Home Care & Social Services Framework for Improvement

Home Care Council

13th March 2012

Content

• Policy Direction

• History

• Position of Home Care v Re-Ablement

• Improvement

Equality & Human Rights Commission – Close to Home

• An Inquiry into older people and human rights in home care.

• “People receiving home care have to trust other people to help them with personal and intimate tasks such as bathing, dressing, meals and getting into bed. When this help is delivered well it is done in a way that respects the older person’s privacy, respects their dignity and enables them to decide how things get done – essentially, it follows a human rights approach to service delivery.” (user – may be in pain, difficult to work with, relationship with carer, etc - SV.)

Policy Direction

• Appropriate hospital admissions – hospital default?• Avoiding inappropriate time in hospital / residential care• Recognition that some people can be treated more

effectively outside hospital – chronic disease / long term conditions

• Hospital – Risks to independence – Infection.• Re-Ablement/ Telecare/ Telehealth/ Community

Equipment / Adaptations/ expert patient/ Home Care.• Managing Demand (Daffodil) – Sustainable Models of

Service Delivery.• Citizen Directed Support• Care at Home – Care Council for Wales

History

• 1970s – fragmented service (LG/ Third Sector) – Government fear of taking over family responsibilities.

• Home Help service – shopping & cleaning – no or limited personal care

• 1980s taking on more significant role in terms of personal care – investment in manual handling training.

• Personal care – Planned development or retreat by NHS????? – Absence of planning with recurring themes.

History

• Community Care Reforms

• Health bath or social care bath

• Discussion of generic worker for health & social care – Care at home – Governance & Training

• 1990s - The private sector becomes significant player

History / Context

• Questions about share of in house/ external provision

• In house often seen as expensive but with better paid & trained staff

• Externalisation of service – Rationale???

• Re-ablement & Crisis Intervention

Re-ablement

• Service for people with poor physical or mental health which will help them accommodate their frailty or illness by learning or relearning the skills necessary for daily living.

• Maximises the service users long term independence and quality of life.

• Reduction in whole life costs of care

Risk

• New Services have appeal but more traditional services can sometimes be neglected

• E.g. Danger of seeing residential care as residual service for people we failed to keep at home – danger of losing residential care as positive option.

• Danger of Home Care being eclipsed by Re-ablement – many people will require ongoing care which continues to promote independence.

Rationale

• Being Clear about the purpose of Home Care / outcomes to be achieved – focus Commissioners.& Providers

• Ensure that all stakeholders understand what the service contributes both in terms of supporting users, carers and maintaining people in their own homes.

• Ensuring NHS understand the dependency of people supported by the service – no longer home help service.

• Ensuring that Councillors / AMs understand the contribution of the service.

Purpose driven by ValuesDignity/ Privacy/ Respect

Maintenance but:• Personal Care• Chronic conditions / sensory impairment/

depression, etc. • Continence Care / Dementia Care/ End of Life

Care/ Challenging behaviour• Communication & Respect• Assessment (Care at Home) – re-ablement• Maximising independence

Equality & Human Rights Commission – Close to Home

“In the worst cases, we heard of older people, not being fed, or being left without access to food and water, or in soiled clothes and sheets. In numerous other instances older people were ignored, strip-washed by care workers who talked over them, confined to their home or bedroom, put to bed in the early afternoon and unable to participate in their community.”

Close to Home

• High turnover rate of care workers also impacts on older people.

• Intimate personal tasks performed by a large number of different people – repeatedly disclosing personal information.

• 1 case – older woman recorded having 32 different home care workers over a two week period

• Continuity of care

Close to Home

• Not having enough time to deliver care to a standard they wanted

• Stress involved in travelling

Purpose driven by values should avoid these scenarios.

Effective Commissioner/ Provider Working Relationships

• Providers need to be able to innovate & user budgets flexibly as agreed with service user.

• Exploring different ways of securing home care services – tendering arrangements have advantages but can break continuity of care and result in experienced staff leaving the service.

• Valuing the workforce – Care at Home report.

Citizen Directed Support

• Personalisation

• Means more than personal budgets.

• WG to publish draft proposals on Welsh Model of Citizen Directed Support in May.

• Assessment/ Support Planning & Reviews

• Extend Direct Payments

• Implications for commissioners & providers with focus on outcomes.

Citizen Directed Support- Implications for Providers

• Shift from payment by volume and services to payment by results and outcomes achieved

• Providers need to be able to understand what forms of provision will be best placed to deliver outcomes desired.

• Deliver more flexible services – workforce may need to change from hourly paid staff to professional staff with wider skills and working in more complex care arrangements as micro teams.

• Preparation work with Providers - Outcomes

Outcomes

• User feels clean and able to present themselves in the way they like.

• User gets all the food and drink he/she likes when he/she wants it

• User’s home is as clean and comfortable as they want it

• Improved personal care, cleanliness, nutritional intake, hydration levels, confidence, sense of personal security etc, etc.

• Maintain health & well being of carer

Opportunities for Providers

Some people may still prefer home care support on a more individualised flexible basis.

Needs not confined to personal care:

• Domestic help

• Home Maintenance

• Being taken out

Threats

• Personalisation – fewer big contracts for standardised services – do not fit with individual choice.

• Loss of contract / change of service provider

• Financial viability

• Loss of staff to Personal assistants

• Need to reform business model

Sustainable Social Services

• Expand re-ablement

• Actions – develop position statements on re-ablement services and intermediate care services – depth & breadth of re-ablement services, skill mix of staff, sources of referral, outcomes achieved, handover process to home care to ensure provider aware of care requirements, etc).

Market Analysis of Dom. Care in Wales

• Size, shape & capacity of the sector• Stability of the market • Gaps in service provision• Current Commissioning & Procurement

arrangements• Current & future pressures• Existing business models • Progress on developing citizen directed

support / use of outcomes

Market Analysis of Dom. Care

• Views on appropriateness of existing models of service delivery

• Is the sector ready to adapt?

• Opportunities for collaborative approaches to commissioning

• Reducing bureaucracy for providers (SQUID).

• Check project brief against workforce

Market Analysis Dom Care.

• NHS & Social Services

• UKHCA / Care Forum Wales / Domicilisary Care Association Wales/ National Home Care Council / Ceretas

• Care Council

• Social services Improvement Agency (SSIA), NLIAH & Value Wales

• Users & Carers representation.