delivering differently in neighbourhoods overarching logic model support individuals’, carers’...

Delivering Differently in Neighbourhoods OVERARCHING LOGIC MODEL

Support individuals’, carers’ and communities’ resilience within Adult Social Care – Supporting people to support themselves and others

GOAL

Transformational change is urgently needed to secure a sustainable model of social care which will continue to meet the needs of the most vulnerable people in our communities. Delivering Differently in Neighbourhoods aims to work with local residents to co-design and develop community owned enterprise to deliver alternative models of care and support which are more community

focussed and accountable - thereby reducing health and social care costs.

CONTEXT

The biggest demand pressure facing local government is from Adult Social Care because of ageing populations, increased longevity and rising expectations combined with the required dramatic budget reductions. The two communities which are the focus of

Delivering Differently in Neighbourhoods in KCC are Wye and Hinxhill, and Newington.Wye and Hinxhill has 2282 residents of which 35% are over 65 and 54 people are 90 or over. There are 28 people who receive an ongoing support package. The total annualised average spend is over £358,000 - in addition to this will be many people who fund

their own care. Newington has 5210 residents of which 14.5% are over 65 and 20 people are 90 or over. There are 51 people receiving an ongoing

support package. The total annualised average spend is over £168,000 - with less people funding their own care.

INPUTS

Kent County Council will work with the two communities, including engaging parish and town councils and users and their families. Each neighbourhood has different local schemes which will be involved, namely: Our Place in Wye and Hinxhill, Big Local

and Ageless Thanet in Newington and Village SOS in both areas.Individuals employing private sector care and local service providers will also be consulted and engaged throughout the process.

External advisors include Department for Communities and Local Government and co-operative development bodies e.g. Co-operatives UK, Principle Six or Mutual Advantage.

ACTIVITIES

Activities are split into 2 areas: The community co-production process being conducted differently and the new community owned enterprise’s impact.

Analyse, develop, plan, implement and review a social co-operative in Wye and Hinxhill and Newington.Develop a business plan for the roll out of a social co-operative scheme to more neighbourhoods in Kent, based upon the

evidence and lessons identified.

USER COMMUNITY FINANCIAL SOCIAL CARE SERVICES EMPLOYMENT

No. users entering care system

Community involvement in the

development of careCost of care Choice in care

Investment in staffNo. of people trained

No. of people recruited

# users managing their own care

# community involvement in the

delivery of care# business income # appropriateness of

care $ tradition provision

# user’s wellbeing and situation

# community responsibility of care

# community outcomes

$ demand$ cost of care

# effectiveness of care

# volunteers networks

# staff retained

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‘As Is’ ‘To Be’ ‘As Is’ Assumptions

Develop commissioning strategy to identify commissioning priorities for the portfolio

Pick Location Location chosen is based upon need / gap in provision

Familiarisation with location & history Data is available

Develop project plan Identify KCC support, resources & timeframe

KCC support will not change during the process

KCC support is adequateKCC timeframes are realistic

Review effectiveness of current service including seeking service user feedback

Engage community activists, other statutory community and voluntary sector bodies

Agreement to be involvedCapacity to be involved

Remain engaged

Make formalised contact with the community Contact is adequate and appropriate

Formal co-design group created Remain engaged

Communications strategy developed and implemented

Communication is adequate and appropriate

Baseline cost of current service Baseline data collection

Viable models identified

Data is availableBest practice exists and is identified

Consider current and future legislation Complete diagnostic report (including needs analysis)

Model options appraisal Robust method implementedCorrect stakeholders are involved

Preferred model identified

Community has capability and capacity to implement

Preferred model is the most appropriate & will make the most

impactModel accepted by the community

Develop clear summary of outcomes to be achieved through the commissioning exercise

Outputs, outcomes and impacts identified

Outputs, outcomes and impact are the most appropriate and SMARTThere is a counterfactual needed

Engage service users to seek their views their needs, how best to them and how to manage demand Agree success criteria and expected outcomes

Confirm resources available Consider EqIA of proposed service

Develop commissioning plan including assessing options for how to meet the identified needs

Lead the development of effective outcome-based specifications

Co-produced business plan developed

Legal responsibilities understood and fulfilled

There is support to write a comprehensive business plan

Training within co-design group identified to implement model

Develop strong relationships with prospective and selected providers

Prepare for contract mobilisation including how the contract will be managed

Carry out initial contract reviewLead on getting necessary approvals for contract award

Model implemented Funding is availableFunding is secured

PROCESS EVALUATION QUESTIONS1) What is the current social care provision like now? Why do you want it to be delivered differently?

2) How was the new model delivered? How did it vary from previous social care commissioning?3) Was the model implemented in the way it had been planned?

4) What did participants and staff feel worked well / less well in delivering the model, why and how?5) What, therefore, might act as facilitators and barriers to desired impacts? How can barriers be overcome and facilitators harnessed?

6) How might the model be refined or improved?

Delivering Differently in Neighbourhoods COMMISSIONING PROCESS THEORY OF CHANGE

Support individuals’, carers’ and communities’ resilience within Adult Social Care – Supporting people to support themselves and others

ANALY

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USER


No. users provided with care and supportNo. users entering care system

Due to unavailable population figures at this level % of users has not been included as a measure

Data from Swift – does it include private social care?

# users managing their own care

No. users managing their own care – Self FundersNo. users managing their own care – Direct Payments

% of users managing their own care – Self Funders% of users managing their own care – Direct Payments

Data from Swift

# user’s wellbeing and situation

Users wellbeing

Warwick-Edinburgh Mental Wellbeing Scale (7 Item Scale):

http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/swemwbs_7_item.pdf

http://www2.warwick.ac.uk/fac/med/research/platform/wemwbs/

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Support individuals’, carers’ and communities’ resilience within Adult Social Care –Supporting people to support themselves and others

If possible all measures to be collected quarterly (starting 3 years prior to project)

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COMMUNITY

Community involvement in the development of care

1. I can make a positive difference to the social care provision within the community around me

2. I consider myself involved in the community

3. I have been able to shape the provision of social care within the community around me

Start and finish of co-design and development:(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)

# community involvement in the delivery of care

1. I can make a positive difference (to the social care provision) within the community around me


3. I am involved in the delivery* of social care within the community around me

Start (question 3 only) and finish of delivery:(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)

* Insert specific initiative activity

# community responsibility of care & # community outcomes

1. I can make a positive difference (to the social care provision) within the community around me


3. I feel that the social care provision* is accountable to community around me

Start (question 3 only) and finish of delivery:(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)

*Insert specific initiative activity

No. of community outcomes* met Community outcomes need to be defined once what is being delivered is finalised

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Support individuals’, carers’ and communities’ resilience within Adult Social Care –Supporting people to support themselves and others


FINANCIAL

Cost of care

Cost of social care – Self fundersCost of social care – Direct Payments

Cost of social care – Other

Cost of social care – No. of users

Data from Swift

# business income

Income generated* *Dependent on specific initiative

$ Demand & $ cost of care

No. users provided with care and support


No. of hospital admissions

No. of Emergency Admissions - primary reasons for admission to hospital

Using the counterfactual area as a comparison the number of prevented / delayed / avoidable can be

calculated

Using the New Economy Manchester Unit Cost database costs prevented can be calculated

No. of hospital admissions from Public Health (in a given age range?)

Delivering Differently in NeighbourhoodsSupport individuals’, carers’ and communities’ resilience within Adult Social Care –

Supporting people to support themselves and others


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SOCIAL CARE SERVICES

Choice in care

No. of users of the initiative Collected by the initiative

# appropriateness of care

1. Overall how satisfied or dissatisfied are you with the care and support services you receive?*

(Extremely satisfied, very satisfied, quite satisfied, nether satisfied or dissatisfied, quite dissatisfied, very

dissatisfied, extremely dissatisfied)

*Ask the users at an appropriate time frame dependent to specific initiative

User satisfaction in this instance is being used as a proxy to appropriateness

Question taken from ‘Personal Social Services Adult Social Care Survey’ (Question 1)

http://www.hscic.gov.uk/catalogue/PUB16162/pss-ascs-eng-1314-fin-rpt.pdf

Compare this score with Kent ASCOF scoringhttp://www.hscic.gov.uk/catalogue/PUB16162/pss-ascs-eng-1314-fin-annx.xlsx

Inappropriate A&E referrals (attendances at A&E for injuries/illnesses that could have been handled

elsewhere)

# effectiveness of care

No. users provided with care and support


No. of hospital admissions

Emergency Admissions - primary reasons for admission to hospital

Re-attendances at A&E

Using the counterfactual area as a comparison the number of prevented / delayed / avoidable can be

calculated

Using the New Economy Manchester Unit Cost database costs prevented can be calculated

No. of hospital admissions from Public Health (in a given age range?)

Emergency admissions - elective data would be useful here as a comparative




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http://www.hscic.gov.uk/catalogue/PUB16162/pss-ascs-eng-1314-fin-annx.xlsx

http://www.hscic.gov.uk/catalogue/PUB16162/pss-ascs-eng-1314-fin-annx.xlsx

EMPLOYMENTInvestment in staff & No. of people trained & No. of people recruited

No. local people / volunteers active within the initiative

No. local people / volunteers trained as a result of the initiative*

This output does not need to be measured for the counterfactual

* The type of training depends on the specific initiative

$ traditional provision

No. users provided with care and supportNo. of users of the initiative

This outcome does not need to be measured for the counterfactual

Calculate proportion of users of the initiative over users provided with care and support

# volunteers networks & # staff retained

No. of local people retainedNo. of volunteers retained

This impact does not need to be measured for the counterfactual




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