FAME Strand Products

PIVOP - Supporting Older People

Steve Batley

Project Director

Single Assessment Process

CIBER UK has been working with health and social care partners in the Woking area of Surrey to deliver a working electronic Single Assessment Tool. The solution has been live since May 2004 and is currently being rolled out.

The following health and social care organisations are partners of the project: -.

  • Woking Borough Council
  • Surrey County Council North West Area Adult and Community Care
  • Surrey Heath and Woking Primary Care Trust
  • North Surrey PCT for Community Rehabilitation
  • Three GP practices operating from the West Byfleet Health Centre
  • Ashford and St Peters Hospital Trust

The project’s aim is to develop a system and process that improves the way older people are jointly assessed for their health, social care and housing needs. As a means of achieving the aim, the objectives of the project are to: -

  • Develop a system and process for exchanging information and improving workflow between different health and social care providers
  • Develop a Single Assessment Process (SAP) solution
  • Provide more cohesive services
  • Deliver a cost efficient high quality service
  • Share the learning from the project

The benefits of the project for both the service providers and service users are as follows: -

Service Provider Benefits:

  • Immediate access to more accurate, comprehensive and up to date information about the service user
  • Easy and intuitive to use
  • Improved workflow
  • Assessments completed more quickly enabling a faster more coordinated response to service users
  • Efficiency gains through reduced duplication in time spent completing and updating assessments
  • A more structured assessment process
  • Better resource utilisation

Service Users Benefits:

  • Not having to repeatedly give the same information to different service providers
  • Receiving assessments that are more person centred
  • Having a named care coordinator where the needs, and resulting assessment process, are complex
  • Taking ownership of a person held record, summarising key pieces of information relating to the assessment process
  • Receiving a more cohesive and responsive service from different service providers
  • Knowing that the service provider has more information about their overall care needs
  • Knowing that the service provider has the ability to immediately share and act on their care needs (with their consent)
  • Having the opportunity to give a more comprehensive explanation of their health, care and housing needs to service providers

“As a GP, involved in SAP development and implementation both locally and nationally, I have found the Ciber approach innovative and practical.  The approach is based on the needs of clinicaI staff, in ease of use as well as in supporting care delivery. Consequently, frontline staff are enthusiastic about the Ciber solution. I am very pleased with the results so far in Surrey.”

Dr. Chris Dunstan , a member of the SHA Clinical Advisory Group and a reviewer for NPfIT SAP Best Practice Group

Delayed Transfers of Care

Liquidlogic has been working with Wirral MDC to develop and deliver a model multi-agency (Health & Social Care) collaborative information sharing solution for joint working to address, amongst other things, delayed discharge and assessment-management. The main focus areas of the model have been to:-

  • Achieve rapid and effective information sharing of patient services between health and social care teams whilst respecting privacy and citizen’s rights.
  • Provide an adaptable and scaleable solution that is replicable to other local authorities.
  • Enable collaboration in order to provide a co-ordinated and seamless service to appropriate services.
  • Reduce duplication of assessments and services.
  • Provide a road map of processes and workflow that deliver the whole single assessment solution.

The model uses Liquidlogic’s multi-agency workflow application, protocol, to deliver a mechanism to share data appropriately between agencies and individual practitioners and to manage processes and tasks across organisational boundaries. Practitioners can access the system via a standard internet browser from a variety of mobile devices as well as their desktop.

The application uses a secure system of logging on, equivalent to that used by the majority of financial institutions, whereby users are asked to provide their unique ID, password and responses to secure questions. The system has also been configured in close consultation with Wirral to reflect the locally agreed Information Sharing Protocols between participating agencies, thereby dictating what information can be seen in the system by which practitioner.

The application has, embedded within it, the EASYCare accredited assessment instrument, which has been developed in conjunction with the Centre for Studies on Ageing at Sheffield University. This allows practitioners across all participating agencies to assess the needs of elderly people within the community using the electronic assessment instrument and for them to refer cases on for further, more in depth assessment electronically. The system will allow them to ‘track’ the referral to ensure that it is picked up and actioned by the recipient agency.

The information which is captured as a result of these assessments is then fed into an ‘overview assessment summary’ to give a complete, holistic picture of that elderly person’s needs and involvement with other agencies. Where there has been a requirement identified to pass some of this information back to ‘back office’ health and social care systems Liquidlogic and Wirral MDC have agreed interfaces to allow this to take place.