Project Brief


Service Review: Carers' Services and Respite Care 2001/02 Review Team Leader: Chris Taylor Review Project Managers: Alison Heywood, Peter Ross Date: 23^rd May 2001
GOAL The following goal is based on carers' requirements identified through consultation with carers in Hampshire (Carers Together, 1999). To carry out a review of carers' services including respite care to ensure continuous improvement and satisfactory outcomes for carers and persons cared for in terms of: -quality; -flexibility; -access; -communication; -wider choice; -working in partnership.
OBJECTIVES The following priority areas to be considered by this review have been identified by the review team with reference to existing consultation with carers, research evidence and national and departmental strategies. _ Improving the ease of access to information regarding services and support for carers through key people or central points _ Linking with providers of primary health care to ensure they have adequate information about services available to carers _ Improving the range, availability, flexibility and appropriateness of respite services _ Delivering models of care that increase independence _ Increasing the level of control carers have over services _ Responding to the needs of specific groups including younger people with dementia, carers with mental health problems and black and ethnic minority carers. _ Increasing the involvement of carers in services for people with mental health problems and among hard to reach groups These areas are translated into the following objectives for the review: 1. To determine how well the department is performing in terms of supporting carers and to identify means of ensuring continuous improvement 2. To review the effectiveness of information, advice and sign-posting to carers and to identify means of improvement. 3. To determine the impact of the Carer's Grant `Take a Break' in terms of the quality, flexibility, accessibility and range of choice of services through consultation with carers and other stakeholders and to maximise the future use 4. To demonstrate the range and distribution of respite provision and to identify means of increasing the efficiency, flexibility and appropriateness of respite care and support for carers 5. To investigate ways of making services more responsive to the needs of the following: - parent carers - younger people with dementia - carers and service users from black and ethnic minorities - carers of adults with mental health problems Objectives (continued) 6. To increase the efficiency and cost effectiveness of carers' services and respite care and to maximise resources through partnerships with other agencies 7. To improve the way simultaneous service delivery and respite activity are measured by the department and to inform the development of the new IT system (SCIS) 8. To consider the management of transitions between services and the impact of this process on carers 9. To establish a cross-cutting team with members of the Best Value Review Looked after Children 2001/02 to review children's respite care 10. To link with the Best Value Review Care Management, Reception and Assessment 2001/02 to review carers' assessments
APPROACH The review aims to measure the department's performance in delivering respite care and support to carers and to demonstrate the range of services provided. This will be done through: i) mapping services ii) developing performance indicators iii) comparison with best practice iv) benchmarking with other authorities The approach to the key elements of the review are outlined below: 1. Challenge: This review intends to integrate the element of challenge through the composition of the review team (appendix i). This includes two carer representatives and a member from the voluntary sector. In addition, the review team plans to link with the chair of the Zanzibari Association in order to reflect the interests of the black community and to access members of the community through his contacts. Further sources of challenge will be provided through; -liaison with the corporate sponsor -consultation and challenge events planned with carers and stakeholders -securing the involvement of a representative from the commercial sector -the involvement of a professor from the Department of Social Science, Southampton University. 2. Consultation: The review aims to build on existing consultation with carers and stakeholders and to focus on what is already known about what carers require from services. A series of Carers Consultation Seminars (Carers Together in Hampshire, June 1999) examined carers requirements in terms of information, consultation and services to enable them to take a break. The review goal is based on outcomes of services identified through this consultation. The review has commissioned Carers Together to carry out three consultation events. These events will provide the opportunity to obtain carer's views regarding the impact of the Carers Grant expenditure and to consult on other areas arising from the review including the needs of carers from black and ethnic minorities. In addition, Consumer Audit will be carrying out consultation with carers of service users with mental health problems as part of the Best Value Review Residential Care 2001/02 3. Comparison There are significant constraints to making effective comparisons for the purpose of this review. Firstly, there are variations in the way `respite care' is defined and quantified within and across local authorities (appendix ii). Secondly, the information provided by performance indicators is limited Comparisons will be carried out by i) Analysis of Carers Grant returns which will identify expenditure by area and by sector, the number of carers assisted and the number of units of service ii) Consultation with local authorities regarding areas of good practice and innovative models of service (e.g. Essex) iii) Internal comparison to examine equity of services across areas and care groups iv) Benchmarking with a comparator authority (agreement has been obtained from Surrey) v) Comparisons through links with other authorities as part of the Southern Region Networking Group and with West Sussex (Beacon Council-Information Points) vi) Establishing a link with other authorities' Best Value Reviews (e.g. Wiltshire `Residential and Respite Services-disability') 4. Competition Carers' services: To be consistent with Hampshire's approach and to work towards partnerships with carers' organisations, the review will seek to ensure that robust contracts are in place to ensure continuity, consistency and equity of approach. Three major contracts are due for renewal in March 2002 and will be informed by this review. The impact of expenditure on specific projects funded through the Carers grant will be evaluated through consultation with carers. Respite services: The review needs to test the competitiveness of in-house units and other sectors in terms cost, quality and forms of provision. This will be done by comparing costs across and within authorities and making reference to PAF indicators. 5. Equalities The review has included in its objectives the need to investigate ways of responding to the needs of specific groups of carers and users of respite services and of consulting with hard to reach groups. The inclusion of a representative of the black community in the review team is intended to ensure this perspective is reflected in the review. In addition, the review will pilot the Equalities Assessment Tool devised by a department working group; a means of assessing performance in terms of equalities. 6. Other considerations (sustainability, e-government, ) The review will consider the provision of information and the role of the Carers Helpline and the implications of the introduction of Social Services Direct in response to the e-government agenda. The review will report on the Hampshire Young Carers Website as an example of innovative practice in this area. Members of the review team will participate in a workshop facilitated by the Environmental Challenge Group in order to address the issue of sustainable development.
SCOPE The difficulties of defining and quantifying `respite care' and dealing with the complexities of simultaneous service delivery have resulted in considerable debate regarding the scope of this review. Areas of expenditure to be included in this review: i. All Carers Grant expenditure ii. Contracted Services for carers iii. Carers Helpline iv. Residential short stays (all client groups)* v. Alternate/ respite care in the home (all client groups)* * Services for children including residential short stays, Family Link (respite scheme) and support services that enable carers to take a break will be considered by a cross-cutting team comprising a project manager and parent carer from this review and the Best Value Review Looked After Children. Areas not included in this review: - Carers' assessments - Residential care categorised as long stay, trial or rehabilitation - Long-stay adult placement - Fostering - Day Care - Domiciliary Care For the purposes of scoping, details of expenditure on day care and domiciliary care (where a main carer can be identified) are included in the Service Specification to demonstrate the cost of delivering services simultaneously to carers and service users Areas that link with other Best Value reviews: - Carers' assessments - Short- stay residential care Carers' assessments will be reviewed by the Best Value Review Reception, Assessment and Care Management 2001/02. However, close links will need to be made between the two reviews. This decision is based on the findings from research commissioned by the department that the majority of carers who wish to be assessed would prefer this to take place jointly with the person they care as a consequence of the reciprocity of their relationship, (`The Assessment of Carers in Hampshire and Portsmouth', Lupton and Prowse, 2000). The difficulties of identifying the various categories of short-stay residential care necessitate close links and clarification of boundaries between this review and the Best Value Review Residential Services (Adults) 2001/02
CONSTRAINTS The capacity of the review team is estimated as follows: Team Leader-average 1.0 days per week over April-December Project Manager ( Performance Management) average 3.0 days per week April-December Project Manager (Operational) 1.5 days per week April-December 4x Internal members 14 days total 3x External members 7 days total Black community representative 2 days total
DEPENDENCIES The following dependencies have been identified at this stage of the review: i. Obtaining agreement to proceed with the review ii. Obtaining additional finance and activity information including Carers Grant Returns and Carers Helpline statistics in May iii. Obtaining agreement to consult with `best practice' authorities iv. The reliability of financial and activity information particularly for comparative purposes v. Agreeing an approach to quantifying various forms of respite care as this is not a recognised service category vi. Extracting financial information pertaining to `respite only' short stays from total residential short-stay expenditure vii. Obtaining information regarding hard to reach groups viii. The degree of work with a range of Black and Ethnic Minority groups that can be carried out in the time available
RESOURCE REQUIREMENTS Project plan: The project managers will formulate a detailed project plan allocating tasks and project days. The outline project plan is presented below. 1) Service Specification/Project Brief to Best Value Review Panel for approval(APRIL/MAY) 2) Detailed Project Planning- Includes setting up sub groups,establishing tasks (MAY) 3) Stakeholder Consultation (JUNE/JULY) 4) Main Review (MAY-AUGUST) 5) Analysing information/data/feedback obtained (AUGUST/SEPT) 6) Interim workshop (SEPT) 7) Preparation of Review Report /Action Plan (SEPT/OCT) 8) Completion of Report (OCTOBER) 9) Presentation of Report (DECEMBER) Regular Review Team Meetings to Review Progress/monthly basis (MARCH to DECEMBER) RESOURCE REQUIREMENTS (Cont.) Milestone dates: May 14^th Informal briefing of Review Panel May 16^th Chair's briefing May 23^rd Best Value Review Panel July 19^th, 25^th Carers Consultation September 18^th Interim workshop october 25^th -options appraisal December 17^th -final report Costs: A budget of £300 has been agreed for holding monthly review team meetings in an accessible, community-based venue in Eastleigh and to cover carers' expenses. £5,462 has been allocated for the three consultation days in July. These will both be funded from the Carers Grant. Staffing costs are based on the estimated average number of days required for review team members. Job title/role No. of Days Cost QPMO (Project Manager) 3 days per week £13,538+- Commissioning manager (Project Leader) 1 day per week £6,941 Team Manager (Project Manager) 1.5. days per week £8,878 Commissioning Officer (Team member) 7 days total £880 Commissioning Officer (Team member) 14 days total £1,914 Social Worker 14 days total £ 1,587 Branch Secretary (Staff Rep) 14 days total £1,620 Total £35, 358 Calculations as follows: Mid point of salary scale plus 20% on costs (pay award pending not accounted for) 5 weeks deducted for sickness and leave Total divided by 47 to give weekly rate Divided by 37 to give hourly rate Timescale: 39 weeks from April 2^nd to December 30^th
AGREED Signature Date Review Team Leader: Sponsor (on behalf of DMT) Corporate Best Value Team

Best Value Review Panel (Social Services)

23 May 2001

Service Specification for the Best Value Review of Carers'

Services and Respite Care 2001

Review Team Leader: Chris Taylor

Project Managers: Alison Heywood, Peter Ross

1 Aims of the Service

To support carers in Hampshire in the central role they play in the delivery of care in the community. To respond to carers' needs and to maximise their choice, independence and welfare.

Four main outcomes can be identified:

i. To allow carers to carry out their caring role;

ii. To allow carers to maintain their other roles;

iii. To enable carers to take a break;

iv. To ensure the well-being of the person cared for

2 Objectives of the Service

To provide information and advice to carers about available services

To signpost carers to other services

To assess the needs of carers and service users

To provide emotional and practical support to carers

To enable carers to access the knowledge, skills and information to carry out their role

To provide replacement care in the home for the person looked after

To provide alternative care away from the home for the person looked after

To involve carers and their organisations in the planning and delivery of services

To consult with carers to ascertain their views

3 Links to the Corporate Aims

The aims of the service link to the following corporate aims:

Aim 1 Developing the quality of life in Hampshire;

Aim 2 Achieving economic prosperity;

Aim 4 Developing strong communities in Hampshire

Aim 5 Providing high quality accessible services.

Supporting carers to carry out their caring role enables them to provide the bulk of care in the community, thus making a significant contribution to the economic prosperity of Hampshire and to the quality of life of many of its residents. The National Carers Strategy states that 2/3 of working age carers are in paid employment. They rely on support from flexible services to remain in employment.

4 Other Links

National Context

The review takes place within the context of increased national recognition of the rights and needs of carers and will be informed by the imperatives contained within the following legislation and national strategies:

· The Carers (Recognition & Services) Act 1995 which defines a carer and establishes the right of carers to request their own assessment of need

· The National Carers Strategy (February 1999) which has established a national agenda of recognition and support for carers to enable them to continue with their caring role while maintaining their own quality of life

· The Carers Special Grant (LAC2000/6) which has now been extended until 2003/4 and will annually rise by approximately 25%. The grant will continue to be `ring-fenced' and while the criteria seem to be adjusted by the Department of Health annually the main focus will continue to be on providing breaks for carers from their caring role.

· The provisions of the Carers and Disabled Children Act 2000 as they affect carers of children. These include the right for carers to request their own assessment without the person being cared for having to be assessed. The Act also introduces both Direct Payments and Voucher Schemes for carers which will provide greater choice, flexibility and control for carers. In addition the Act introduces the power to provide services direct to carers as well as the power to charge carers for services delivered directly to them.

Following on from the Government' National Carers Strategy, the emphasis on carers issues is also reflected through the following:

i. National Service Framework for Mental Health

ii. National Service Framework for Older Persons

iii. National Learning Disability Strategy which highlights a number of challenges for services including;

· poorly co-ordinated services for families with disabled children

· poor planning for young disabled people at the point of transition into adulthood

· insufficient support for carers, particularly for those caring for people with complex needs

5 Service Policies

Key policy documents which inform this review include:

· The Carers Support Policy (November 1995) which outlines the strategic approach to the recognition of carers, the development of support and the assessment of their needs

· The Carers Commissioning Plan 2000/2004 which includes the following objectives:

- development of direct access breaks for carers through voluntary sector

- development of respite care provided in home to include carer choice

- delivery of planned respite care for carers by care group

· The updated Residential Respite Care Strategy - Children with Disabilities (2000) which outlines implementation plans and progress towards the development of family-support and family-based respite services . This area has been thoroughly researched and consulted upon.

· The Commissioning Plans for each care group as they reflect the National Carers Strategy

6 Summary of existing services and delivery methods

Carers' Services

Support for carers in Hampshire is central to the activity of all care groups in the department when responding to the needs of the community. In addition, the following services are delivered directly to carers:

· The assessment of carers within the context of The Carers (Recognition & Services) Act 1995 as part of the care management process;

· The provision and support of local carers support networks which extend across the county through Carers Together, The Eastleigh Carers Centre, The Princess Royal Trust Carers Centre and local in-house provision in Aldershot and Gosport and Fareham;

· The provision of an out-of-hours service to carers through the Carers Helpline as part of `Social Services Direct';

· The provision of breaks for carers through use of The Carers Special Grant which includes the development of pilot schemes providing increased choice and flexibility for carers;

· Hampshire Young Carers Website and young carers development project (New Forest/Eastleigh/Romsey area)

· Carers Development workers

· The Carers Handbook which has been redrafted to take account of the benefits of assessment and the provision of breaks for carers.

Respite Services

A range of services are delivered to service users in or away from the home which enable carers to take a break. The classification of these services as `respite' is contentious as it is unclear whether service users or their carers are the main beneficiaries. The following services have been identified. However, the list is not exhaustive.

i) Short Stay Residential Care for all client groups

ii) Sitting and Companion Services

iii) Family LInk schemes which provide family-based respite for children with disabilities

iv) Holiday Schemes for children with disabilities

v) Opportunity groups and play groups for children with disabilities

7. Recent Consultation

The department commissioned a series of consultation seminars attended by 138 carers and 60 professionals 'Take a Break-Information-Consultation' (June 1999). Carers' views were sought to identify;

· how to spend the Carers Grant `Take a Break'

· the means by which they prefer to receive information

· ways in which they wish to be consulted

The key issues raised by carers were;

i) the need for flexibility and choice in the provision of services

ii) signposting of information

iii) continuity and personal contact with regard to consultation

iv) the need for action on the points raised through consultation

In addition, Carers Together have carried out local consultation with carers from 1999- present date to fill gaps identified in the earlier seminars.

8. Current Performance Information

Cost:

· Expenditure has been identified under each service category by sector and by area

· Unit costs for short stay residential care (all sectors) have been obtained

· Unit costs for other respite services will need to be obtained from Areas for comparative purposes

Activity:

· The number of clients in receipt of short stay residential care adults and children where there is a main carer in the household have been obtained

· Numbers of total short-stay resident days have been identified. Non-respite categories need to be extracted

· The Carers Grant returns will indicate the number of carers given assistance through the grant against each service type

Resources:

· Staffing profiles for the department have been identified

· Further analysis is required to extract the proportion of staff delivering short-stay residential care from long-stay totals and to estimate the proportion of day & domiciliary care staff delivering `respite'

Further cost, activity and resource information is required for each category of service. It is not possible to identify expenditure on children's respite services as the pattern of provision is extremely complex. Costs will be calculated by sampling. Additional staffing information will be obtained from contracted carers centres. This information will require detailed analysis in order to calculate the proportion of carers helped through funding from the department.

Budget Summary 2001/2002 £

Carers Grant Allocation 1, 367, 000

Contracted Services 139, 000

Carers Helpline 72, 000

All Short Stay Residential (adults) 2, 585, 000

Other Respite Services 737, 660

i) Carers Grant

The Carers Special Grant from the Department of Health has been extended to 2003/2004 and is expected to rise by 25%. It is used to deliver an enhanced level of support to the carer to enable them to take a break. This can be done by providing services to the cared for person or directly to the carer. The table below shows the total allocations to Hampshire SSD together with breakdowns by area and specific sector allocations for 2000/01-2001/02

Carers Grant Allocations 2001/2002

`Area'	2000/01	2001/02
Alton/Aldershot	129,800	175,899
Andover/Winchester	100,800	136,003
Basingstoke	86,000	116,032
Eastleigh/Romsey	91,200	123,616
Fareham/Gosport	112,500	151,985
Havant/Petersfield	110,600	149,054
New Forest	75,600	150,377
Sub Total	706,500	1,002,966

Children & Families	176,600	239,717
Mental Health	54,900	78,416
Direct Payments Infrastucture	-	30,000
Central Allocation	15,000	15,000

Totals	953,000	1,367,000

ii) Contracted Services-Carer Network and Local Support Development

Net Budget 2000/01 £

Carers Together 79, 000

Policy & Resources Committee

Eastleigh Community Services 30, 000

Winchester Princess Royal Trust for Carers 30, 000

Total 139, 000

iii)Carers Helpline

Net Budget 2000/01 £ 72, 000

A total of 676 contacts were made to the Helpline in the period April 2000-Sept 2000. The statistical analysis report for the current period is awaiting completion and distribution.

Counselling 159 (18%)

Info & Advice 322 (48%)

Practical Help 235 (35%)

Total 676

iv) Short Stay Residential Care

Figures below indicate total net expenditure on short-stay residential care for adults and older persons. Figures are based on estimated costs split between long and short stays. These figures include all short stays whether a main carer has been identified or not. Figures also include short stays categorised as trial, emergency or rehabilitation in addition to programmed short stays.

Projected Outturn Estimated Net Budget

2000/2001 2001/2002

£.2,465,000 £2,585, 000

v) Other Respite Services

Budgets for a range of respite services including sitting and companion services, Family Link, holiday schemes and opportunity groups have been identified by sector and by area.

Net budget 2000/2001 £

Children & Families 469,970

Older People 156,500

Mental Health 41,790

Learning Disability 0

Total 737,660

vi) Day & Domiciliary Care-Simultaneous Service Delivery

The net budget for day and domiciliary care (purchased and provided) for 2001/2002 totals £34,278,000. Between one quarter and one third of clients in receipt of day and/or domiciliary care can be identified as living with a main care. It could, therefore, be argued that between one quarter and one third of this budget provides a simultaneous service to carers and service users as carers receive implicit respite from this provision. As an estimate, 30% of the total day/dom budget equates to £10,283,400

Numbers of clients (aged over 18) 2000 in receipt of day/domiciliary care December 2000

	Total clients	Clients with carer in the same household	Clients with carer in the same household as % of total
Day	3346	1229	37%
Dom	7194	1610	22%

Information, Advice and Signposting

i) Carers Helpline.

The Out of Hours Services Statistical Analysis Report 1^st April 2000-30^th September indicates a continued overall increase in the use of this service. Requests for information and advice in this period increased by 79% in comparison with the corresponding period for the previous year while there was an overall increase in the use of the service of 17%. The Helpline has a net budget allocation of £72, 000 for 2000/01.

Information & Advice 322

Practical Help 235

Counselling 159

Total 676

ii) Carers Handbook

The revised handbook was published in March 2001. The print run was increased by 100% on previous years from 13,000 to 26,000 copies. To date, 6,500 copies have been distributed. In addition, carers' services are publicised through mainstream brochures and leaflets including `Care at Home'.

iii) Carers Together

The report compiled by Carers Together gives the following details of activities for the three-month period January 2001-April 2001.

· distributed quarterly newsletter to 99 statutory organisations, 467 individual carers and 131carers' groups (figures based on database entries for March 2001)

· responded to 119 requests from carers and statutory organisations for general information, representing 60% of all responses to contact in relation to carers

· signposted 63 carer contacts to other services (SSD, Carer Support Worker, other agencies)

· developed an information leaflet aimed at new carers to raise awareness of types of support available (to be located in hospitals and surgeries from May 2001)

· planned display stands at public information points to coincide with National Carers Week -June 2001

Carers' Assessments

Figures for 2000-2001 show an increase of 12% in the number of carers' assessments in comparison with the previous year. Numbers include carer assessments carried out separately and those carried out jointly with the client assessment.

Area	1999-2000	2000-2001	Total
Alton/Aldershot	18	8	26
Basingstoke	12	48	60
Eastleigh/Romsey	28	20	48
Fareham/Gosport	29	24	53
Havant/Petersfield	23	79	102
New Forest	122	76	198
Winchester/Andover	34	42	76
Total	266	297	563

Support for Carers

Emotional and practical support for carers is provided through a range of provided and contracted services. These include:

i) Counselling

Carers Helpline statistics for April-September 2000 shows a total of 119 counselling responses; a reduction of 16% for the corresponding period in the previous year as the use of the Helpline has shifted from counselling to providing information and advice . The Report for the September 2000-April 2001 is awaiting distribution.

`Carers Together' report a total of 36 requests for support/'a listening ear' from January -March 2001

ii) Relaxation and Training events

Carers Together have delivered the following relaxation and training events to carers:


Event/Location	Date	Attendance
Relaxation:
County-wide	March 2001	70 carers
New Forest	January 2001	50 carers
Training:
First Aid	February 2001	6 carers
Young Carer workers	February 2001	16 delegates
Impact on Carers	March 2001	8 delegates
Mental Health Awareness	April 2001	10 delegates

Respite/Breaks for Carers

i) `Respite nights'

The total of `respite nights' (adults) for April 2000-March 2001 is estimated at 25,700. These draft figures indicate a decrease in the number of `respite nights in comparison with the total for 1999/2000 of 26,657.

Citizen's Charter L4 returns for 1999/2000 indicate that Hampshire delivers the lowest number of respite nights compared with other Shire Counties. However, the reliability of the data with respect to this indicator is questionable and the indicator has been discontinued. The Performance Assessment Framework (PAF) asks authorities to provide details of progress towards the provision of breaks services under The Carers & Disabled Children Act 2000. The review will carry out a mapping exercise to identify the range and distribution of these services.

ii) Carers Grant Additional Breaks Services

The Carers Grant funded a range of additional breaks services including day care, sitting services and residential care since 1999.

Carers Grant Expenditure on additional breaks services 1999/2000

Area	Spend £
Alton/Aldershot	75,250
Basingstoke	52,000
Eastleigh/Romsey	52,228
Fareham/Gosport	84,795
Havant/Petersfield	68,500
New Forest	29,612
Winchester/Andover	20,300
Total	382,685

Carers Consultation and Involvement

Carers are involved in the planning and delivery of services in the following ways:

· Financial support-5% of annual Carers Grant Allocation spent on consultation with carers

· Contracting organisations who support carers to carry out consultations

· Funding to local organisations involved in planning services (this needs to be identified through mapping)

· Involvement of carers in the democratic process e.g. through the Adult Sub Committee

· Consultation facilitated by Carers Together. Events include:

- `Take a Break', July 1999 (138 carers, 60 professionals)

- `The Carers & Disabled Children Act', January 2001 (20 carers attended)

- Partnership Plan for Working with Carers, planned for June 2001

9. Competition and other providers

10. Challenges facing the service

There is no acceptable determinant of who, as a carer, is likely to seek access for service and from which source. The carers population is estimated to change at the rate of up to 40% per annum. The National Census (2001) will provide detailed data on the incidence and needs of carers. The number of adult carers in Hampshire in 2002 is estimated at 127384, of this total, 42460 will be eligible for an assessment of their needs.

Challenges to services include:

· Responding to the needs of carers identified through annual increase in carers' assessments

· Addressing the complexities of simultaneous service delivery to carers and service users

· The challenging partnership agenda across agencies

· Obtaining information to measure the range and choice of services available and to measure outcomes for carers

· The implications of the convergence with Health and representing the ethos of carers' perspectives within this process

· Responding to the demands of carers for information, advice and support through increased recognition of their rights.

Appendix (i)

Review Team:

Adult carer

Parent carer

P. Chambers-Area Finance Manager, seconded to Best Value

P. Massey-Social Worker Eastleigh/Romsey(Carers)

A. Heywood-Quality & Performance Management Unit, Project Manager

J. Hider-Alzheimer's Disease Society

P. Ross-Team Manager Eastleigh/Romsey (Older Persons), Project Manager

C. Taylor-Commissioning Manager Physical Disability, Review Team Leader

J. Temple-Hampshire Unison,

G. Woollan-Commissioning Officer, Carers

P Noble-Commissioning Officer, Mental Health

Links:

Council Member-Cllr Mrs P Devereux

Corporate Sponsor-Bob Lisney

F. Sheldon-Southampton University

Black community representative

APPENDIX (ii)

Best Value Review 2001 - Carers and Respite Care

Definition of a Carer

(ref: Carers (Recognition & Services Act) 1995)

Anyone who provides a substantial amount of care on a regular basis and does not provide that care on the basis of a contract of employment or other formal arrangement.

Note: note defined by age, sex, relationship to cared for person, `care group' of person cared for or location.

Interpretation of `substantial' and `regular'

(ref: HCC Social Services Committee 1996)

Substantial - an amount of care such that the carer is unable to stop providing without the person receiving the care being at significant risk.

Regular - appropriate to the needs of the person receiving the care.

(Note: draft guidance issued for `The Carers and Disabled Children Act 2001 indicates that the above interpretations may require revision to better reflect the impact of the caring role of the carer. However to date the above definition and interpretation has not caused any difficulties either for the department or the carers.)

Geoff Woollan

Commissioning Officer - Carers

28^th February 2001

APPENDIX ii

Best Value Review 2001 - Carers and Respite Care

Definition of Respite Care

(In line with probable definition of respite care contained within the regulations and guidance expected end March 2001 for the Carers & Disabled Children Act 2000 - therefore this may be subject to change.)

Definition

Respite care is a service delivered to someone living in the community who has been assessed as needing personal care and/or supervision as an alternative to their original care provider.

Original Care Provider

1. Care provided by a carer (as defined in Carers (Recognition & Services) Act 1995).

2. Care provided by any agency by formal arrangement/contact/etc.

3. A combination of 1 & 2.

Time Frame

1. Respite care is delivered within a fixed time frame with an end (although this can be renegotiated.

2. On an annualised basis the majority of care will be provided by the original care provider.

`Implicit Respite Care'

Respite care provided without specific time frame i.e. presumed (by carer and/or care recipient) long term attendance at a day unit for example. Not formally recognised as respite care but in practice is.

Beneficiary

1. The original care provider , particularly the carer.

2. The person receiving the service.

Sources of alternate care

1. Service provided in the home of the person receiving care.

2. Service provided away from the home of the person receiving care.

1. Day Care agency

2. Luncheon Club

3. Social Club

4. Training Centre

5. Education Centre

6. Residential Care (Statutory and Private)

7. Nursing Care

8. Hospital Care

9. Adult Placement Care

10. Foster Care

11. Etc. etc

Appendix (iii)

EFQM Excellence Model- Exercises Review Team 5^th April 2001

Objectives:

· To identify strengths and areas for improvement

· To look at existing evidence regarding performance and identify gaps

· To identify priority areas to be reviewed

Tasks:

Consider the questions below.

1. Identify strengths and areas for improvement

2. List supporting evidence and areas where further evidence/information is needed

Customer Results

Are carers satisfied with the services they receive?

Consider:

· Outcomes of consultation

· Review findings

· Survey results

· Number of complaints/compliments

· Proportion of carers complaints that have been informally resolved

· Any other measures?

To what extent are carers involved in services?

Consider:

· Mechanisms of involving carers and their effectiveness

· Consultation findings

How well do services meet the needs of specific groups of carers?

Consider:

· Ethnicity of carers

Key Performance Results

1. How well are we performing as a department?

Consider:

· Performance Indicators (Audit Commission, RAP)

· Outcomes of the Joint Review

· Outcomes of other Best Value Reviews

· SSI standards (`A matter of chance for carers')

· Unit costs ( in comparison with other authorities and providers)

· Carers Grant returns

· Contracts (Carers Centres, Carers Together)

· Carers Consultation Report

· Carers Helpline

· Carers Assessments (Portsmouth research)

· Any other measures not listed above?

2. What areas of good practice are there? Are these linked to performance measures?

Best Value Review Carers' Services & Respite Care-Priorities Matrix

Function

Strengths

Areas For Improvement

Supporting Evidence

Further action/info needed

Information & advice

_ Carers Helpline and Out of Hours Service

_ Information Centres

_ Grants and contracts to voluntary organisations

_ Carers handbook

_ Young Carers Website

· Staff in respite services don't have knowledge & info re carers' services

· Provision of information to hard to reach groups

Statistical Analysis Report (EDS)

· Link with corporate information team

· Link with West Sussex

· (Beacon status for information centres)

Assessment and care management

_ 100% increase in the number of carers' assessments 2000-2001

_ Transitional workers

_ Transitions (children/adult; adult/older persons; LD/dementia)

· Access to services

_ Ensuring seamless services

_ Gap between assessed needs and resources

_ Shortage of social workers to carry out assessments

_ RAP returns

_ SSRIU Research

_ `Separate Assessment of Carers'

_ Carers' knowledge, experiences, networks (Review Team)

_ Identify outcomes from assessments and consider the implications (e.g. resource) from increased no. of assessments

_ Findings from Transitions Project (QPMU)

Alternate care

(in/away from home)

· Range of services

· Alzheimer's Cafe (Aldershot)

· Sitting services

· Adult placement (LD)

_ Lack of adequate respite care

_ Poor performance against ACL4 (no. of respite nights)

_ High cost of providing residential respite care

_ Inappropriate forms of provision (suitability for age of user, 16-25 age group not catered for)

_ Increasing the flexibility of voucher scheme

_ Draft Housing Strategy ROCC

_ Community Care Statistics

_ Service mapping-Commissioning Plan Mental Health 2001

_ Idenifying levels of need and resource availability

_ map the range of services to identify whether flexible models can be accessed across the county

_ What services are provided by Health and Voluntary Sectors?

_ What evidence of working in partnership with the above?

Support and practical assistance

· Counselling via Carers Helpline

· Voucher scheme (Havant Petersfield)

_ Out of Hours Services (EDS) Statistical Analysis Report

_ Consumer Audit

Function

Strengths

Areas For Improvement

Supporting Evidence

Further action/info needed

Involvement

_ Network of carers' groups across Hampshire

_ Support to carer and groups through contracts and use of facilities

_ Project workers (MH) in each area

_ Little evidence of engagement of services with carers. Need for systematic involvement of service users and carers in planning, delivery & review of services' (MH)

_ Legal barriers to involvement

_ BV Review MH Provider & Contracted Services 2000

_ Carers Togther-list of carers' groups (approx 142)

_ Identify hard to reach groups and means of involvement/

_ consultation

Meeting the needs of specific groups

_ Support for service users with caring responsibilities `patchy' (MH)

_ Access to information for specific groups .g. black and ethnic minorities

_ BV Review MH Provider & Contracted Services 2000

_ ?Cheryl Martin's research

_ Younger persons with dementia project. Alzheimer's Society/SS/Health

_ Check out approach to providing information to hard to reach groups

_ Identify means of consultation with hard to reach groups

_ Seek guidance from Equalities Advisor