The project allows early intervention with customers providing a range of services aimed at decreasing their reliance on medical or other statutory provision. Many of the customers were socially isolated and did not know how or where to access services and community supports OPAL allows for the customer to gain information about local social activities, lunch clubs and advice and information on such issues as benefits, income generation, housing, support for carers and volunteering.
Information Services Division (ISD) was keen to further develop the Scottish Patients at Risk of Readmission and Admission (SPARRA) tool to identify patients who may benefit from a more anticipatory approach to their care; planning for events or exacerbations to reduce the risk of emergency hospital admission.
SPARRA is a tool which predicts a patient’s risk of emergency admission; a patient with a SPARRA score of 50% has a one in two chance of being admitted to hospital in the following year.
The negotiation of each organisation’s contribution to making the pathway work. Developing a pathway that is easy to access and offers the fallen person timely assistance. Promoting and embedding the pathway across all organisations.
The service was established in 1998 by Lochalsh and Skye Houisng Association to provide a ‘traditional’ small repairs service to disabled people and the elderly. Through collaboration with the Highland Council and NHS Highland it has since set up and operated Joint Equipment Stores in Portree and Broadford to collect, deliver and manage all equipment owned by Social Work Services and NHS Highland. The service also now includes telecare and occupational therapy support, and runs a demonstration/assessment room within Portree hospital as a training facility for the use and benefits of devices.
All these complementary services are aimed to support people to remain in their own homes and to shift the balance of care from hospital into homely settings. They illustrate the key contribution that locally based housing associations can make to the reshaping care agenda, working in partnership with health and social care.