Post-Shielding Focused Support for our most Clinically Extremely Vulnerable (CEV) Residents: Engagement – Evaluation and Insight on Outcomes
Briefly describe the initiative/ project/service; please include your aims and objectives
This resident engagement activity was undertaken following the end of shielding for CEV (31 March 2021). We wanted to understand how people were feeling with regards to their health and wellbeing, and whether they were confident and able to get back into the community. Additionally, this would enable us to offer any connections or support where required. We took a preventative, proactive approach to try and identify the need for any care or support for those who may not otherwise have encountered services. This was done by:
– Having the use of a data set that would not normally have been available to us before the pandemic– i.e., CEV. This enabled us to target more effectively and overlay existing council data to further refine it, to fully utilise a finite staff resource.
– Focussing on trying to reach people early and pro-actively.
– Including Public Health staff, leisure and wellbeing, and health improvement staff.
– Using staff with good existing communication skills to talk to people and encourage people to talk more openly, using an asset focused conversation rather than a scripted call. Staff also felt it was a valuable thing to do.
– Identifying if people were digitally enabled or wanted to be – e.g. support through ‘Techmates’ for people who may not want to go out, but could link with people in other ways through technology.
– Identifying if people had experienced deconditioning/ falls and offer support through strength and balance, falls prevention assessment – which is important locally, as fall incidence are higher in Wigan than the North West and England for this age group.
We took a boroughwide approach to identifying and contacting our most vulnerable residents. We worked across various teams and departments within Wigan council and with our partners, sharing information where appropriate. Teams involved where from intelligence led roles, housing advice, falls prevention teams along with call handlers. The view was to be pro-active and engage with the residents we could identify as our most vulnerable. By doing this the aim was to support them and enable them to engage with services before their situation became critical or an emergency. By offering support/engagement with services and making contact, our aim was to help residents avoid things like falls due to potential physical deconditioning, and/or mental health issues arising from loneliness during the isolated times of the pandemic. In some instances, this allowed residents to access preventative services in their homes and to access support and services that they would otherwise not have accessed. This was confirmed via staff feedback. A key initial focus had been to give support to those that may have had some physical deconditioning due to shielding and worked with our NHS Falls Clinic at WWL to refer to an assessment. It was clear that this was only a small part of the holistic support that this group required to feel mentally, emotionally, and physically ready to emerge back into their usual activities. Those called could also benefit from; a friendly voice, access to voluntary services, strength and balance and exercise offerings via our BeWell service, social care assessments, housing support, along with escalation of emergency domestic violence situations or supporting those on the edge.
Aims and objectives
– To use the outcomes and appropriate analysis and interpretation to support better informed decisions for similar residents
– To share the learning internally and externally where appropriate e.g. across Greater Manchester
A cohort was identified from the CEV group. The aim being that the group may not be receiving regular or, indeed, any contact with services or community support. They were all aged 70 plus and:
– Had contact with us during the pandemic for support and had been Clinically Extremely Vulnerable (CEV)
– Were not open to social care or receiving homecare support
– Were not in a residential care
– Used the assisted bins service or had a Blue Badge
– Wigan Borough-wide
A letter was sent that pre-empted a well-being phone call
– 758 letters were issued
– Training given to staff making calls. The majority of whom were on redeployment from their usual role due to the pandemic.21 staff were call handlers
– Follow up work with staff involved, to gain further insight into what they felt were the positive outcomes and any potential lessons they feel we could learn. Feedback included: qualitative feedback (2 workshop-based focus groups with 17 staff) and quantitative feedback (in the form of an electronic survey)
What are the key achievements?
The main high level results showed that the impact of the call was, typically, wider than fall prevention and the aims were exceeded with the wellbeing of the residents being the prime focus. In terms of headlines:
– 86% of the residents mailed were contacted by phone
– 24% reported having had a fall
– 20% said they had a recent hospital visit/stay
– 9% had had a recent A&E visit
– 70% had an internet connection and 10% of this group had a Tech Mates support need
In all, 55% of those contacted were provided with information and/or had a referral 21 referrals to Adult Social Care and 17 to the Falls Clinic. There were 31 follow on calls made. Anecdotally, a high number of residents were feeling lonely and so referring them to Silverline or pointing them to the Keeping Well this winter booklet and telling them about services they could use was appreciated. Capturing if someone is feeling isolated /lonely would have been an advantage in the analysis and next steps in offering support. Many contacted did have support or no help needed
Key achievements include:
– Cross cutting work in various services/partners using accurate and appropriate data on our residents to support their transition out of shielding
– Using redeployed staff effectively and providing staff development
– Preventing emergency care services if falls prevention accessed/signposted to.
– Supporting vulnerable people’s mental health during the pandemic and therefore potentially helping prevent access to mental health services which were already overwhelmed.
– Signposting the most vulnerable people to services they may otherwise not have been aware of/accessed.
– Good PR for the council, showed the vulnerable residents that we were being pro-active and caring of their circumstances which most people really appreciated more than anything else.
– The residents contacted had a conversation that could – and did in many cases – cover wide ranging topics from simply a friendly chat and some signposting to ongoing referrals to council, voluntary and NHS services
Using the falls prevention tool (PHE) and considering potential hospital and social care costs. We have surmised some approximate potential cost savings:
– 10 falls assessments (8 positive outcomes, 2 potentially prevented falls, 1 potentially prevented fracture). These were conservative estimates based on the incidence of falls and hip fractures in the population in the cohort in the Wigan borough
– 2 emergency hospitalisations
– 1 hip fracture
– At least £42,500 in hospital costs alone
– £60k benefit to maintained quality of life through prevented falls (Fall Prevention Tool 2018)
Clearly there were costs associated with the activity:
– Staff time for calls – Most staff were redeployed so were not able to deliver their usual roles e.g. library and leisure staff
– Cost of mailing letters
All participants in the focus groups agreed that:
– The calls were very valuable and in many instances the CEV people were unaware of the services they were directed to.
– It was a worthwhile exercise – some people saying it was essential.
– Most people agreed that IT/Digital ways of accessing services were a big issue for many people they spoke to.
How innovative is your initiative?
The innovation came mainly through the joining up of services; including with our NHS Falls Clinic. In breaking down the barriers between sharing the information and contacting residents directly, we were able to support residents and offer advice and pass on information about alternative support/voluntary groups, helplines etc.
We utilised the database and SQL coding to join the datasets which provided us with a cohort of our most vulnerable residents. This built on development work started during 2020 at the height of the first wave of the pandemic. Another key innovation was to have an open discussion with the resident. This led to a range of support services and/or long conversations to gain a full understanding of the needs of the individual resident.
In April 2021, Inspiring Healthy Lifestyles staff moved to Wigan Council and this engagement started to be developed. This was the first integrated engagement with BeWell (was IHL), Public Health, Redeployed staff supporting Customer Services and the Analytics team working together. Asking the call handlers to take part in one of two focus groups was another creative approach used in this activity. This wasone of the most insightful and pivotal moments of the work, as the analysts, call handlers and senior service staff could seethe wider impact of the work including the impact on staff.
What are the key learning points?
We directed residents to already established support/services in the council and from partners and voluntary groups/charities, breaking down barriers and attempting to by-pass some of the “red tape” that Local Authorities are sometimes accused of putting in the way. This allowed us to put the residents needs and wellbeing at the forefront of what we were doing. Residents who may have just allowed their circumstances to become overwhelming or a bigger issue where offered preventative support and signposted to support that they would not have accessed if it wasn’t for this project.
Mental health has been a huge factor during the pandemic and loneliness was highlighted on numerous calls. By offering advice and signposting to services such as carelines some residents stated how much better they felt just knowing that we cared and that there was support if they should need it. Not only could this be seen as “good PR” for the Council, but it shows that we are actively trying to work together to prevent already stretched services being accessed if avoidable. Some points that emerged via the staff focus groups included:
– Understanding the true value of the connection /conversation in preventing isolation and giving the message of support
– Added value in support to health and well being
– The biggest impact potentially being at an individual level of feeling supported and being offered help to find services if needed as opposed to having to make the first contact although the well-being impact is difficult to quantify but mental wellbeing, activities and feeling supported have a key role in physical wellbeing
– Access to accurate referral information is key and this can quickly get out of date
– Need to have the contact information on support partners kept accurate and accessible as well as Local Authority support
– Training to the callers (Including a “crib sheet” with key information) was critical to confident and supportive conversations with residents
– Training was given on the Falls Conversation Tool
– Giving time was key. Some calls were close to an hour long and could be emotional for resident and also staff. Staff needed support too
The engagement was successful in terms of positive outcomes for residents. We want to continue to monitor this cohort and investigate if their longer term outcomes e.g. less falls, can be partially attributable to engagement with services earlier. Capturing the details of the calls focused on fall prevention but for a repeat or analogous activity, wider factors would be appropriate e.g. is resident isolated, level of use of the internet (we just asked if they have the internet), how they want to receive information from the Council e.g. some were happy to receive emails or texts.
Possible next steps/discussions we have identified following on from the success of this project:
– Future engagements should provide more stringent evidence for pro-active contacts
– Enhance this engagement approach to an alternative cohort e.g. more targeted
– More rigorous, systematic identification of risks in the older population would enable:
– Ongoing identification of emerging groups of possible vulnerable/at risk people
-Target on-off contacts and/or
– Rolling programme of contacts
– Investigate the use of engagement, such as this one, to inform integrated care and funding discussions
This engagement should be considered as a regular activity. It could be resource intensive and potentially the criteria for future cohorts needs to be further risk stratified to be viable. But, talking to vulnerable, residents works!