Hampshire County Council

Adult Social Care Policy Review Committee Item 9

28 September 2005

Home Care Service Modernisation

Report by the Director of Adult Services

These proposals for change support three aims of Hampshire County Council's Corporate strategy.

Aim 1 - maximising life opportunities by providing increased access to the Home Care Service.

Aim 2 - stewardship of the environment through the reduction of paper within the service.

Aim 5 - improving services through the delivery of person centred care designed to maximise independence and well-being.

1.

Summary

1.1

The in-house home care service currently has 22% of the domiciliary

market in Hampshire. The service employs 639 full time equivalent front line staff and delivers 9,800 hours of care per week. Approximately 80% of the hours commissioned by care management from the home care service are used to provide general mainstream domiciliary care similar to the services purchased from the independent sector.

1.2

During the last two years, 20% of the home care service has been moved into new service developments. This has resulted in the development of Intermediate Care Teams, First Response Teams and more recently a dedicated Dementia Care Team based in the Havant and Petersfield area. Twenty-four hour care is now available in the Winchester / Andover area.

1.3

The publication of the Government's green paper on the future of Adults Services has shown that there is likely to be an impact on the way that domiciliary care will be provided in the future. The home care service will need to be clear about its role within the market and be in a position to support and complement the move towards personalised budgets and anticipatory models of care.

1.4

Further integration of the home care service with community health teams will be fundamental to the successful management of long term conditions and there will be opportunities to support the development of home based care as an alternative to hospital based care.

1.5

There is a need now to build on the successful services that are currently in place within the home care service and to move away from the provision of general mainstream domiciliary care. This paper sets out the proposals for change within a two year timescale and recommends that the Policy and Review Committee advises the Executive Member for Social Care to endorse this approach subject to consultation with staff and service users.

2.

Research

2.1

Discussions with local authorities around the country have shown that many Social Services departments are beginning to position their in-house home care service into providing specialist care. Short term reablement services that include an assessment function have been identified as the most appropriate use of the in-house resource. Reablement is defined in literature from the Kings Fund as a service for people with poor physical or mental health, to help them accommodate their illness by learning or re-learning the skills necessary for daily living.

2.2

Kent, Leicestershire, Buckinghamshire, Essex, Lincolnshire and Shropshire have all contributed to this paper. Each of these authorities has already implemented short term reablement services using their in-house home care services. Particular interest has been paid to Leicestershire and Kent due to their three star status.

2.3

Leicestershire County Council has been particularly helpful in sharing the experiences of developing reablement services. A full evaluation of the change in service direction has been undertaken by Leicester University and this has been shared with Hampshire. The findings of the evaluation are impressive, showing that a significant number of care packages were reduced and even terminated following the intervention of the reablement team for a period of six weeks. It has been identified that the critical success factors of this service have been the introduction of assessment skills training for senior home care staff and reablement training for all home carers.

2.4

In 2004, a research project was undertaken by a management science student from Southampton University to look at the feasibility of the home care service providing short term, intensive, rapid response services as its core business. The conclusion reached by the project author was that the capacity and spread of hours within the service was sufficient to support this change in direction.

3.

The Proposal

3.1

It is proposed that the home care service should move the majority of its business from providing long term maintenance care to the provision of a short term assessment and reablement service.

The new service will develop on a locality basis linking closely with community health care partners and complementing the jointly managed intermediate care teams that are providing therapeutic specialist care.

3.2

The service will aim to provide intensive care and support to service users requiring assistance to regain confidence and independence following an episode of illness, deterioration of health or hospitalisation. The service will be provided for a period of six weeks. During this time, care plans of achievable goals and outcomes will be drawn up by trained home care staff together with the service user to ensure that the care package is tailored to meet individual needs.

3.3

The care plan will be reviewed frequently during this period and at the end of the six weeks (or shorter if appropriate), those people requiring on-going long term home care will either continue their care through an independent care provider, Direct Payments or the specialist in-house home care long term service. One of the key principles is that people requiring a complex on-going package of care will have been assessed and stabilised to the most appropriate level by care management and home care staff. It is planned that the home care service will play a key role at this point in assisting and encouraging service users to move to using Direct Payments and assistive technology such as "telecare".

3.4

By focussing on short term interventions that aim to `right size' packages of care, there will be an increase in the numbers of people able to access the service as the aim will be to provide initial care to nearly all new referrals. Efficiencies will be gained not only through a reduction in the costs of care packages, but also in terms of the reviewing process and care management time.

3.5

Discussions with Service Managers in the Older Persons' sector have shown that this style of service is required and there is enthusiasm for moving this proposal forward. However it has been recognised that there will still be a need for the home care service to be able to take "hard to place" care packages that the independent sector are unable to provide. It is therefore proposed that a small long term service should be available to care management, to meet this need.

3.6

The home care service currently provides care to 91 people who are under the age of 65 years. The breakdown of service users per care group is as follows:

_ 74 Physical Disability

_ 8 Mental Health

_ 4 Learning Disability

_ 5 Children and Families

The continuity of care for service users who are not older people will be protected.

3.7

The home care service will also develop a long term Dementia Care Team in each area. It has been recognised that the demand for highly trained staff in the community is an essential part of maintaining this growing group of service users. This service will deliver on a key part of the Older Persons' Mental Health Strategy.

3.8

The first multi-disciplinary dementia care service has commenced in the Havant and Petersfield area. Working in partnership with care management and health colleagues, this service is making a significant difference to the well being, self esteem and confidence of service users who would otherwise need to enter residential care.

This model of service delivery will be evaluated in September by the Performance Management Unit and will form the basis of future developments across the County.

3.9

The proposed changes to the home care service will need to carried out on an incremental basis. There will be a need to consult with care management at a local level to ensure that the capacity within the independent sector is sufficient to enable service users to be transferred from the reablement service following the 6 week intervention.

3.10

It is expected that the majority of home care staff will move across to the short term reablement service. However, it is recognised that for some staff there may be good reasons as to why they are unable to work as flexibly as required. These staff will continue to provide the smaller mainstream service that will be supporting difficult to place care packages.

4.

Terms and Conditions of Home Care Staff

4.1

The introduction of market supplements in advance of the forthcoming Pay and Benefits review have enabled the home care service to recruit to almost its full establishment of staff for the first time for several years. The flexibility of staff has improved over the last two years and now 75% of home carers are working during the evenings and at weekends.

4.2

The majority of home care staff are paid through the guaranteed hours scheme that requires the completion of weekly timesheets. Due to the large number of varying work patterns and rates of pay, the administrative costs of processing these timesheets is in the region of £80,000 per year.

4.3

The costs of processing large numbers of timesheets can be significantly reduced if home care staff are placed onto salaries that reflect the level of flexibility being worked. This can be achieved by simplifying the existing multiple working arrangements of staff and introducing consistent work patterns that can respond more effectively to service users' needs. This will remove the need for staff to complete timesheets. By implementing this change, in parallel with the Pay and Benefits Review, there will be an opportunity to review all business processes and supporting technologies with a view to securing further efficiencies. It is anticipated that the administrative costs released from the home care service will be used towards Gershon efficiency savings.

5.

Consultation

5.1

Agreement to commence the consultation process with staff and service users was given by the Executive Member for Adult Social Care on the 24^th June 2005.

5.2

During July, a series of consultation workshops were held with staff across the county. Fifty four percent of home care staff attended the meetings and the remaining staff who were unable to able to attend were consulted on the proposals at local meetings with their manager.

5.3

In general the feedback from staff on the proposals has been positive with some concerns being raised regarding working patterns. Staff were given the opportunity to ask questions during the workshops and to speak to their Union representatives who were also present at the meetings. The consultation process with staff is due to finish at the end of September.

5.4

The consultation period with service users commenced in August 2005. Individual meetings have been arranged with service users and their families. The views of each service user will be analysed at the end of September and will be reported to the Executive Member for Adult Social Care in December 2005.

5.5

Initial discussions with Hampshire Domiciliary Care Association as representatives of the domiciliary care market have also taken place. Feedback on the proposals has been positive as independent providers of care will be receiving well managed, stable packages of care from the home care service.

6.

Implementation

6.1

A strategic project team will be a key requirement in taking the proposals forward. Membership of the team will include human resources, performance management, finance team, home care staff, union representation and care management. It is anticipated that the project team will aim to deliver the changes within a two year timescale.

7.

Financial Implications

7.1

Opportunities have been identified from research carried out by other local authorities that this model of service may achieve financial efficiencies within commissioning budgets. Analysis of the risks will be included in a full cost benefit analysis and will be undertaken as part of the work being directed by the project team. A final report will be presented to the Executive Member for Adult Social Care in December 2005.

8.

Impact Assessment

8.1

An impact assessment on the proposals for change has shown that the plans are not discriminatory. All home care staff are currently being trained in anti-discriminatory practice and an analysis of the staff profile has shown that the numbers of black and minority ethnic employees reflect the population in each locality.

Recommendation(s)

That:

The Policy Review Committee advises the Executive Member for Adult Social Care

1

To endorse this approach subject to the completion of the consultation process.