Draft 2 April 071 Strategic Review of Adult Social Care Services Update April 2007

Draft 2 April 072 Contents Drivers for the review Process being followed Key findings from baseline assessment Workstreams: issues, options Next steps

Draft 2 April 073 Drivers Needs of Merton Residents: Older people Young adults With complex Disabilities Ethnicity National And local Policy: Choice and Control Integration with Health Prevention Financial Situation Corporate Savings of £20m National Pressures on Social care

Draft 2 April 074 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 075 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 076 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 077 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 078 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 079 Workstreams: overview Care Management Care At home Housing & support Day Opportunities Planning & commissioning Re-shaping services WorkforceInformation Engagement & communication Co- production Supports the re-shaping Core output of review Cross-cutting Enable outputs to happen

Draft 2 April 0710 Workstream 1: care management 1 st contact Screening Assessment Arranging care Review Choice & control Existing 10+ contact points? One for social care? Part of Merton Link? Screening tools? Self screening? SAP? Self assessment?Financial assessments? Audit? Mobile working/computing? Done by specialist procurement, or care managers? Done by specialist reviewers, procurement, or care managers? Input from providers? How to mainstream? Costing needs? Who supports users/carers? ISSUESQUESTIONS AND OPTIONS

Draft 2 April 0711 Workstream 2: care at home Enablement Mix of providers Equipment Telecare Meals NHS integration All new care to be streamed through enablement? Eligibility? Review? In house service: specialise, reduce, end? 7 approved providers? Access with no assessment? Who can order? Realising benefits 24/7? Frozen/hot mix? Who provides? Alignment of enablement and intermediate Care? Telehealth?

Draft 2 April 0712 Workstream 3: housing & support Costs Ordinary housing Specialist housing Care homes Type of support Access Comparative costs of own-front-door –v- group living, and of different tenures? Private rented sector? Shared ownership? Adult placement? Forecast need for purpose built? Are current block contracts right? New supply for high needs? Future of in-house? Generic or specialist? Use of third sector? Eligibility criteria for housing with support? Joined up assessment?

Draft 2 April 0713 Workstream 4: day opportunities Participation in community Buildings Service to carers Eligibility Transport Employment Mutual roles of adult social care & mainstream opportunities?Support needed? Volunteering? Flexible local resource centres? Specialist? Extended hours? Use of e.g.libraries What has biggest impact in meeting carers’ needs? All by assessment only? Drop in? How to re-shape to match service changes? Best ways of supporting more people? Generic or specialist support?

Draft 2 April 0714 Workstream 5: planning & commissioning Need and demand Capacity planning Macro- Procurement Quality assurance Impact of choice Partnerships Turning pure “needs” into forecast demand Modelling demand into required capacity, impact of service changes on this Procuring capacity: types of contract, obtaining VFM Using accreditation, monitoring quality What will impact on above from more user choice and control? Joint commissioning with PCT, other boroughs

Draft 2 April 0715 Supportstream 1: workforce Mix of skills Competencies Flexibility Recruitment & retention Development & wellbeing Mix of qualified and non qualified staff, e.g. first contact/screening/assessment Competencies needed for core tasks. Same as qualifications? How to test for them? If services extend hours and location (e.g. day ops), impact on flexibility needed? Planning ahead.Users involved in selection? Retention of scarce skills. Diversity. Developing required competencies. Use of validation e.g.NVQs. Lowering sickness absence

Draft 2 April 0716 Supportstream 2: information Info for users/ carers CRM Choice & control Joint working Supporting staff Rationalising leaflets? Use of e-info e.g. internet? Use of other public access points? Care Connect? Potential use of Customer Relationship Management for first point of contact Info for self screening & assessment? Info for arranging own care? Helping referrers. Use of info for joint assessment. Shared records/reducing hand-offs Mobile working. Direct input to Care1 st.

Draft 2 April 0717 Supportstream 3: engagement With users & carers With staff With wider community Diversity From one off consultation to continuous discussion? Using ways other than meetings? How can more staff be fully engaged? Continuous improvement? Communication? Should social care have higher profile? If so, how? How do we go further to ensure that services and staffing reflects Merton’s diverse communities?

Draft 2 April 0718 Supportstream 4: co-production Funding Third Sector Partners Wider community Users and carers Balance of Council tax, fees from service users, any other income? Opportunities for new roles, both as advocates and providers? Vehicle for integrated services? Role of main community plan partnerships? Joint commissioning and provision with NHS?.Contribution to improve life chances for vulnerable people? What can be expected from everyone, and what is a matter of choice? Impact of managing own care?

Draft 2 April 0719 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 Tel: