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Hampshire County Council Executive Member, Social Care Item 24 January 2003 Additional outcome report of the Best Value review of carers' services and respite care Report of the Director of Social Services |
Contact: Alison Heywood, ext 7235
1 Purpose of report
1.1 This report is to appraise members of the progress made by the Best Value review of carers' services and respite care 2001/2002 in consulting with stakeholders and members regarding the future development of carers' support services. Its purpose is to seek final agreement to the outcome report and member approval of proposals to develop a cohesive, consistent network of carer support services across the county.
2 Background
2.1 The outcome report from this review was first presented to the Social Care Policy Review Committee on 22 February 2002. At this meeting, members agreed the following six outcomes for delivering improvements to services that benefit carers in Hampshire:
- improved access for carers and professionals to information about help and services available to carers
- improved communication with carers from hard-to-reach groups and wider recognition of their needs
- improved access to assessment for carers to ensure recognition of their needs
- an increased range of flexible services to enable carers to take a break when they need it
- improved efficiency of in-house resources providing respite care
- more responsive services to support carers of people with mental health problems.
2.2 The committee advised that further consultation involving key stakeholders and members be carried out regarding outcome 4 of the review; `increased cost effectiveness and consistency of local carers' support services'.
2.3 To this end, a stakeholders' and members' seminar was held on 12 April 2002 to appraise alternative models for developing carer support services. The seminar included a presentation from John Bangs, Carers Development Manager, Surrey County Council. This provided an opportunity to make comparisons with carer support services in Surrey and to learn from their experiences of developing a county-wide network of services.
2.4 Participants agreed the following objectives for developing a refined model of carer support services tailored to Hampshire's needs:
- have clear objectives and roles
- ensure an even spread of services across the county without reducing existing services
- use resources as efficiently as possible avoiding duplication of costs
- generate additional investment from key partnerships e.g. Health
- ensure greater collaboration between organisations
- ensure equity of access for carers
- strengthen the voice of carers in planning services.
2.5 A process was agreed for further consultation with stakeholders and informing members for developing the refined model of carer support services.
2.6 On 31 May 2002, the Social Care Policy Review Committee resolved that:
i. The outcome report of the Best Value review of carers' services and respite care be approved subject to a refined model of carer support services being developed
ii. The process of developing a refined model of carer support services be agreed
3 Stakeholder seminar 8 October 2002
3.1 A second stakeholder seminar was held on 8 October to give further consideration to the development of a refined model of carer support services, as requested by the PRC. The seminar was chaired by the Director of Social Services. Participants included representatives from each of the carer support service providers, County Council Members and the Best Value review team.
3.2 Yvonne Le Brun, County Manager, Health and Social Care Planning, outlined the current configuration of carer support services in Hampshire and highlighted some gaps in provision and an uneven geographical distribution of Social Services investment.
3.3 Gerry Mahaffey, from the Princess Royal Trust for Carers national organisation (PRTC), addressed the seminar on the history of the carers' movement and the national development of the Trust. Mr Mahaffey presented details of the support provided to members of the PRTC network that carer support services in Hampshire could benefit from through county-wide affiliation. This includes access to:
· Quality assurance tools and models of good practice
· Learning networks
· IT support
· Funding sources
· Training
· Updating about regional and national developments
3.4 From the discussion that followed, participants reached broad agreement regarding the aims and principles that will inform the future development of carer support services.
3.5 Future development of carer support services is needed to ensure a cohesive county-wide approach and greater consistency of service delivery. There are no fixed ideas about who should provide services and no planned reduction in the core investment from Social Services. Further investment to raise the level of services in those areas that are currently less well served, should be met by additional investment, including use of partnerships, and not through redistributing existing funding to other areas.
3.6 Some initial objectives were identified for developing services:
- to fill current gaps in provision
- to generate additional income
- to identify a central body to co-ordinate the network.
3.7 It was acknowledged that the vision of a county-wide network of services will take time to achieve. Further work is required to consult with carers about the future development of support services and to address outstanding issues, including;
- whether to affiliate to the national PRTC network and what form this might take
- whether a `consortium' model is the best model for developing a network of services and how this could be adapted to suit the county's needs
- the role of contracted and in-house services within a county-wide network of service providers.
3.8 It was agreed that John Clifton and Yvonne Le Brun, with help from the Princess Royal Trust for Carers (national), would draft a proposal to develop a network of services, setting out the process for consultation and that they would establish a steering group to take this work forward.
3.9 The first meeting of the steering group took place on 13 November 2002. It was agreed to approach Gerry Mahaffey, PRTC national organisation, to facilitate the consultation process and future development of carer support services.
4 Conclusions
Broad agreement has now been reached with stakeholders regarding the aims and principles of developing a network of carer support services. While there is further work to be done, there are plans in place for stakeholders to work collaboratively with Social Services to achieve this vision.
Appendix A Improvement plan
Outcome 1. Improved access for carers and professionals to information about help and services available to carers. | |
Action |
Cost |
Create a new electronic database of resources that are available to carers. |
Ongoing additional cost of £29,000 per year to be met by reallocating budget associated with The Carers' (Recognition & Services Act). To be reviewed each year. |
Set up a web site to allow carers and professionals access to the new database and other facilities with links to local and national information sources. | |
Employ a development worker to maintain the new database and website and publicise information sources. | |
Establish baselines for the database and website and monitor performance over 3 years. | |
Commission survey of carers (to include questions about access to specific sources of information relating to Social Services). |
One-off additional cost £6,000 to be met from The Carers' Special Grant |
Outcome 2. Improved communication with carers from hard to reach groups and wider recognition of their needs. | |
Action |
Cost |
Incorporate a requirement to target communication with specified groups of carers who are hard to reach in contracts with carers' support services. |
No additional cost |
Develop a programme of briefings for carers' support services outlining their responsibilities in relation to the Race Relations Amendment Act 2000 and Social Services' policies. |
No additional cost |
Establish links with carers from Black and minority ethnic groups and consult on their needs by extending the remit of the outreach worker (Direct Payments). |
Additional one-off cost to be met within £10,000 NHS/Social Care Award. |
Ensure membership of Carers' Helpline steering group includes a Black or minority ethnic carer. |
No additional cost |
Commission training for residential staff to promote awareness of the needs of gay carers. |
Cost to be identified |
Incorporate the needs of gay carers and carers from ethnic minorities in care management training. |
No additional cost |
Outcome 3. Improved access to assessment for carers to ensure recognition of their needs. | |
Action |
Cost |
Monitor progress against the Best Value Review of Care Management/Reception and Assessment 2001/2002 improvement plan |
Costs identified in this Review |
Commission survey of carers' views including ease of access to assessment and care management. |
See Outcome 1 |
Outcome 4. A cohesive, consistent network of carer support services across the county. | |
Action |
Cost |
Manage all contacts with carers' support services from one source. |
Costs to be met within current level of funding of £195,000 p/a (to March 2003) Plus costs of £6,000 identified for consultation (see outcome 1) |
Extend existing contracts/service level agreements with carers' support services for one year from March 2002 | |
Establish a steering group comprising representatives from the department, contracted and in-house carer support services | |
Engage an external facilitator to support the consultation process and the subsequent development of carers support services | |
Implement the Department of Health Quality Standards for Local Carer Support Services and monitor performance against these. | |
Outcome 5. An increased range of flexible services to enable carers to take a break when they need it. | |
Action |
Cost |
Roll out voucher-type schemes to deliver flexible carer replacement services across the county. |
Additional ongoing cost met from annual increase in the Carers' Grant. Up to: £260,000 (2002/03) £560,000 (2003/04) |
Implement schemes to provide intensive support for children with complex needs. |
Additional ongoing costs to be met from Quality Protects funding. Estimated ceiling = £23,000 per child. |
Raise ceiling for number of families receiving Direct Payments. |
No additional cost |
Develop additional respite facilities for children with a disability in targeted areas (as identified in the county-wide audit of respite services 2001). |
Costs to be identified by April 2003. To be funded from Partnership bid. |
Identify options to increase availability of respite care for parent carers at peak times. | |
Commission survey of carers' views including services to enable carers to take a break. |
See outcome 1 |
Outcome 6. Improved efficiency of in-house resources providing respite care. | |
Action |
Cost |
Outline initial approach to improving efficiency of in-house resources providing respite care. |
No additional cost. |
Outcome 7: More responsive services to support carers of people with Mental Health problems. | ||||
What |
Who |
When |
Cost | |
Involvement |
a) Effective carer involvement underpins an integrated planning process. | |||
_ Ensure there is a `carer champion' on each LIT and PCT to promote need for funding and highlight Carers agenda. Also ensure carer representation on Patient Forums at PCT and Trust level. _ Develop mechanisms to pay carers for their time and involvement |
MH leads on PCTs and LITs. MH Training Manager/ Commissioning Team |
From April 02 October 02 |
Opportunity cost MH Training Manager to cost | |
Information |
b) A comprehensive range of information is available at points of need in accessible formats. | |||
_ Develop a MH Information Pack for Carers |
LIT/ CPA Lead Officers/ SSD Commissioning Team. |
April 03 |
Additional cost contingent upon joint funding agreement. | |
Systems |
c) Delivery of the joint adult Mental Health Information System to provide accurate and consistent resource management and financial information | |||
_ Develop joint Adult Mental Health Information System |
Joint Information Project Board covering three Health Authority areas |
2004 |
Significant, joint funding by Health/ SSD. | |
Assessments |
d) Effective eligibility criteria for access to assessment, support and services are agreed and implemented. | |||
_ Develop draft eligibility criteria between Health and Social Services |
MH leads on PCTs,/ LIT's/CPA Lead Officers and SSD Commissioning Team |
October 02 |
Opportunity cost | |
e) Shared good practice exists in relation to carers' assessments, service delivery and involvement. | ||||
Develop joint format for carers' assessments and care plans |
MH leads on PCTs,/ LIT's/CPA Lead Officers and SSD Commissioning Team |
June 02 |
||
Services |
f) A full range of services, including respite care, will meet need in each locality. | |||
_ Develop a plan to improve the range of respite and other services for carers (based on MH Service Map) |
Service Managers MH Multi-agency group |
April 03 |
Opportunity cost | |
Training |
g) Appropriate training to meet the range of carer need is developed and delivered. | |||
_ Deliver multi-agency training to raise awareness and responsiveness of professionals in carers issues and rights. _ Develop a range of MH-specific training for carers |
MH Training Manager |
From April 02 |
MH Training Manager to cost | |
Promotion |
h) Carers' rights are promoted across agencies at strategic and operational levels | |||
_ Highlight carers' agenda in MH health promotion schemes |
MH leads on PCTs |
From April 02 |
Contingent upon Health funding via NHS Plan | |
Outcome 1. Improved access for carers and professionals to information about help and services available to carers. | ||
Performance Indicator |
Current Performance |
Target Performance |
Number of requests received by the Carers' Helpline (all functions). |
1,147 - 1999/2000 1,299 - 2000/2001 (13% increase) |
Target to be set by Carers' Helpline Steering Group April 2003 |
Number of requests received by carers' centres for information and advice. |
No standard measure (see appendix). |
Target to be set April 2003 |
Number of hits on the new carers' website. |
N/A -service does not exist. |
Target to be set May 2003 |
% of carers (responding to a survey) who said that they found it easy to get hold of specified information and advice relating to Social Services. |
Not identified. Survey to be commissioned for 2003 |
Target to be set pending outcome of survey 2003 |
Outcome 1. Improved access for carers and professionals to information about help and services available to carers. | ||
What |
Who |
When |
Create a new electronic database of resources that are available to carers. |
Strategic Development Manager -Carers |
April 2003-2006 |
Set up a website to allow carers and professionals access to the new database and other facilities with links to local and national information sources. |
Strategic Development Manager -Carers |
April 2003-2006 |
Employ a development worker to maintain the new database and website and publicise information sources. |
Strategic Development Manager -Carers |
April 2003 |
Establish baselines for the database and website and monitor performance over 3 years. |
Development Worker-Carers' Information |
From April 2003 |
Commission survey of carers (to include questions about access to specific sources of information relating to Social Services). |
Strategic Development Manager -Carers |
July 2003 |
Outcome 2. Improved communication with carers from hard to reach groups and wider recognition of their needs. | ||
Performance Indicator |
Current Performance |
Target Performance |
Contracts with carers' support services include a specification to target communication with hard to reach groups. |
Not currently specified. |
Inclusion in 100% contracts by April 2003 |
The proportion of residential and care management staff in the department who have received training. |
Training to be commissioned by April 2003 |
Target to be set by April 2003 |
The proportion of groups included in the Race Equality Directory giving a substantive response to local carers' services or to the development worker. |
Development work to be commissioned from April 2002 |
Targets to be set by April 2003 |
The profile by ethnicity of carers with an assessment. |
Not identified. |
Identify profile by April 2003 |
Outcome 2. Improved communication with carers from hard to reach groups and wider recognition of their needs. | ||
What |
Who |
When |
Incorporate a requirement to target communication with specified groups of carers who are hard to reach in contracts with carers' support services. |
Strategic Development Manager -Carers |
By April 2003 |
Develop a programme of briefings for carers' support services outlining their responsibilities in relation to the Race Relations Amendment Act 2000 and Social Services' policies. |
-Strategic Development Manager -Carers -Race Policy Advisor |
Delivered by April 2003 |
Establish links with carers from Black and minority ethnic groups and consult on their needs by extending the remit of the outreach worker (Direct Payments). |
Outreach worker (Direct Payments) |
By April 2003 |
Ensure membership of Carers' Helpline steering group includes a Black or minority ethnic carer. |
Strategic Development Manager -Carers |
By May 2003 |
Commission training for residential staff to promote awareness of the needs of gay carers. |
Strategic Development Manager -Carers |
By April 2003 |
Incorporate the needs of gay carers and carers from ethnic minorities in care management training. |
Strategic Development Manager -Carers |
From July 2002 |
Outcome 3. Improved access to assessment for carers to ensure recognition of their needs. | ||
Performance Indicator |
Current Performance |
Target Performance |
PAF Indicator D42 `The number of informal carers receiving an assessment as a proportion of the total number of users and carers receiving an assessment'. |
2000/01: - 47.2% `Good' (4 `blobs' out of 4) - Total number of joint and separate carers' assessments = 9142 |
Increase total number of assessments (no target has been set) Carers to be identified for all service users on CPA and to be offered an assessment |
RAP return. ref: A7 `Length of time from first contact to completed assessment for new clients. |
35% assessments new clients 2000/01 took over 6 weeks from first contact to completion. |
25% by July 2003 17% by July 2004 (see Best Value Review of Care Management) |
% Carers surveyed who say they got help quickly. |
Survey to be commissioned for 2003. |
Performance target to be set by Oct 2003 pending outcome of survey. |
The Best Value Review of Care Management/Reception and Assessment to make recommendations to address carers' difficulties in accessing care managers and delays in assessments. |
Review Leader/Project Manager |
May 2002 |
Commission survey of carers' views including ease of access to assessment and care management. |
Strategic Development Manager -Carers |
July 2003 |
Outcome 4. A cohesive, consistent network of carer support services across the county. | ||
Performance Indicator |
Current Performance |
Target Performance |
Cost of contracts. |
Current cost of contracts and in-house services £195,000 |
Cost levels maintained in first year (April 2002-March 2003). |
Level of investment in carers support services by area |
£35,000 p/a = max SSD investment |
Minimum total investment (SSD plus external sources) £35,000 per area |
Other performance indicators to be determined and included in new contracts from April 2003. | ||
Outcome 4. A cohesive, consistent network of carer support services across the county. | ||
What |
Who |
When |
Manage all contacts with carers' support services from one source. |
Strategic Development Manager -Carers |
From 01 April 2002 |
Extend existing contracts/service level agreements with carers' support services for one year from March 2002 |
Strategic Development Manager -Carers |
April 2002-March 2003 |
Establish a steering group comprising representatives from the department, contracted and in-house carer support services |
County Manager Health & Social Care Planning |
November 2002 |
Engage an external facilitator to support the consultation process and the subsequent development of carers support services |
County Manager Health & Social Care Planning |
November 2002 |
Implement the Department of Health Quality Standards for Local Carer Support Services and monitor performance against these. |
Strategic Development Manager -Carers |
March 2003 |
Outcome 5. An increased range of flexible services to enable carers to take a break when they need it. | ||
Performance Indicator |
Current Performance |
Target Performance |
% Carers' Grant spent on voucher-type schemes. |
10% grant spent on voucher-type schemes. |
25% spent on voucher-type schemes. |
% Children in receipt of respite care aged under 10 using family-based support. |
Not identified |
Identify current performance and set targets |
Number of families of children aged under 18 using Direct Payments. |
6 families anticipated by April 2002 |
10 families by March 2003 |
% of carers surveyed who say that the range and flexibility of services is good. |
Survey to be commissioned for 2003. |
Performance target to be set by Oct 2003 pending outcome of survey. |
Outcome 5. An increased range of flexible services to enable carers to take a break when they need it. | ||
What |
Who |
When |
Roll out voucher-type schemes to deliver flexible carer replacement services across the county. |
Strategic Development Manager -Carers |
April 2002-2005 |
Implement schemes to provide intensive support for children with complex needs. |
Strategic Service Manager-Children with Special Needs |
Target date to be set pending outcome of submission to cabinet in April 2002 |
Raise ceiling for number of families receiving Direct Payments. |
Children and Families Project Development Officer (JP) |
April 2002 |
Develop additional respite facilities for children with a disability in targeted areas (as identified in the county-wide audit of respite services 2001). |
Strategic Service Manager-Children with Special Needs Children and Families Project Development Officer (JT) |
Target date to be set pending outcome of partnership bid March 2003 |
Identify options to increase availability of respite care for parent carers at peak times |
Strategic Service Manager- |
April 2003 |
Commission survey of carers' views including services to enable carers to take a break. |
Strategic Development Manager -Carers |
July 2003 |
Outcome 6. Improved efficiency of in-house resources providing respite care. | ||
Performance Indicator |
Current Performance |
Target Performance |
% Occupancy in-house units providing respite care. |
Short stay occupancy levels cannot be identified using current methods of data collection Combined long-stay and short-stay residential average occupancy levels 2000/2001 (LD sector) = 71.6% |
Targets to be set July 2002 (Learning Disability Sector) |
Actual unit costs per week residential units providing respite care. | ||
Accuracy of occupancy recording. | ||
Outcome 6. Improved efficiency of in-house resources providing respite care. | ||
What |
Who |
When |
Establish baseline occupancy levels Identify barriers to maximising occupancy of residential units providing respite care Outline initial approach to improving efficiency of in-house resources providing respite care and identify associated costs |
Strategic Service Manager (Learning Disability) |
July 2002 |
Outcome 7. More responsive services to support carers of people with mental health problems. | ||
Performance Indicator |
Current Performance |
Target Performance |
PAF C31 Adults aged 18-64 with MH problems helped to live at home per 1,000 population aged 18-64. |
2000/01 2.8 per 1,000 pop 4 `blob'= good |
Maintain good performance |
Number of carers involved in strategic planning through Local Implementation Teams (LITs) and Patient Forums at PCT and Health Trust levels. |
- Carer representation on approx. 4 out of 7 LITs. - Patient Forums start in April 2002 |
1x carer representative on each LIT (7 in total) |
% Carers of people on enhanced CPA given a Mental Health Information Pack for Carers. |
MH Information pack does not exist (local MH Directory has 60% county-wide coverage) |
100% |
Number of carers of adults with severe and enduring MH problems who have had a separate assessment and have their own care plan. |
Estimated 50 carers |
200 carers in 2002/2003 |
The level of satisfaction expressed by carers completing the CPA Audit. |
CPA Audit to be introduced in April 2002 |
Target performance to be set following completion of first CPA Audit, April 2002 |
% Care Co-ordinators receiving joint funded multi-agency training covering all aspects of cares' rights and needs. |
None to date as training newly commissioned. Estimated 50% have received general carer-related training. |
100% by April 2003 |
Number of carers of people with a severe and enduring mental illness receiving bespoke training for carers. |
Initial training plan developed and subject to tender. |
Total 25 carers by April 2003 |
Section 100 D - Local Government Act 1972 - Background Documents
The Following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.
Working papers and records of the Best Value review of carers' services and respite care team meetings held by the review project manager.