New Ways Transformation Programme Health and Adult Care

‘New Ways’ Transformation Programme Health and Adult Care Cabinet Panel 6 December 2011 www. hertsdirect. org

New Ways: Four main projects • ‘Social Care Access Service’ with Serco • ‘Lean review’ of Older People’s Teams • ‘Lean review’ of Learning Disability Teams • Assessment and care management of older people with dementia www. hertsdirect. org

Consultation to date • Consultation event with service users and carers, local groups and vol orgs • Second event for people with learning disabilities, their carers and vol orgs • Workshops with people and carers using dementia services and GP consortia • Staff consultation events and feedback www. hertsdirect. org

Government vision for social care • More informed people and families through better information and advice • People told if they are eligible quickly • People empowered to take control • Choice in the care and support available • People are safe and providers high quality www. hertsdirect. org

Project 1: Social Care Access Service Health and Community Services New Ways Programme www. hertsdirect. org

Project 1: ‘Social Care Access Service’ • Partnership with Serco as part of HCC’s shared and managed services contract • Quality advice at first point of contact • Eligibility assessments and options • ‘Channel shift’ and new ‘e. Marketplace’ • Service finding and care reviews www. hertsdirect. org

Project 1: Social Care Access Service Calls to the Customer Service Centre 44, 000 Number of new referrals per year 15, 500 Eligibility assessments per year 8, 000 Care package changes per year 20, 000 Scheduled care reviews per year 5, 000 www. hertsdirect. org

Service User Social Care Access from the way we do it now … Other professionals CSC Referral Management Teams Unscheduled Reviews www. hertsdirect. org Enablement Social Work Locality Teams Service Solutions Scheduled Reviews

SERCO/HCS Partnership Hosp Teams / HCT Goldsborough Partnership Slide 9 HCS Increasing access to direct support and self-help opportunities Other professionals TIER 1 Information Advice Triage TIER 2 Service Finding & Brokerage Reviews Hospitals Service User Web Services Social SERCO Care Access Reducing the need for longer term provision Extended Involvement Enablement

Project 1: ‘Social Care Access Service’ Web-based services fit for 21 st Century • …for use by service users and their families – a web portal with user account • New ‘e. Marketplace’ – allows people to buy care and support services directly • IT system integration to improve back– office efficiency – linked to SAP etc www. hertsdirect. org

www. hertsdirect. org

www. hertsdirect. org

Project 1: ‘Social Care Access Service’ Housing Solutions Service: • Adaptations to people’s homes (inc DFG) • More consistent OT assessments • Working with Serco and 6 Districts • Shorter and simpler processes • Standardised electronic applications • e. Marketplace for builders www. hertsdirect. org

Project 1: ‘Social Care Access Service’ Monitoring quality and safeguarding: • Partnerships & Quality Unit • Key performance indicators agreed • Activity levels agreed and staffing matched • Interfaces with other teams automated • Audit mechanisms in place • Satisfaction levels monitored • Budget levels monitored www. hertsdirect. org

Project 1: ‘Social Care Access Service’ Monitoring quality and safeguarding Assistant Director Older People and Physical Disabilities Head of Partnerships and Quality County OT Development Manager Performance and Quality Manager SERCO www. hertsdirect. org Performance and Quality Manager Goldsborough Information Quality Officer

Project 2: ‘Lean review’ of Older People’s Social Work Teams Health and Community Services New Ways Programme www. hertsdirect. org

Project 2: Lean review of OP Teams WHAT IS A LEAN REVIEW? • Reduce duplication and waste • Appropriate delegated authority to spend • Eliminate bureaucracy • Shorten forms and paperwork www. hertsdirect. org

Project 2: Lean review of OP Teams Success of enablement – key stats: • Of 1, 708 people into enablement this year, 50% needed no on-going service • Homecare population fell by 700 last year with a further reduction projected • This has led to a 40% reduction in the number of personal budget assessments by Older People’s Teams www. hertsdirect. org

Project 2: Lean review of OP Teams Processes made lean: • • • ‘Trusted assessors’ – budget authorisers New universal assessment process New pathways for enablement services Review of caseload expectations Design new operational structure Define roles and responsibilities www. hertsdirect. org

Project 2: Lean review of OP Teams Efficiency drivers: • Success of enablement services • More streamlined assessments • Target reduction in management Benefits: • Financial savings of £ 1. 6 M per annum • Headcount reduction of approx 70 – trying to avoid compulsory redundancies www. hertsdirect. org

Project 3: ‘Lean review’ of Learning Disability Teams Health and Community Services New Ways Programme www. hertsdirect. org

Project 3: Lean review of LD Teams Processes made lean: • Universal assessment • Expectations at care review • Alternative sources of care and support • Authorisations and approvals Review of team structures: • Maintain community teams • Changes to transition team www. hertsdirect. org

Project 3: Lean review of LD Teams Older Family Carer’s Workers (4 posts): • Staff who provide support to family carers over the age of 70 caring for an adult with LD at home • This work has been mainstreamed into the community social work role • Support managed through teams • Named team lead for older family carers www. hertsdirect. org

Project 3: Lean review of LD Teams Efficiency drivers: • Better throughput required in teams • More streamlined assessments • Reduction in specialist posts Benefits: • Financial savings of £ 0. 5 M per annum • Headcount reduction of approx 15 – trying to avoid compulsory redundancies www. hertsdirect. org

Project 4: Assessment and care management of older people with dementia Health and Community Services New Ways Programme www. hertsdirect. org

Project 4: Older People with Dementia Current arrangements: • HPf. T have provided assessment and care management for all older people with mental ill health in integrated teams since 2005 Perceived problem: • • Whilst integrated health and social care input works well for older people with functional mental illness (e. g. depression or schizophrenia) it does not work well for older people with dementia Care purchasing budget was never given to HPf. T www. hertsdirect. org

Project 4: Older People with Dementia Drivers for change: • • • Delays to appropriate social care interventions Delayed transfers of care Slow uptake of enablement services Relatively high permanent admission to care homes High numbers of complaints Proposed solution: • Transfer back the care management responsibility for older people with dementia and Alzheimer’s www. hertsdirect. org

Project 4: Older People with Dementia Detailed proposals: • • Transfer approx 40 social care staff who work in the Specialist MH Teams for Older People (HPf. T) back to HCC via TUPE Integrate the workers into newly configured locality social work teams to support all older people Ensure that any older person who is referred to HPf. T navigates the system quickly Transfer the care purchasing budget for older people with functional MH problems to HPf. T www. hertsdirect. org

Equality Impact Assessments • Have been developed iteratively for impact on both service users and staff Impact Mitigation Web services inaccessible to some group Use accessibility technology Continued use of other channels ‘Assisted’ access to technology Reduction of support to older carers Maintain support through CLDT of individuals with LD Staff restructures could negatively impact on certain groups www. hertsdirect. org Maintain flexible working, monitoring workforce profile Transparent change processes

Decision-making and next steps Health and Adult Care Panel – Presentation on consultation Formal staff consultation ends 6 Dec 2011 Health and Adult Care Panel – Recommendation to Cabinet Decision 31 Jan 2012 Changes Go Live 2 April 2012 www. hertsdirect. org 19 Dec 2011 20 Feb 2012