HEALTH & SOCIAL CARE
PARTNERSHIP
STRATEGY
MainStreet was commissioned by North Ayrshire Health & Social Care Partnership (NAHSCP) to provide strategic planning support across various services within Learning Disabilities in North Ayrshire. This involved determining the ‘why, what, who, how & when’ components of how NAHSCP designs, commissions and delivers services (directly or with its partners) over the coming years. As well as providing a framework for further discussion: NAHSCP, users and partners will continue to plan service re-design and other changes.
In doing so, MainStreet engaged with key staff, partners (including providers), service users and their support networks.
HEALTH & SOCIAL CARE
PARTNERSHIP
MainStreet was commissioned by the new Health & Social Care Partnership to review the partnership’s CAH provision, on which it spends £14m per annum. In delivering the review, MainStreet conducted interviews with over 100 CAH, wider NAHSCP professionals and service users (with a special focus on whether services assist in meeting wider partnership outcomes); and to outline and assesses possible alternative ‘good practice’ organisation and delivery models for CAH and its interfaces with health. MainStreet’s comprehensive report was delivered and presented to the Integrated Joint Board.
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“MainStreet’s work was excellent: they engaged well with all our key groups and presented considered and well-evidenced findings and recommendations. They’ve given us a firm foundation for future development of CAH locally.”
David Rowland
Head of Service Health & Community Care
North Ayrshire Council
MainStreet is undertaking an objective review of the partnership’s current operating model. The work involves working closely with senior managers to explore capacity, workflow organisation, processes and systems (including management of risk) as well as reviewing progress against the integration scheme.
Outputs will include:
- the extent of integration across component parts of social care in Clacks and Stirling
- the care pathway as understood across the Partnership, including use of EI&P, SDS and multi-disciplinary teams
- approaches to risk management, with particular focus on statutory obligations
- areas of good practice and their applicability across the rest of the Partnership
- areas for service development, including an outline improvement plan.
In preparation for the implementation of the new Carer’s Act in 2018, MainStreet helped the Partnership develop and produce a policy document that can be accessed by the public and clearly explains its position on respite and short breaks. The policy set out what Short Breaks and Respite are and how they can be accessed locally, information about the Partnership’s assessment process, what Short Break and Respite options and services are available locally and nationally, and how these link with Self-Directed Support arrangements. The work was carried out in consultation with carers and individuals in receipt of services in South Ayrshire, and with local short break service providers.
The completed policy will be used as a context to inform the commissioning of new respite and short breaks services from 2018 onwards.
YOU
In April 2018, Places for People Scotland Care & Support officially become an independent, Scottish charity called with YOU. The new organisation provides a range of services across Edinburgh and the Lothians including support for people with Learning Disabilities and Autism, people affected by poor mental health, older people, young people and people affected by homelessness.
MainStreet has provided light-touch support to the senior team prior to and after the transition to the ‘new organisation’. That work has included:
- Defining requirements and procurement documentation for IT and telephony support for the new organisation 2018-2021
- Determining an appropriate risk management system for the new organisation
- Facilitating discussions on with YOU’s Five-Year strategy (2018-2023), which included discussions with service users, board member and staff.
& ARRAN
MainStreet carried out a high-level appraisal of the Community Eating Disorders Service (CEDS) delivered by NHS Ayrshire & Arran (‘NHS A&A’) in 2022. Senior staff wanted the review to provide objective advice to inform its direction over the medium to long terms.
Our work included 30+ interviews and discussions with staff and other stakeholders from across Ayrshire & Arran.
The findings included:
- Recognition that services are delivered by a committed staff group who have coped well with considerable changes – tough financial environments, health & social care integration efforts across three partnerships, and COVID19 delivery changes
- That CEDS has met its original goals from 2009: to reduce referrals outwith Ayrshire & Arran (and subsequent cost)
- Appreciation of new challenges from increased demand and case complexity – as well as provision for anorexia and bulimia, increased recognition of binge eating and avoidant/restrictive food intake disorder (ARFID) and others
- A clear, shared view that CEDS should have interests beyond its caseloads – including developing early intervention and prevention capabilities as well as shaping and commissioning support in the community for sustained patient recovery.
The main output of the project was designed around a revised patient & carer journey. It assumes that subsequent work is not a ‘fix’ to existing services but design of a new provision. That work is now being taken forward by service staff locally.
Image from BEAT, the national eating disorders charity
MainStreet carried out a detailed service review of the Addiction & Recovery Services in East Ayrshire. Senior staff were concerned that the teams involved in the services have been subject to significant change in the past few years, not least in responding to the specific requirements on Medication Assisted Treatment Standards (MATS). Some operational issues had emerged.
Our work included a review of various documents, interviews with over 60 stakeholders including staff, service users, partners, the recovery network and the Alcohol & Drug Partnership. We also conducted a SWOT analysis, set out the current situation and made over 40 prioritised recommendations.
Our work painted a mixed picture. Whilst the services have a passionate and dedicated staff and do life changing work, they are experiencing some operational difficulties. The recommendations focused on:
- immediate mechanism to address internal tensions
- new arrangements for airing frustrations/addressing internal tensions
- commitments on internal communications
- a shared vision for the services, co-developed between staff, users and partners
- a renamed service to better emphasise the treatment and recovery aspects of the service
- better appreciation of likely demand
- better geographical spread for service delivery
- commitments on improving the accommodation.
We brought our work together in a report, which we presented to the project steering group. We also presented the findings to staff, who have been asked to prioritise future service development.
& ARRAN
SERVICES
MainStreet was commissioned by NHS Ayrshire & Arran (NHSA&A) to review their Children’s Services. They wanted advice and support to review the current pathways and services available to children and families whose care in Ayrshire & Arran is supported by (among others):
- CAMHS
- in-patient Paediatrics
- community Paediatrics
- CEDS
- Neuro-developmental services.
They believed that the core challenge was a fragmentation and inconsistency of delivery for children and their parents/carers in need of support from these services – in terms of assessment, case ownership, expectations setting & management, information sharing, governance, systems use, and underpinning processes. There is a sense among senior staff that while the majority of patients in these services never see the others, there is a group that sits between services who are not well served. A particular focus might be patients for whom ADHD is the primary diagnosis.
During our review, we interviewed 26 staff across NHSA&A, NAHSCP and North Ayrshire Council, reviewed relevant documentation and facilitated two workshops. Our work showed a hugely complex situation through which staff, patients and families must navigate. A system that has a single NHS Board (with a mixed geography including rural areas and an island); three HSCPs; five services; and several health & care specialisms. Our review included the following specific tasks:
- undertook a situation analysis
- drafted a new vision, mission and objectives for the service
- developed a detailed pathway for patients with ADHD showing all the interfaces
- set out a relationship map (see image above) showing the complexity of the system and the many interfaces
- proposed a new demand management system to address the increase in recent demand
- wrote a detailed prioritised programme of activities for staff to manage the necessary changes.