How many times do the same questions get asked of residents who come into contact with a social care worker or a community health worker? From the most simple of questions such as date of birth and address, right through to what residents can and can’t do for themselves. Year after year residents in Havering and elsewhere talk about the frustration of having to repeat their story over and over again and ask themselves, do we not talk to each other?!

We’ve not cracked this chestnut completely yet, but we’ve definitely started the journey! We have integrated health and social care teams based in four health centres across the borough. Working closely with community health services means that we are able to provide a more holistic, joined up approach in our work with residents that ensures better care, helps to minimise risks and improves the experience of individuals.

The Community Learning Disability Team (CLDT) is a joint health and social services professionals. The team is made up of London Borough of Havering (LBH) and North East London Foundation Trust (NELFT) staffs. The team offers a service to adults aged 18 and over who may need help and support as a result of their learning disability. This may include people who also have additional needs, such as physical disabilities, mental health problems, challenging behaviour, sensory disabilities, autism, epilepsy etc.

The Team has the following specialist services; Community Nursing, Occupational Therapy, Physiotherapy, Psychiatry, Psychology, Social Work, Behaviour Specialists and Speech and Language Therapy. The team aims to provide high quality specialist services to ensure that people with learning disabilities are valued and accepted, afforded dignity and respect and have equality of rights and responsibilities with other members of society.

Our objectives relate directly to the things that people with learning disabilities have told us matter and the aspects of their lives where they need support; good information,help to speak up and be heard, help with life planning and making decisions, a place to live and support in daily living, enough money and help to manage it, learning, employment, everyday activities and social and leisure activities, keeping safe and feeling safe, keeping as healthy as possible, support for family and carers.

The team will work in partnership with service users, carers and statutory and non-statutory agencies in order to ensure the highest standards are maintained and the service evolves to meet their complex needs. The Team will work with mainstream services so that they are accessible to people with learning disabilities.

The JAD Service is made up of qualified social workers, nurses, occupational therapists and administrators. The Service brings together teams from Barking, Havering and Redbridge University Trust, North East London Foundation Trust, London Borough of Barking & Dagenham and London Borough of Havering. The Service is responsible for the safe and timely discharges of adults with health or social needs in Hospital. The JAD Service operates a seven-day working pattern.

Based in our local acute hospitals (Queens and King George, part of Barking Havering and Redbridge University Hospitals NHS Trust), is our multidisciplinary, multiagency Joint Assessment & Discharge Team. Our team has staff from Havering, the London Borough of Barking & Dagenham, our community health provider (North East London Foundation NHS Trust) and the hospital trust itself. It’s a busy environment, there is no doubt of that, but the social workers and nurses that sit within the team, work with residents across Havering and Barking & Dagenham who need support to get out of hospital.

The JAD Service works in partnerships with allied health professionals and our integrated approach means we are best placed to support the complex needs of adults with health and social care needs. Social Workers are expected to complete strengths based assessments under the Care Act 2014. Experience of completing Mental Capacity Assessment is an essential requirement as well as previous experience of multi-disciplinary working.

Each case has to be managed carefully using strong professional judgement and in a proactive and tenacious way in order to take responsibility for efficiently enabling patients discharge.

Social care is vital to the successful and safe discharge of people back to their own home. Supporting people with the right care and information at the right time can help prevent future need, enable independence and promote positive wellbeing that will empower people to live the lives they want to.

What is it like to have a sensory disability – whether than be from birth or due to disease or trauma – and how can we support people to maintain or regain their independence when they have a visual and/or hearing loss that affects their day to day life?

Our Sensory Team supports individuals to find solutions to challenges being faced and offers tailored information, advice and guidance. We can support with: specialist training, such as mobility and orienteering training or hearing aid management training; assistive equipment, to help individuals make the most of residual sight or hearing such as a TV listener or specialist lighting; minor adaptations around the home, such as tactile markings on the cooker or use of contrasting colours around light switches.

The Sensory Team prides itself on really listening to individuals about their strengths and aspirations as well as areas they might need support with.  Our service wants people to be as independent as they possibly can.

Most everyone likes to be involved in things that bring them together with other people, be that school, work, or socialising with friends. Why would having a disability or getting older mean that you or I are any different?

Where it fits the bill, we either commission or offer a range of activities for our residents.  An individual may be supported to access volunteering, leisure or work-related opportunities, education classes, college and other activities connecting residents with friends and family

In addition, we offer day opportunities located within specialist centres and community based activity programmes designed for each individual depending on their interests. Our internally offered day opportunity services are available for people according to their assessed support needs and are for those residents whose care and support needs (including providing their informal carers with a break) are particularly high

What would you want if you needed or started to need help to manage your house, or indeed yourself? You’d probably want support from people you can get to know and start to trust. You’d probably want services of a high quality, from friendly and committed staff, who treated you like, well, a human being.

In Havering we don’t provide services directly anymore (other than some day opportunities), so we continue to put a huge amount of effort in ensuring that services commissioned for our residents strive for and maintain quality.  Whether it be home care, residential or nursing care, or availability of services to buy via a direct payment, we work continuously with our Joint Commissioning Unit to make sure where it is needed, we have the right care at the right time for our residents.

The Havering Access Team is an integrated team consisting of social care, occupational staff and contact workers. The team functions as the  first point of access for service users and their carers who has care needs or are in  need of care or support in the community or residential care. The focus of HAT is to respond to the needs of service users using 3 part conversations ( part of the better living model initiative) to  address any urgent or presenting care needs to prevent/reduce risks and prevent them being dependent on social care support and help them to achieve their desired or assessed outcome(s).

Initial calls are undertaken by contact worker(s)/customer advisors who hold meaningful conversation(s)  with the service users by using conversation part 1  to establish service users strengths and capabilities and direct service users to resources/ support networks in the community. If there is need for crisis intervention, the contact workers would escalate the conversation to part 2 for senior staff to  pass over the case to a front line work to initiate conversation part two and provide short term services ( such as reablement).  Any long-term care services/support would be transferred over to one of the adult community services ( depending on service users locality) to assess ongoing care and support needs.