Domiciliary provider meeting 28 November 2016 Nigel Harvey-Whitten

Agenda 9.30 Welcome & apologies (NHW) 9.35 Actions from previous meeting (KL) 9.45 Indicative procurement timeline (SP) 9.50 The Future Model (TM) 10.10 Transitional model (TM) 10.15 Question Time 10.30 System Pressures (NHW) 10.35 ProContract demonstration (Claire Morecroft) 10.45 Adult Social Care Survey – Dorset: Feeling Safe (Sara Macbeth) 10.55 Any Other Business including future meetings 11.00 BREAK 11.20 Exercise 1 - A question of area? 11.50 Exercise 2 – Working Differently together. 12.20 CLOSE

Indicative procurement timeline   TASK DATE  PRE-PROCUREMENT  Provider Engagement Event Thursday 12 January 2017  TENDER STAGE  Tender Live on Procurement Portal Week ending 10 March 2017  TENDER CLOSE Tender Close Week ending 5 May 2017 Notification of intention to award Prior to 31 July 2017 Contract Award following 10 day standstill Prior to 31 August 2017 Service to commence 01 December 2017

The Future Model You told us… Don’t have different tiers Allow for flexibility, e.g. focus on outcomes rather than specific times. There could be opportunities for providers to work together. There are sometimes issues with supply due to cash flow – late payment from DCC.

The Future Model Our thoughts so far… A standard universal rate for each locality lot which is sensitive to market pressures. Improved payment terms – 2 weeks in arrears. A move to a more outcome focussed approach which allows the provider and service user to co-ordinate the use of their allocated hours. Support with targeted recruitment advertising. Approved DCC Framework Provider status for marketing.

A Question of Area? Insert hours map here 24% no care found * Annualised hours based on figures between 1.9.15 to 31.8.16 * % no care found based on figures between 1.2.16 to 31.8.16 by current localities

The Future Model – A Whole System Approach Assess individual’s needs, health interdependencies, desired outcomes and maximise independence Support & Care Offer Adaptations, equipment and assistive technology to support independence. Maximise carer support Maximise community input to meet informal care needs. Funded care to complete outcomes.

Transitional Model No big bang. Transfer to new rates and terms on service user review. Maximum 12 months transition – aiming for 6 months.

Question Time

System Pressures It’s not just a winter pressure! No additional funding this year but we want to be prepared for the future. We are looking to build a contractual framework that enables us to easily address system pressures as they arise, and to work proactively with providers to explore solutions.

Adult Social Care Survey – Dorset Feeling Safe

Feeling Safe Which of the following statements best describes how safe you feel? By feeling safe we mean how safe you feel both inside and outside the home. This includes fear of abuse, falling or other physical harm.

A little local analysis Survey data suggest that feeling unsafe is correlated with middle age poor physical health poor suitability of accommodation. Feeling unsafe also appears to be more likely in North Dorset, East Dorset and Christchurch localities – these are areas with the greatest proportion of over 85 year olds.

Impact of Services to help you feel safe

Locally we found that… Poor physical health is a predictor. Those who also feel their home is unsuitable for their needs are more likely to report that services do not help them to feel safer and this is more likely to be the case if the person lives in the community. People living in Christchurch, Purbeck and East Dorset are least likely to report that the services they receive help them to feel safe. Interestingly these are the areas with the greatest proportion of respondents aged 85+.

An extra question If you feel less than adequately safe, or if you don’t feel safe at all, please tell us what makes you feel unsafe. Free text box added to the questionnaire. Over 100 respondents told us what makes them feel unsafe. We carried out a thematic analysis of the comments

People told us: Falling (32) Physical condition (19) I fear falling, I have had several falls, but I have everything possible in my home to help me. I am learning to do things more slowly. Physical condition (19) Because of my age and health and unable to walk more than 8 yards. I am bent double with arthritis of the spine in 5 places. Continuity of care (8) My feeling of safety depends on which carer/carers are here. I question the amount of training given. My care notes are readily available at all visits to be read but I wonder if they are. Anxiety & Isolation (8) That I'm here on my own a lot as my boys work and go out. I do have 2 dogs but sometimes I worry about being on my own. Home Security (3) Constant changes in care staff make it difficult to "bond" - but yet agency staff know all my details (key codes) etc, some younger carers are very lax in security issues - an ongoing brain disease causes me to sleep more hence confusion.

Solutions The focus of an Outcome Based Accountability project A greater awareness at fieldwork level to enable people to identify feeling unsafe Information and advice sent to all survey respondents on keeping safe at home A work in progress – please tell us your ideas for helping people to feel safer…

Break (20 mins)

Exercise 1 We received mixed feedback regarding whether to retain a district based model or to move to a smaller zoned approach. At present we have chosen to keep with a ‘district’ approach following formal boundaries.

In small groups, please feedback on the flipchart paper provided your responses to the following questions: Does an increased rate and outcome approach (i.e. a block of hours to directly manage with the service user) help to address some of the challenges? From your knowledge of the County can you highlight where you feel that this approach will still provide us all with problems in service delivery.

Exercise 2 The only way we believe we can maintain a sustainable and financially viable approach to funded care is by making sure that we view an individuals needs in a more holistic way. This means that we have to ensure that funded care is focussed on unmet need and that we maximise every opportunity to enable individuals to meet their needs outside of statutory service provision. As providers how can you support us to do this? Please feed back on the flipchart paper provided. 30 minutes