Domiciliary Care Workshop

1. Domiciliary Care Workshop Waterfront Place, Chelmsford 11 October 2007 Gill Herbert, Consultancy & Development Ltd

2. Policy Changes and implication for Practice Gill Herbert September 2007 Gill Herbert, Consultancy & Development Ltd

3. The Nineties • Social workers are increasingly becoming “resource managers” • Needs assessment increasingly governed by “supply” in the system – more “slotting in” of people to existing services • More moves to eligibility criteria which exclude rather than include • Realisation that partnership is key to making things work, but lack of joined up policy to support this • Performance management on costs, outputs and throughputs dominating over personal outcomes Gill Herbert, Consultancy & Development Ltd

4. The Twenty First Century • The concept of choice, independence & “the expert patient” emerge • Structural shift to “case management” using health led models – Evercare, Kaiser Permenante and Castlefields models influence • Skill development of nurses and other health professionals into care management roles traditionally dominated by social care • Partnerships and inter-disciplinary working still primarily focused around the hospital fulcrum – difficulties shifting resources from acute to community • “Prevention” is seen to be as important as “The Cure” (for crises at least) • The Voluntary Sector seen as increasingly important partners • FACS, Hospital Discharge Policies and Reimbursement and tighter eligibility criteria for social care result Gill Herbert, Consultancy & Development Ltd

5. Modernising Social Care – what’s working • Changing the style – advocacy & support • Achieving synergies – partnerships & well-being • Staff & leadership – new roles relating to direct payments & individual budgets • Modernising systems – self assessment & equity • Standards and protection – balancing tensions & user voice • Steering change – vol sector roles • Super-ordinate goals – making sure independence, well-being, choice & control are not undermined by efficiency, targetting & risk management Department of Health. 2007 Gill Herbert, Consultancy & Development Ltd

6. Other Influencers • POPPS (Partnerships for older people programme) • focused on physical and mental health and well-being • prevent unnecessary admissions & remain at home if possible • provide a range of preventive “low level” support • All Our Tomorrows • A new vision on future of older peoples’ services produced by ADSS & LGA • Better Government for Older People (BGOP) • projects led and governed by older people for older people • Older People Policy & Practice • Series of research projects steered and used by older people through the Joseph Rowntree Foundation • More work on outcomes • SPRU (Univ of York) and OSCA (Collaboration) research programmes Gill Herbert, Consultancy & Development Ltd

7. The Implications for Home Care • Need to move toward more person-centred care plans which achieve the outcomes people want • Commissioning to achieve outcomes for populations and use individual budgets effectively • Enablement rather than maintenance will become more important • Working in partnership with (or under the supervision of) health professionals likely Gill Herbert, Consultancy & Development Ltd

8. Our health, our care, our say: a new direction for community services • Moved from an “adult social care” White Paper to a “care outside hospitals” focus during 2005 • Four main aims: • More choice and a louder voice • more access to GP practices • Better prevention services with earlier intervention • New NHS “Health Check” – assessment tool and specific health & social care advice • More support to maintain mental health& emotional well-being • Individual budgets bringing together social care, community equipment, Access to Work, Disability Facilities Grant & Supporting People • Tackling Inequalities & Improving Access to Community Services • quantity & quality of primary care • new access to social care through Social Care Link • Support for people with long-term needs • more control for people with long-term conditions • Expert Patient programmes • More integrated approach to health & social care through new joint teams • More support for carers Gill Herbert, Consultancy & Development Ltd

9. The Mechanisms • Practice based commissioning • GPs will have local budgets • Individual budgets for social care • Drivers for local services which provide value for money • Payment by Results • Much stronger focus on personalised purchasing • Shifting resources into prevention • More services and support closer to where people most need them • More care undertaken outside hospitals and in the home • Safe primary care clinical pathways for many health conditions • More community hospitals A recognition that social care is an essential part of the equation Gill Herbert, Consultancy & Development Ltd

10. And… • Better joining up of services at the local level • Joint commissioning between PCTs and Local Authorities • New procurement model and best practice guidance • Streamlining of budgets and cycles between PCTs and LAs with aligned performance & inspection regimes • Strengthened role for Director of Adult Care & more joint appointments • Encouraging innovation • Greater patient & user choice • “Triggers” for public satisfaction & services quality for PCTs to respond publicly • Direct payments & individual budgets (cash & services) for social care to develop more responsively • Allowing different providers to compete for services • Increase quantity and quality of primary care • Remover barriers for “third sector” as providers of primary care Gill Herbert, Consultancy & Development Ltd

11. But…. • We will not extend individual budgets & direct payment to the NHS – so that we can keep this free at the point of need • National approach to risk management in social care – standardised procedures to ensure regulated and trained workforce • Outreach to vulnerable groups and easier access to local services will have health focus • New guidance for older people published focused on better dignity in care settings and improved services for people with strokes, falls, dementia & multiple conditions (but does this have a user perspective?) Gill Herbert, Consultancy & Development Ltd

12. The State of Social Care (CSCI - 2005/6) In 2005-6 2 million people used social care services commissioned by councils Real concerns about: • People not using services but seeking advice & info (what happens when signposted elsewhere?) • Carers increasingly picking up the costs of ever-tightening eligibility criteria • People who have little choice or control over the services they use • People who are using services not meeting national minimum standards and simply not good enough Gill Herbert, Consultancy & Development Ltd

13. Evidence Based Policy & Practice • A dominant feature in commissioning of the last decade • Relies on inadequate source of data and inappropriate methodologies in relation to much of social care (we spend a lot more on health research) • Basic approaches to quality assurance are lost in the split between commissioning and provision • Performance management often totally misses things that are important to those dependent on services Gill Herbert, Consultancy & Development Ltd

14. Listening for Commissioning • Strategies for Change led by people very distanced from service provision • Very few commissioners are in direct regular contact with users or potential users • Providers in regular contact with users & carers are not often consulted in relation to commissioning • Assessors have very little input to commissioning • No feed-back loops on unmet needs, preferences, appropriateness of services provided or basic quality to those assessing or commissioning i.e Most users and carers get nowhere near those with power to change things, and have no voice Gill Herbert, Consultancy & Development Ltd

15. Using Research Effectively • Draw from the considerable volume of messages about what those relying on services want • Learn to use appropriate research methods to evaluate what we do and improve services • Work together – commissioners & providers to improve quality and appropriateness in user terms and therefore effectiveness and efficiency Gill Herbert, Consultancy & Development Ltd