1. Allied Health within the Community Independence Service Hammersmith & Fulham Penny Magud & Gillian McTaggart 12th November2014

2. The Community Independence Service
Is an Integrated Health & Social Care Crisis Response/Admission Avoidance Service within the community , 7 days per week
The Service operates a ‘virtual ward’ model of case management & care coordination to avoid unnecessary institutional care
Provides an In reach service into A & E/Medical Assessment Unit & the Older Persons Rapid Access Clinic (OPRAC) , as well as supporting earlier discharge & providing care to facilitate discharge
Provides an integrated Intermediate Care/Therapy Led Reablement Service for up to 12 weeks
Is the entry point for Health & Social care services

3. CIS service coordinator
Community Independence Service Structure 1st November 2014
CIS service coordinator
Assistant CIS coordinator
1 WTE
Assistive Technology Coordinator
1 WTE
Clinical nurse specialist, older age mental health.
2 WTE
Physiotherapy Clinical lead
1WTE
SPoR coordinator
1WTE
Community Independence Assistants Team Leader
2 WTE
Occupational Therapy Clinical Lead
1WTE
Nurse clinical lead
1WTE
Independent Living Assessment Team Lead
1WTE
Physiotherapy Team
6 WTE
Nursing team
6.2 WTE
Admin team
7 WTE
Assessor Group
10 WTE
Community Independence Assistants
30 WTE
OT team
7 WTE
In-reach Team
6 WTE

4. The development of the Community Independence Service
3 Separate teams across Health & Social care to 1 integrated Health & Social Care Service
Limited Allied Health Professionals in the services, 15 clinical Allied Health Staff within the team
Care being provided under an enabling ethos, without Allied Health oversight or governance, to a multi professional, multi provider service managed by a Physiotherapist
Unqualified assessing staff are now managed by an Allied Health Professional
Health & Social Care senior leadership & oversight provided by 2 Occupational Therapists

5. Core Achievements Implementation of a Workforce Competency framework
Development of a pre-registration to registered career pathway
The development of the Hybrid Worker programme - up skilling of unqualified staff providing non-invasive nursing & therapeutic programmes -
Multiskilled competencies developed for the Social Work, Nursing staff, Occupational Therapist’s & Physiotherapist ‘s within the service
Increased complex patients supported in the community out of institutional care
Increased patients whom have achieved their GOALS with the support of Therapeutic programme overseen by OT/Physio & under taken by CIA’s
Setting up & managing the ‘Virtual Ward’, across multiple professions & multiple providers.

6. Virtual Ward team Adult Social Care Community Independence Service
Patient
Case Manager
VW GP
Health & Social Care Coordinator
Community Independence Service
Adult Social Care
Other care providers community/
social/
voluntary
Hospital Consultant
Community Matron
GP Practice

7. Outcomes
Provision of in excess of 40,000 therapeutically delivered care hours last year for 1470 patients
45% of patients leave the CIS with no ongoing Health & Social Care needs
Since April 2014, 508 ‘virtual ward’ patients have avoided an unnecessary hospital stay
A further 468 people have been enabled to go straight home from A & E, avoiding unnecessary admission following a therapies assessment, review of their home situation & supported on the way home from Charing Cross Hospital
1000 bed days saved by providing a therapeutically lead in reach service enabling earlier supported discharge in 13/14