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Strategic Review of Adult Social Care Services

Update April 2007

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Contents

• Drivers for the review

• Process being followed

• Key findings from baseline assessment

• Workstreams: issues, options

• Next steps

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Drivers

Needs of Merton Residents:

Older people

Young adultsWith complexDisabilities

Ethnicity

NationalAnd local Policy:

Choice and Control

Integration with Health

Prevention

FinancialSituation

CorporateSavings of £20m 2008-2010

National Pressures on Social care

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Process• Programme steering group, Director as

sponsor chairs it

• Programme management from Sarah Wells

• Five workstreams each with lead manager

• Wider engagement through Partnership Boards and one off sessions

• Regular “challenge” sessions from Chief Executive and Members

• £25k funding from Capital Ambition

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Parameters• Pro-rata share of required corporate savings

for 08/9 and 09/10 would be 10% of net budget each year

• Want to at least keep current CSCI rating, which means responding to White Paper drivers as well as detailed KPIs

• At least some of conclusions in time to influence budget setting for 08/9, i.e. July 07

• Engaged process: staff, users, carers, wider Council and community

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Baseline assessment (1)• CSCI rating: serving most people well with

promising prospects• History of improvement from low baseline

in 2000• Generally strong performance on outcomes,

e.g. intensive home care, low admissions to care homes, low delayed transfers of care, telecare, equipment delivery

• Further to go on process in some care management areas, e.g. direct payments, waiting times for assessments

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Baseline assessment (2)• Generally successful integration of LD and

MH services with NHS, little progress to date for older people or PDSI

• Customer feedback mostly positive, key areas of concern in initial access to services and time lags in billing for services

• Some good services for carers, but PIs show lack of consistent focus on assessing needs as part of core practice

• Day services well regarded, but scope for making them less building based

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Baseline assessment (3)• Low spender per head: bottom quartile

• Generally low unit costs when benchmarked

• Variable commissioning capacity: good housing strategies, others need updating, and good modelling framework needed

• Could do more on finding ordinary housing for people and then supporting them in it

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Workstreams: overviewCare

ManagementCare

At homeHousing &

supportDay

OpportunitiesPlanning &

commissioning

Re-shaping services

Workforce InformationEngagement

&communication

Co-production

Supports the re-shaping

Core output of review

Cross-cuttingEnable outputs

to happen

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Workstream 1: care management

1st contact

Screening

Assessment

Arranging care

Review

Choice & control

Existing 10+ contact points? One for social care?Part of Merton Link?

Screening tools? Self screening?

SAP? Self assessment?Financial assessments? Audit? Mobile working/computing?

Done by specialist procurement, or caremanagers?

Done by specialist reviewers, procurement,or care managers? Input from providers?

How to mainstream? Costing needs?Who supports users/carers?

ISSUES QUESTIONS AND OPTIONS

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Workstream 2: care at home

Enablement

Mix of providers

Equipment

Telecare

Meals

NHSintegration

All new care to be streamed through enablement? Eligibility? Review?

In house service: specialise, reduce, end?7 approved providers?

Access with no assessment? Who can order?

Realising benefits 24/7?

Frozen/hot mix? Who provides?

Alignment of enablement and intermediate Care? Telehealth?

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Workstream 3: housing & support

Costs

Ordinary housing

Specialisthousing

Care homes

Type of support

Access

Comparative costs of own-front-door –v-group living, and of different tenures?

Private rented sector? Shared ownership? Adult placement?

Forecast need for purpose built?

Are current block contracts right? New supply for high needs? Future of in-house?

Generic or specialist? Use of third sector?

Eligibility criteria for housing with support?Joined up assessment?

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Workstream 4: day opportunities

Participationin community

Buildings

Service to carers

Eligibility

Transport

Employment

Mutual roles of adult social care & mainstream opportunities?Support needed? Volunteering?

Flexible local resource centres? Specialist?Extended hours? Use of e.g.libraries

What has biggest impact in meeting carers’ needs?

All by assessment only? Drop in?

How to re-shape to match service changes?

Best ways of supporting more people? Generic or specialist support?

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Workstream 5: planning & commissioning

Need anddemand

Capacityplanning

Macro-Procurement

Quality assurance

Impact of choice

Partnerships

Turning pure “needs” into forecast demand

Modelling demand into required capacity,impact of service changes on this

Procuring capacity: types of contract, obtaining VFM

Using accreditation, monitoring quality

What will impact on above from more userchoice and control?

Joint commissioning with PCT, other boroughs

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Supportstream 1: workforce

Mix of skills

Competencies

Flexibility

Recruitment &retention

Development &wellbeing

Mix of qualified and non qualified staff, e.g.first contact/screening/assessment

Competencies needed for core tasks. Same as qualifications? How to test for them?

If services extend hours and location (e.g.day ops), impact on flexibility needed?

Planning ahead .Users involved in selection? Retention of scarce skills. Diversity.

Developing required competencies. Useof validation e.g.NVQs. Lowering sickness absence

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Supportstream 2: information

Info for users/carers

CRM

Choice &control

Joint working

Supporting staff

Rationalising leaflets? Use of e-info e.g. internet?Use of other public access points? Care Connect?

Potential use of Customer Relationship Management for first point of contact

Info for self screening & assessment? Info for arranging own care?

Helping referrers. Use of info for joint assessment.Shared records/reducing hand-offs

Mobile working. Direct input to Care1st.

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Supportstream 3: engagement

With users &carers

With staff

With wider community

Diversity

From one off consultation to continuous discussion?Using ways other than meetings?

How can more staff be fully engaged? Continuous improvement? Communication?

Should social care have higher profile? If so, how?

How do we go further to ensure that services and staffing reflects Merton’s diverse communities?

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Supportstream 4: co-production

Funding

Third Sector

Partners

Wider community

Users and carers

Balance of Council tax, fees from service users,any other income?

Opportunities for new roles, both as advocates and providers? Vehicle for integrated services?

Role of main community plan partnerships?Joint commissioning and provision with NHS?

.Contribution to improve life chances for vulnerablepeople?

What can be expected from everyone, and what is a matter of choice? Impact of managing own care?

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Your thoughts….• Could the overall process be improved, and

if so how?• Do you agree with the baseline assessment?• Do you agree with the workstreams, key

issues and options highlighted?• How do you (and others you know) want to

be engaged?

Contact: hilary di.salvo@merton.gov.uk sarah.wells@merton.gov.uk

Tel: 0208 545 3694