Effectiveness Day : Case Load Weighting Friday 29 th November 2013 Where People Matter Most

Case Load Management  Case load weighting – mechanism to ensure that the demands on care coordinator time are manageable and to support delivery of a high quality service (Care, Communication).  Committed to improving the service user experience by providing high quality clinical interventions that promote recovery and well being (Compassion, Commitment)  Need to ensure clinical staff are empowered and enabled to spend a significant proportion of their time (at least 50%) in direct client face to face contact (Courage, Competence).  Ensure that direct clinical care is provided in line with evidence of best practice and effectiveness is managed and organised in a clinically safe way that minimises risk (Care, Compassion, Competence).

Case Load Management Tool  Lead professionals have been working together to pilot and evaluate a case load weighting tool  Tool from North East London NHS Trust; full review of tool / study in Nursing Times 2007*.  Recognise limited tool for measuring performance as it does not take account of the quality of the contacts, need to be used alongside service user reported outcome measures as well as internal quality assurance tools * ‘Workload weighting in community mental health teams’, 17 April, 2007, VOL: 103, ISSUE: 16, PAGE NO: 32-33

Aims  to promote the delivery of high quality clinical services.  to ensure clinical staff have manageable caseloads.  to ensure equity of clinical caseload between clinicians and teams.  to ensure individual clinicians and teams have caseload levels that are clinically safe and appropriate.  to support performance management of teams and individual clinicians.

How does it work?  Three identified ‘routine’ indicators of demand on care coordinator time alongside an additional category ‘extra-ordinary / additional demand’. The routine demands are: ALevel of risk /vulnerability BCare co-ordinating CTime commitment Extra-ordinary / additional demand category: DIndirect professional demand/additional responsibilities

Scoring  Normally agreed within supervision between manager and care coordinator  Every open, allocated case scored against each of the three main indicators (A, B and C) on a scale running 0-5 risk/vulnerability 1-5 in terms of Care co-ordination/advocacy 1-10 for Time Commitment D is scored by time spent in activities – working on an agreed set of activity times for our Trust 225 WTE (all 4 scores together)

Pilot  Looked at 13 cases loads and scored A-C – desk top exercise  Shared with care coordinators to establish WTE and additional non-caseload commitments (D)  Useful tool to enable consistency across teams and standardised approach (FACS / Clustering aligned to scores)  Useful to identify step up and step down in care pathways  Key to work with care coordinators and mangers in supervision  Further work required to establish Trust approach

Next steps  Trust wide Guidance  Average / standard time for non case load commitment / activity  Roll out for all teams to use and feedback results  Clarity on resources and pressures  Further recommendations Management supervision - monthly basis with pro forma to record scores and discussions Monthly management audit forms to be completed Update amigos to include a supervision tab for recording discussions re case and plans for service user