January 1999 a Project Development Manager was appointed and two working groups established, a Project Management Team and a Project Implementation Team, both of these groups had representatives of the main drug service providers within Aberdeen City each looking at management implications and operational implications respectively.
The project is an Aberdeen City DAT initiative. The project manager is hosted by NHS Grampian and the funding for the project has jointly come from DAT members NHS Grampian and Aberdeen City Council.
Horizontal and Vertical Integration
The IDS development has attempted to integrate the range of services involved in delivering drug treatment and care. What has also been of value has been establishing a mechanism for linking strategic management with operational management by having sub-groups of the DAT to take the development forward.
Phase 1: Integrated Infrastructure
The first phase of the IDS focussed on developing infrastructure changes that would allow organisations to work with clients together without changing the structure of the services. Some of the key features developed include:
Agreed Model of Integration
Common Assessment Form
Review Form
Case Closure Form
Care Plan
Referral Form
Agreed Key-worker Job Description
Agreed Referral Criteria between agencies
Agreed Care Pathways
Agreed methods of multi-agency Working
Multi-agency Assessment Panel
Common Policy on Confidentiality / Sharing Information
Operational Handbook / Training and Guidance Notes
The project took an operational approach to development by attempting to develop integration through joint casework.
Some of the principles that we attempted to establish were that assessment was continuous and that assessment was a passport into the range of care required. By developing four care pathways that required different levels of information sharing, the issue of confidentiality could be managed to suit the client.
A key feature of the IDS at that stage was the development of "Assessment Panels". The term Assessment Panel is inaccurate and would have been better described as multi-agency case conferences. Ideally the Assessment Panels would have developed into managing their own budgets. The key principle of the facility was to have a regular "forum" where key worker could confidentially discuss cases and care plans on multi-disciplinary basis.
Phase 2: Structural Integration
As the first phase started to develop a number of issues arose which began to drive forward discussions about changing the way that services were delivered. A number of national and strategic guidelines were also beginning to shape service delivery - in particular the Scottish Executive's "A Joint Future".
Staff involved in working with the IDS felt that as services were still delivered by separate organisations there often was not a consensus about what the treatment and care objectives were. There still maintained a culture of individual organisations wanting faster referral rates into other organisations rather than actually delivering integrated care.
From these discussions initial plans were drawn up that started to build multi-agency "teams" around GP practices and other identifiable client groupings. However at this time there were no additional resources to take this further forward.
The background context to this is that the Shared Care Scheme, which had GPs at the front line of delivering treatment services, was becoming overloaded and GPs increasingly dissatisfied with the specialist level of treatment they were expected to deliver as waiting times to the specialist service grew.
During this time discussions took place about establishing a core set of treatment and care objectives. Services for drug users have traditionally been delivered on a "functional basis" with clients attending a range of professional services to gain support. The developments proposed a move from "functional" based service delivery to "process" based service delivery. At the core of this process are the care and treatment objectives of:
The DAT agreed that from now on service outcomes, design and development would be centred on these objectives. The objectives were then incorporated into a "whole system" Treatment and Care Process. This is illustrated in the figure below.
Discussions are taking place to establish an Integrated Care Planning Service which will be delivered multi-disciplinary team of Nursing Staff, Specialist GPs, Care Management and Voluntary Sector Staff with a key objective of
stabilising the client's lifestyle through medical and social interventions.
Discussions are also taking place to establish a Community Rehabilitation Service that will be delivered by a multi-disciplinary team made up from voluntary sector partners with specialisms in drugs, accommodation, training, employment and benefits advice. The key objective being to help clients
Move On from their drug use and
Move Out of services.
What we have learned / things that helped and hindered
There are pros and cons to taking a bottom up approach to change management
Having supportive GPs involved is helpful
The publication of the Joint Future Report was helpful although time-scales and targets for substance use would have been especially beneficial
EIU publications that highlight the requirement for integrated services are helpful
Organisational managers took differing approaches to implementing and driving change within their organisations
Competitive culture for resources within the voluntary sector can lead to fragmentation and resource led development
The wide range of funding streams that do not require DAT approval fosters fragmented service development
A specific commissioning and development budget for the IDS could have been helpful
The sheer volume of client demand and staff caseload affects service development and change
National initiatives that cut across national strategy and local initiatives generally are not helpful
Organisations locked into legacy databases find it hard to implement new assessment forms/ developments
Investment in IT and development of IT strategy locally and nationally
Lack of resources: Aberdeen has the third highest drug prevalence in Scotland but receives the second lowest funding in Scotland per patient
National standards against which to develop and measure integrated services would be helpful
A national definition / model of "Community Rehabilitation" would be helpful
« Previous | Contents | Next »