BEST VALUE REVIEW - CARE MANAGEMENT

Customer: Best Value Review Committee

Corporate sponsor : Neil Jones

Review Team Leader: Yvonne Le Brun

Project Managers: Peter Knight Clive Lindsay

1.1

1.2

1.3 GOAL

Within the final outcome report for the Best Value review of assessment, we propose to have completed :

    - A fundamental evaluation of the efficiency and effectiveness of care management and the Out Of Hours service within Hampshire

    - Costed options to improve these services from the perspective of users, carers and partner agencies

    - Identified 5% efficiency savings in the way that these services operate

1.4 OBJECTIVES

    1. To assess the degree to which the current care management system is meeting the needs of vulnerable people in Hampshire who may need community care services

    2. To critically evaluate the system processes involved in assessing, meeting and reviewing need, with particular attention to intra agency interface issues, e.g.

    - client transition between workgroups

    - allocation procedures and practice between intake and long term

    3. To ensure efficacy of joint working relationships where specialists from more than 1 social services team are involved in the response to identified need

    4. To determine the efficiency and effectiveness of interagency working in meeting the health and social care needs of clients

    5. To examine options that will support the stated objectives of care management, making the service more accessible, timely, consistent, comprehensive and user focused.

    6. To investigate and recommend specific models of inter agency working, with reference to the approaches used in other local authorities and in line with emerging guidance from central government. The criteria against which to assess the practices of other authorities will be the perceptual measures of major stakeholders coupled with the respective performance data from the return to central government on Reception, Assessment and Packages of Care (RAP) and Performance Assessment Framework (PAF) information. Examples of relevant authorities include:

    - Brighton and Hove SSD : Torbay SSD

The radical re focussing of the role of care manager in relation to specific functions, such as managing client financial contributions

- Wiltshire SSD: Cornwall SSD

Restructuring of social services departments in order to work much more closely with the NHS.

    - To assess how well the IT systems support the business process of care management

    - To test the feasibility of client self assessment

APPROACH

The review will address the "4 Cs" of Best Value in the following manner

1. Challenge

The composition of the main review team will include:

    - project leader (social services)

    - 2 project leaders (social services, including 1 operational team manager)

    - 3 team members (1 from each of the Health Authorities)

    - staff representative (social services)

Thus challenge to the review is inbuilt through the active involvement of members representing our major partner agency within the main team.

In addition to this core review team, separate team members have been identified to work on discreet projects in support of the main review. These include:

- 8 operational care managers and team managers

    - a senior lecturer in social work from Southampton University (Dr Richards)

    - lecturer in social work, Southampton Institute (Laura Grey)

    - user perspective representatives Wendy Marchment and Wendy Hicks from Hampshire Users Bureau

    - carer perspective representative from the Principal Officer, Carers Together in Hampshire

Members of the external challenge team, whose previous contribution has already influenced the scope of this review, have also offered their services for 2 additional events at key stages of the review process. This will occur at the mid- point of the review process and again as we finalise the outcome report. Membership of this group includes representatives from:-

    - Health (3 General Practitioners, 1 hospital based consultant geriatrician,1 nurse practice manager, 1 CPN)

    - Hampshire Care Association (the voice of the private residential care sector)

    - Community Action Hampshire (representing the charitable and voluntary sector)

    - Domicillary Care Association

    - Hampshire Users Bureau

    - Carers Together in Hampshire

    - District Audit

    - Best Value Panel (Cllr Ted Gale)

1.4.1 Consult

The first stage of consultation will involve a detailed analysis and re-evaluation of the existing materials gathered through recent previous consultation activity. This includes responses to:

    - the Care Management survey (2000), requesting users to evaluate the service they received from Care Management

    - the Reception and Assessment survey (2000), distributed to the first 30 callers to social services area officers per quarter

    - returns from the 700 PAF questionnaires

    - returns from the Joint Review of Hampshire Social Services questionnaire to users (1999)

    - the focus group work and report that contributed towards framing the Care Management Standards (2001)

    - evaluating trends and messages from formal complaints

Additional consultation activity will include:

    - Commissioning Consumer Audit to undertake 2 separate pieces of consultation work with users and carers who have had recent experience of the care management process

    - Use of the 2 CompassLG questionnaires to assess the extent to which policy has permeated throughout the organisation and for "people results" information

1.4.2 Compare

Comparison will initially be made against our Best Value "family" of comparator authorities in relation to activity and performance data returns from the Performance Assessment Framework (PAF) and Reception Assessment and Packages of Care (RAP). Some of the relevant areas for comparison include:

1.4.3 PAF

    - A5 Emergency admissions to hospital of older people

    - B11 Intensive home care as a proportion of intensive home and residential care

    - C29-32 Numbers of vulnerable adults and older people helped to live at home

    - D39 Percentage of people receiving a statement of their needs and how they will be met

    - D40 Clients receiving a review

    - D41 Delayed discharge

    - D42 Carer assessments

    - D43 Waiting time for care packages

1.4.4 RAP

    - R 1 and 3 Numbers of referrals leading to full assessment and referrals dealt with at reception stage

    - A1,2,3,4,5,6,7.Numbers of users and carers assessed (by client group and ethnicity, time taken from first contact to completed assessment and proportion receiving reviews of existing packages within departmental timescales

    - P1,2,3,4,5,6 Numbers of new and existing clients, by client group and ethnicity and length of time from first contact to first service starting

In addition to this performance data, we propose to benchmark care management processes against both Unitary and Local Authorities which either operate markedly different processes or who have already undertaken Best Value reviews. In this context we will be continuing our comparison of systems with Portsmouth SSD who compared elements of their service with such private sector operators as IBM, Zurich Insurance and Whitbreads, with challenging results emerging.

1.4.5 Compete

Several potential competitors for undertaking assessment care planning and reviewing have already been identified. During the course of the review we shall be seeking to establish their relative effectiveness, efficiency, unit cost, outcome for users and compliance with departmental standards and policies. These include:

    - primary care trusts employing nurses trained in care management practice

    - devolving elements of care management practice to provider services

    - care management services contracted from the private sector

Please see Appendix 1 for details of the project plan

1.5 SCOPE

1 The scope of this review is necessarily wide to encompass the range of diverse activities and functions, as the intention is review services from the perspective of a client's pathway through the constituent elements of social services. Thus we propose to use the following framework.

    1) Information and intake

Contains

    a) how information about the range of activities conducted or commissioned by social services are publicised, including:

    - how accurate and useful the information is perceived to be

    - the degree of market penetration

    b) the care pathway through which an individual makes contact with social services, including:

    - hospital based social work teams

    - direct self referrals through to Area based social work teams and Community Mental Health Teams

    - intra departmental referrals (e.g. transitions between teams or units)

    - inter agency referrals. In this context we propose to compare and evaluate a range of structures currently operating, e.g.

    - care managers outposted to GP surgeries

    - care managers linked to GP surgeries

2 - central "call centre" approach

- care managers "zoned" to GP surgeries

3

    2) Assessment and care planning

Includes:

    - policy and process that govern this element of the care management business process

    - carers assessments

    - the respective roles of individual practitioners within this

    - single assessment models

    - systems (esp. ACMS) that support this function

    3) Reviewing outcomes of intervention

Includes

    - comparative analysis of differing models of reviewing existing care packages, from both the aspects of:

    financial variation to package

    success of intervention in relation to identified needs

    user satisfaction with the process (to be evaluated by Consumer Audit)

These 3 aspects will be investigated in the body of the review as they operate in respect to services to all people over 18 who have contact with social services, including:

Older people

People with learning disabilities

People with a physical disability

People with visual impairment, are hard of hearing and deaf people

4

5 As this review of assessment is essentially thematic, rather than service based, it is seen to be important that the care management service provided by the Out Of Hours team and Social Services Direct fall within the compass of this review. This will be informed by the recent fundamental review of the service undertaken by the Performance Management Unit (1999). We are conscious that the service is already facing major change with the emergence of Social Services Direct and proposed plans for a second site, to allow for quicker responses in the north of the County (Project North). However the service they provide to users outside office hours, and the way that service interfaces with others, are core components of the care management activity of this department.

It is proposed that this review will not be considering the following elements:

    - the quality of services that are provided or commissioned strategically by social services (e.g. residential care or day care) as these aspects of service are being addressed in separate Best Value reviews

5.1 CONSTRAINTS

The major constraints to undertaking this review and delivering the greatest improvements to services are:

    - the time span allotted to the completion of the review dictates that some areas of activity will necessarily receive less attention and consequent improvement recommendations

    - the review activity has to be completed within existing resources, thereby reducing the potential for commissioning independent research and evaluation

    - 4 large scale Best Value reviews of social services are being undertaken this year, meaning that the pool of representatives from user, carer and professional groups is having increased demands put upon it. Thus the extent of their contribution to the review process may be limited by other similar commitments

5.2 DEPENDENCIES

    1) The production of robust RAP and PAF performance data by the Information Analysis team within projected deadlines

    e.g.

    - time from initial assessment to services being received, by client group

    2) The production of requested financial information by County Treasurers

    e.g. - average price of care package, by client group and area

    - activity costs of operating care management

    3) Introduction of the single assessment tool for older people by central government, anticipated in June 2001. The prescribed format of this will have implications for the scope of review recommendations relating to this client group. If it's introduction is delayed (as was the case with the National Service Framework for older people) then this may impact on the timescales of the review

    4) Permissive or statutory legislation and regulation from central government, in respect of either the personal social services or partner agencies.

    5) Implementation of proposed radical changes to the way in which services are provided outside office hours. In particular, the way in which both Social Services Direct and Project North are introduced and subsequently evolve will have major implications for the EDS component of the review

RESOURCE REQUIREMENTS

Opportunity costs

    6) Quality and Performance Management Officer seconded to project manager the review = 90 days £11,000

    7) Commissioning Manager (Care Management) and Commissioning Manager (Mental Health) leading the review = 40 days £9,000

    8) Activity of core team members in support of the review = 40 days

    £9,000

    - Activity of non core members = 30 days £7,000

    - Admin support = 30 days £3,000

    Total £43,000

Direct costs

    9) Backfill for team manager seconded to co-project manage the review

    = 56 days £12,000

- Fieldwork travel costs and venue hire for consultation £1,000

Total £13,000

5.3 AGREED

Signature Date

Review Team Leader:

Sponsor (on behalf of DMT)

Corporate Best Value Team