Hampshire County Council

Executive Member - Adult Social Care Item 3

9 December 2005

Home Care Service Modernisation

Report by the Director of Adult Services

1

Summary

1.1

The following decisions are sought:

1. That approval be given to commence the Modernisation of the Home Care Service and a further progress report be brought to the Executive Member for Adult Social Care in July 2006

2

Reason(s)

2.1

In June 2005 a report was received by the Executive Member for Adult Social Care outlining proposals to modernise the in-house Home Care Service.

This paper details the results of the consultation process with staff and service users and provides a financial analysis of the proposed changes.

2.2

These proposals for change support three of the aims of the 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.

3

Other options considered and rejected

3.1

None

4

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

4.1

None

5

Dispensation granted by the Standards Committee

5.1

None

6

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

6.1

Not applicable

Approved by:

..........................

Date of decision:

.........................

Councillor Patricia Banks

Hampshire County Council

Executive Member - Adult Social Care

9 December 2005

Home Care Service Modernisation

Report by the Director of Adult Services

How the conclusion in this report fits with the Corporate Strategy

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

1.2

1.3

1.4

2.

2.1

2.2

2.3

2.4

2.5

3.

3.1

3.2

3.3

3.4

3.5

3.6

3.7

3.8

3.9

3.10

3.11

4.

4.1

4.2

5.

5.1

5.2

6.

6.1

On the 24 June 2005, a report was received by the Executive Member for Adult Social Care outlining proposals to modernise the in-house Home Care Service.

A key recommendation was that the in-house service should reposition itself within the domiciliary market by providing a short term assessment and reablement service, that will link closely with care management, community health care partners and existing Welcome Home Schemes.

Approval was given by the Executive Member for Adult Social Care to commence consultation with service users and staff and it was requested that a further report be submitted in December 2005 following the consultation process.

This report details the results of the consultation process with staff and service users and provides a financial analysis of the proposed changes.

Consultation with staff

In June 2005, all staff received a letter which summarised the proposed developments in the Home Care Service.

During July 2005, a series of workshops and briefings were held across the County for staff and Union representatives. 54% of staff attended the workshops which were followed up by local area meetings, in most cases attended by the local Team Manager. At the end of August 2005, 100% of staff had been consulted on the modernisation proposals and the change from guaranteed hours to salaried payments.

Throughout the process, staff have been encouraged to raise questions and to highlight legitimate concerns. The questions raised and the answers given have subsequently been circulated to all staff in the service.

A survey of area Home Care teams has shown that there is positive support for the modernisation proposals. Home Carers feel that in the new service they will have greater job satisfaction through seeing people improve and regain their independence. They are also encouraged by what they see as an opportunity to work more closely with care management and health professionals. In particular the move to salaried payments and more clarity around the way payments are made were well received.

Approximately 70% of staff are in favour of the proposed changes to the Home Care Service, however it is acknowledged that the remaining 30% of staff are unsure or anxious about the modernisation of the service at this current time. As it is planned to move 80% of the present service into short term reablement care, the staff who are not able to move willingly into the new way of working will remain with the long term service and in combination with the natural turnover rates of staff, the 20% working in the long term service will be achievable over a period of two years.

On going communication and consultation with staff will continue at a local level and Home Carer representation will be actively sought to ensure that staff at the front line are involved in future developments.

Consultation with Service Users

During August and September 2005, consultation with people who are currently using the Home Care Service took place. It was recognised that due to the large number of people currently receiving care that a survey could not take in everyone's views during such a short timescale. It was agreed that 50% of all service users should be interviewed on a face to face basis, this would also make sure that time was available for relatives of people who were not able to express an opinion could also be consulted. At the end of September, 62% of service users had received a face-to-face interview with a Team Leader from the Home Care Service. In total a third party was present for 40% of the interviews.

Service users were asked the same two open questions allowing them the opportunity to respond in a way that was most appropriate to their personal situation and experiences.

The proposals to modernise the Home Care Service were explained to service users during the face-to-face meetings. Service users were then asked to explain what was most important to them about the care that they currently receive and what they would want to see improved about the plans for modernisation.

Six main themes emerged in relation to what service users felt was most important to them about the care that they currently receive. (Table 1)

Table 1

Overall, 66% of the responses referred directly to the care that they receive, stating that the personal care and the consistency of care was most important to them. The other main themes related to how the care was delivered, including the regularity, punctuality and the high standards of care that is provided

Of the people consulted, only 7% raised concerns relating to the level of service that an independent agency could provide. These concerns were not necessarily based on experience, as only small numbers of people stated that they had direct experience of care being delivered by an independent agency.

Other factors raised as being important to service users, included the respect that Home Care staff showed to the people that they are caring for and the good reputation of the Home Care Service.

When service users were asked for their views on the plans to modernise the Home Care Service and how it could be improved it was possible to identify 5 main themes. See table 2.

Table 2

Overall, 48% of people interviewed did not add any further suggestions or changes to the proposals to modernise the Home Care Service. This type of response is often the case when people are asked to comment on a service that they already receive as in general people are uncertain about change.

Although there were concerns regarding change it was still possible to identify areas where users would like to see improvements made. Whilst 31% of service users stated that they valued the consistency of care that they currently received, 10% of service users identified that they would like to see improvements in the consistency of staff who visited them.

In general the service delivered by the in-house Home Care Service is valued by its users. One in three people stated that as along as they continued to receive a service comparable to the current in-house service they felt that they could adjust to change. Few concerns were raised regarding services being delivered by the independent sector.

The consultation process has provided an invaluable opportunity to understand what is really important to people receiving domiciliary care services. Any changes in the way that the Home Care Service is delivered in the future must take account of these factors. The ability of the service to provide greater choice and flexibility in the way that care is provided will be particularly important.

Consultation with stakeholders

Consultation with private sector providers is currently being undertaken on an area basis. Hampshire Domiciliary Care Association have been consulted on the proposals for change and the proposals were received favourably. It is recognised by the independent sector that there will be significant advantages to providers on receiving well managed and stabilised care packages.

Discussions have also taken place with Age Concern Hampshire regarding the proposals for change. Support was given to continue the consultation process through older persons forums and Age Concern newsletters if required.

Impact Assessment

In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme.

An Impact Assessment of the Home Care Service undertaken recently highlighted that the Home Care workforce should reflect the Black Minority Ethnic (BME) groups using the service.

This work has now been completed and has shown that 0.4% of current service users are from BME groups and 1.3% of staff working in the Home Care Service are from BME groups. Whilst this figure looks as though the BME workforce more than reflects BME service users, this is not the case in the Eastleigh and Romsey area where the highest number of service users from BME groups are living. Therefore proactive recruitment of BME workers in this area will become a priority.

Financial Implications

The staffing requirements of the new service have been costed using set working patterns currently in place in the First Response teams. These working patterns provide the flexibility that is required to operate a seven-day service that focuses on intensive levels of care. During the next two years it is anticipated that the Home Care Service will have the capacity to receive 80% of all service users referred to Reception and Assessment teams who are likely to require complex or ongoing packages. Based on this level of referral and the commitment to transfer a percentage of current mainstream hours into the new ways of working, it has been estimated that 484 full-time equivalent care staff will be required to deliver the service (excluding the current Intermediate Care teams jointly managed with health partners). The costs of the new working patterns and the continued smaller mainstream service are £9.6m, and include enhancements for weekend working and market supplements, the current budget for front-line care staff is £9.7m.

6.2

The figures in table 3 show that on 05/06 prices the new working patterns can be achieved within the current staffing budget, however there are several unknown factors that have not been accounted for. Firstly it is not known whether the impending Pay and Benefits agreement will impact on the current market supplements and whether Home Care staff will continue to receive them and also there is a risk that the new working patterns will attract a 14% shift payment which has not been shown in table 3.

The modernisation of the Home Care Service will need to be achieved within existing resources and therefore any impact of the above unknown factors will determine the future levels of staffing within the service.

7.

7.1

Effect on care packages and outcomes

For the period from January 2005 to August 2005 inclusive, data regarding all service users of one of the existing First Response teams has been analysed, as this team is operating under a model similar to that proposed for the future short-term reablement service. The analysis is summarised in Table 4. Of those users who completed the short-term intervention during the period analysed, two thirds no longer required domiciliary care at the end of the intervention and one third were stabilised and continued to receive ongoing care with right-sized packages. In both cases, levels of support at the end of the intervention were lower than at the outset, by an average of about 2 ½ hours of care per week. An analysis of new mainstream Home Care service users has shown that during the first three months of care there is little or no reduction in the level of service being given.

Outcome

Proportion of total service users

Average reduction in service

Reabled and no ongoing domiciliary care required

51%

2 hours 35 minutes per week

Stabilised and transferred to ongoing long-term care

26%

2 hours 14 minutes per week

Admitted to residential care

2%

N/A

Admitted to hospital

9%

N/A

Deceased

12%

N/A

7.2

7.3

Overall, older people receiving home care, whether from in-house or independent providers, receive an average of around 7 ½ hours of care per week.

Based on the new service being suitable for 80% of service users and outcomes being similar to those seen in Table 4, it is estimated that the reduction in care packages will mean that non cashable Gershon savings will be realised as an additional 20% of service users will be supported with the same level of resources, once the new model is fully implemented. Table 5 shows how this would vary with differing numbers of users receiving the new service and differing reductions in weekly hours resulting from the service.

Table 5: Estimated increase in service users able to be supported with same level of resources, due to reablement and right-sized care packages.

8.

8.1

8.2

9.

9.1

9.2

10.

10.1

10.2

Administrative costs

Team Leaders spend on average 15 hours per week programming calls for home carers and rostering their individual work patterns for the mainstream service. This is due to the large number of work patterns and the need to provide care within rigid timeslots. In analysing the current First Response Service where there are no timed calls and set working patterns only 3 hours on average per week are spent by team leaders on rostering and programming care.

It is anticipated that the additional hours released from the Team Leaders role will be diverted into the assessment and case reviewing function that will be critical in ensuring that care packages are at the correct level.

Timesheets

As part of the County Councils Pay and Benefits review and a desire to professionalise the in-house service, Home Carers transferred to salaried payments with effect from October 2005.

As a direct result of this, the timesheets currently used will become obsolete and the need for home care administrative staff to process them weekly in order to meet County Treasures payroll deadlines will no longer be a requirement.

The reduction in administrative time for processing the timesheets equates to approximately 66 hours per week across the County. This further non-cashable Gershon saving will be channelled into supporting the care management functions relating to the new service on SWIFT and the acceptance and processing of new referrals.

Further minor efficiencies will be gained within the printing budget through the reduction of printing costs currently associated with timesheets.

Training

In order to support staff thorough this period of change within the in house service a programme of training has been specifically designed and commissioned for them by Home Care senior management in consultation with the departments Learning and Development team. This has included sessions specifically covering change management and role development issues that all Team Leaders across the county have attended and this has resulted in extremely positive feedback from each of the sessions.

The costs associated with these sessions have been met from the departments Learning and Development budget which specifically supports the departments modernisation agenda.

Specialist areas of training will include courses to assist care staff in delivering the new services covering promoting independence, well-being and also specialist dementia awareness training. These will be commissioned for teams where appropriate and the costs met by the existing service level agreement with the Learning and Development team.

2

Impact Assessment

2.1

See paragraph 5

3

Consultation with Local Members

3.1

Not applicable

Recommendation(s)

That:

1

* Approval be given to commence the modernisation of the Home Care Service and a further progress report be brought to the Executive Member for Adult Social Care in July 2006