Presentation slides Frailty: building understanding, empathy and the skills to support self-care

www.england.nhs.uk

Long Term Conditions Lunch & Learn

Frailty: building understanding, empathy and the skills to support self care

With Dawn MoodyDirector, Fusiion48

31 March 2016

www.england.nhs.uk

LTC Framework

Commitment to Carers

Frailty

Health AgeingGuide

Fire Service as an asset

Care Homes Quick Guides

Care & Support Planning

Navigating Health& Social Care

Self Care

Ambitions for End of Life Care

Our Declaration

Delivery Models

Planning for Change:• Capitated Budget• Contracting• Simulation Modelling

Patient and Service Selection

Planning for Change:Workforce

Whole Population Analysis;Understanding your population

LTC Dashboard LTC Toolkit

www.england.nhs.uk

Long term conditions resources

Simulation modelUnbundling recovery simulation model

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/house-of-care-toolkit.aspx

http://ccgtools.england.nhs.uk/ltcdashboard/flash/atlas.html

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-year-of-care-commissioning-model.aspx

https://bettercare.tibbr.com/tibbr/web/login

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/monthly-bulletins.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/long-term-conditions-improvement-programme/ltc-stakeholder-map.aspx

https://www.engage.england.nhs.uk/survey/ltc-declaration/consultation/intro/view

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/navigating-health-and-care.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-year-of-care-commissioning-model/long-term-conditions-year-of-care-commissioning-simulation-model.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-year-of-care-commissioning-model/long-term-conditions-year-of-care-commissioning-simulation-model.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-year-of-care-commissioning-model/long-term-conditions-year-of-care-commissioning-unbundling-recovery-simulation-model.aspx

http://www.nhsiq.nhs.uk/improvement-programmes/long-term-conditions-and-integrated-care/ltc-year-of-care-commissioning-model/long-term-conditions-year-of-care-commissioning-unbundling-recovery-simulation-model.aspx

https://www.england.nhs.uk/ourwork/pe/commitment-to-carers/

http://www.nhs.uk/NHSEngland/keogh-review/Pages/quick-guides.aspx

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/healthy-ageing/

https://www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/fire-asset/

https://www.england.nhs.uk/ourwork/pe/safe-care/

http://endoflifecareambitions.org.uk/

www.england.nhs.uk

7

Using behavioural change to open

minds

#A4PCC – Action for Person-Centred Care

Person with long term

condition

o Make a declaration at www.engage.england.nhs.uk/survey/ltc-declaration

o Tell your teams about our worko Encourage them to make a declarationo Ask them to feed back thoughts and

ideaso Use our hashtag – #A4PCC – when

you see work that is relevant to person-centred care for people with LTCs

o Let us know of any events, activities or social media opportunities that we can join forces with you

http://www.engage.england.nhs.uk/survey/ltc-declaration

http://www.engage.england.nhs.uk/survey/ltc-declaration

www.england.nhs.uk

Long Term Conditions Lunch & Learn

Frailty: building understanding, empathy and the skills to support self care

With Dawn MoodyDirector, Fusion48

31 March 2016

Frailty: building understanding, empathy and the skills to support self-care

31st March 2016Dr Dawn Moody

An opportunity to learn about some innovative approaches to making the

health and care workforce ‘fit for frailty’.

@Fusion48net@Moody_D_K

#frailty

www.frailtytoolkit.org 7

What are the aims of the session?

• To explore the Frailty Fulcrum as a tool for holistic assessment and management of frailty

• To hear how Virtual Reality is being used to build empathy for older people living with frailty

• To learn about the impact of a county-wide, multi-agency, multi-professional training and toolkit for care professionals working with older people

7


What we are going to cover

• The importance of supported self-care for people with frailty

• An introduction to the Frailty Fulcrum

• FrailSIM - a Virtual Reality experience to build empathy

• Integrated training & person centred case studies

• The Frailty Toolkit App.


What is ‘Frailty’?

A state of reduced resilience and increased vulnerability

A state which minor events can trigger disproportionate adverse outcomes in health, wellbeing or functional ability

Related to, but distinct from, ageing, comorbidity and disability

Delivering safe, effective & consistent care to people with frailty is the greatest challenge facing the NHS in 2016 and beyond.


What is self-care?

Regulatory Preventative

Reactive Restorative

Self-care

Recovery & rehabilitation

Health & well-beingDaily Living

Diagnosing & dealing with symptoms


Supported self-care

What’s required:

1. Engaged, informed individuals and carers.

2. Professionals who recognise the central role of the person in their own care and are committed to partnership working.

3. Care systems and services that are organised in ways that enable individuals, carers and professionals to work together.

‘Supported Self-care’ is the process of assisting people to manage their own care in a way that helps to improve their quality and experience of life.


Empowerment

CapabilityMotivation

Enable individuals to develop skills in self-care and to use technology and equipment.

Understand the emotional, behavioural and relationship

factors

Moving from ‘recipients of care’ to equal partners in care

Principles of supported self-care


Ten components of care for older people

13

Shift to prevention and pro-active care:

1. Age well and stay well2. Live well with one or more

LTC3. Support for complex co-

morbidities / frailty


Person-centred

partnership

Engaging Family and Support Networks

Effective communications

Supporting Choice and Managing Risk

Maintaining skills and confidence

Deploying assistive

technology

Signposting and providing information

Skills for supported self-care









Frailty Fulcrum










The role of simulation in training

o Simulation Based Medical Education is believed to be superior to the traditional style from the viewpoint of the active and adult learning theories

o Generally used to simulate patient / person for practitioner to practice on e.g., mannequins, role play, actors

o Simulation suits allow practitioners to experience some aspects of an individual’s situation e.g., Age Simulation, Obesity simulation

o Suits tend to be difficult to scale up and easily change the environment


The basic idea for FrailSIM

1. Create a virtual living space, building in clues about the person’s situation and interest

3. Develop a scenario that gives the user simple tasks to do to experience life as “Victor”

2. Develop an avatar that can have different levels of frailty-related impairments


The learning goals

1. “Virtually” walk in the shoes of an older person with frailty to increase understanding of their situation and help develop greater empathy

2. Promote observational skills and develop greater awareness of clues in the environment about an individual and their situation.

3. Deploy novel assistive technology to support training goals and thereby mirror one of the skills for supported self-care


Key facts from FrailSIM to date (1)

320+ individuals40+ roles

50+ organisations

93%of participants rated it ‘good’ or ‘excellent’ in terms of helpfulness in building empathy / walking in the shoes of an older person with frailty


Key facts from FrailSIM to date (2)

14.6Average number of years participant had worked in the health & care sector

27%Of participants rated themselves as 5 out of 5 for familiarity and comfort using smart phones

What words would you use to describe the VR experience to a colleague?

85% of participants were female









Training event design principles

Integration

Individuals

Innovation


Mid Notts Transformation Programme (inc. PACS

vanguard)

Open to all…

26

Domiciliary Care providers

Care Homes

Primary & Urgent Care

Community & Mental Health services

Acute servicesNottingham University

HospitalsSherwood Forest

Hospitals

City Care

County Health Partnerships

226 Practices

85 Nursing Homes

131 Residential Homes

100 Provider “locations”

Nottingham City Council Nottinghamshire

County

Council

South Notts Transformation Programme

Nottingham City CCG (inc. Care Home Vanguard)

Nottingham North & East CCG

Rushcliffe CCG (inc. MCP vanguard)

Nottingham West CCG

Newark & Sherwood CCG

Mansfield & Ashfield CCG

Health Education EnglandSkills for Care

Nottinghamshire Healthcare

East Midlands Ambulance Service

Age UKBritish Red Cross

Nottinghamshire Care Homes Association

Nottingham Community & Voluntary Service

Carers Trust

Dentistry, Pharmacy, Optometry

OOHs ProvidersAdult Social Services

Adult Socia

l Servi

ces

Fire & Rescue ServiceHousing Associations


Multi-agency, multi-professional to support person along journey of care

Open to all

Table planning to ensure multi-agency MDTs on the day

Lots of interaction through doing work together

Quiz as Ice breaker

Sharing cases through Fulcrum exercise

Help & hinder: roles within the wider system (and shared frustrations)

Home and hospital-based case scenarios

Time and space for networking over lunch and at breaks


Putting the older person with frailty at the centre of the training

Case introduced through VR simulation

Care planning exercise starts with video using actors for Vic & Kath plus memorabilia

Victor’s story

“Voice of” cards available for both stories plus additional input from facilitators

Case introduced through hospital-based MDT role-play

Care planning exercise starts with video using relatives’ voice over of Nirmala & Baldev’s story

Nirmala & Baldev’s story


Outline of the day

Outline Timings Session0915 - 0930 Overview of the day0930 - 0950 Team quiz: Concepts & Consequences of Frailty0950 - 1100 Understanding frailty

1100 - 1115 Break

1115 - 1230 Frailty & Supported self-care1230 - 1245 Introducing the Frailty Toolkit App: Learning Zone & Enabling Zone

1245 - 1330 Lunch

1330 - 1345 Overview of the afternoon’s programme1345 - 1515 Supported self-care along journeys of frailty - Case-based scenarios, Part 1

1515 - 1530 Break

1530 - 1615 Supported self-care along journeys of frailty - Case-based scenarios, Part 21615 - 1635 Presentation of supported self-care plans1635 - 1650 Introducing the Frailty Toolkit App: Development Zone & Feedback1650 - 1700 Recap of the day and close


Evaluation of outcomes of training

+37%92%

of participants rated the

training ‘very effective’ or

‘effective’

1

On a scale of 1 - 10 how well do you

think you have achieved your goals

from the training?

10

7.8


Three biggest challenges for training programme

Reaching 700+ primary care and social care providers!

Trust in Special Measures unable to release staff for training


Development of shorter training modules

• 2 hour sessions

• …. 1. Raising awareness of frailty and supported self-care

2. Case-based multi-agency, multi-professional team experience









Toolkit as an App: basic functionality

34

‘Web-based application’ that is platform agnostic: works on Apple or Android devices, desktop or laptop

Basic log in functionality set up as part of registration process for training event

Consistent ‘look and feel for ease of usability Clear structure of drop down and expandable

menus and sub-menus, lists and features Search function and ‘tagged’ content for ease

of navigation Access to videos without leaving application Links to external content available Localisation of content in key menus (e.g.,

directory of services / resources) Highly scalable for increased numbers of users


Add to home screen for ease of access


Search function


What is available now?1. Home: Welcome page, latest additions

2. My profile: Change profile, log out, bookmarks

3. Concepts & consequences: Contextual reports and background information

4. Learning Zone: A range of modules covering frailty and supported self-care theory & principles

5. Enabling Zone: Supported self-care planning templates

6. Development Zone: Additional training & education resources

7. Case studies: 3 examples of person centred care to bring the theory to life plus a service innovation

8. Directory of resources: Links to helplines, support and assistive technology relevant to clients and their families

9. About the Toolkit: Background to the development and contacts

Frailty: building understanding, empathy and the skills to support self-care

Dr Dawn [email protected]

An opportunity to learn about some innovative approaches to making the

health and care workforce ‘fit for frailty’.

@Fusion48net@Moody_D_K

#frailty