Swansea - establishing a 'Paris Theme' in the delivery of community services
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The first Paris implementation within social services, incorporating a single client record (the first in Wales), was within the learning disability service with direct input from Bro Morgannwg NHS Trust. Community mental health followed shortly after with practitioner teams provided jointly by both social services and Swansea NHS Trust. The implementation of Paris into services for elderly and disabled people, also working collaboratively with health partners, was completed in the autumn last year. Work with the Swansea LHB (?) on funded nursing care assessments and continuing care assessments has only recently been completed.
With a long history of multi-organisational partner engagement, undertaken to provide the best possible service and care to their clients, the City and County of Swansea have accomplished a highly successful transition from paper to multi-disciplinary electronic recording, taking their NHS partners with them on the journey. By any standard this is a commendable performance for an organisation of some 200 practitioners when compared with the approximately 4,000 community and ward staff employed by the local NHS.
Social services considerable success with the implementations across services to date has reinforced their enthusiasm to maintain impetus and make additional change. Management and service leaders agreed to further enhance their system by meeting the requirements of the Welsh unified assessment (UA - SAP in England) and the care programme approach (CPA), all joined together and including risk management assessment for individuals.
They are one of the few organisations to have fully combined the UA, CPA and risk assessment tools all in one place. Other developments currently in progress include plans to extend the Paris system to encompass children with an integrated children’s system and to take the system forward into elderly mentally ill (EMI) in the current calendar year, which will see joint working expanded even further.
According to Chris Maggs, head of adult services in Swansea and sponsor of the Paris implementation, they have very clearly established a “Paris Theme” in the delivery of community services in the City and County of Swansea. He said that the implementation, although very successful had not been without its trials and tribulations, adding: “In an undertaking as extensive and intensive as this has been, and in completely uncharted territory, we must expect to face and overcome many hurdles.
“We have been very fortunate in the calibre of our management team and staff who have shown extraordinary resourcefulness, commitment and endeavour and a willingness to proceed until a solution was found. It has been this very quality, coupled with the nature of the system, that has engendered a spirit of openness and communication across all our service teams in our own department and, through example, has strengthened the joint working with our health partners.”
This is clearly illustrated with the success they have achieved with adults with learning disabilities and mental health; joint working in these areas encouraged their health partners to consider using the system in other areas of service. Now the nursing care assessment team is currently process mapping and looking at how the system can be made to work for them.
However, although social services and health already had that underlying commitment to joint working in some services, social services found that working with their local NHS trust at times extremely difficult, which created huge tension. Chris explained, “On the health side of the business in terms of, for example, the unified assessment, they have so many staff that we needed to engage with us that it really was a very major challenge.”
Their small team had to work with the trust and engage virtually every nurse on every ward, every OT, every district nurse, physiotherapist and community professional, all of whom is expected to understand the basis of the UA, that they found was a serious challenge. But, they do have established process and are fortunate that locally the NHS actually has access to the Paris system on the wards. They have set up separate mental health ward teams with Paris as read-only for the moment. Its use will increase as social services develop things and it is expected that other pockets of the trust will be using the system more in the near future. Also, work is currently on going to extend Paris into A&E, acute admission wards and community nursing services.
Social services Paris project manager, Tony Brindley, believes that the Paris implementation has been an enabler that has opened up many opportunities. He said, “Paris is working well because this has never been an administrative process, it is entirely clinically driven, the work has been done by practitioners to actually, very carefully, process map what they did, then design that into the system to link their practice needs. The system is flexible and capable of being adjusted and further developed to meet our local needs.
“It is certainly assisting us in achieving greater efficiency and effectiveness and people are saying they can get even more from the system and, importantly, they are actually talking to each other now, discussing achievements, exchanging notes and experiences. We now have various groups set up to look at what the training needs are, how to deal with individual cases, or how we look at our own eligibility criteria. We also have trainers in-house to support the system; they are on call to go out to meet teams or individuals whenever needed. Communications have increased dramatically.”
The council has a statutory responsibility for gaining information, knowing how things are working and assisting with planning for the future, and they see IT development within the council as long-term venture. “Because we see the Paris system not coming to a situation where we think we’ve cracked it,” Chris commented. “It will evolve naturally, we will be looking at Paris finance, we will be looking into links with the care planning process, and no doubt we will continue to receive further guidance about things in the future. So we really can’t see a time when we don’t need additional support and development, new staff will need training and induction into using the system; it will be ongoing and the issue of engaging people will carry on.”
Practitioner reaction to the new technology has been mixed, Tony has found, and this has highlighted the importance of training and the importance of discussion, which can’t be overestimated in terms of joint working. Every change creates anxiety and confusion, but staff at Swansea Council and their health partners have come through that and are recognising the benefits and seeing their efforts come to fruition. What they have found interesting is that whilst for those who worked with the old system it could possibly be a challenge, for those staff joining after the technology was implemented they would find it very difficult to work in an environment where it didn’t exist.
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