Domiciliary Care Workshop Town Hall Sheffield 17 April 2008 Gill Herbert, Consultancy & Development Ltd1

2 Policy Changes and implication for Practice Gill Herbert March 2008

Gill Herbert, Consultancy & Development Ltd3 The Nineties Social workers are increasingly becoming “resource managers” Social workers are increasingly becoming “resource managers” Needs assessment increasingly governed by “supply” in the system – more “slotting in” of people to existing services 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 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 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 Performance management on costs, outputs and throughputs dominating over personal outcomes

Gill Herbert, Consultancy & Development Ltd4 The Twenty First Century The concept of choice, independence & “the expert patient” emerge 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 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 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 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) “Prevention” is seen to be as important as “The Cure” (for crises at least) The Voluntary Sector seen as increasingly important partners The Voluntary Sector seen as increasingly important partners FACS, Hospital Discharge Policies and Reimbursement and tighter eligibility criteria for social care result FACS, Hospital Discharge Policies and Reimbursement and tighter eligibility criteria for social care result

Gill Herbert, Consultancy & Development Ltd5 Modernising Social Care – what’s working Changing the style – advocacy & support Changing the style – advocacy & support Achieving synergies – partnerships & well-being Achieving synergies – partnerships & well-being Staff & leadership – new roles relating to direct payments & individual budgets Staff & leadership – new roles relating to direct payments & individual budgets Modernising systems – self assessment & equity Modernising systems – self assessment & equity Standards and protection – balancing tensions & user voice Standards and protection – balancing tensions & user voice Steering change – vol sector roles increasing Steering change – vol sector roles increasing Super-ordinate goals – making sure independence, well-being, choice & control are not undermined by efficiency, targeting & risk management Super-ordinate goals – making sure independence, well-being, choice & control are not undermined by efficiency, targeting & risk management Department of Health. 2007

Gill Herbert, Consultancy & Development Ltd6 The Big Changes to Come Putting People First: A shared vision and commitment to the transformation of Adult Social Care November 2008 Local Authority working with NHS & other providers Local Authority working with NHS & other providers Agreed and shared outcomes which should ensure people are supported to: Agreed and shared outcomes which should ensure people are supported to: –Live independently –Stay healthy & recover quickly from illness –Exercise maximum control over their life –Sustain a family unit which avoids children taking on inappropriate care –Participate as active and equal citizens, both economically and socially

Gill Herbert, Consultancy & Development Ltd7 And… System wide transformation developed by local partners including: System wide transformation developed by local partners including: –Joint needs assessment –Commissioning with incentives and stimlation to deliver high standards of care, dignity and maximum choice & controls for service users –Sustainable Community Strategy –Universal information, advice & advocacy service – including one stop shops –Common assessment process with greater emphasis on self- assessment –Person centred planning and self directed care –Personal budgets for everyone eligible for publicly funded adult social care –And more….

Gill Herbert, Consultancy & Development Ltd8 Other Influencers POPPS (Partnerships for older people programme) 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 All Our Tomorrows –A new vision on future of older peoples’ services produced by ADSS & LGA Better Government for Older People (BGOP) Better Government for Older People (BGOP) –projects led and governed by older people for older people Older People Policy & Practice Older People Policy & Practice –Series of research projects steered and used by older people through the Joseph Rowntree Foundation More work on outcomes More work on outcomes –SPRU (Univ of York) and OSCA (Collaboration) research programmes

Gill Herbert, Consultancy & Development Ltd9 The Implications for Home Care Need to move toward more person-centred care plans which achieve the outcomes people want 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 Commissioning to achieve outcomes for populations and use individual budgets effectively Enablement rather than maintenance will become more important Enablement rather than maintenance will become more important Working in partnership with (or under the supervision of) health professionals likely Working in partnership with (or under the supervision of) health professionals likely

Gill Herbert, Consultancy & Development Ltd10 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 Moved from an “adult social care” White Paper to a “care outside hospitals” focus during 2005 Four main aims: Four main aims: –More choice and a louder voice more access to GP practices more access to GP practices –Better prevention services with earlier intervention New NHS “Health Check” – assessment tool and specific health & social care advice New NHS “Health Check” – assessment tool and specific health & social care advice More support to maintain mental health& emotional well-being 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 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 quantity & quality of primary care new access to social care through Social Care Link new access to social care through Social Care Link –Support for people with long-term needs more control for people with long-term conditions more control for people with long-term conditions Expert Patient programmes Expert Patient programmes More integrated approach to health & social care through new joint teams More integrated approach to health & social care through new joint teams More support for carers More support for carers

Gill Herbert, Consultancy & Development Ltd11 The Mechanisms Practice based commissioning Practice based commissioning –GPs will have local budgets –Individual budgets for social care Drivers for local services which provide value for money Drivers for local services which provide value for money –Payment by Results –Much stronger focus on personalised purchasing Shifting resources into prevention Shifting resources into prevention –More services and support closer to where people most need them More care undertaken outside hospitals and in the home 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 Ltd12 And… Better joining up of services at the local level 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 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 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 Ltd13 But…. We will not extend individual budgets & direct payment to the NHS – so that we can keep this free at the point of need 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 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 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?) 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 Ltd14 The State of Social Care (CSCI – 2006/7) January 2008 In million people used social care services commissioned by councils Real concerns about: –6000 people with high support needs receiving no services or informal care –275,000 people with less intensive needs receiving no assistance –1.5 million older people have shortfall in care –Large variation between authorities –50% expenditure on social care from private contributions (£5.9billion) – no expert advice for many –Rationing leads to poor quality of life for many people who receive “signposting” but little help

Gill Herbert, Consultancy & Development Ltd15 Evidence Based Policy & Practice A dominant feature in commissioning of the last decade 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) 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 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 Performance management often totally misses things that are important to those dependent on services

Gill Herbert, Consultancy & Development Ltd16 Listening for Commissioning Strategies for Change led by people very distanced from service provision Strategies for Change led by people very distanced from service provision Very few commissioners are in direct regular contact with users or potential users 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 Providers in regular contact with users & carers are not often consulted in relation to commissioning Assessors have very little input 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 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 Ltd17 Using Research Effectively Draw from the considerable volume of messages about what those relying on services want 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 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 Work together – commissioners & providers to improve quality and appropriateness in user terms and therefore effectiveness and efficiency