ISLE OF WIGHT COUNCIL SOCIAL SERVICES AND HOUSING
DIRECTORATE.
BEST VALUE REVIEW OF
COMMUNITY CARE SERVICES FOR OLDER PEOPLE AND PHYSICALLY DISABLED ADULTS 2001-02
1.1 INTRODUCTION.
The aim of the
review of community care services currently provided for older people and
adults with a physical disability is to consider their value and plan for
improvements. The purpose of the review is to:
·
Challenge and
improve existing provision.
·
Set clearer
objectives for services, guided by consultation.
·
Absorb the
views of inspection, review, guidance and good practice.
·
Compare with
other care providers.
·
Ensure fair
and equitable access and care.
The 1999 Joint
Review of Social Services drew attention to the need for improvements in
services for adults. These services have particular importance given the social
and economic composition of the Isle of Wight, together with the current pace
of modernisation in health and social care.
A Best Value review
of Care Management and Commissioning was undertaken in 2000-01, focussing on
‘how’ services are arranged. This review addresses the quality of ‘what’ is
provided. The reviews of 2000/01 and 2001/02, taken together, are expected to
improve services for adults.
The scope of the
review was identified after pre-review consultation on which aspects of
community care would benefit most from review. The chosen subject areas were:
·
Homecare.
·
Occupational
Therapy.
·
Meals
Services.
·
Information
and Advice.
·
Working
Together.
During
consultation, a set of criteria for assessing the value of services was
identified. These criteria match national research into service user views.
The criteria (in
no order of priority) were:
·
Choice.
·
A personal
and unhurried service.
·
Positive
impact on daily life.
·
Access to
advice and information.
·
Value for
money.
·
Community
care services that work together well.
The principal
stakeholders in this review have been:
·
Service Users
and Carers.
·
Voluntary and
representative organisations.
·
Council staff
and members.
·
Care
providers and staff.
·
Healthcare
commissioners and providers.
·
Housing
Associations.
1.2
OUTCOMES, OPTIONS AND RECOMMENDATIONS
1.2.1 MAIN
FINDINGS
The agreed scope
of the review highlighted three community care services and two critical themes
that influence quality and value in community care services. The theme of
information and advice, together with communication, has proved to be a
consistent issue in all review areas.
The main elements
of Best Value; Challenge, Consultation, Comparison and Competition, have been
applied to the services reviewed. To bring these elements together the summary
focuses on the main themes set out in the agreed scope of the review, looking
at each service or theme in turn.
The main
improvement issues have been found to be:
·
Improving the
service users experience of homecare and other home-based care services.
·
Improvement
of the Meals on Wheels Service.
·
The
development of a more comprehensive community disability service.
·
Significant
improvement in information and communication arrangements.
·
A greater
emphasis on health and social care services acting as a ‘Care Team’ from the
perspective of service users and their carers.
·
Ensuring that
service improvements are matched to existing improvement plans
Summary.
The Island has a
mixed economy in homecare provision, with a range of specialist care services
designed to support and promote independence for older and physically disabled
people. Services are well regarded by service users and carers, with a
sometimes exceptional level of service by carers from a variety of service
providers. Care is however often scarce, particularly in rural areas, with care
packages frequently using more than one provider. Care is also not always
available at times that best meet service user and carer needs. In addition,
the homecare workforce is not always as well trained, prepared and informed as
an increasingly personal service could be.
Significant
Findings.
During the last
few years, homecare has changed to providing more intensive personal care for
those most in need, often diverting people from hospital or residential care.
Change has reduced domestic and some preventative care.
Homecarers have
responded to this shift toward personal care with a growing concern for
training and the safety of caregivers and service users. There has also been a
growth in demand for specialist personal care skills and services such as
night-sitting and tucking-in services.
As a result of
budget difficulties in 2001, many care plans have been reviewed; with some care
needs now no longer regarded as meeting tightened eligibility criteria. This
change has resulted in anxiety among many service users consulted, that their
service would be withdrawn. Any continued reduction in spending on homecare may
also result in increased pressure on the viability of some homecare providers,
with some providers who are concerned over sustainability at current prices
withdrawing their capacity. These last two factors increase pressure on those
remaining in the market and on the in-house provider.
The shift to
prioritising those with the most intensive personal care needs will continue.
Some domestic care is regarded by those consulted with as essential or of
preventative value, and there is concern that people without domestic support
do not always have alternative means of coping. Pressure on care providers to
ensure that carers focus on tasks identified in care plans can cause
misunderstandings or anxiety in staff and service users, who sometimes feel
that their wider needs and well-being are overlooked.
Daytime personal
care is limited, but specialist home care services such as Tucking-in, Weekend
and Night-sitting services are highly valued and widely regarded as
under-provided. Recent attempts to increase capacity of these specialist
services have been unsuccessful; providers have regarded contract terms as
unattractive.
The homecare
market is comparatively open, with a changing but steady balance of personal
and domestic care shared between external and in-house providers. Many other
councils use in-house services for mainstream care, with external providers
taking up extra need or more complex care packages.
Changes to the
purchasing and commissioning of homecare set out in a previous review are
needed to improve care capacity, a primary factor in ensuring quality community
care. The review confirms the findings of the commissioning review of 2000/01,
which regards spot purchasing as necessary but not on its own the best option.
Consultation and comparison showed the value of basing services around
communities, estates or sheltered housing schemes. This could deliver some
domestic support, improve consistency and assist in the take up of Transitional
Housing Benefit. With the collaboration of landlords and homecare providers,
this could result in a significant improvement in care to many tenants and a
wider benefit in the switching of council funded care to other service users.
The low level of
investment in homecare services is a national concern. Recruitment and
retention difficulties are common to comparable councils, with agency closures
commonly resulting in a loss of staff and capacity to other markets. This often
leads to a background of inadequate market capacity, lack of carers and unhappy
care staff.
Many users and
staff feel that homecare increasingly relies on the goodwill of caregivers who
work within tightening time schedules and working requirements. There are
strong feelings among those consulted, including service users, that homecare
is unfairly regarded as a low status job. This appears confirmed by relatively
low wages.
At current
margins, homecare providers who do not have a sustainable private customer-base
see little return on investment. This will become more noticeable when the
National Standards for Homecare (2001) are implemented. Increasing management
costs to meet new regulation and standards will have an impact on trading
viability. Under-investment is a key barrier to sustaining and developing
homecare services.
Service standards
are closely linked to contract and service level agreement terms. New national
standards and inspection regimes may result in further withdrawal of market
capacity. Audit and investigation reveal that the remaining Island homecare
providers meet most of the requirements of the national standards, but gaps may
be costly to fill. Supervisory and training costs may rise steeply for
independent and council providers.
Staff and health
professionals are concerned that homecare, while generally good, has gaps,
often based on communication difficulties such as carers not always being made
fully aware of the users needs or what is required of them. Also critical is
management support for caregivers, which has significantly improved in recent
years. Some contract requirements such as the need for manual handling and
other risk assessments are still not always carried out, although since the
audit in 2001 this situation is improving.
Service users want
consistent and informed care from their homecarers. Consultation highlights
service user and carer need for well briefed, familiar, well trained and
properly equipped homecarers. Their experience is often that changes of carer,
including relief care, result in care being delivered in unfamiliar or
unsatisfactory ways.
With pressure to
maximise the benefit of homecare staff, carers are being used more intensively,
leading to increased travelling, increasing overtime and inconsistent
carer-user relationships. Benchmark community care services have contracts able
to provide continuity of carer in often intensive circumstances. Island care
providers are not able to provide such a service, with capacity stretched
across the Island.
The various
contributors to care at the service users home need to act as an informed team
or partnership. Review shows that in practice this partnership is sometimes not
present or is not working effectively.
Despite some
evidence of problems, stakeholders believe that homecare is value for money,
with ability to pay or a basic flat rate both regarded as an acceptable basis
for charging. Charges have been high compared to other councils, but increases
elsewhere have reduced any significant difference.
The cost of
in-house provision is the lowest among our comparable councils, with the Island
also paying the lowest fees for purchased care. The Department of Health rates
the Islands costs for homecare as ‘Good’, although they are at the very lowest
end of councils in this group.
A particular
concern of users is homecarer travelling time, which reduces the face-to-face
care time paid for by the service user. Service users are not always clear
about the terms that their care is provided on and what they can expect from
their service. This often produces the ‘rushing about’ and ‘hurried service’
much criticised by care staff and service users, and confusion over whether or
not a complaint is justified.
Choice of homcare provider
is not regarded as a highly significant issue for service users. Service users
and care managers are more concerned with getting a reliable and competent
service provider, tending to opt for the bigger providers.
The Occupational
Therapy service provided by the council is part of a jointly managed service
that includes Health Service Occupational Therapists (OTs). Service quality is
difficult to compare, but consultation describes the service as well regarded,
with a high degree of satisfaction for the personal style of service provided
by the OT staff and manager. The service is improving its performance in
delivery of equipment and services, now measured as above average in comparison
to other councils. The council service appears to compare well in waiting
times, but stakeholders would like to see these times shortened, in parallel
with a much clearer and more understandable role for Island OT services.
Waiting times are
the largest source of criticism. The current average longest waiting time for
assessment is 10 to 13 weeks although this was one of the shortest waiting
times found in comparable and benchmark councils.
The waiting time
is managed by systems found in comparable councils, including eligibility
criteria, risk assessment, self assessment, re-deploying tasks to unqualified
OT staff, a charge for minor adaptation services, a unified approach across the
council including close working with Housing Officers. The worst example of waiting
times is for adaptations funded by the Disabled Facilities Grant, administered
by the directorate, which can take up to a year, resulting from a need to
carefully manage a low government grant allocation.
Comparison with
similar councils shows that vacancies and recruitment difficulties suffered by
the Island are a common determining factor in waiting times. The service is
also comparably small and not well staffed.
The service has
poor public and user understanding of its role. Expectations of the service
vary widely. Despite its professional mission to rehabilitate and improve the
social and physical abilities of the people it serves, the service is generally
defined by its role in arranging aids and adaptations. The professional mission
increasingly matches a key requirement of national health and social care
objectives for older and disabled people, which may not be well served by the
focus on equipment and adaptations.
The relatively
small scale of the service is sometimes a disadvantage, with staffing
difficulties having a disproportionate impact on the service. This affects
ability to meet the service’s standards, which are closely linked to the
eligibility criteria and risk assessment framework. These compare well with
other councils in content, although there are no monitored measures on outcomes
other than those related to national returns.
Service users and
other stakeholders support change to a more holistic approach. This would
involve putting into practice the wider objective of developing the social and
physical abilities of service users, including children, learning disabled
people and the mentally ill. OT input can be critical in supporting the
development of intermediate and rehabilitative care. Consultation and challenge
indicate that there is considerable support for restructuring and bringing
together Island OT and allied services in order to improve performance across
organisational boundaries. Benchmark councils are making this change by
building a community disability service also embracing housing, health and care
management.
Some users and
health professionals also highlighted the need for people to make choices about
their OT support and the aids and adaptations they were given. There was some
dissatisfaction with a reliance on the OTs decision on what equipment is
provided, and no real choice of what may be available. There was support for
the establishment of an Island based Independent Living Centre, where aids
could be demonstrated and advice given.
The development of
‘General Practitioner’ OTs who support a patient across and through
organisational boundaries, and who can streamline assessment and decision
making, is now promoted by the professional body; a practice now emerging in benchmark
councils. Many OT staff support such a reduction in complexity for service
users, making the OT role more rewarding.
MEALS ON WHEELS SERVICES.
The meals on
wheels service is the largest provider of meals to older people and people with
a physical disability, receiving a questionably high but variable rate of
satisfaction among service users. The service provides meals, part prepared
food and, importantly, regular social contact to many otherwise socially
isolated and excluded people.
Despite high user
satisfaction ratings, the meals on wheels services has many ‘former’ users who
have not been happy with the meal quality, often people who had an alternative
to turn to. The key issues arising in consultation and comparison with other services
were the quality of the food and the social (and safety) benefit of the
delivery itself. The service requires improvement in management, cooking and the delivery of meals.
The quality of
uncooked meals delivered by the current wholesale provider (at a comparably low
price) has tested as good. The range and choice of dishes, the amounts provided
and the range of diet related options appear to offer value.
The directorate’s
Contracting Team manages the service despite there being no provision for meals
service management within the team with a growing contracting workload. The
service is audited for quality by it’s own management; not the case with other
community care services. Management problems have included cooking, delivery
and staffing issues.
Meals are cooked
at a small number of kitchens, often based in schools. Consultation and
evidence shows that there are some differences in the quality of meals being
prepared in different kitchens. The location of these kitchens, and the
relative importance of their normal role (for instance cooking school meals),
is a constant source of disruption and inconsistency. There is a need to
rationalise and invest in cooking arrangements.
Meals are
distributed by a volunteer workforce who are welcome visitors for many service
users. The service provides valuable social contact, and service users warmly
appreciate the meals delivery staff. There is concern over the future
availability of sufficient volunteers
Despite safety
measures and delivery agreements, there are continuing instances of meals being
delivered too early in the day. The food, while mostly in good condition after
cooking, often shows evidence of too long a period in warm storage. Existing
supervisory arrangements also require a great deal of trust in the delivery
staff regarding health and safety issues.
A significant
number of service users said that they would not be able to live at home
without the meals, or that the meals service and the social contact it brings
improved their quality of life. There is concern over the limited number of
days in the week when meals can be delivered; many would prefer cooked meals
throughout the week. The current service compares well with other areas on the
number of days it cooks and delivers food. The current four days per week is
often the norm in urban councils. In many rural areas, other councils provide
hot deliveries only two days per week. Some councils now only deliver frozen
meals once a week. Expanding the frequency and scope of the existing service
would require significant investment in cooking and delivery arrangements.
Users felt that
the service represented value for money, but that more menu choice would
improve the service.
Lunch clubs and
day centre meals provision are a popular service, some are full or part funded
by the council. Many clubs rely for their effectiveness on subsidised transport
or the users personal mobility. Organised transport is limited and centres
often rely on voluntary transport arrangements.
Other sources of
meals include ad-hoc contracting from meals providers. Despite the ability to
make use of community-based meals sources such as hotels, practical
difficulties and health and safety issues have so far limited this potential.
INFORMATION AND ADVICE.
Summary
The increasingly
complex nature of managing and providing community care is creating a shortfall
in information and communication arrangements. The marketing of services,
public access to information, and communication arrangements that protect and
benefit the service user are outstripping current arrangements and policies.
Public
expectations of health and social care services appear confused and lower than
expected, often influenced by the media. Service users and carers are also
sometimes confused over what services are available and what services can do.
Accurate and up-to-date advice that clarifies expectations is not always easy
to find from a variety of possible contact points.
Significant Findings
The quality and
availability of public information and advice about community care services is
increasingly short of what is expected. Recent attempts to improve information
have worked well; including the establishment of the single service access
point for adult services. However, pace of change together with increasing
expectations, has resulted in criticism of our ability to find, communicate
with, and inform potential service users and carers.
Comparison with
other councils showed that there is scope for improvement in public information,
advice and communications arrangements. Other comparably well-run information
services on the Island may provide important benchmarks or improvement
partners.
There is concern
among partners in health and social care, that channels of distribution for information
about services and service users have become overloaded and inaccurate, not
helping the right information to be available in the right place, at the right
time. The directorate has little or no resources committed to information and
communication, with time limited grants being used to fund the only information
professional available to the service. Despite praise for the content and
distribution of recent leaflets and campaigns, information about community care
services vital to service users and carers is often absent, inaccurate or lacks
suitable alternative media or communication methods. Despite current attempts
to improve communication with people who have communication difficulties, more
needs to be done to help people from a range of cultural backgrounds.
There is guarded
support for internet and electronic means of circulating information.
Stakeholders
identify a general lack of information that sets out clear expectation of care
services, charges and choices. This sustains low public expectations,
misunderstandings about care that is provided, and is a barrier to informed
comment or complaint.
Communications
between care management staff and care providers is mostly effective. However,
despite information on care arrangements and the details of care services being
made available in a form designed to be useful in the home, in practice this
information is sometimes omitted, late or inaccurate. The principles of Person
Centred Care Planning (‘Valuing People’
2002) and the Single Assessment Process (‘National
Service Framework for Older People’ 2001) will require improvements in
information available to users, carers and care providers in the users home.
Current information about care arrangements is frequently described by
stakeholders as confusing and sometimes misleading.
Safe care planning
and communication, together with performance management, make increasing
demands on information and communication systems. The directorate increasingly
relies on a database that struggles to cope with the information needs of care
providers, staff and service users. It also no longer adequately compares to
benchmark systems in use elsewhere. This situation increases fears over the
safety and accuracy of information. Performance information required by
managers and regulators is not readily available, and is sometimes expensive to
collect.
This review
examined how well services work at the users level. It is increasingly
important for health, social care and housing services to work together, in the
same way that care services, often sourced from different organisations, must
work well to succeed.
Consultation
indicates that organisations that work together directly with service users do
it well most of the time. There is a high degree of familiarity and close
collaboration between primary and acute health care, social services staff,
provider agencies and others including voluntary care providers. Care providers
want to be included much more as part of the ‘Care Team’. Some Housing
Associations feel that they could also contribute more to an integrated service
if they were regarded as part of the
‘Care Team’.
A significant
strategic observation of some stakeholders is that Social Services and
Healthcare services on the Island (and to a large degree nationally) are
budget-led. This makes rational planning, development and investment in future
services very difficult. A well publicised and consulted Commissioning
Strategy, which deals with demand, purchasing priorities and investment needs,
is sought by care providers and managers.
Stakeholders
expressed concern over a perceived failure to invest in preventative community
care services. The gap between the expectations and priorities of the
directorate and many important stakeholders appears to require constant
explanation and sensitivity, as do perceptions that some groups of service
users are better provided for than others, a view not supported by performance
information.
The scale,
organisational and political advantages of the Island have resulted in a
long-term ability to work comparably well with health services. The council is
also experienced at finding alternative means of providing services. Within
this context, the ability to form a Care Trust has been a subject of
consultation. With specific regard to community care services, and given the
very early stage of this model of health and social care, there is extreme
caution and a ‘wait and see’ attitude toward any early application to merge
health and social services, with the possibility of disruption and uncertainty.
At an operational
level there are differences in professional cultures that have made previous
changes sometimes difficult to realise. Future change and the continuing
development of Person Centred Planning, together with the development of new
services and structures will need to take account of robust professional and
organisational differences.
Day to day
communication between service users, care providers and care management staff
appears to work well but this can be inconsistent. There are instances where
changes are made to care plans by providers that the social work staff are
unaware of and this can have implications for complex and costly care plans
involving a range of services. There are also instances of care providers being
unaware that their care staff have changed the content of care, often for the
best of reasons, but with consequences that can undermine the objectives of
care.
The involvement of
a service provider in a joint assessment of need is recommended as good
practice. The provider’s advice and understanding of care needs, and their
capacity to meet the need, may lead to clearer understanding and expectation of
what is required. This does happen, but in the view of some providers is not
used frequently enough.
While recent care
management training divided staff into groups determined by their function,
this approach will not improve team working and highlights a lack of
inter-professional or inter-provider training or development. There is no
evidence of joint care management and care provider training or development
activity for operational staff during 2000-01.
Consultation and
comparison raise concerns over the inherent problems of receiving services from
a range of providers. There is a strong desire for a single provider to be
available to simplify the service user's experience of care and purchasing
arrangements. Providers are also concerned at how to respond to care plans that
may not be relevant or viable, sometimes leading to disagreement over the care
requested for a service user. There is also evidence of weaknesses in some of
the written information provided to service users by the Care Manager and
others, including providers.
Choice and freedom
to develop more personalised and integrated community care services can also be
enhanced by increased take-up of the right to Direct Payments. Current attempts
to promote this service should continue.
The views and
experiences of service users and carers are particularly important in planning
and reviewing services. The directorate is continuing to develop a means of
improving user and carer consultation.
OTHER SIGNIFICANT COMMUNITY CARE SERVICES.
In brief, other
community care services were discussed during the review, the findings on these
services are:
Wightcare Community Alarm Service.
This community
alarm and mobile warden service has the very highest satisfaction rating among
service users and carers.
There is day care
provision across the Island, provided by day centres, independent service
providers, the council and the health service. Day care has a clear
preventative value and stakeholders have a high regard for the existing mixed
provision. However, the development of day care, which can offer social
contact, treatment, advice and physical benefits such as food, bath or warmth,
is highly dependant on transport. A continuing limit on suitable transport will
inhibit significant development of day care.
Respite Care was
not included in the review as a specific topic, but nevertheless has been a
continuous element in consultation, particularly for carers. This form of care
is seen as one of the most important support services provided by the council,
it is very popular, highly regarded and desired.
The growth of
respite care services, including the ability of users to book care on a
pre-arranged basis has been regarded as an invaluable carer support. The
council’s investment in respite care, together with its responsibilities to
work closely with intermediate care and the improvement of hospital discharge
arrangements, is resulting in the growth of respite and rehabilitative
residential care capacity.
1.2.2. OPTIONS AND RECOMMENDATIONS
The following
options and recommended actions have drawn on the work of the review, and have
been discussed in review forums. These options and recommendations are
discussed in more detail in the main review report.
Improvement Options And Actions –
1. Homecare Service Options.
Option 1. Continue
making changes to the contracting methods used to secure care, including the
development of block contracts, locality based contracting and service
delivery.
Option 2. Contracts
with providers should have an agreed and adequate price, duration or scale to
ensure that the provider can invest in and sustain the required level of
service and flexibility.
Recommendation
Although
these have been regarded as options throughout the review, it is recommended
that in order to improve homecare to a level that meets service user and
stakeholder criteria for value, both options for improvement should be agreed
in combination.
Option 1. Investing
in management and cooking facilities, and retaining the existing model and
objectives of the service.
Option 2. Tendering
the complete service with its current objectives, to an independent provider
who would manage and deliver a meals service within current budget.
It is recommended
that the service be tendered (option 2). This will improve the efficiency of
the service allowing expert management of improvements. It will also result in
improved effectiveness of the directorate Contracts Team.
Should
a satisfactory tender not be achieved, option 1 would be required. Management
of the service by council staff or a management contract will require
investment. This may add to the costs of the service if efficiencies in the
existing funding cannot be found.
Option 1. Retaining
the current jointly managed organisational structure and objectives, with the
objective of developing a more holistic service in both host organisations.
Option 2. Recent
investigation of a merger between the existing Health and Social Services OT
services could be re-activated.
Option 3. The
council can lead the development of an Island Community Disability Service that
meets the objectives of the existing services, where possible bringing together
Health, Housing, social care and all Island OT staff, providing a single
integrated and streamlined disability service to all adults and children.
It
is recommended that the council support the development of a Community
Disability Service (option 3) and that a consultant or project manager be
appointed to investigate and produce multi agency agreement and a service
development project plan.
Other Main
Recommended Actions:
2.
Continued implementation of the Best Value Review of Care Management
and Commissioning 2001.
5.
A strategic review of in-house social care services for adults and
children provided by Wightcare Services.
C:\WINDOWS\Desktop\Summary base 1.doc
1.3 ADULT SERVICES
BEST VALUE SERVICE IMPROVEMENT PLAN.
Key to ‘Who’: ‘Head of Adult Services’-To be appointed. ‘EDC’-Dawn
Cousins, Head of Policy and Performance Unit. ‘MH’-Martin
Henson (Adult Service Manager), ‘PS’-Pete
Scott (Manager of Wightcare Services).
|
No. |
Improvement |
Action |
Resource Implications |
Who |
When |
Indicator |
||
Ensure Fair And Informed Access
To Information, Advice And Services
|
||||||||
Improve the
quality and consistency of access to social care information, assessment and
services.
|
Review new
adult services working arrangements:
-The single
adult services referral and information service.
-New specialist Team service. -Customer services and support arrangements. |
Head of Adult Services |
Review of functioning
and opening hours to be completed by July 2002 |
Review to recommend
necessary adjustments to structure and working arrangements. |
||||
Improve the
quality of public information about health and care services for adults.
|
Information
leaflets and other public information arrangements to be updated.
Develop a One-Stop multi-agency information and
advice service |
Directorate Information and Communications Group
to develop a new Information Strategy. Some investment in a joint service will be
required depending on the form of partnership. |
EDC |
6 monthly review of progress underway. Information strategy to be in place and
operating from September 2002 Secure a multi-agency agreement by January 2003. |
A continuous process. An Information and Communications Strategy to be
in place. Success indicated by measurable improvement in
user and partner satisfaction (survey). |
|||
The quality
and availability of information, which can be of help to all stakeholders,
requires improvement, with better use made of the potential benefits of
e-government.
|
Active
support for a single and managed adult services resources database networked
to all Council staff and significant health and voluntary partners.
|
EDC |
Pilot database available by September 2002. Networked database from September 2003. |
A networked and secure
database of care services and resources available on the Council Intranet and
available to other approved stakeholders. |
||||
Improve the
take-up of the Direct Payments scheme
|
Promote and
market Direct Payments availability and arrangements.
|
Continued investment
in training and IW Advocacy Consortium support to service users. |
MH |
Review April 2002 Service re-launch in July 2002 |
Best Value Performance
Plan Targets for increasing take-up to be met from 2002-2005 |
|||
Improve
awareness of multi-cultural needs.
|
Staff
training to include multi-cultural and ethnic minority awareness raising.
|
To be included as
appropriate in planned training events |
Head of Adult
Services& Learn Centre |
Inclusion in the
Annual Directorate Training Plan |
Evidenced content in
training events |
|||
Improvement In The Commissioning And Arranging Of Care |
||||||||
Improve consistency
in commissioning services and building capacity.
|
Protocols
required for clarifying the responsibilities of lead Commissioners and the
Contracting service
|
None |
EDC and Head of Adult
Services |
Protocol in place by
June 2002 |
The use of agreed
protocols. |
|||
Improve
commissioning and capacity building through the collection of data about
unmet and new needs
|
Continue
improvement to care planning and purchasing (including ‘brokerage’), and
regular updating of Market Maps.
|
None. The invest to save ‘Brokerage’ Pilot to be
evaluated and acted upon. |
Head of Adult Services
and EDC |
Review of new and
pilot arrangements by October 2002 |
Improved robustness of unmet need data. Measurable improvement in staff satisfaction
with processes. |
|||
Improve
value for money in time paid for by users of the homecare service
|
Continue to
reduce the homecare travelling time paid for by service users.
|
None |
EDC |
Review impact of team
and locality based care services by April 2003 |
Reduction of 10% or
greater in charged travelling time. |
|||
Ensure
future capacity and long-term sustainability in care services and improve
provider relationships.
|
Continuous
development of a flexible range of contracting and pricing arrangements for
service providers.
|
None at present |
EDC |
Continuous development |
Meet capacity building targets set out in the
commissioning strategy. Improved stakeholder satisfaction (survey). |
|||
Improvement
is needed in the efficiency and transparency of contracting and billing
arrangements for community care services.
|
Contracting
and billing arrangements that apply to externally purchased homecare should
also apply to the in-house provider.
|
Extra staff would be
required to extend current systems to all providers. However, investment in
IT systems will reduce administrative costs. This cannot be costed at present
(see point 27 below) |
EDC and Head of Adult
Services |
See point 27 below |
The operation of a
single billing system for all providers. |
|||
Improve
stakeholder understanding of contract arrangements and links between contracting
and outcomes
|
Staff
training on contracting arrangements. To include awareness of the need for
diversity and flexibility in arranging services.
|
To be met from
existing training resources |
EDC and Head of Adult
Services |
Staff training to be
undertaken annually from 2002 |
Recorded training of
all care management staff. |
|||
Improve the
speed, efficiency and accuracy of charging arrangements
|
Extend the
role of specialist Finance Officers to community care services.
|
None at present but
resources will be required by Oct 2002. Cost not yet known |
EDC |
From October 2002 |
DoH guidance on
charging will drive detailed success factors. |
|||
Simplify
purchasing processes and ensure effective use of care management staff.
|
Pilot
‘Brokerage’, which will transfer purchasing activity to expert staff
|
Pilot funded to
October 2002 by Council grant funding. |
EDC and MH |
Evaluation of pilot
scheme by October 2002 |
Costed decision on the
future of brokerage. |
|||
The meals on
wheels service must improve in response to concerns over efficiency, service
quality and sustainability.
|
Tender the
complete service to an independent provider who would contract to manage and
deliver a meals service within current budget.
|
EDC |
Current contract
conditions indicate that a contract could be arranged by March 2003 |
Measurable improvement in stakeholder
satisfaction. Measurable efficiency gains in the Contracting
team. |
||||
The independence
of older and physically disabled people would be improved by greater choice
and flexibility in meals services.
|
Investigation
of a frozen meals service, which allows people to manage their own meal
arrangements.
|
None, the service
would be funded through charges paid by the service user. |
EDC |
Investigation of
options by September 2002. |
Service provision at
no cost to the Directorate. |
|||
The
transport needs of the community and those who need access to health and care
services need to be more clearly defined and explained.
|
The
Directorate to collaborate with a Council Best Value review of transport.
|
None, to be assisted
by current Central Support Services and Adult Services staff |
Head of Adult Services |
Complete by March 2003 |
Completion of a review
and a costed improvement plan. |
|||
A strategy
for the future provision of in-house care services is needed to clarify the
role of in-house services
|
A ‘value for
money’ review of Wightcare Services should be undertaken.
|
The review can be
conducted by Directorate staff. The Council may choose to engage independent
consultants at a cost of approx £30,000 |
Head of Adult Services |
Complete by March 2003 |
Completion of the
review and future strategy for in-house service provision. |
|||
Development Of More Consistent
And High Quality Assessment And Care Services
|
||||||||
Significant
improvement is needed in the information given to care providers, their staff
and service users about care arrangements, risks and change.
|
Clear
instructions and monitored standards to be provided. The documentation and
information provided to service users and carers to be improved in line with
the aspirations of the ‘Single Assessment Process’.
|
To be undertaken as
part of the Directorate’s Information Strategy (see point 2 above) and the
response to the DoH ‘Single Assessment Process’. |
Head of Adult Services |
The Information Strategy will co-ordinate
change. Timescale to be determined as part of the
Directorate response to the Single Assessment Process. |
Measurable improvement
in stakeholder satisfaction with the exchange of information, which is
currently very low (survey). |
|||
Care
providers are reluctant to complain about Directorate staff or their actions.
Investigate and act on unjustified adverse impact on trade
|
Contracts
with providers to undertake to act on allegations that trade has been
adversely affected as the result of a complaint about the Directorate or a
member of it’s staff
|
None |
EDC |
Continuous process as
contracts renewed or created. |
All contracts to have
the commitment included. |
|||
Care
Management and access to services must be become more consistent across the
Island
|
Common
practice and policy guidelines (care management) to continuously improved.
|
None |
Head of Adult Services |
Continuous process. To
be revised following review of adult services re-organisation (point 1 above) |
Care planning audit to
demonstrate compliance and to indicate areas for improvement |
|||
Develop
consistently high quality and reliable Homecare services.
|
Develop a team based approach
to providing informed and consistent homecare to service users.
|
Support and evaluate the impact of team working
at Wightcare Services Homecare. Promote as a model through contracts. (See point 32 below) |
Head of Adult Service
EDC and PS |
Evaluate team working
and other options by March 2003 |
Improve user
stakeholder satisfaction and demonstrate improvement through case audit. |
|||
Improve the
consistency of case recording by staff, which currently leads to misleading
performance information and possible risk to users.
|
Recording of
activity to be subject to re-training and improvements to the information
system.
|
Casework audit to be
included in new supervision policies. |
Head of Adult Services
and EDC |
Care planning audit to
be undertaken by June 2002 |
Measurable improvement
on audit undertaken in 1999 |
|||
|
Improve The Speed And
Quality Of Response To Meeting Care Needs |
||||||||
Service
response times should be improved and be subject to clear reported standards.
|
The practice
of fast-tracking less complex or single service cases will be developed and
implemented using clear and challenging service standards, a common screening
tool and the re-allocation of responsibilities among staff.
|
The future development
of the selected service standards will be considered in the review of
re-organisation in point 1 above |
Head of Adult Services |
See point 1 above |
Continuous improvement toward adult services
response standards. Piloting of service standards will result in
targets against the benchmark service standards. |
|||
Clarify And Promote Informed Public Understanding Of Eligibility Criteria For Care Services |
||||||||
Improve
stakeholder understanding of entitlement to services to assessment and care.
|
DoH guidance
on ‘Fair Access to Care’, criteria will be applied as part of the Directorate
Information Strategy
|
None at present |
Head of Adult Services |
Dates to be compliant
with DoH requirements when known |
Awaiting final
guidance |
|||
Reduce
continuing anxiety and possible confusion among service users who are
concerned that their care will be removed through service cuts.
|
Clarify and
define the role of Domestic Care.
Communicate with service users to allay fears
and clarify reasonable expectations. |
None Build effective communication with service users
into the Information Strategy |
Head of Adult Services
and EDC |
By July 2002 Continuous (via the Information Strategy, see
point 2 above) |
Policy in place Measurably improve user expectations regarding
their eligibility for services. |
|||
The
application of Eligibility Criteria and contract terms by staff and service
providers must be made more consistent.
|
Ensure
equitable application of eligibility criteria and contract terms through:
Supervision and audit. Provider consultation |
Casework audit to be part of improved
supervision practice. Audit of provider experience of services to be
undertaken by the contracting service. |
Head of Adult Services
and EDC |
Continuous process.
Audit of supervision improvements by May 2003 |
Improved service
provider satisfaction with service consistency (survey). |
|||
Improve The Range And Quality Of Information
Collected And Used By The Directorate
|
||||||||
Managers and
staff need performance reporting tools that help to improve team and
individual performance.
|
Implement a
reporting process linked to team objectives and with information in a
suitable format for team and individual performance review and planning.
|
Manual reporting
arrangements to be negotiated and continued until investment in database
development is completed. |
EDC |
Improvements to
information systems to be costed and planned by September 2003 |
Implementation of
team-based automatic reporting of performance. |
|||
Improvements
and changes in the skills of staff and care providers are needed to respond
to changing needs.
|
Ensure that
staff and service skills are updated and improved to reflect needs.
|
Training to be
prioritised and contained within existing Training Plan funding any other
possible grant sources |
Head of Adult Services
& EDC |
Training Plan
completed annually as required |
Measurable improvement
in qualification levels in staff and provider services. |
|||
Improvement
is needed to adult services supervision and quality assurance.
|
Apply a new
and more rigorous supervision policy.
|
None |
Head of Adult Services |
May 2002. Review progress by May 2003 |
Draft policy in place. Audit improvement in performance in May 2002,
use as benchmark for future improvement. |
|||
The Council
needs more consistent and reliable information on the views of users and
carers.
|
-Establish
partnership with a voluntary partner(s) who can undertake regular and independent
reporting on the service users experience of services.
-Establish regular reporting of user and carer
views to members, managers and staff. |
An independent
provider(s) may require funding to approx £5,000 per annum to be found from
existing revenue. |
Head of Adult Services
and EDC |
First contracts with provider to be in place by
June 2002. Other reporting arrangements to commence from
May to March 2003. Detailed timetable for user inclusion via the Information
Strategy (Point 2 above) |
Quarterly reporting of
service user views from independent and Directorate sources. |
|||
Improve the
Directorate information systems to increase efficiency, safeguard information
and make the system safe for service users, carers and partners.
|
Update and
improve the Directorate client information systems to include the increased
use of networking and remote laptop computer access to information.
|
Total Capital
Investment in excess of £600,000 is required. |
EDC |
Investment decision
required by Dec 2002 in order to exploit grant funding and possible regional
procurement opportunities |
The procurement and
implementation of a new information database and infrastructure. |
|||
Continue To Develop Effective Links With
Healthcare And Other Partner Organisations
|
||||||||
Raise
awareness of the need to work closely with other agencies to provide
consistent assessment and community care services.
|
Development of a ‘Care Team Approach’, through more inclusive training and
development events that bring together staff from health, social services,
housing and care providers. Service
users and carers to be represented in training planning and practice.
|
Head of Adult Services |
Appropriate staff to
have been subject to appropriate joint training by March 2003 |
All adult services
joint training related events to include healthcare based staff. |
||||
Links with
Primary Healthcare providers should be further developed and improved.
|
Continuous development of
primary healthcare attachment and liaison.
Continue the
development and evaluation of GP attachment and self directed nursing and
care teams. |
See point 32 above |
Head of Adult Services |
Continuous process in association with the
Primary Care Trust. Support external assessment of pilots, timescale
to be agreed with health partners. |
Improved stakeholder
satisfaction and improved performance against service standards (audit and
survey). |
|||
Care
providers can offer greater involvement in assessing care needs and
developing safer and more effective responses to need.
|
Increased
use of joint assessment and review of need involving service providers, fully
involving service users, carers and others.
|
None. Some joint training will be required to
establish new working relationships |
Head of Adult Services |
Long term development
with policies and practice guidelines in place by March 2003 |
Measurable increased
stakeholder satisfaction with effectiveness of care planning & safety and
consistency of care (audit and
survey). |
|||
Improve the
performance and value of community Occupational Therapy and other allied
services that promote independence.
|
Support the
establishment of a Community Disability Service and service standards based
on the existing jointly managed OT service.
Continue inter-agency development of the
existing Joint Aids and Equipment store |
Additional temporary
Management capacity will required to investigate, develop and implement
further integration of health and social community disability services. (est
£40,000 consultancy and management costs). Some capital may be required to
develop the service (£n/a at present) |
MH |
To be completed by
2004 (A deadline for further joint aid services integration set by the DoH). |
The establishment of a joint service that meets
DoH requirements. Provide a service that equals or exceeds a
benchmark service identified during service development. |
|||
|
36 |
The independence of
service users who are recovering from illness or coping with disability will
be improved by making possible informed decisions about the strategies and
equipment that can best help them. |
Actively support
partners able to develop an Island Independent Living Centre, which could
demonstrate and advise on aids and adaptations, divert referrals and assist
the development of a focus on rehabilitation and independence. |
Not known, the
voluntary sector is currently exploring the provision of such a service and
funding. The Council’s active support and involvement will be required as
part of a project plan. |
MH |
To be defined with
voluntary partners. |
The opening of a
Disability Living Centre. |
||
C:\WINDOWS\Desktop\Com Care
Report\The FInal Report\Final Summary Version Version.doc 18/03/2002 14:43