HERTFORDSHIRE COUNTY COUNCIL
ADULT CARE AND HEALTH CABINET PANEL
THURSDAY 4 MARCH 2010 AT 10.00AM
ADULT CARE SERVICES PERFORMANCE MONITOR Q3 2009/10
Report of the Director of Adult Care Services
[Authors:- Iain MacBeath, Assistant Director, Performance & Business Support
01992 556363
Greg Hewitson, Head of Performance
01438 843550]
Executive Member: Richard Smith (Adult Care and Health)
1. Purpose of the report
1.1. To allow the Panel to review the overall performance of Adult Care Services (ACS) for the third quarter of this year 1 October to 31 December 2009 including: key departmental priorities, national performance indicators, major projects and safeguarding adults information.
2. Background
2.1. This performance monitor is structured under the seven Care Quality Commission ‘Performance Outcomes Framework’ domains. This is the way information about the performance of ACS is reported annually to the inspectorate and ultimately informs the CAA rating.
2.2. The full ACS Management Board quarterly performance report can be found on Connect under ‘Knowledge’ on the performance hub.
2.3. Panel are reminded that the Commission for Social Care (CSCI) inspection of ACS in November 2008 recommended that members receive more regular performance information, particularly on safeguarding adults. This report is a regular quarterly report to Adult Care and Health Panel.
3. Recommendations
3.1. The Panel is invited to note the report and comment on the performance monitor for Adult Care Services.
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100304 Adult Care and Health Cabinet Panel
Item 3 – ACS Performance Monitor Q3 2009/10
4. Outcome One: Improved Health and Wellbeing
4.1. CQC expectations: “People in the council area have good physical and mental health. Healthier and safer lifestyles help lower their risk of illness, accidents, and long-term conditions. Fewer people need care or treatment in hospitals and care homes. People who have long-term needs and their carers are supported to live as independently as they choose, and have well timed, well-coordinated treatment and support.”
Summary of Key Priorities
4.2. A project to develop an enhanced enablement homecare service is well advanced. Discussions with existing providers are progressing, a service specification has been drafted and business process agreed. The target start is 1 April 2010 – with people being discharged from hospital prioritised first.
4.3 Thirty-two ‘enablement beds’ have been commissioned with Quantum Care to improve discharge arrangements from both acute and community hospitals. These are for people with no physical rehabilitation needs – but who do have social care, confidence building or mental health needs. Twelve beds are specifically for dementia patients. This will prevent permanent admission to a care home from an acute bed and has been successful in the first 60 days4.4 Delayed discharges continue to improve through a steady decrease in the numbers of people delayed; admissions to residential care for all client groups have fallen over the quarter but are still higher than the national average. The new maximum target for admissions to care homes (77 per month) was met for the first time in December.
4.5 The renewal of the HPfT Contract (scheduled for 1 April 2010) is on target, with the specification and scoping document identifying future performance requirements and other contractual changes.
/ / NATIONAL PERFORMANCE INDICATORS:People being ‘Helped to Live at Home’
/
Indicator
/ Comment
/ Local target
/ Result
/
People with learning disabilities / Represents 2,205 people in Hertfordshire and compares well nationally. / 3.3 per 1,000 pop. / 3.4 v
People with physical disabilities / Represents 2,472 people – local target exceeded. / 3.7 per 1,000 pop. / 4.0 r
People with mental health problems / Represents 2,672 people – local target exceeded. / 4.0 per 1,000 pop. / 4.4 v
Older people / Represents 13,523 people. Target action plan in place. Fall due to increased popln stats. / 82 per 1,000 pop. / 78.9 s
Successful intermediate care services (new) / Measures is people are living independently at home three months after receiving ICS. / 78% / 81.9%s
Delayed discharges from acute wards aged 18+ / Low delayed discharges and a very low number of these are attributable to ACS. / 6.6 average delays per week / 6.2 r
Permanent care admissions of younger people / Projection: 100 new adults per year aged under 65 placed with LD, MH or PD. / 1.5 per 10,000 pop. / 2.24 r
Permanent care admissions of older people (65+) / Projection: 1,319 new older people per year placed in care homes. / 80 per 10,000 pop. / 84.7 s
Health and Wellbeing Related Projects /
Project / Description / Progress update / Status /
Health and Wellbeing project / To engage, in new and imaginative ways, with working aged adults including people aged 50 plus, in each district/borough area of Herts, in order to identify what would improve their health, well-being and quality of life and act on these through new initiatives. / New commissioning manager appointed; community agents and health trainers contract awarded to Vertex in Nov 2009; Procured three new projects to start April 2010:- ‘In touch’ scheme with Age Concern; Time Banking project with Watford CVS; Gardening Project; Produced new information and advice when considering moving into residential care. / On target
Enhanced Enablement Homecare / To provide service users with effective enabling and rehab services in order that they may be assisted to live as independently as possible in their own home. / 688 service users received the established enablement service with all homecare providers (from April – December 2009).
A new project board is in place with project team; county wide training to block providers completed; Activity mapping completed and service spec created. Target to start 1 April 2010. / On target
4.3. Summary of health and wellbeing outcomes reported by service users and carers
§ Previously very independent, Mrs L was discharged from hospital following a stroke. Following a very difficult period after returning home where her family felt unable to cope, she was admitted to Rivercourt for respite care and an enablement service where staff worked with her to regain her independence, come to terms with what had happened and improve here mobility. In a short period, she became more cheerful and confident, her appetite returned and she benefited immensely from occupational therapy and physiotherapy. She returned home with minimal support and now has all the benefits she is entitled to through the help of the Money Advice Unit. Mrs L is now maintaining her independence and her family felt relieved and supported throughout, and are now able to spend quality time with their mother.
§ ACS is spreading the Health & Wellbeing message through a series of presentations to elderly people from Black and Minority Ethnic communities with the help of interpreters. These sessions not only look at nutrition but also look at ‘backcare’ when moving and handling people. Over 80 elderly people attended the first 2 session in November and several sessions have been planned across Hertfordshire for 2010.
5. Outcome Two: Improved Quality of Life
5.1. CQC expectations: “People who use services and their carers enjoy the best possible quality of life. Support is given at an early stage, and helps people to stay independent. Families are supported so that children do not have to take on inappropriate caring roles. Carers are able to balance caring with a life of their own. People feel safe when they are supported at home, in care homes, and in the neighbourhood. They are able to have a social life and to use leisure, learning and other local services.”
Summary of Key Priorities
5.2. The number of assessments and services provided to family carers is higher than all previous years, with over 5,500 carers in touch with ACS. We are on track to meet the stretch LAA2 target of 25%.
5.3. There has been a significant increase in the numbers of beds and pressure mattresses procured through the pooled ACS/PCT budget for the Herts Equipment Service. This is linked to the county’s palliative care strategy for terminally ill patients who wish to go home to die. The budget is projected to overspend by £150k (3.8%).
5.4. A short-term project manager has been appointed to take forward the re-tendering of large block contracts for older people’s housing related support where efficiency can be released and reinvested back into the Supporting People programme. Plans were approved at Board with a September implementation date.
5.5 A programme for providing accredited Telecare assessor training has started and Telecare will be a key consideration as part of the new enhanced enablement teams. / / NATIONAL PERFORMANCE INDICATORS:/
Indicator
/ Comment
/ Local target
/ Result
/
Carers receiving an assessment leading to a service / Expecting to come in on target. Nationally rated as ‘good’. Better accurate recording practice needed. / 25% / 23.9% s
Care reviews for all care groups / Very good progress against this indicator. / 80% completed / 86.1% r
Assessments which lead to a service / Indicates we are not assessing people unnecessarily. / 75% / 73.1% v
Equipment delivered in 7 working days / More items of equipment are being prescribed which has led to a fall in performance and pressure on the budget. / 90% / 85.8% s
‘Having Your Say’ feedback forms from service users and carers in Q3 for 2009/10 indicates that:-
§ 88% satisfied with their care plan§ 90% people said they ‘were offered choice’
§ 92.% satisfied with way they were treated
Improved Quality of Life Related Projects /
Project / Description / Progress update / Status /
Multi-Agency Carer’s Strategy / Improve carers’ practice generally specifically building on improvements in contingency planning and achieving good performance against national indicators. / Carers in Herts ‘Making a Difference’ project pilot received 81 referrals from GPs in Dacorum. ‘Caring with Confidence’ have trained 86 carers. New carer’s manager in HPfT resulting in PI focus and surge (441) in new carer’s assessments in 2009/10. / On target
Physical disability and Sensory Needs strategy / To work towards independent living and self-directed support for people with physical disabilities to provide choice, control and flexibility for their social care needs. / Young people are currently being identified for Lavender Fields assessment beds. Identifying tenants for the Castle Project in St Albans for young physically disabled people; new user-led organisation created to increase the voice for Hertfordshire’s deaf community. / On target
Supporting people strategy / Increase the percentage of service users moving-on in a planned way from temporary living. Increase the percentage of vulnerable people who are supported to maintain independent living. / Continued improvement against national PIs on keeping people independent. Service user DVD now published; Simplified arrangements for future governance agreed by Commissioning Body. Overspend position reduced. / On target
Modernising day services / To work with partners to develop day opportunities for people with learning disabilities. Aim is to move away from disconnected day services and develop a wider range of smaller services, integrated with other mainstream community facilities. / Property searches continue for Phase 3 reprovision. Employment strategy workshops held; jobs for LD people supported; New base opened at Rose & Crown Baldock; plans ready for Cunningham Library, Southgate, Fleetville and Hornbeams. / On target
Transition Team
NEW / To establish a countywide transition team for disabled young people age 16-25yrs providing a point of contact and support through the processes of transition from CSF to ACS / Team now up and running and accepting new cases. Recruitment to 2 out of 18 posts outstanding. Team induction completed. Protocols and procedures done. / On target
Equipment Service transformation
NEW / To develop an integrated managed equipment service with an appropriate retail model; to improve provision across Hertfordshire. / Redesign of The Mundells for HES and Wheelchair services underway; 12 independent retail outlets identified; Telecare and on-line buying training programme developed for staff. Handy Person Service review completed. / On target
6. Outcome Three: Making a Positive Contribution
6.1. CQC expectations: “People who use services and their carers are supported to take part in community life. They contribute their views on services and this helps to shape improvements. Voluntary organisations are thriving and accessible. Organisations for people who use services and carers are well supported.”
Summary of Key Priorities
6.2 Service users and carers continue to contribute strongly to service improvement and development. The business process of the EPD service has now delivered its recommendations. In January, 90% of people had an immediate contact assessment completed on the phone (compared to 10% before implementation). Number of ‘very satisfied’ people increased by 12% from a high base.6.3 Service users and carers continue to actively participate in staff learning and development activity (with direct involvement in staff training, featuring in DVDs, HR recruitment and selection). Recent business process review in Community Learning Disabilities Services has also been led by service users and carers.
6.4 Day services newsletters and other service publications provide many examples of service user involvement as volunteers engaged in a range of community projects. Further examples will be evident from ACS’ annual review meetings which will take place in June 2010.
/ /
Summary of outcomes reported by service users and carers
· Borehamwood Day Services – The Gardening Project – seven service users, supported by staff, are involved in this work which goes from strength to strength with demand for this service resulting in an increase in days available.· The Shepherd Centre – two services users assist every month at the coffee morning at which carers, parents and friends of service users attend.
· A services user at Elara House was very concerned about local road safety and organised a petition. He was invited to speak about the subject at Dacorum Borough Council. A pedestrian crossing is now being installed on his road.
· A service user form Watford volunteers at a local Mencap charity shop two days a week. With staff support he found and applied for a permanent volunteering role. Staff say that his self esteem and confidence has improved and he is keen to move on to paid employment.
Making a Positive Contribution Related Projects /
Project / Description / Progress update / Status /
Elderly and Physical Disability (EPD) Services Business Process Review Project
Exit strategy completed / A project which examined the end to end business process for EPD services including assessment, care planning, service commissioning and care review. This was done in full consultation with service user, carers and other key stakeholders. Sixty recommendations for change were made – and all were accepted by ACS Management Board. Service users and carers are still engaged in the change process and are participating in staff training and mystery shopping exercises.
55 of the 60 recommendations have now been completed. / Immediate benefit - the number of calls being taken live increased from 64% to 89% in first full month; the number of people having to call back reduced from 34% to 9%. Where we were unable to answer immediately, 100% of people received a call back within 48 hours.
At first call, Referral Management Teams (RMT) complete a telephone assessment, sign-post people and order simple equipment if appropriate. This service was suggested by service users and went live in November 2009. Those ‘very satisfied’ has gone up from 45% to 57% within the 2 months of the start date.
Fifty service users and carers came to a follow-up consultation event in November 09 to review the project and its implementation. Discussions were very positive with further suggestions taken up by the project team. / On target
‘Slivers of Time’ time-banking project
Now called 'Book Your Own Breaks' / ACS has been successful in bidding for a government grant to implement an internet booking system for paid or voluntary care services. The initial phase will see Carer’s Breaks advertised online for people or their families to book flexibly.
Sample website available at:
www.bookyourownbreaks.info
www.testbyob.com / A number of family carers have been engaged to sit on the design group to ensure the format of web pages is user friendly and accessible.
An information website has been created and a demonstration site, so people can see what 'Book Your Own Break' is and how it works. Presentations have been given to the Carers in Herts AGM.
Pilot phase is planned for March 2010. / On target
7. Outcome Four: Increased Choice and Control