2002 ADULT SERVICES BEST VALUE SERVICE IMPROVEMENT PLAN (Updated January 2003).

Key to ‘Who’:

JL-James Lowe (Acting Head Of Adult Services) CS – Claire Shand, (Learning Centre). ‘EDC’-Dawn Cousins, (Head of Policy and Performance and Resources). ‘MH’-Martin Henson (Adult Service Manager), ‘PS’-Pete Scott (Manager of Wightcare Services).

‘PCT’- Primary Care Trust, ‘SHA’- Strategic Health Authority, ‘DoH’- Department of Health, SW – Sara Weech (Commissioner), PCT, GB – Gillian Baker (Commissioner) PCT.

	Improvement	Action	Resource Implications	Who	When	Indicator			Current Situation
Ensure Fair And Informed Access To Information, Advice And Services
1	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.	Review to be undertaken by management team. Extended hours to be key aspects of job descriptions and staff expectations.	JL	Review of functioning and opening hours to be completed by July 2002	Review of reorganisation to recommend necessary adjustments to structure and working arrangements.	A review of reorganisation has been undertaken. Findings include satisfaction with improved access to services. Areas for improvement include further reduction in assessment times and continued workload rebalancing. Extended working hours were judged unnecessary at present.
2	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).	Information strategy in place and the updating of information has commenced. New carers handbooks and a catalogue of services for older people will be published in February 2003. Significant further progress will be dependent on the successful re-appointment of a communications co-ordinator in March 2003
3	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.	Requires investment in database management. Could be funded from existing admin costs, corporate web and intranet development or grant funding.	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.	A resources database has been developed and is in pilot operation. This is networked on the intranet. All adult services staff and out of hours workers will have access from February 2003. Selected health staff will have web access during 2003.
4	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	Take up increased as planned, but levels are still below the increased expectations of the department of health (DoH). Take up will be promoted again from April 2003.
5	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	JL & CS	Inclusion in the Annual Directorate Training Plan	Evidenced content in training events	Cultural awareness is now included as a core element of all relevant events in the directorate’s training plan.
Improvement In The Commissioning And Arranging Of Care
6	Improve consistency in commissioning services and building capacity.	Protocols required for clarifying the responsibilities of lead Commissioners and the Contracting service	None	EDC SW and GB	Protocol in place by June 2002	The use of agreed protocols.	From November 2002, single agency lead commissioning has been in place using section 31 flexibilities in the Health Act 1999. Some protocols are in place as part of this process, all to be completed by March 2003
7	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.	JL and EDC	Review of new and pilot arrangements by October 2002	Improved robustness of unmet need data. Measurable improvement in staff satisfaction with processes.	Two brokers were appointed for a pilot period. The scheme proved effective in collecting information and making effective use of resources. The service requires one broker. Funding for one post has been found from adult services budgets. The permanent position will commence April 2003
8	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 and GB	Review impact of team and locality based care services by April 2003	Reduction of 10% or greater in charged travelling time.	An audit has been completed; internal costing mechanism will need to be adjusted for financial year 2003/4 to take account of this.
9	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 and GB	Continuous development	Meet capacity building targets set out in the commissioning strategy. Improved stakeholder satisfaction (survey).	Improved information on contracting options and processes has been published. A stakeholder conference has been held and a partnership forum set up. The procurement strategy is finalised and a contracts portfolio will be published by April 2003.
10	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 fully costed at present (see point 27 below)	EDC and JL	See point 27 below	The operation of a single billing system for all providers.	Progress is dependent on improvement in the directorate’s main database, which should include the capacity for a unified billing system. This is referred to in point 27 below.
11	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 JL	Staff training to be undertaken annually from 2002	Recorded training of all care management staff.	Care management updates now include a contracting refresher session. Staff also receive a newsletter from the contracts team.
12	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.	New specialist finance officers are in place. Fairer charging is the subject of a separate report to select committee. Fairer charging will have a significant workload and financial implication for the Directorate. The timescales for implementation are contained within this separate report but in brief consultation commences January 2003 and full implementation from April 2003.
13	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.	See section 7 above. Stakeholders have expressed satisfaction with improved consistency. Some Care Manager time has been saved.
14	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.	Contract terms would need to be negotiated with the objective of no budget growth. Some capital may be required (est £8,000)	EDC and GB	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 tendering process has been subject to delay. A tender will be issued in February with a new contract in place from September 2003.
15	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 and GB	Investigation of options by September 2002.	Service provision at no cost to the Directorate.	Options investigated on time. Considerable interest has been shown in providing this service; it will form a part of 14 above.
16	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	JL	Complete by March 2003	Completion of a review and a costed improvement plan.	The council BV review has not taken place as anticipated. There are no plans at present for a separate review to take place within the directorate.
17	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	GB	Complete by March 2003	Completion of the review and future strategy for in-house service provision.	The directorate has not had the capacity to undertake a separate review of Wightcare Services. By March 2004, the new commissioners will prepare a costed plan for future review
Development Of More Consistent And High Quality Assessment And Care Services
18	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’.	JL	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).	The information strategy (point 2 above) has commenced a ‘good practice’ group is developing improved documentation for all directorate services. A Long-Term Care Charter is in place. The PCT is leading development of the Single Assessment Process, which will require further change in documentation. The PCT is reporting annually on progress to the SHA, the process to be completed by April 2005.
19	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.	This commitment is now in place. The contracts team and the Designated Complaints Receiving Officer deal with provider concerns or complaints.
20	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	JL	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	Continuous file audits and audit of care plans are in place. The contracts team audit the provider and users experience to ensure that services are contracted for properly. Policy on compliance with service contracts will be part of the contract portfolio to be published in April 2003
21	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)	JL, EDC and PS	Evaluate team working and other options by March 2003	Improve user stakeholder satisfaction and demonstrate improvement through case audit.	Evaluation is in progress; this has been delayed until May 2003 to enable more robust data to be gathered.
22	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.	JL and EDC	Care planning audit to be undertaken by June 2002	Measurable improvement on audit undertaken in 1999	A new directorate database will assist in this process. Current audit is manual and limited due to continuous lack of capacity. File audits are carried out by supervisors and findings reported to service managers.
23	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	JL	See point 1 above	Continuous improvement toward adult services response standards. Piloting of service standards will result in targets against the benchmark service standards.	Fast tracking of less complex cases, having been tried for 18 months, has not proved possible without staff increases. The government will shortly publish national response times and criteria, which will have to be adhered to. It is proposed that the service reverts to pre 2001 response time standards while working towards the new national standards by December 2004.
Clarify And Promote Informed Public Understanding Of Eligibility Criteria For Care Services
24	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	JL	Dates to be compliant with DoH requirements when known	Awaiting final guidance	The implementation of the ‘Single Assessment Process’ is not yet in place. This complex work is being led by the PCT. Final implementation will be April 2005, with annual updates to the SHA, the next being April 2003. The ‘Fair Access to Care’ guidance is incorporated into ours development process. This is to be reviewe3d in April 2003.
25	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	JL 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.	Clarification of entitlement to care has taken place within the existing eligibility criteria. Efforts to reduce misconceptions or misunderstanding are a permanent aspect of the directorate’s information and communication strategy. Focus groups in 2002 have shown less concern about loss of services among existing users than similar groups during 2001.
26	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.	JL and EDC	Continuous process. Audit of supervision improvements by May 2003	Improved service provider satisfaction with service consistency (survey).	Audit is in progress (see 20 above). Focus groups and user surveys show that user satisfaction levels are being maintained.
Improve The Range And Quality Of Information Collected And Used By The Directorate
27	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.	The procurement of an improved directorate database is a priority in the face of greater demands for reliable and safe user and performance information. A project plan is in place, complimenting the highly rated Local Information Plan required by the DoH. Funding remains uncertain with future milestones difficult to identify.
28	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	JL and EDC	Training Plan completed annually as required	Measurable improvement in qualification levels in staff and provider services.	The strategic management group leads the directorate-training plan. The current plan and preparation for 2003/04 focuses clearly on meeting identified needs including skills, qualification training and professional development. Training is determined from national and local priorities and from negotiation with staff.
29	Improvement is needed to adult services supervision and quality assurance.	Apply a new and more rigorous supervision policy.	None	JL	May 2002. Review progress by May 2003	Draft policy in place. Audit improvement in performance in May 2002, use as benchmark for future improvement.	A new supervision policy is in place, but review of effectiveness is limited by a lack of professional audit capacity. A longer-term use of the policy is required than that set out in the plan, in order to measure effectiveness. It is proposed that review takes place by May 2004.
30	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.	JL (GB) 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.	Age Concern has been contracted to undertake independent surveys of user satisfaction. This is in operation and effectiveness will be reviewed before March 2003. This pilot arrangement will lead to quarterly reporting to service management if the pilot is extended at review.
31	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.	Improvement plan has been submitted to the D.O.H and £89,000 grants monies received. Project proposals presented to members and approved. Business case is being prepared and on going discussions with region and our health partners are progressing. Without financial resources of around 1 million pounds this project cannot progress. See point 27 above.
Continue To Develop Effective Links With Healthcare And Other Partner Organisations
32	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.	To be funded from existing training budget, with support from the health service	JL	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.		Training has been offered to healthcare staff. This is an evolving process, which reflects greater working together at operational levels. The involvement of partners from other care and housing providers will be part of the 2003/04 directorate-training plan, this plan will be completed during March 2003.
33	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	JL GB	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).		Out posting of staff to primary care is continuing. A further post will be placed in a GP practice in 2003 (Freshwater). This is an evolving process based on partnerships that are possible when opportunities arise.
34	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	JL	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).		Progress in joint care assessment and planning is being measured as part of the long term development, led by the PCT, which will lead to the implementation of the Single Assessment Process in April 2005.
35	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.		A firm of consultants have been appointed to develop a business plan for the development of a Community Disability Service, including a joint OT service. There is as yet no clear estimate of the costs of such integration, which remains a clear direction encouraged by the DoH. The timescale remains 2004.
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.		The directorate continues to support the Disability Living Centre project planned by the Riverside Centre and partners. This centre will be based on independent research undertaken during the life of the council’s best value review of community care services. This is being led by the Riverside Centre and is dependent on its gaining resources. Integration of community equipment centre is on course for April 2004

C:\Workspace\BESTVAL\Review 2001\Comm Care Review\Com Care Report\Action Plan Final Update Jan 2003.doc