ADULT SOCIAL CARE FEATURE
While stories in OTnews often help to put members in touch with each other to share good practice , few have prompted as much of a response as a feature carried a year ago on a social care team that overhauled its assessment processes to better focus its care .
The feature on the adult social care Reigate and Banstead locality team in Surrey ( OTnews May 2020 , pages 25 to 27 ) documented how the team ’ s new five-step process helped it to handle referrals ( see page 40 ).
With the new process , the team had cut waiting lists and an £ 85,000 annual bill for outsourced assessments , so it ’ s little wonder it prompted such interest .
Jonè Vosloo , the assistant team manager at Reigate and Banstead , who instituted the changes , said : ‘ I contacted all the people who got in touch with OTnews about the article and we had Teams meetings with all of them . It was amazing and I loved it ; I remember how before five-steps we were desperate and the fivestep programme rescued us . I saw the same desperation for so many of the other teams .’
The Scottish twin Among them was Clare Serginson , the occupational therapy lead of the community team in the Shetland Islands , who Jonè now calls her ‘ Scottish twin ’. After speaking with Jonè , Clare adapted the five-step process for her own team , resulting in positive feedback from staff and users alike .
Says Clare : ‘ Working in local authorities is not a glamorous part of occupational therapy and doesn ’ t get much publicity , but we punch above our weight . Our colleagues in social work often seem to think there ’ s more of us than there are because of the reach of the service .
‘ But it was coming into last May and I felt a bit depressed that we were going to end up with the same situation as before lockdown with a high waiting list . So much change had happened during the first lockdown , but not in a direction that was helpful to us .
‘ One of my colleagues told me about the OTnews article ; I read it and it was like a shot in the arm for what we ’ re doing . I emailed Jonè and I ’ m so glad I did , because she was so enthusiastic straight away to share what they had done .’
Clare had already started to look at reviewing their processes and reviewing their waiting list , but what the Shetland team wanted was a way to structure the change . ‘ We had a waiting list of 100 people before we looked at triage , which for a small service like us can be demoralising ,’ says Clare .
After Clare spoke with Jonè and received her materials , she started to look at how she could institute the whole process in Shetland – moving more support to provide on-the-day solutions , providing more equipment , information and advice without requiring full blown occupational therapy appointments .
‘ The five-step triage from Jonè gave us a way to work through it while keeping flexibility , putting more onus onto the client to get more information ,’ says Clare . ‘ What I tried to bear in mind is , having an occupational therapy assessment is a precious resource , and we need to make sure that people who have them really do need them , so we ’ re using our resources appropriately .
‘ The duty process on the day used to deal with emergencies and put cases on the waiting list , but five-step is a lot more proactive . Everyone gets a conversation and we see what on that day can be done to sort that problem out , even if it ’ s just a little bit of problem-solving through equipment .’
Bringing about a culture shift
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What I tried to bear in mind is , having an occupational therapy assessment is a precious resource , and we need to make sure that people who have them really do need them , so we ’ re using our resources appropriately .
A big part of the change at Shetland has been about bringing in a culture change , moving away from waiting on providing everyone with a specialist occupational therapy assessment , and instead towards seeing how else they can be supported . Says Clare : ‘ Some staff found that difficult , as there ’ s a lot of value in doing a home visit as you see the environment . A remote assessment is not easier , and you have to relearn and think smarter about what you want to do – we find we have to prepare more beforehand . But people were willing to give it a go , and as we ’ ve gone through this we have been proactive in reviewing it and seeing what people think about it .’ Technology has also been more fully embraced , with the team ’ s intake forms asking clients if they would be willing to use technology to find solutions for them , such as a greater use of video calling – something that clients , including lots of older clients , are .
The Shetland team has now been able to cut their waiting list down to 20 . Clare thinks the waiting list would be gone if it wasn ’ t for the impact of COVID-19 and maternity leave in the team . Clients have given positive feedback , and Clare is now looking at how to best capture and evaluate the work , and also how the team can provide videos and other information via a local website to meet even more local need .
‘ It ’ s been so fruitful to have worked with Jonè ’ s team and I can only thank them for their generosity ,’ she says .
Deepening the work at Reigate and Banstead In Reigate and Banstead itself , the five-step process is still in full use , with work focused on deepening the implementation .
Key to that has been reiterating a focus on strength-based working , with a shift from a subjective , objective , assessment , plan ( SOAP ) approach , to a story , analysis , plan approach .
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