In 2015, East Lancashire Hospitals NHS Trust worked with commissioners to transform community services.
They started to provide integrated care, coordinated around the needs of individuals in the community.
The trust commissioned the Intensive Home Support Service (IHSS). The model includes the social element of the Intermediate Care Allocation Team (ICAT). Combined with therapy and nursing, the team delivers fast access that deals with crisis intervention based on needs.
ICAT is a multidisciplinary community-based team. It takes referrals from a range of health and social care disciplines in both the community and acute sector. The team allocates short term, community care using a ‘trusted assessment’. This can be both step up and step down. It focuses on the highest need patients. Those at risk of hospital admission or requiring intensive support following hospital discharge.
The team provides rapid access to sub-acute and crisis care. The care is based on the needs of patients and their carers. And they’re supported in their own home or care home.
At first, IHSS consisted of nurses, physiotherapists and occupational therapists. They worked alongside social care staff.
Patients with long term conditions often manifest mental health anxieties. Recognising and managing these anxieties prevents attendances at the emergency department. So shortly afterwards, a mental health practitioner joined the service. The practitioner enhanced the service by supporting patients with those anxieties.
This multidisciplinary approach offers advantages in diagnosis and treatment. Shared skills and competencies make sure patients receive comprehensive care. That care meets their physical, mental and social needs that they can manage at home.
The team is now progressing from multidisciplinary to trans-disciplinary. Professionals within the team are moving out of their own discipline and undertaking other tasks and skills.
Therapists have developed skills and competence to undertake clinical observations. They record early warning scores and recognise the deteriorating patient.
An assistant practitioner now works across therapy and nursing. They provide low level chest exercises and order therapy equipment.
Existing assistant practitioners already provide a nursing function. The service has plans for them to gain competence and work across all disciplines.
One of the therapists is competent in venepuncture. Two of the advanced therapy technicians are undertaking the assistant practitioner training.
Effective staffing
This case study is part of a series that highlights what providers have done to take a flexible approach to staffing.