Wendy Wallace explains how health, care, mental health and the third sector can work together
The Tile House
Tile House, a collaboration between Camden and Islington Foundation Trust and One Housing Group (OHG), provides supported accommodation for people who have complex long term mental health issues. It is an alternative to being hospitalised or being put in a care home.
We are proud to have been involved in such an innovative scheme – the first of its kind in the UK – which has helped save the NHS nearly £900,000, according to a report released at the beginning of the year.
The Tile House
Tile House opened in September 2012 and provides 15 high quality, self-contained supported housing units in King’s Cross, London for customers with a range of complex mental health issues. Each customer has their own flat which is designed to the same specification as One Housing Group’s private sale units.
The One Housing Group has collaborated with Camden and Islington Foundation Trust to provide a safe, positive and supportive environment to help customers with their recovery. All customers at Tile House are referred by Camden Council.
Need based
The nature of need among those at Tile House is complex and of a level that would not usually enable other forms of supported housing to offer the nature of support needed. Many of those referred to Tile House have issues around treatment or medication, they may have a forensic component to their mental health history or a history of placement breakdown.
They are often high risk, especially in terms of self-harm, and require clinical input to manage their mental health. Due to a combination of these factors and the complexities of their conditions they require a unique support system to aid their recovery and encourage independent living.
There are a number of clinical staff who manage the needs of the accommodation’s service users. All residents have access to support staff who are on site 24 hours a day and everyone will be allocated a key worker who will develop an individualised support plan.
‘They require a unique support system to aid recovery and encourage independent living’
On-site visits are carried out by a care coordinator, while an occupation therapist facilitates life skill training and a psychologist provides individual assessments and therapeutic interventions. The multidisciplinary team works closely to avoid crises in people’s care which very often results in hospital admissions.
Prior to moving to Tile House many of the service users had little engagement in social and community activities, but in this environment they are encouraged to maintain positive relationships and build these skills. This underpins part of the philosophy behind the project – service users are not just living with a mental health diagnosis, but living well.
Case example: Prevented admissions
Mark has a history of several suicide attempts, one of which had resulted in serious permanent physical harm. This stems from severe auditory hallucinations and paranoid beliefs during most of his life.
Mark had found talking about this difficult in his previous placements, and had often isolated himself.
When Mark moved to Tile House, the One Housing Group clinical lead worked closely with him to develop a positive relationship and encouraged him to attend the in-house hearing voices group with which he began to engage well.
This helped him to feel able to speak to the clinical lead and psychologist when his voices increased and he began to experience suicidal feelings, and reaffirm his crisis plan and coping strategies. The psychologist and care coordinator worked with all staff around containing a suicide crisis and how to approach the voice hearing experience in a non-challenging way.
Mark’s suicidal feelings continued for approximately two weeks before they subsided. The crisis was contained in-house through therapeutic intervention by the onsite clinical team with no change of medication or hospital admission being required.
Besides mental wellbeing
Good mental health and resilience are fundamental to our physical health but each cannot be thought of as separate entities. All Tile House residents are registered with a local GP and encouraged to raise any health concerns they have.
This has resulted in a few who have engaged in the stop smoking programme, a target which has been included in their support plan, and they all receive an annual health check. The staff also run cycling sessions, nutrition workshops and cooking groups to encourage them to think about health and wellbeing.
Critical to the success of the model is a shared approach to risk management and governance. As well as daily discussions with their key worker and weekly joint team meetings, Tile House is overseen by a strategic implementation board made up of senior managers from the One Housing Group and the FT.
The senior oversight ensures the momentum for the partnership is maintained and patient outcomes remain a clear focus.
Following their time at Tile House service users who would have been in very high cost placements funded by social care or hospital, move onto more independent
and often cheaper accommodation. We are proud to have pioneered an approach that so effectively delivers our values of a positive and dignified recovery journey for our patients.
The success of Tile House means we are committed to making the most of further opportunities and deliver the very best outcomes for our patients across London.
Wendy Wallace is chief executive of Camden and Islington FT.
From anathema to the answer: Technology’s emerging role in home care
The objectives are simple. First, the need to maximise operational efficiencies to meet current and projected fiscal challenges and demographic changes.
Second, to then deliver outcomes based care solutions that meet the expectations of funders and the increasingly complex personal needs and priorities of individuals.
Of course, on paper the objectives are straightforward. However, the practicalities of delivering effective, reliable, consistent, affordable and sustainable care in the home are quite another matter. And the disparate and evolving needs of individuals adds further complexity.
Knowing what’s gone before is not sustainable, Allied Healthcare are determined to provide their customers with the reliable and personalised care they rightly expect. So they’re gone back to the drawing board to determine how they can deliver person-centred care as efficiently and effectively as possible – and to do so within known funding parameters. The aim is to develop a comprehensive, truly integrated, scalable approach for the delivery of care services that will provide the required operational capacity in tandem with an unprecedented level of service personalisation.
Grasping the nettle
Although the health sector has benefited from technological advances over many years, when it comes to care in the home, service delivery is often still dependent on spreadsheets, handwritten instructions and manual interventions. Here, new technology has been pretty much an anathema.
Keen to test long held assumptions, the team set out to identify how, where and what technologies could make a real difference in delivering both operational and financial benefits in the delivery of person centred care solutions in the home. To do that in a planned and controlled way, a new method of working needed to be created that was more conducive to innovation and progression.
Technology experts were commissioned and they consulted extensively with the organisation’s care teams and commissioning bodies. This helped to develop a roadmap for implementing a new generation of care solutions based on new ways of working where both emerging as well as proven technologies could be harnessed fully.
And, significantly, the new model will move towards care to be measured in terms of effectiveness and wellbeing of customers rather than arbitrary records of visit, punctuality and duration.
Plans into practice
The first major step was the development of a new operational structure where care teams are created to focus entirely on local service delivery. The new approach provides the right processes and management structure to ensure the right people with the right skills are in the right place at the right time.
This provides the foundations for progressive service developments that fit the best processes and meet the real needs of those receiving care, as well as their families, regulators and, not least, the carers themselves.
The people and processes have been piloted and embedded in a number of community based branches. The team is now building on this by working closely with specialist IT software solutions companies developing new technology for service transformation, covering three areas:
- automated scheduling of visits, including route optimisation and all variables regarding the availability, experience and skillset of carers;
- digitised care plans for every recipient of care services; and
- mobile enablement for every member of a care team.
Critically, all of these initiatives have to be integrated fully to deliver real time information, service consistency and accountability if the risks of errors and delays arising from the manual routing and scheduling of visits are to be eliminated. Technology is enabling us to achieve just that. And carers have all the information and updated instructions at their fingertips and in real time.
Digitisation is the cornerstone
Digitised care plans and the mobile enablement of care teams are at the heart of the new service delivery model. Significantly, comprehensive and personalised care plans can now be captured on the secure smartphones, providing carers with all relevant instructions and constantly updated support information.
The new mobile enablement also provides automatic verification of visits using a near field communication devices and the ability to capture any early warning signs so that, for example, a care delivery manager can take prompt steps to arrange for the intervention of specialist support as required.
Ongoing analysis of the new digital data will help to constantly align the care being delivered with the outcomes that matter most to individuals and to the funders of care. This truly integrated and expansive approach will help to extend service capabilities and responsiveness.
It will also create new opportunities for dedicated portals for clients, customers and families, as well new gateways to client systems.
It is not change for the sake of change. The considered adoption of new technologies can help provide an even greater level of personalisation and responsiveness at a lower cost.
And this is being achieved at the same time as delivering new care paths, the transparency and greater accountability expected by regulators and the agility that is required in an ever changing care environment. All of this has only been possible by truly grasping the opportunities presented by new technologies.
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