Early intervention and timely access for service users and carers
Experience across a range of health settings suggests that for some people, early access to services results in better outcomes. Developing systems to ensure timely access to AHPs for service users and carers will contribute to the prevention of hospital admissions, reduce length of stay and ease transitions from hospital care to the community, probably resulting in outcomes that are clinically and cost effective. AHP services therefore need to be reconfigured to provide interventions in different locations and at different times.
Realising Potential made two recommendations on promoting early access: encouraging full engagement of AHPs in facilitating early access and promoting collaborative cross-sectoral working to ensure the provision of integrated services and smooth transitions for service users and carers.
Much good practice in this area existed before Realising Potential was published and further good practice examples are now emerging from NHS boards. It is too early to expect all services to have adopted this approach, but the good practice examples that do exist provide pointers for other services on how early access can be provided. These examples include:
- an occupational therapy assessment clinic in NHS Fife that is enabling earlier cognitive and functional assessments for older people
- an integrated service involving NHS Shetland and Shetland Islands Council through which clients are able to self-refer, enabling swift and appropriate assessment of need
- an early intervention service and integrated group programme in NHS Greater Glasgow and Clyde for people aged 16 to 35 who have early psychosis
- the development of new models of partnership working with colleagues in the fire service in NHS Tayside
- early access through self referral to an evidence-based service provided through an individual placement and support (IPS) model in NHS Lothian
- partnership working in NHS Lanarkshire that is building on social prescribing to enhance social capacity of localities to pilot a community clinical model supporting early intervention and self-management
- job clubs in Dumfries and Galloway facilitated by mental health occupational therapists and vocational support workers from Support in Mind in which participants are offered individually tailored support to maximise their potential to move into and sustain mainstream employment or volunteer worker roles; the model is now being rolled out across the region.
Some indicators of elements that support early access approaches are also beginning to emerge. Integration of AHPs within specialist teams, such as those who provide services to people with dementia and their carers, and the capacity to provide autonomous AHP services are typical of the kinds of circumstances which, when in place, can facilitate early access for service users and carers.
But there is not a sense yet of a consistent national approach to engaging AHPs in facilitating early access to services. It seems probable, therefore, that a "national model" of how to facilitate early access is unlikely to develop. Instead, local needs, local circumstances, local ways of working and local motivation will most likely be the greatest drivers for creating innovative local approaches to enabling service users and carers to fast-track access to services and reap the consequent benefits. Realising Potential, which sets out to provide national support for local implementation, offers AHPs and AHP directors an opportunity to develop such approaches within their own NHS boards.
Email: Elaine Hunter
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