Strategic Review of Adult Social Care Services

1. Strategic Review of Adult Social Care Services Update April 2007 Draft 2 April 07

2. Contents • Drivers for the review • Process being followed • Key findings from baseline assessment • Workstreams: issues, options • Next steps Draft 2 April 07

3. Drivers Financial Situation Corporate Savings of £20m 2008-2010 National Pressures on Social care Needs of Merton Residents: Older people Young adults With complex Disabilities Ethnicity National And local Policy: Choice and Control Integration with Health Prevention Draft 2 April 07

4. Process • Programme steering group, Director as sponsor chairs it • Programme management from Sarah Wells • Five workstreams each with lead manager • Wider engagement through Partnership Boards and one off sessions • Regular “challenge” sessions from Chief Executive and Members • £25k funding from Capital Ambition Draft 2 April 07

5. Parameters • Pro-rata share of required corporate savings for 08/9 and 09/10 would be 10% of net budget each year • Want to at least keep current CSCI rating, which means responding to White Paper drivers as well as detailed KPIs • At least some of conclusions in time to influence budget setting for 08/9, i.e. July 07 • Engaged process: staff, users, carers, wider Council and community Draft 2 April 07

6. Baseline assessment (1) • CSCI rating: serving most people well with promising prospects • History of improvement from low baseline in 2000 • Generally strong performance on outcomes, e.g. intensive home care, low admissions to care homes, low delayed transfers of care, telecare, equipment delivery • Further to go on process in some care management areas, e.g. direct payments, waiting times for assessments Draft 2 April 07

7. Baseline assessment (2) • Generally successful integration of LD and MH services with NHS, little progress to date for older people or PDSI • Customer feedback mostly positive, key areas of concern in initial access to services and time lags in billing for services • Some good services for carers, but PIs show lack of consistent focus on assessing needs as part of core practice • Day services well regarded, but scope for making them less building based Draft 2 April 07

8. Baseline assessment (3) • Low spender per head: bottom quartile • Generally low unit costs when benchmarked • Variable commissioning capacity: good housing strategies, others need updating, and good modelling framework needed • Could do more on finding ordinary housing for people and then supporting them in it Draft 2 April 07

9. Workstreams: overview Care Management Care At home Housing & support Day Opportunities Planning & commissioning Re-shaping services Core output of review Cross-cutting Enable outputs to happen Supports the re-shaping Workforce Information Engagement & communication Co- production Draft 2 April 07

10. Workstream 1: care management ISSUES QUESTIONS AND OPTIONS 1st contact Existing 10+ contact points? One for social care? Part of Merton Link? Screening Screening tools? Self screening? Assessment SAP? Self assessment?Financial assessments? Audit? Mobile working/computing? Arranging care Done by specialist procurement, or care managers? Review Done by specialist reviewers, procurement, or care managers? Input from providers? Choice & control How to mainstream? Costing needs? Who supports users/carers? Draft 2 April 07

11. Workstream 2: care at home Enablement All new care to be streamed through enablement? Eligibility? Review? Mix of providers In house service: specialise, reduce, end? 7 approved providers? Equipment Access with no assessment? Who can order? Telecare Realising benefits 24/7? Meals Frozen/hot mix? Who provides? NHS integration Alignment of enablement and intermediate Care? Telehealth? Draft 2 April 07

12. Workstream 3: housing & support Costs Comparative costs of own-front-door –v- group living, and of different tenures? Ordinary housing Private rented sector? Shared ownership? Adult placement? Specialist housing Forecast need for purpose built? Care homes Are current block contracts right? New supply for high needs? Future of in-house? Type of support Generic or specialist? Use of third sector? Access Eligibility criteria for housing with support? Joined up assessment? Draft 2 April 07

13. Workstream 4: day opportunities Participation in community Mutual roles of adult social care & mainstream opportunities?Support needed? Volunteering? Buildings Flexible local resource centres? Specialist? Extended hours? Use of e.g.libraries Service to carers What has biggest impact in meeting carers’ needs? Eligibility All by assessment only? Drop in? Transport How to re-shape to match service changes? Employment Best ways of supporting more people? Generic or specialist support? Draft 2 April 07

14. Workstream 5: planning & commissioning Need and demand Turning pure “needs” into forecast demand Capacity planning Modelling demand into required capacity, impact of service changes on this Macro- Procurement Procuring capacity: types of contract, obtaining VFM Quality assurance Using accreditation, monitoring quality Impact of choice What will impact on above from more user choice and control? Partnerships Joint commissioning with PCT, other boroughs Draft 2 April 07

15. Supportstream 1: workforce Mix of skills Mix of qualified and non qualified staff, e.g. first contact/screening/assessment Competencies Competencies needed for core tasks. Same as qualifications? How to test for them? Flexibility If services extend hours and location (e.g. day ops), impact on flexibility needed? Recruitment & retention Planning ahead .Users involved in selection? Retention of scarce skills. Diversity. Development & wellbeing Developing required competencies. Use of validation e.g.NVQs. Lowering sickness absence Draft 2 April 07

16. Supportstream 2: information Info for users/ carers Rationalising leaflets? Use of e-info e.g. internet? Use of other public access points? Care Connect? CRM Potential use of Customer Relationship Management for first point of contact Choice & control Info for self screening & assessment? Info for arranging own care? Joint working Helping referrers. Use of info for joint assessment. Shared records/reducing hand-offs Supporting staff Mobile working. Direct input to Care1st. Draft 2 April 07

17. Supportstream 3: engagement With users & carers From one off consultation to continuous discussion? Using ways other than meetings? With staff How can more staff be fully engaged? Continuous improvement? Communication? With wider community Should social care have higher profile? If so, how? Diversity How do we go further to ensure that services and staffing reflects Merton’s diverse communities? Draft 2 April 07

18. Supportstream 4: co-production Funding Balance of Council tax, fees from service users, any other income? Third Sector Opportunities for new roles, both as advocates and providers? Vehicle for integrated services? Partners Role of main community plan partnerships? Joint commissioning and provision with NHS? Wider community .Contribution to improve life chances for vulnerable people? Users and carers What can be expected from everyone, and what is a matter of choice? Impact of managing own care? Draft 2 April 07

19. Your thoughts…. • Could the overall process be improved, and if so how? • Do you agree with the baseline assessment? • Do you agree with the workstreams, key issues and options highlighted? • How do you (and others you know) want to be engaged? Contact: hilary di.salvo@merton.gov.uk sarah.wells@merton.gov.uk Tel: 0208 545 3694 Draft 2 April 07