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Analysis of Current and Future Home Support Delivery (NCC Funded Care)

This presentation provides an analysis of the current and future home support delivery in Norfolk, including key statistics, population demographics, quality ratings, commissioned hours, and unmet home care needs.

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Analysis of Current and Future Home Support Delivery (NCC Funded Care)

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  1. Analysis of Current and Future Home Support Delivery (NCC Funded Care) Presented 19 July 2019 to Home Support in Norfolk Event – Dereham Football Club Presented by Analyst in Norfolk County Council - Adult Social Care Quality Assurance and Market Development Team

  2. Summary of the NCC Funded Home Care Market in Norfolk • The Key Statistics • 75 home care providers are delivering care, with some providers delivering care from more than one location, about 90 locations/offices in total • It is estimated that 9,500 people work in home care in Norfolk • Home care providers are commissioned by NCC to provide around 40,000 hours of care weekly • About 36,000 hours of care are recorded as being delivered weekly, through a combination of block, framework and spot arrangements • 40% of the hours are delivered by the 5 largest providers, 58% of the hours are delivered by the 10 largest providers • Home care is delivered to around 3,500 people weekly • It is estimated that at least 850 users of home care users have dementia, with about 325 of these people with undiagnosed dementia • About 1,500 people have a direct payment to purchase home support without having a directly commissioned home care service. This money can be spent on home support from the care market or a personal assistant • The average hourly rate NCC pays for home care is always on or above the average for the East of England which is higher than the Great Britain average

  3. Primary Care Networks (PCNs) • Groups of GP practices working together with community, mental health, social care, pharmacy, hospital and voluntary organisations to deliver services in their local areas • Population = 30,000 to 50,000 people in each PCN (Norwich now comprises 4 PCNs under 1 “super” PCN) • The current and future calculations of usage and need for care services are PCN based: • Care availability by PCN • Usage by PCN • Need by PCN Geographical Areas of Analysis (PCNs) The main benefit of PCN based analysis is that much smaller geographical areas can be analysed, moving beyond the “we need more home support in north Norfolk” level of detail

  4. Age Groups and Genders of Home Care Recipients People receiving a commissioned home care service are very likely to be over 65 and more likely to be female People receiving a direct payment for home support (and don’t have a commissioned home care service) are very likely to be under 65 and more likely to be female

  5. Age Groups of Home Care Recipients The proportion of people in different PCNs receiving home care who are 18-64 and 65+ differs noticeably In Norwich the % of 18-64 home care recipients is 29% In Coastal – North West Norfolk the % of 18-64 home care recipients is 12% This causes different demands on home care providers in different geographical areas

  6. Service User Groups of Home Care Recipients Weekly Hours Received in Norfolk People

  7. Quality in the Home Care Market • Norfolk ranks 11/11 in the East of England for home support providers rated good or outstanding by CQC (77%) • NCCs target is for this to be 85% by March 2020 Norfolk • Norfolk ranks 16/16 against similar local authorities for home support providers rated good or outstanding by CQC (77%) • NCCs target is for this to be 85% by March 2020 Norfolk

  8. Percentage of Commissioned Hours that are Delivered Weekly The percentage of commissioned hours that are delivered weekly varies considerably by PCN Some PCNs that border each other or are in the same Clinical Commissioning Group (CCG) have very different percentages of commissioned hours that are delivered It is important to try to understand why this is, including where this demonstrates flexible delivery of home care or where delivery falls below expected levels

  9. Size Differences of Home Care Packages • Considerations: • Can the care needs of those with very small home care packages be met in other ways? • Are different sized care packages being commissioned in different PCNs for people with similar care needs?

  10. Unmet Home Care Need – What is Unmet Need? • Where home care agency care providers cannot be sourced or cannot fully meet the homecare needs of a person who has been assessed for services. This is recorded on an “Unmet Needs Report”, for example: • Where the full home care package of a person cannot be met at all – the person is at home with no home care package (c.30% of people on list) • The person is at home with a home care package that is considered to not be meeting their needs fully (c.21% of people on the list): • Smaller than they have been assessed for • Where there are issues between the service user and the provider • Is being provided at inappropriate/inconvenient times or by male/female carers against the wishes of the service user or their family • The person is in an acute or community hospital and cannot be discharged because an agency homecare package cannot be sourced (c.4% of people on the list) • The person is in a temporary residential home bed and cannot be discharged home because an agency care package cannot be sourced. This can sometimes arise from the failure to source a homecare package when the person is in hospital resulting in discharge to a temporary residential care bed (c.12% of people on the list) • The person is at home with home care being provided by NCCs reablement service (Norfolk First Response) when the person requires a permanent care package. This causes a lack of capacity for hospital/temporary residential bed discharge into home based reablement (c.33% of people on the list)

  11. Unmet Home Care Need – Causes and Characteristics • Certain types of Care Packages can be difficult to source due to their added complexity and/or cost: • Short-term care packages • Palliative care (short duration, high cost to provider) • Packages where male only (especially) and female only carers are requested • Single carer packages which can’t be built into an existing round • Double up care packages • Packages in rural areas (however there is unmet need in urban and semi-urban areas) • Packages where the calls are required or requested at very specific times • Packages where the service user, their family or associates demonstrate unacceptable or threatening behaviours towards care staff • The more of the above characteristics a care package has, the more likely it is to be “unmet” • Staff turnover rates in Norfolk are high (43.5% of staff per year): • Many home care providers competing for staff • Many alternative employment opportunities • If the Council requests a care package from a provider but does not confirm it quickly enough then these hours will be given to another person who requires it • NCC restrictions on placing with a provider due to quality issues, and provider failures can • have a short term impact on availability of homecare in certain geographies The number of people on the Unmet Needs List reduced by 45% between January and June 2019 Thank you for your efforts in achieving this

  12. Where is Unmet Home Care Need?

  13. Norfolk Home Care Workforce Characteristics and Issues

  14. Future Demand for Home Care • The number of people in Norfolk aged over 75 is projected to increase by nearly 35,000 in the next 10 years • If NCC continued to purchase home care at current levels this population increase would mean that an additional 8,500 hours of home care would need to be purchased each week in 10 years time • Population growth is just one factor that will determine levels of home care that will be needed in future: • The health of the population and how this differs in different areas • NCC strategies such as: • Promoting Independence and Living Well • Facilitation of a significant increase in extra care housing and a reduction in standard residential care placements for older people • Potential increased use of direct payments • Future NCC budgets for home care • In future home care: • Should focus on improving or at least maintaining peoples independence, with the expectation that for some people their care package should reduce • More home care would as a consequence be temporary in nature • Very small care packages may become fewer as more community and voluntary sector solutions are sought instead • Smaller average care packages supported by community and voluntary sector services may increase

  15. Thank you for your attention

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