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Integrated Community
Support Teams (ICST)
East Kilbride and Strathaven
Lanarkshire
Where did we start from
• Stakeholder event – Tentative model
• Information sessions with staff
• Ongoing development sessions with staff
and carers and stakeholders
INTEGRATED COMMUNITY
SUPPORT TEAM
• ICST uses a township based, whole
system approach to support the health and
social care needs of older people. The
twenty four hour, seven day service allows
them to remain in their community setting,
for as long as possible.
Integrated Community Support
Team
LTC Team Leader
District Nurses
Community Staff Nurse
Clinical Support
Workers
Physiotherapists
Occupational Therapists
Admin & Clerical
Social Care Team
Leader
Social Workers
Homecare Team Leader
Homecarers
Social Work OTs
Carers
3rd sector
support
Specialist
nurses
Specialist
AHP’s
Community
Mental Health
Other change
fund projects
Falls TeamDischarge
Hub
Rapid
Response
Community
Geriatrician
Pharmacy
GP
Bases
OVERNIGHT ICSTs 1&2 and HOMECARE
DISCHARGE HUB in HAIRMYRES HOSPITAL
ICST 2
GREENHILLS
HEALTH CENTRE
ICST 1
HUNTER
HEALTH CENTRE
GP caseload
Population=35,603
3,196>65yr
2,536>75yr
700>85yr
GP caseload
Population=31,808
3,447>65yr
2,164>75yr
670>85yr
Social
work and
Homecare
Civic
Centre
PROCESSES
• Eligibility criteria
• Referral process
• Single Point of Access
• Documentation
• Info sharing – MIDIS and e-care viewer
• Equipment
• Supporting groups e.g LCG, RAG,
Practitioner Group, Lead Professional
SUCCESSES
• Motivation levels of existing staff
• Commitment to improve the experience of
individuals using the service
• Continuity of nursing services
• Improved practitioner communication
• Staff feel they are offering much more for
the person
• Single point of access
Successes
• Commitment from all disciplines and partners
• Leadership and a robust consultation process
• One nursing team 24/7 with additional co-
located Homecare overnight
• Joint processes and procedures for Health and
Social Work
• Greater respect and understanding of roles and
responsibilities; this has brought about a blurring
of professional boundaries with integrated
outcomes for the person/carer
Challenges
• Recruitment , new and changes
• Accommodation Issues
• Responsiveness/ flexibility of agencies
• Cultural Change for Staff
• Contractual changes for some staff
• Size of teams
• Agreement of processes within different
organisations
Challenges
• Changing traditions and cultures
• Having one discipline manage multiple
professionals
• Lack of co-located facility
• Negotiating new interagency boundaries
• Demonstrating the achievement of the set
strategic outcomes for the project against
a backdrop of an ever changing political
agenda
What do staff say
• They did not feel that there was enough representation
from them at the planning stage.
• Some people found it difficult to adapt to the organic
growth nature of the project
• They would have liked definite policies and procedures
at the beginning
• All liked that they helped the project to grow, this was
empowering
• Communication was much improved and speedier
between disciplines
• There is now a sense of identity with ICST
What staff say continued
• The outcome for the individual and their carers/family is
much better
• The use of other agencies such as the voluntary sector
has improved
• The blurring of the professional boundaries continues to
develop
• Their understanding of each others roles and
responsibilities is far greater than before
• I.T. has to improve to enhance what is being delivered on
the ground
• A joint management structure is the way to go

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S42 Integrated Community Teams

  • 1. Integrated Community Support Teams (ICST) East Kilbride and Strathaven Lanarkshire
  • 2. Where did we start from • Stakeholder event – Tentative model • Information sessions with staff • Ongoing development sessions with staff and carers and stakeholders
  • 3. INTEGRATED COMMUNITY SUPPORT TEAM • ICST uses a township based, whole system approach to support the health and social care needs of older people. The twenty four hour, seven day service allows them to remain in their community setting, for as long as possible.
  • 4. Integrated Community Support Team LTC Team Leader District Nurses Community Staff Nurse Clinical Support Workers Physiotherapists Occupational Therapists Admin & Clerical Social Care Team Leader Social Workers Homecare Team Leader Homecarers Social Work OTs
  • 5. Carers 3rd sector support Specialist nurses Specialist AHP’s Community Mental Health Other change fund projects Falls TeamDischarge Hub Rapid Response Community Geriatrician Pharmacy GP
  • 6. Bases OVERNIGHT ICSTs 1&2 and HOMECARE DISCHARGE HUB in HAIRMYRES HOSPITAL ICST 2 GREENHILLS HEALTH CENTRE ICST 1 HUNTER HEALTH CENTRE GP caseload Population=35,603 3,196>65yr 2,536>75yr 700>85yr GP caseload Population=31,808 3,447>65yr 2,164>75yr 670>85yr Social work and Homecare Civic Centre
  • 7. PROCESSES • Eligibility criteria • Referral process • Single Point of Access • Documentation • Info sharing – MIDIS and e-care viewer • Equipment • Supporting groups e.g LCG, RAG, Practitioner Group, Lead Professional
  • 8. SUCCESSES • Motivation levels of existing staff • Commitment to improve the experience of individuals using the service • Continuity of nursing services • Improved practitioner communication • Staff feel they are offering much more for the person • Single point of access
  • 9. Successes • Commitment from all disciplines and partners • Leadership and a robust consultation process • One nursing team 24/7 with additional co- located Homecare overnight • Joint processes and procedures for Health and Social Work • Greater respect and understanding of roles and responsibilities; this has brought about a blurring of professional boundaries with integrated outcomes for the person/carer
  • 10. Challenges • Recruitment , new and changes • Accommodation Issues • Responsiveness/ flexibility of agencies • Cultural Change for Staff • Contractual changes for some staff • Size of teams • Agreement of processes within different organisations
  • 11. Challenges • Changing traditions and cultures • Having one discipline manage multiple professionals • Lack of co-located facility • Negotiating new interagency boundaries • Demonstrating the achievement of the set strategic outcomes for the project against a backdrop of an ever changing political agenda
  • 12. What do staff say • They did not feel that there was enough representation from them at the planning stage. • Some people found it difficult to adapt to the organic growth nature of the project • They would have liked definite policies and procedures at the beginning • All liked that they helped the project to grow, this was empowering • Communication was much improved and speedier between disciplines • There is now a sense of identity with ICST
  • 13. What staff say continued • The outcome for the individual and their carers/family is much better • The use of other agencies such as the voluntary sector has improved • The blurring of the professional boundaries continues to develop • Their understanding of each others roles and responsibilities is far greater than before • I.T. has to improve to enhance what is being delivered on the ground • A joint management structure is the way to go