Report of the Strategic Director Service Group 2
REPORT OF THE STRATEGIC DIRECTOR SERVICE GROUP 2
COMMUNITY HEALTH AND SOCIAL CARE
TO THE ASSISTANT MAYOR
FOR
Adult Services and Services for Older People
ON
12.6.13
TITLE: Re-commission Intermediate Home Support Service from Independent
Domiciliary Care Agencies
RECOMMENDATION:
1. To continue with the Section 75 Intermediate Care joint arrangements to ensure effective delivery of health and social care, maximising people’s independence and preventing unnecessary hospital admissions or placements into long term care
2. To approve reconfiguration of the Intermediate Home Support Service, which is part of Intermediate Care, to provide an assessment and review function, and quality assurance as detailed in the report
3. To approve the service commissioning arrangements with independent domiciliary care providers for direct care as detailed in the report.
EXECUTIVE SUMMARY:
Salford has a Section 75 agreement is in place to deliver Intermediate Care which comprises a range of services. . Intermediate Home Support is one of the services providing short term domiciliary care, maximising people’s independence through a process of reablement for up to six weeks. It supports people being discharged from hospital or at risk of going into hospital or long term care (detail on page 4).
The objective of the proposal is to transfer the delivery of direct care work by the Intermediate Home Support Service and commission this aspect of provision from the independent sector domiciliary care providers – a model that is utilised in general terms across adult social care via the provision of domiciliary care.
Salford City Council will retain accountability for statutory duty of care through the new arrangements.
The Intermediate Home Support service will be reconfigured to deliver a referral, assessment and care planning function.
Financial profiling indicates that Salford City Council will make estimated annual savings of £653,000 in 2013/14 and £812,000 from 2014/15.
Consultation has taken place with the Trade Union regarding possible options for service options prior to this proposal. Following decision the Council will commence the formal consultation process with staff and the Trade Unions and consultation with the independent sector domiciliary care providers to manage the transfer of direct service delivery capacity from the council to the independent sector.
BACKGROUND DOCUMENTS:
(Available for public inspection)
KEY DECISION: Yes
DETAILS:
1. Commissioning arrangements
The Intermediate Home Support Service is part of the Section 75 Intermediate Care formal partnership arrangements, the primary outcomes of which include but not limited to:
· Reduce unnecessarily prolonged hospital stays or inappropriate admission to acute inpatient care, long term residential care or continuing care NHS inpatient care
· Maximise independence and enable patients and service users to remain or resume living at home.
· Deliver a personalised response to meet need.
The Section 75 agreement includes the following health and social care service areas:
Service name / Provideragency / Main purpose and focus of service
Single Entry Point (SEP) / SRFT / Provides one consistent access point into intermediate care services to ensure patients/clients are channelled into Intermediate Care Services efficiently
Rapid Response Service / SRFT / To prevent avoidable admissions to hospital, facilitate timely discharge and prevent admissions into long term residential care, Provides a response to calls in under 4 hours; operating Salford city wide.
Community Rehabilitation & & Supported Discharge Team / SRFT / Provides home based assessment and therapy based rehabilitation. Also provides clinical sessions for falls and amputee clinics in order to maximise individual potential for independence. Service aimed at admissions avoidance and timely discharge from hospital or residential settings.
Hospital Discharge Team / SRFT / Hospital based clinical discharge team, mainly ward based and working closely with S/W hospital team whose main purpose is to ensure the safe and timely transfer of care of those patients requiring post discharge support in the community.
Multi Disciplinary Therapy Team / SRFT / To deliver rehabilitative therapy to patients admitted to community based nursing and residential Intermediate Care Units
Heartly Green Nursing Team / SRFT / Team to deliver nursing care on 29 bedded Community based unit for patients requiring on going assessment, rehabilitation and/or recuperation needs requiring 24 hour nursing support.
IV Therapy Team / SRFT / Provide community based service to patients who would otherwise require IV treatment in a hospital setting.
Intermediate Home Support Service / SCC / Team to provide co-ordination, commissioning and monitoring of home care and enablement support to people in their own homes in order to reduce dependency on services and maintain maximum potential for independence & reduce admissions to permanent residential care.
Intermediate Care Social
Work team / SCC / Team provides assessment to service
users and carers for service users receiving care in on an IC unit or in their own homes. Focus on optimising service user potential for independence and reduction in avoidable residential admissions.
Intermediate Care Mental
Health Service / To ensure service user and their carers potential for independence is maximised. Providing support for specialist mental health and capacity assessments
GP Service / SRFT / To provide medical care to patients for the duration of their stay on Intermediate Care Units.
Heartly Green Residential Nursing Care / SRFT Contract / To provide step down step up nursing beds in the community to prevent avoidable admissions to residential or hospital care and support timely discharge.
Swinton Hall Residential Nursing Care / SRFT Contract / To provide step down step up nursing beds in the community to prevent avoidable admissions to residential or hospital care and support timely discharge.
The Limes Residential Care / SCC / To provide step down step up residential beds in the community to prevent avoidable admissions
to residential or hospital care and support timely discharge.
The funding allocations for the financial year 2012/13 are:
NHS Salford: £6.151m
Salford City Council: £2.317m
Total: £8.468m
2. Scope of the service
The principle aim of Intermediate Support Service is to provide short term free domiciliary support to people living in Salford who require up to six weeks intervention following a period of acute hospital care or to support and address developing social care needs and prevent hospital admission. The service offers holistic reablement and assessment to identify long term care needs and the most efficient means of delivery. The service provides reablement, care and support closer to home to maintain independence and prevent premature admission to long-term care, inclusive of promoting early supported discharge and in order to improve and maintain independence.
The service provides high quality, skilled care and support in the community as a safe alternative to acute based services. The provision works closely with other Intermediate Care services to provide a model of intervention and support tailored to meet the needs of individuals in order to maintain their optimum independence, ensuring the right reablement care and support is provided in the right place at the right time.
The service will support people (clients and patients) with:
· All aspects of daily living
· Building confidence and assisting with reablement programmes
· Promoting independence
· Reducing dependency on high packages of health and social care
· Reducing admissions to residential and acute care
· Facilitating timely discharge
3. Current Service establishment including new commissioning arrangements
The current ‘in-house’ Intermediate Home Support Service delivers both the assessment and reablement/care function, with the team divided to manage both these functions.
The assessment, care coordination and reablement/care delivery function is managed through a team of a Team Manager, three Home Support Managers and 11 Home Support Coordinators (10 Home Support Coordinators are currently in post with one vacancy).
During 2011/12, a number requests for voluntary severance/voluntary retirement (VS/VR) applications from staff were received, in response and in order to achieve continued efficiency the reablement/care function of the service was subject to a review and redesign. The VR/VS requests and the review resulted in a reduction in the staffing allocation to deliver the reablement/care function of 29 (87 to 58). An additional six staff left in March 2012 leaving 52 support assistants (2 vacant posts).
To maintain the service activity of the reablement/care component, agreements were reached with the local independent sector domiciliary care providers to provide additional capacity and accept referrals from Intermediate Home Support, following an assessment and care support plan coordination.
The outcome of the new ‘commissioning’ arrangements with the independent sector domiciliary care providers was to:
· Commission home support hours from four independent providers at an agreed financial rate.
· Embed reablement outcomes within support plans.
· Monitor and review the commissioned service activity.
· Redesign the assessment and care coordination function of the service to ensure it was fit for purpose within the new model.
The new commissioning arrangements have been developed with a range of new management procedures:
· Updated assessment and care coordination procedures, including documentation
· Revised referral procedures
· A recognition that review and quality assurance processes between Intermediate Home Support and the independent provider need to be further developed
· Case closure and discharge arrangements
The changes to the service were communicated to staff and union representative through staff meetings and briefings.
Throughout the implementation of the new model the arrangements have been reviewed. The model is working effectively and the ‘in house’ service reports the outcomes for clients have been unaffected.
In addition, the service carried out a further assessment and review of the remaining ‘in-house’ reablement/care function. The service has used additional ‘reablement’ investment to support the redesign of the care model and this has resulted in further efficiencies in the reablement/care function of the service. This includes changes to rotas to reduce ‘down time’ and the inclusion of lone working after 6pm. A clearer ‘referral in’ criteria has been developed and changes to service documentation has given a greater reablement and outcome emphasis. The use of equipment has been introduced into the service to support the aim to create greater client independence. Training has been provided for all staff on the new processes and associated documentation.
4. Recommissioning of service ‘care’ component and impact on existing service/team
The roll-out and assessment of the new commissioning arrangements has demonstrated that the independent sector domiciliary care providers are able to deliver the desired level of service to clients referred to the providers.
It is proposed to further develop and expand this function with the independent sector such that the remaining ‘care’ delivery component of the in-house service will be transferred in totality to the independent sector. It is also proposed to retain the assessment and care coordination function within the in-house service and that this team will be redesigned to reflect the new ‘commissioning’ function of the model.
In recommissioning the service there will be an impact on the staffing establishment for the current team. The ‘care’ component of the in house service is made up of 54 posts that delivery direct care work, one Team Manager and three Home Support Managers’ posts.
In analysing the demand for direct reablement/care service and the current level of supply provided by the in house service, it is calculated, based on past delivery, that an average of 660 hours per week of direct contact time would be required to meet the current level of need. There will need to be an additional 90 hours per week available as a contingency to allow for any fluctuation in demand and ensure service delivery. The 660 and 90 contingency hours per week would be commissioned from the independent sector under the established arrangements that have been developed through the service redesign that has taken place in 2012.
The recommissioning of the ‘care’ component of the service will remove the need to provide direct management support to the staff providing this service. However a new role will be required to process referrals/allocation and deliver quality assurance and performance monitoring support to the commissioning arrangements with the independent sector to ensure the service providers deliver quality outcomes within a performance management framework. This reconfiguration will result in the disestablishment of one of the manager posts, who manage the staff providing the direct ‘care’ component. There are also three care coordination posts that will be disestablished through voluntary arrangements (currently one post is vacant).
5. New Model – In house team reconfiguration.
In order to deliver the new ‘commissioning’ model a new service structure will need to be established. The function of this new model will be divided into to specific areas of a) quality, performance and staff management b) assessment and coordination
The quality, performance and staff management function will delivered through the Team Manager role
· provide staff management, supervision and appraisal to remaining SCC staff.
· manage referrals and the interface with referrers and the independent sector domiciliary care providers
· allocate work to Coordinators
· ensure Coordinators are given professional guidance to deliver a safe, quality service
· understand, manage and maximise capacity within the independent sector domiciliary care providers
· engage with the independent sector domiciliary care providers to ensure services are delivered within a specified quality and performance management framework. This will include setting up quality assurance service monitoring and measuring outcomes against performance targets.
· ensure the independent sector domiciliary care providers deliver reablement programmes including support for workforce development
· continue to ensure appropriate interface with other Intermediate Care and reablement services and other health and social care initiatives that complement the service
It is recognised that the primary staff management function of the existing Home Support Manager role will not be required. There will be a need to focus on managing the interface with referrers and providers, ensuring outcomes are delivered within a performance management framework. This role is provisionally called Quality Assurance Officer and will:
· undertake assessments to identify service requirements to meet needs, reablement goals and risks