1 Summary

1.1 The following decisions are sought.

1.2 That option 2, restructuring the current management and changing one of the existing partnership manager posts to a new county manager post to deliver the contact centre agenda in partnership with care group leads, health and education, be adopted.

1.3 That the new County Manager carries out a further review of the current management structure alongside the development of the service.

1.4 That proposals by North Hants Primary Care Trust for joint working with Social Services be welcomed.

2 Reason(s)

2.1 The current management arrangements for Social Services Direct were established to manage the extended Out of Hours service, including emergency duty service, the carers helpline, the children's information service and the Fareham and Gosport call centre. An additional part time post was added to take forward the Occupational Therapy Direct (OT Direct) developments. There are opportunities to develop Out of Hours services and contact centres further, to ensure more responsive and accessible services to the public, but this will need leadership from a senior manager.

3 Other options considered and rejected

3.1 Do nothing.

2.2 For the current county managers to develop their separate strands of the service.

3 Conflicts of Interest declared by the decision-maker or other Executive Member consulted

4.1 None.

4 Dispensation granted by the Standards Committee

5.1 None.

5 Reason(s) for the matter being dealt with if urgent

6.1 Not applicable.

Approved by: Date of decision:

Councillor Felicity Hindson

1 Summary

1.1 Current Management Arrangements

1.2 The current management arrangements for Social Services Direct were established to manage the extended Out of Hours service, including emergency duty service, the carers helpline, the children's information service and the Fareham and Gosport call centre.

1.2 An additional part time post was added to take forward the Occupational Therapy Direct (OT Direct) developments. There are opportunities to develop Out of Hours services and contact centres further, to ensure more responsive and accessible services to the public, but this will need leadership from a senior manager.

2. Introduction

2.1 Following a successful Invest to Save Bid, Hampshire was awarded a grant to develop a telephone call centre to link up area office telephone systems to the Out of Hours service.

2.2 The system has allowed service users to access services after office hours and has housed the day time telephone reception service for Fareham & Gosport.

2.3 Recently OT Direct has been established as the first point of contact for all occupational therapy referrals. Service advisors take calls directly and with the use of a screening tool have diverted 30% of referrals from area offices supplying equipment or advice at this first point of contact.

2.4 This report is not an Information Technology report but a report about organisational change and the management arrangements to support that change. It reviews the future demands on Out of Hours services arising from the managed care agenda, the developments in primary care, the plans for the children's call centre, the Reception and Assessment developments and the Mental Health National Service Framework.

2.5 Options for the management of the service are set out and a preferred option is recommended.

3. Hampshire County Council's Corporate Strategy

3.1 This report supports the County Council's Corporate Strategy specifically:-

3.2 Aim 1 - Maximising Life opportunities by improving access to health and social care services for the residents of Hampshire.

3.3 Aim 5 - Improving Services by being more responsive to users and carers by offering extended opening hours.

4. Future demands on the development of Contact Centres/Out of Hours Services

4.1 Primary Care and Managed Care.

4.2 Hampshire's Primary Care Trusts took over responsibility for Primary Care Out of Hours services on 1^st July 2004 and now offer a range of services to local people including Primary Care Centres, advice and assessments, home visits etc. The plans for the development of Managed Care cite as critical the coordination of Out of Hours services to prevent the need for inappropriate emergency admission to hospital or long term care. Jane Duncan at North Hampshire Primary Care Trust¹ proposed that:

4.3 "the PCT work with SSD to develop a 24 hour `rapid response' service - this could be developed by linking together and enhancing existing services" building upon "opportunities that are available through the new GP and Pharmacy contracts".

4.4 Social Services Direct already has the ability to receive and transfer calls directly to NHS Direct. In the last year, 7 calls were transferred from NHS Direct to Social Services and 4 passed through to them.

5. Plans for Children's Call Centre

5.1 Following the visit to New Zealand and the study of their national call centre, the benefits of extending the Social Service Direct service by employing staff with social work skills to carry out initial assessments and the resolution of straightforward problems have been reported.² A pilot scheme is at the early stage of development.

6. Reception and Assessment Developments

6.1 Building on the work and lessons learnt from Occupational Therapy Direct and the review of Reception and Assessment (R & A) functions in Adult services, a project group has been established to explore whether the current Social Services Direct model can be expanded to meet the requirements of the R&A service to pilot a call centre approach possibly in one locality. Recent metrics exercises which collated information on the volumes, nature and outcome of calls to R & A, have suggested that around 70% of calls could be dealt with at first point of contact. It is clear already that the current management structure within Social Service Direct cannot simply absorb this work.

7. Mental Health National Service Framework

7.1 The mental health NSF has two standards that make specific reference to Out of Hours services.

7.2 Standard 3: Any individual with a common mental health problem should:

7.3 Be able to make contact round the clock with the local services necessary to meet needs and receive adequate care

7.4 Be able to use NHS Direct, as it develops, for first level advice and referral on to specialist help lines or to local services.

7.5 The main target in this standard is that there are local protocols in place between NHS Direct and mental health services, and this has been achieved locally.

7.6 Standard 4: All mental health service users on Care Programme Approach should be able to access services 24 hours a day, 365 days a year. There are specific targets as follows:

7.6.1 Assertive outreach: By December 2003 assertive outreach services should be available to all adult patients with severe mental illness and complex problems who regularly discharge from services.

7.6.2 Crisis resolution and Home Treatment: 24 hour crisis resolution should be available by 2005.

7.6.3 Early intervention: reduce the duration of untreated psychosis to less than three months for all young people by 2004. Policy Implementation Guides prescribe national standards for hours of operation for these and other services including community mental health teams, primary care liaison and support to carers.

7.7 In Hampshire assertive outreach teams are in place in all localities. Crisis teams are in place in North Hampshire and Blackwater Valley. In most cases teams do not yet comply with national models regarding hours of opening or caseload activity. Work is in progress across Hampshire and Isle of Wight to agree a model for Early Intervention but there are no teams in place. There will be increasing pressure on the health and social care system in Hampshire and Isle of Wight over the next few months, to ensure that national targets are reached and services are in place to support implementation of a new Mental Health Act.

7.8 In addition to the National Service Framework there have been difficulties with Approved Social Worker coverage across Hampshire after hours with day time staff needing to work additional hours to provide cover. The interface of NSF developments and Social Services Direct needs urgent attention.

8. National Developments in Local Authority Call Centres

8.1 Social Services accounts for 75% of all the calls coming into Hampshire County Council. Experience of other councils who have successfully implemented customer service centres and customer relationship management, have demonstrated that improving customer experience at the point of contact and informing them of the progress of their requests has resulted in improved overall satisfaction with the service.

8.2 A corporate working group has been established to produce a business case for the development of contact centres across Hampshire County Council. The first draft is likely to be ready by February 2005.

8.3 Developments within the contact centre will need to be Impact Assessed to ensure that people from the Black and Ethnic communities have improved access to services and people who do not use spoken English e.g. British Sign Language users are not disadvantaged in accessing services.

9. Current Management Arrangements

9.1 Social Services Direct is managed by a Service Manager who reports to the County Manager Physical Disability. The County Manager is the only County Manager responsible for both the strategy and operational elements of service. In addition Social Services Direct has 3 team managers and a senior practitioner with responsibility for Occupational Therapy Direct.

9.2 Current management costs are 17.2% of all staffing costs which is higher than most other care groups. Opportunities for restructuring the current management structure will need to be considered. Not withstanding this it is acknowledged that the current staffing profile does not allow for a senior enough post to provide the leadership required for the future development of the service.

9.3 The current service is based in Glen House, which has no disabled access and room for 17 staff. The building is already at full capacity and future developments will require alternative accommodation.

10. Options

10.1 Option 1: Do nothing. -the current management structure continues to manage the current business.

10.2 Option 2: Efficiencies in the region of £25,000 can be achieved by changing roles and responsibilities within the unit. This resource can then be reinvested in the proposed post.

10.3 The balance of the funding estimated at £40,000 can be achieved by changing one of the existing partnership managers posts to a new county manager post to deliver the contact centre agenda described in this paper in partnership with care groups, health and education. This will ensure that there is management capacity to pursue the agenda. The post holder would need to have the necessary leadership and partnership skills with a detailed knowledge of Social Services business.

10.4 Option 3: For the current county managers to develop their separate strands of the service and find the resources within care groups to do this. There is a real risk to fragmenting the service and lessons not being learnt across sectors.

11. Financial Implications

11.1 As table 1 below shows the cost of all 3 options is estimated to be a breakeven position in 2005-06 ( proposed start date 1^st April 2005).

Table 1 Summary of financial implications of options

Option	Social Services Direct Budget £'000	Outturn £'000	Variance £'000
1	1,066	1,066	0
2	1,106	1,106	0
3	1,066	1,066	0

Note : figures are based on 2004/05 prices

RECOMMENDATIONS

1 That option 2, restructuring the current management and changing one of the existing partnership manager posts to a new county manager to deliver the contact centre agenda in partnership with care group leads, health and education be adopted.

2 That the new county manager carries out a further review of the current management structure alongside the development of the service

Section 100 D - Local Government Act 1972 - Background Documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Jane Duncan, North Hampshire PCT - paper Unscheduled Care and Chronic Disease Management

2. New Zealand study tour. Report of the Executive Member for Social Care and the Assistant Director of Social Services 1/6/04.