Early Indicators of Concern in Care Services

Monitoring the Application of the Findings

Observations on the Pilot of the Early Indicators Across Both Service User Groups

Following the training and information sessions in the summer of 2012 six teams were asked to try out the early indicator tool and process:

• Dundee Older People Review Team
• 2 Older People Community Mental Health Teams (NHS)
• 2 Older People Care Management Teams (Local authority)
• Dundee Adult Learning Disability Team (NHS and Local authority)

The teams interpreted the process or application in slightly different ways in accordance with their own situations and existing practices. The aim was to encourage flexible and creative approaches rather than to prescribe a set procedure that should be followed by each team. It was hoped that such flexibility would enable the project team to learn more about how best to apply the information identified in the research.

The local authority teams involved did begin to use the computer based recording system that had been constructed. For one team in particular this helped them to manage information that was being gathered in respect of whole services, as opposed to individual service users. Therefore this enabled a database of services (rather than individual service users) to be constructed which potentially could be accessed and added to by practitioners and team managers. For this Older People Review team it did become common practice for practitioners to record their concerns (Early Indicators) on this database and for staff to consult this database when reflecting on a whole service.

It is interesting to note that the Older People Review team did report that this 'whole service' focus had existed prior to any involvement in the early indicators initiative and therefore did not necessitate any significant shift in thinking.

In the other teams the application of the tool and information was much more mixed. Individual practitioners did report that they had recorded their concerns and made sure that this information was added to the database of services. However, a more common picture was that practitioners were inconsistent in their recording and sharing of information with regard to concerns that they identify. This does not mean that they did not take appropriate action when necessary, but that they did not use the early indicators process to record and share these concerns.

Two main barriers to implementation became apparent during the trial or pilot period. First, it is apparent that without agreed organisational procedures, guidance and training, the use of any such system for recording and sharing will be inconsistently followed and therefore may be less helpful. Responses from the teams concerned suggest that for priority to be given to such a 'new role', the identification and discussion of early indicators must become a recognised part of wider, protection or other care monitoring, procedures.

Secondly, across joint health and social care teams there was discovered to be significant ICT compatibility problems which prevented many staff from being able to share any information collected electronically with colleagues. It appears to be essential to ensure that appropriate and effective data sharing systems are available to all practitioners.