1. Single Assessment Process Regional Overview from North and East Yorkshire and Northern Lincolnshire SAP Learning Consortium.

2. Some Common Givens All Partners –are committed to focusing on the needs of users/carers at the centre of their processes. –have stages in their assessment processes identical to or similar to those outlined in SAP –have numerous examples of multidisciplinary teams –cover the domains outlined in guidance –have agreed common data sets –have agreed common assessment tools for their area –The majority have plans and timetables for detailed pilot work on electronic exchange of data and assessments However there are also a range of electronic pilots at different stages of development

3. Harrogate Pilot Fast Response Team -Intermediate Care Partner organisations: –North Yorkshire Social Services –Harrogate Borough Council –Harrogate Healthcare Trust An electronic pilot – EasyCare/MDS using Liquid Logic

4. The Craven pilot will include all elderly clients in the South Craven area. Partner Organisations –Social Services Community care Team –GP Practices, –Craven, Harrogate and Rural District PCT –Airedale NHS Trust. –Craven District Council An electronic pilot – EasyCare/MDS using Liquid Logic

5. North East Lincolnshire Patients of 1 Primary Health Care Team who are moving from community to intermediate care or from acute to IC. Partner organisations: –N. E. Lincolnshire Council –N.E. Lincolnshire PCT –Northern Lincolnshire & Goole Acute NHS Trust An electronic pilot – EasyCare/MDS using Liquid Logic

6. North Lincolnshire - -Scunthorpe Geographical location: specifically looking at the interface between intermediate care and two wards at Scunthorpe General Hospital. Partner organisations: –North Lincolnshire Council, –North Lincolnshire PCT, –North Lincolnshire General Hospital An electronic pilot – EasyCare/MDS using Liquid Logic

7. Scarborough Area Those patients referred to the Community Assessment and Rehabilitation Team from Filey Surgery Partner organisations: –GP Surgery and health team –Scarborough Acute Trust –Social Services team An electronic pilot – EasyCare/MDS using Liquid Logic

8. Selby and York PCT area Using SAP within an Intermediate Care setting – both residential and home based. Primarily for people aged 65 plus but not exclusively as some people under 65 can access the scheme if they live in their own homes, Partner organisations: –Selby and York PCT –Acute Trust –North Yorkshire County Council –City of York Council Will be a paper based process using locally developed tools

9. Driffield Alfred Bean Hospital & Hull, Acute Trust Pilots Driffield: District Nursing, community mental health team, care management team (Social Services), GP ward + Day hospital ABH, East Riding intermediate care Hull: NHS Continuing care team, two medical elderly wards (ward 5, castle hill hospital, ward 23 HRI), Integrated transfer of care team, social services – training & development team, and emergency duty team. Partner organisations: –Eastern Hull Primary Care Trust –East Riding of Yorkshire Council –GP Practices –Hull City Council –Hull and East Riding Community Health NHS Trust – Hull and East Yorkshire Hospitals NHS Trust – Private Residential Homes – Voluntary organisations e.g. Red Cross – West Hull Primary Care Trust – Yorkshire Wolds and Coast Primary Care Trust An electronic pilot – EasyCare/MDS using Liquid Logic

10. The Hambleton & Richmondshire pilot is around the Independent Living Scheme at the Friary Hospital, Richmond. 12 community hospital beds and 6 intermediate care beds. Partners: –NYCC Social Services, –Hambleton & Richmond PCT, –South Tees NHS Trust and –Key GP Practices An electronic pilot – EasyCare/MDS using Liquid Logic

11. Some Common Challenges Receiving a national direction and a set of principles in itself was not enough Long discussions and delays nationally on accredited assessment tools initially focused the attention on tools and not processes. The initial national emphasis seemed to be on electronic process..e.g. Cambridge was the national example! The ultimate measure of success was lauded as a electronic assessment summary record. No understanding or investment on how this was to be delivered across wide geographical areas and across boundaries without IT systems. The stagnation of the National Health IT strategy resulted in a vacuum of planning and the absence of commitment to the SAP agenda. So at many locality levels there was no designated ‘lead’ from the start, problems with fitting SAP priorities within day jobs – no resources to fund roles. ‘Patient involvement’ is a difficult issue – older people are not keen on attending policy meetings Confusion by the sheer amount of SAP information out there!

12. Some Common Challenges managing cross-boundary issues (e.g. a trust or team working with more than one area or organisation. unfamiliarity with new assessment tool, & any supportive IT supporting staff during a new learning process (when inevitably they will be under increased pressure), Freeing staff up for training in new common tools Getting understanding of acute Trust re: EPR & IT Integration of IT systems big challenge Getting agreed collective direction caused long delays. The cost & complexity of connecting a number of dispersed workplaces (always an issue in a rural areas), Some agencies see SAP as a very small part of their work and because of other major I & MT work and financial difficulties SAP until lately fell to the bottom. Paper based approaches across complex and widely dispersed localities is extremely difficult to manage

13. Moving Forward and making it happen –finding solutions. Working in focussed specific areas: –Teams where patient/user flows are shared:  Hospital discharge  Mental health teams  Learning disability teams,  Rehabilitation teams  The challenge involved and skills required to this not to be underestimated. Working in tight geographic locations Linking professions who are in close proximity  Linked to a GP Practice  Linked to a hospital ward or rehab unit or  particular rural area.

14. Moving Forward and making it happen –finding solutions. Agreed common assessment tools across agencies: –* LAs and * PCTs in the North East and Yorkshire and Northern Lincolnshire NHS Area are using Easy Care plus  a multiplicity of trial from which to share learning  the capacity and creativity to create common training programmes  Sharing of templates, job descriptions and committee/board papers  information sharing protocols will become more common across more boundaries. Driving towards a common IT infrastructure and architecture The whole area is a sub set of the wider geography covered by NHS Agent Accentua  One common SAP linking product - Liquid Logic  Common standards across GP practices, Acute Trusts, PCTs with LAs recognising the benefits of being part of the solution.  The common electronic record now becomes a tangible goal with SAP as its subset.  The test will be linking local authorities to this NHS Information Spine and the associated costs of this.

15. A recognition that success depends on having “a common mindset” User in the centre – a given. Common summary record..a given objective Requires common standards and standardisation of approaches Common language Shared skills Shared perception of risk Requires new incoming staff trained in SAP principles and approaches All existing staff to be similarly skilled. Large investment required in training Regionally driven & co-ordinated. Yet locally delivered. Academically accredited yet accessible to all

16. NEYNL – Proposed Virtual Learning Environment