ECC Update

1. ECA Conference 17 July 2019 ECC Update Patrick Higgs, Director of Commissioning

2. Contents IRN Update Winter Newton Europe update Live at Home Workforce Project Meaningful Lives Matter Transformation program Awareness ASC Business plan

3. IRN Update Key Changes to the IRN contract • PSRL • Ranked list using CQC rating (good and outstanding first then Requires Improvement and Not yet rated) and then price • updated month on the previous months CQC published data • TPTU • Now allowed within the IRN framework, please note TPTU can only be implemented when it is the service user choice of home and not just as a way of increasing income. • Working on a process change were ECC will collect the TPTU, therefore providers will be paid the gross amount • Strategic Provider Group • New Strategic Provider Group for IRN will be set up in the next couple of months. • This will look at the how providers can support ECC to resolve issues within the residential and nursing market • BedFinder • Ability for ECC and CGGs to see the beds available • Provider will be able to advertise their home to the private market • Expected roll out the new system to homes in August • ECC will be supporting providers to populate their information

4. Winter 2018 c£5.9m was allocated to Essex County Council in 2018 and intentions at a countywide level were to: • Incentivise providers to take on new packages of care over the winter period and over weekends. • Set up a scheme that supports people out of hospital with live in care for a period of time, reducing the need for interim beds. • Invest in social care employees to ensure more cover over the winter period • Fund extra capacity for mental health assessment • Invest in public health initiatives and community resilience to help prevent admissions, such as winter warmth schemes, flu jabs and care navigators. • Specifically, providers on the Live At Home Framework offered a “Golden Hello” for taking on new packages of care. This incentive (£500) was extended to include all hospital restarts. The aim of this initiative was to try and help improve discharge pathways from hospital over the winter period • This initiative did create some capacity and additional hours but was not as widely taken up as hoped. To the end of March ‘19, there were 401 Golden Hello payments, total value £200,500. There were 71 suppliers in total, around half of which received a Golden Hello in any given month. • Winter 2018 was also a fragile time for our reablement providers, following the Allied crisis, so additional support was required to maintain the offer to our partners and users.

5. Winter 2019 • In 2019 c£5,9m for social care has been included as part of the Better Care Fund. The funding is to support social care and winter pressures but this year it does not mean it can only be spent during the winter period – it can support seasonal pressures, and also areas can invest in schemes earlier to better prepare in advance for winter. • As in 2018 it is proposed that a countywide and local approach is the best way to manage this fund, with a split 30% for county-wide schemes and 70% for local schemes • Although there will be local differences in schemes, it is important that ECC has a consistent set of outcomes we want this money to achieve for the people of Essex. We expect the £5.9m funding to prioritise improvements in the following areas: • Prevention: including admissions avoidance for health and social care; investment in carers; and community resilience • Early Intervention and enablement: including reducing rates of permanent admissions to residential care and reduced social care DTOCs • Safeguarding: including keeping people safe and free from harm • Care market quality and sustainability • Countywide and local schemes should then show a link to these outcomes. Local schemes would be subject to local discretion and agreement with local partners

6. Winter – Slido Interactive Session Go to: Slido.Com(on laptop, phone or tablet) Type the following event code: #T778 Answer the following question: “As providers what would be the key aspects for commissioners to focus on to support pressures in the system during seasonal, particularly winter, pressures.”

8. Newton Europe • System partners engaged for this work include: • All Essex Clinical Commissioning Groups • East of England Ambulance Service • Acute Trusts • Community Health Providers (ACE, EPUT, Provide) • Essex Cares Limited • North East London NHS Foundation Trust • Newton staff now based at County Hall • Team will grow to around 15 once the full diagnostic begins • Planning for workshops and full activity is ongoing • Timeline for completion of Diagnostic – 3/4 Months

9. Newton Europe

10. Newton Europe

11. Live at Home Update • Live at Home Year 3 went live in April 2019 • Currently 115 providers on the framework and around 185 spot purchase Providers. • At any one time there are around 7,000 service users receiving longer term domiciliary care, which equates to almost 123,000 hours of care per week. • The Live at Home contract ends in April 2021. ECA and providers are driving forward the future model of domiciliary care. Workstreams including workforce, technology, contract models / documentation and integration are currently in place with a provider and ECC lead in each. • Electronic Homecare Monitoring provider & ECA workshop took place on 16th July looking at provider experiences and provider requirements of an EHM system. Carer notes is also in scope.

12. Workforce Project • ECC task and finish project set up to identify workforce issues and work to resolve them • ECA members working with ECC on the project • Survey to care workers to be sent out in September to understand their views of why they work in care and what makes them stay / leave • Workforce Hub pages to be reviewed as part of the work with a view to make it a resource centre for providers for recruitment and retention Four objectives agreed by the ECA/ECC group: • Change the perception of working in care • Providing access to workforce information (e.g. funding) • Attracting new staff • Influencing changes to future care contracts

13. Meaningful Lives Matter Transformation program AwarenessMaking the most of life : A strategy to enable people in Essex with a learning disability and/or autism, their families and carers to live fulfilling and healthy lives

14. VISON ECC vision is that people should thrive in their community, have a place to call home, someone to love and be loved. This should be linked to the specific outcomes that are most relevant to the person including their health, employment, connection to their community, aspects of recovery and wellbeing and relationships. By developing a person’s strengths, skills, knowledge, assets and aspirations alongside them via using person centred planning tools they can maximise both what the person can do for themselves and what they can access from others to live a meaningful life. . 

15. The case for change …. There is inequality in health outcomes for learning disabled people nationally. This is preventable and needs to be tackled. Life outcomes for people with learning disabilities and/or autism remain poorer than for the general population. People with learning disabilities die, on average, 15-20 years sooner than the general population. They are more likely to experience physical and mental health problems, be unemployed and experience isolation and loneliness. Social care practice is variable in terms of the quality of support planning to maximise empowerment and progression rather than create dependency. Analysis of open packages suggests only 47% of recipients had high and intensive needs. 13% had low to medium needs (receiving 0-14 hours of care a week), 20% had medium needs (receiving 15-56 hours a week): suggesting there may be scope for supporting more people by connecting them to community solutions or universal services, with adjustments. Planning for people with LD/autism is not beginning early enough and is not sufficiently focussed on progression and empowerment. There needs to be a much greater emphasis on preparing children to maximise independence and helping them to progress. There is a need for a commissioning strategy to support enablement and progression of people with learning disabilities/autism and that encompasses housing and employment – two of the most important areas that enable people to make the most of life. For employment, good practice shows that supporting entry to the job market through internships, apprenticeships, job carving and coaching can have an impact. Employees then need support to keep them in jobs.

16. The case for change …. We need to co-produce local housing solutions leading to security of tenure, that enable people to live as independently as possible, rather than in residential settings. For those requiring more support, there is still the prospect of greater independence being achievable. We also need to review how Shared Lives schemes (a regulated service in which a family, couple or single person include another individual in their family and community life) The Council currently spends nearly a quarter of its entire budget providing support to c.4000 people with a learning disability. Despite high levels of spend by the Council, people who use our services and their families have expressed significant frustration about their lived experience of health, housing, social care, levels of employment and the risks of social isolation and say that the overall approach to practice and the current market configuration will not meet the desired outcomes and expectations that people have for their futures. Benchmarking suggests Council spend on people with learning disabilities/autism is high in relative as well as absolute terms: ECC spends around 23-26% more per annum than the ‘average’ county council (amounting to £37-40m spend more than the average). ECC has not actively engaged , shaped or coproduced with the market for services to support people with LD and/or autism – as a result the services available do not match need and are not sufficiently focussed on progression. . 

17. Structure and Ambition WLP TSC MS&E CML H&I Ambition Ensure that individuals are well supported across their whole life and that they experience a seamless and smooth transition across services and pathways. Ensure that Portfolios of work across ECC are strategically aligned. A skilled front line social care workforce that is statutorily compliant and enables people and their carers to live a meaningful life through excellent practice focussed on early intervention, prevention, positive risk taking, progression, safeguarding and recovery. Commissioning that enables people to be listened to and valued, have lifestyle opportunities, take risks, make their own choices and are integrated within and contributors to their community. Improving health outcomes by reducing health inequalities, improving access and working strategically with health partners through championing the needs of those with a disability and developing integrated services. In addition to this, we will meet the ambitions of the NHS Long Term Plan. To shape a stable and sustainable market that helps to deliver the employment, housing, health and progressive social care outcomes to meet the ambitions and expectations of service users and their families.

18. The ASC Business Plan Describes our vision and priorities and how we will contribute to delivery of the Council’s strategic aims Sets out how we will build capacity and competencies, improve how we work and maintain financial sustainability so as to deliver the best possible outcomes for vulnerable people

19. Our Vision Our Direction of Travel Longer-term(10 years) working towards a transformational power shift so that individuals and communities are empowered to self-support and direct their social care. Shorter-term (next 4 years) shift from a focus on long-term care and support to those in crisis to a focus on prevention and early intervention, and enabling people to live independently for as long as possible For every adult to be able to live as independently as possible and to enjoy a good and meaningful life We want people to live healthier lifestyles to help prevent the impact of ageing, reduce health inequalities (especially in deprived communities) and develop initiatives that improve mental health and wellbeing

20. Our priority programmes 2019 - 24 Although we are in the process of developing a longer-term vision and detailed roadmap for the future of Adult Social Care we know that the following programmes of work are needed to provide sustainability and improve citizen outcomes The Meaningful Lives Matter (MLM) programme to improve outcomes for adults with learning disabilities and autism and to improve value for money for ECC. This affects +£200m pa of ASC spend. Benchmarking indicates ECC spends more than its peers but outcomes are variable and sub-optimal. The MLM programme includes 5 work streams looking at Market Shaping & Engagement, Commissioning Meaningful Lives, Health Integration, Transforming Frontline Practice and Whole Life Pathways. • Learning Disabilities and Autism(Meaningful Lives Matter) • Developing a strategic approach to prevention, and support for carers Work is starting with Public Health and other parts of ECC to develop thinking in this area to address the social determinants of health. An estimated 40% of ill-health is preventable. This work links closely to improving support to carers and building community resilience. It is absolutely critical that ECC is forward thinking and forward planning in this area by investing to save. Evidence from elsewhere suggests that very high percentages (c30-40%) of people leave hospital and enter the wrong – and costly – care package. We are working with health partners and with Newton Europe to look at care pathways to inform our recommissioning of out of hospital and intermediate care. The aim is better outcomes for people and better Value for Money for ECC. The number of people affected by dementia is forecast to rise significantly This work will focus on developing an all-age integrated Service Model pathway; improving identification, diagnosis, information and support. • Transforming Out of Hospital Care, and Dementia support • Transforming Mental Health outcomes and service model Transforming the approach to mental health from a medical model to one that addresses the socio-economic determinants of mental health: this is a relatively small part of ECC spend but outcomes for these people are poor (they are less likely to be in employment and more likely to die earlier) and they are often “frequent flyers” within the healthcare system. Our Vision is to enable people to live independently and to self-care, but this requires a strategic and joined-up commitment to personalisation: one embedded in our policies and practice and in how we enable people through the appropriate infrastructure. • Choice & Control(Personalisation & Sustainable Futures)

21. Cross-cutting enabling areas • Achieving the objectives in our Business Plan also requires cross-organisational support and effort in a number of cross-cutting enabling areas: • Deprivation: there is a correlation between deprivation and demand for health and care services. An ECC approach to tackling deprivation and disadvantage, improving education and skills, and removing the barriers to people doing well for themselves is needed to reduce avoidable long-term demand on adult social care (and children’s social care). • Modern Technologies: there is a need to review the existing social care case management to maximise service productivity and to support mobile working. Modern technologies can also help support people to live independently, to self-care and to reduce the size of care packages. • Housing and accommodation: access to suitable housing and accommodation is a challenge for adults with physical and sensory impairment, learning disabilities and autism and with mental health problems. In the absence of supply, ECC incurs costs on care packages. This requires an ECC approach. • Employment: those with mental health problems and with learning disabilities and autism struggle to access meaningful employment. Addressing this will lead to better outcomes for the individuals; help support genuine new employment opportunities for a group of vulnerable people who otherwise would not access employment; make lives better for carers, enabling them to stay caring longer; and help reduce care package sizes and costs. • Market Shaping – in order to meet needs in a sustainable way we need to work with the market to develop capacity, test new ways of working and develop more community-based activities.