BACKGROUND PAPERS
A summary of the Best Value Review
is submitted for background information. Also attached is a bid for >Invest To Save= funding, which will be presented to the
Executive Committee at a later date.
A full version of the review will be
made available from the end of March 2002 on the Council=s Intranet at
Click Here for Best Value
Reports or
http://wightnet2000.iow.gov.uk/library/best-value/current_reports/default.asp
Contact Point: Martin Johnson, F 520600
C
WADDICOR
Strategic
Director
Social Services & Housing
APPENDIX A
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
REVIEW SUMMARY
1.1 INTRODUCTION.
Aims and Objectives
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 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.
Background to this Review
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.
Scope of the Review and the Most Important
Issues
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.
Stakeholders Involved
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
HOMECARE SERVICES
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.
OCCUPATIONAL THERAPY
Summary
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.
Significant Findings
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.
Consultation
with users highlighted confusion over the various OT and housing staff involved
in assessment for adaptation, and lengthy budget driven delays. The current
single management of the council and hospital based OT services has been
effective, but it does not bring the full advantages of a single organisation,
with staff working across organisational boundaries. While the council OT
service has undertaken many of the improvements that many comparable councils
have made, further innovation and improvement may require more radical change.
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.
Summary
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.
Significant Findings
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.
COMMUNITY CARE SERVICES - WORKING TOGETHER
Summary.
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’.
Significant Findings
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 service has the highest rating among service
users and carers.
Day Care
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
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.
2. Meals On Wheels Service Options
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.
Recommendation
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.
3. Occupational
Therapy Service Options.
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.
Recommendation
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:
- The development of a ‘Care Team’ approach between health and social
care providers including the increased use of joint assessment of need
with community care service providers.
2.
Continued
implementation of the Best Value Review of Care Management and Commissioning
2001.
- Development of a new Information Strategy which will improve the
quality and accessibility of information for those needing, arranging and
providing community care, health and housing services, including service
users and carers.
- Improve service user feedback and inclusion in community care
service planning and review.
5.
A
strategic review of in-house social care services for adults and children
provided by Wightcare Services.
- Support the development of an Island-based independent living
centre or a comparable equivalent service.
- Investigation of service user and carer
transport needs and effective use of transport resources through corporate
Best Value review.
1.3 Improvement Plan
A Service
Improvement Plan, which draws together tasks from this and previous Adult
Services Best Value reviews, is attached to this summary.
C:\WINDOWS\Desktop\Summary
base 1.doc
APPENDIX B
Social Services and Housing Directorate
Best Value Review of Care
Management and Commissioning
A bid to the Council Executive for funding from the >Invest to Save= provision.
The
Occupational Therapy Service
The Best Value Review of
Community Care Services has recommended the benefits of amalgamating the
Occupational Therapy (OT) Services currently provided by the Isle of Wight
Healthcare Trust and Social Services. The main advantage will be a
rationalisation of resources available to OT and disability services, allowing
greater efficiency and other practical benefits including reduced waiting
times.
It is proposed that a
consultant or temporary manager is seconded to explore the various options,
build a business case recommending the best way forward and at the same time
detailing how their proposals could be implemented.
Integration of Community
Equipment Services.
The Best Value Review
recommends that the Healthcare Trust and Social Services community equipment
services should also be fully integrated.
In fact this is a requirement of the Department of Health to be
completed by 2004. There will be numerous advantages for Social Services, with
a likely saving in resources and the immediate impact of considerably reducing
waiting times.
It is
proposed that an experienced consultant or temporary manager is seconded to
explore the various options, build a business case recommending the best way
forward and at the same time detailing how their most beneficial options could
be implemented. In addition, it would
be necessary to appoint a Project Manager to implement the
recommendations. We would aim to
appoint the Project Manager at the end of the consultancy or secondment period,
and would expect this person to eventually manage the service.
Proposal
Costs for the consultancy
or secondment are a one-off expenditure. It is anticipated that the savings
over time with both integrations would greatly improve the services available
to disabled people on the Island. The main benefit for Island people would be a
much more cost effective and streamlined service with reduced waiting times (an
issue noted by the Best Value Review). An >Outline Proposal For
Consultancy= is attached to this bid.
Costs
Consultancy
costs (See attached draft schedule) ,17,000
Store Project Manager ,23,000
Total ,40,000
The Department of Health
has promised future funding for Community Equipment Services and it would be
expected that this funding would pick up the salary of the Project Manager for
the equipment services after the Best Value Invest to save Bid resources had
been used.
Charles Waddicor,
Strategic Director of
Social Services and Housing
