1. www.hertsdirect.org What Service Users and Carers Tell Us Tim Anfilogoff Policy Manager, Users and Carers

2. www.hertsdirect.org Contents 1.Getting it right (and wrong) in Hertfordshire 2.National picture 3.How powerful is the consumer? 4.Strengthening the service-user voice 5.Details of Quality Monitoring Officer (QMO) findings 6.QMO role in customer care

3. www.hertsdirect.org 1.1 Getting It Right ‘She knows my way and does everything how I like.’ ‘The office rang last Friday to say the Saturday would be someone we didn’t know and I was a bit worried. Then on the Saturday at about 11, they rang to ask how they had got on and I appreciate that.’

4. www.hertsdirect.org 1.2 Getting It Right ‘Your care[worke]rs are wonderful, very pleasant and willing to help in any way. Sometimes they are the only people I see in a day.’ ‘The staff have been extremely helpful to my mum and will always keep either my sister or myself informed should there be a problem.’

5. www.hertsdirect.org 1.3 Getting It Right ‘They do ask if I need anything else and will open cans and bottles for me, which I find very hard?’ ‘The staff have learnt a few words of my mother’s language which she really appreciates. She speaks no English and we feel this makes her feel valued’

6. www.hertsdirect.org 1.4 Getting It Wrong ‘Sometimes people turn up and look at the equipment and clearly don’t know. I don’t consider one day in the office using it once and them coming here adequate training.’ ‘I have had a few problems with the attitude of some care workers. They come in and say they aren’t doing things I’ve asked them to do.’

7. www.hertsdirect.org 1.5 Getting It Wrong ‘The last few weeks, its not so good. Sometimes it’s too early in the evening and X is in bed for 12/13 hours, it’s too long.’ ‘Y has to have medication at a regular time, however call times vary greatly…’ ‘Too rushed.’

8. www.hertsdirect.org 1.6 Getting It Wrong ‘I wish I had a rough time as to when they are coming.’ ‘It can be 9 – 12 [evidenced in diary sheets]. Never know what time.’

9. www.hertsdirect.org 1.7 Getting It Wrong ‘They come in and say they aren’t doing things I’ve asked them to do...’ ‘Can’t fault the workers, but the office seem to be very disorganised.’ ‘I’ll give you an incident; I kept ringing [manager], to no avail, I got no answers. In the end I sent a letter and I never got a reply. In the end I did without the extra help.’

10. www.hertsdirect.org 2. The National Picture ‘At present councils - not people themselves – play the role of 'customer' in the home care market. New ways must be found of giving people control over the services they receive.’ An Overview of home care services for older people in England CSCI 2006

11. www.hertsdirect.org Performance Indicators (DH Survey Spring 2006) Extremely or very satisfied with homecare (D52) Hertfordshire 53% England59% Care workers always do the things I want done Hertfordshire 67% England65%

12. www.hertsdirect.org 3. How Powerful Is The Consumer? ‘I am afraid we never think to complain. We count ourselves lucky to get help at all.’ ‘I’ve had no response.’ ‘I’ve given up trying.’ ‘Cancelled evenings as timing of visits was so erratic.’

13. www.hertsdirect.org 4. Strengthening the Service-User Voice Two Quality Monitoring Officers 561 visits 2005-06 One Black and Minority Ethnic Involvement Worker 50 visits to homecare users Having Your Say process 2,000+ forms

14. www.hertsdirect.org 5. Details of QMO Findings 561 visits (2005-06) 3% to ‘concerns sample’ Less than 5% decline visit Overall high levels of satisfaction with care staff Lower satisfaction with office and customer care

15. www.hertsdirect.org Three Year Overview Subjective Data - consistent 1 in 5 had reason to complain to agency 90+% satisfaction that care workers are a) respectful b) competent 20-30% lower satisfaction with ‘the office’ Subjective Data - variations 13% said they were told in advance if different careworker coming (38% last year)

16. www.hertsdirect.org Three Year Overview Objective data - consistent 35-40% reported at least one missed visit in last three months (verified by QMOs) Objective data - variations Improved evidence of risk assessments Increase in percentage with medication policy not properly implemented (18 people)

17. www.hertsdirect.org 6. QMO Role In Customer Care 2/3 of visits lead to follow up actions Small percentage of these ‘serious’ QMOs contacted years afterwards Role in ensuring staff under pressure don’t miss users’ issues

18. www.hertsdirect.org Examples ‘It was a great relief to meet you and to know that you had been willing to come [with finance worker] and see us in order to sort out the invoicing problems…you have been so kind and helpful.’

19. www.hertsdirect.org 7. Enhancing The User Voice Further Involvement in Homecare Tendering 2006 (setting questions and interviewing) Block Tendering process this year Quality issues Ensuring customer care addressed to their satisfaction

20. www.hertsdirect.org And finally…. toenails HCC Policy – homecare agencies don’t cut toenails NHS will cut toenails if necessary for health reasons What about the group in between?