Transcript 1 Lanarkshire (CONTINUITY) ICST birmingham feb

East Kilbride and
Strathaven
Liz Swan and Morag Hearty
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Population 88,000 approx.
Above Scottish average older age group
Scotland's first “New Town” in 1947
Both urban and rural areas
Mixed social strata
Large acute hospital –Hairmyres
Known locally for its traffic roundabouts,
snow and Strathaven “toffee”.
Discharge
therapists
Social work
OTs
Evening nurses
GP
Re
enablement
Home
carers
Physiotherapists
Night nurses
District Nurses
Social workers
Other
specialist
services
Older Person
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We needed to join people up into one team
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That we should not create a bolt on team
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Needs to be a neighbourhood model
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To enhance existing knowledge, skills and
practice, building confidence and resilience of
the local workforce
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To make the model sustainable
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GP’s wanted to remain responsible medical
officer for patients
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To provide safe, effective, person centred support
to enable people to remain safely at home for as
long as possible
When someone admitted to hospital support the
person to return home as soon as possible
To support older people with complex health and
social care needs to have their community care
assessments carried out in their own home if
possible
ICST
Other
specialist
services
24 hour Nursing and Home Care
Physiotherapists
Occupational Therapists
Social workers
Re enablement staff
Carers Support
rd
3 Sector agencies
Hospital discharge
Independent Providers
GP
Older Person
Even during the
night-amazing
It came at the right
time
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Adopted across NHS Lanarkshire
“Shared Care “ for tier 3 patients
Improve use of 3rd sector
Direct links with A&E and Scottish Ambulance
service
Step down beds in Care homes
Co Location
Scottish Health and Social care integration
Continue to listen to older people and
their carers!