Home Care Provision in Fife

Transcription

1 Social Work and Health Committee. 6 March 2012 Agenda Item No. 7 Home Care Provision in Fife Report by: Stephen Moore, Executive Director (Social Work) Wards Affected: All Purpose This report is presented in response to a request made at the Social Work and Health Committee on the 24 th January 2012 for a report be provided to advise members about the Social Work Home Care Service. Recommendation(s) Members are asked to note the report on the Social Work Home Care Service. Resource Implications The allocated budget for the Home Care Service is 25.5 million. Legal & Risk Implications No issues identified. Impact Assessment There are no service changes identified in this report and therefore an impact assessment is not required. Consultation Not applicable.

2 1.0 Introduction 1.1 Following consideration of a report presented to the Social Work and Health Committee on 24 th January detailing developments in the Social Work Home Care Service, a further report was requested by the Committee to outline the following : The process in place for accessing a home care service including referral, assessment, eligibility criteria, service standards and waiting times. Details of the staff structure, roles and responsibilities. Details of external providers of care at home for all adults, children and families, the nature and level of work which we commission from them. 2.0 Background 2.1 Fife Council Home Care Service provides hours per week of personal care and support to people of all ages:- older people, adults with physical, learning difficulties, mental health problems, substance misuse and children with disabilities and their families. A definition of Personal Care from Scottish Government circular CCD5/2003 is in Appendix We employ 1200 staff to carry out this work and it should be noted that 93% of the total budget of 25.5 million is spent on staff and staff travel to visit service users, which represents direct provision to service users. Details of staff structure roles and responsibilities can be found in Appendix In addition Fife Council provides hours per week of support to enable people to live in the community in small group living arrangements and individual tenancies. 2.4 Care at home is purchased from the private and voluntary sector through a framework agreement - details of these are in section 5 of this report. 2.5 All care at home services are registered and inspected by the Care Inspectorate and the most recent inspection carried out in December 2011 graded the Social Work Home Care Service as Grade 5 (very good) for Quality of Care and Support and Grade 5 (very good) for Quality of Staffing. Quality of Management and Leadership was not inspected. 2.6 The Home Care Service in Fife has a high level of service user satisfaction, 93% of people are satisfied with the service they receive. Comments from the recent Care Inspectorate inspections were positive about the service.

3 I m quite happy; they re very good girls They re friendly, supportive and chatty I m happy with the service; I d leave it the way it is I am treated with dignity and respect If they didn t come here I d have nobody to talk to about things in general It s brilliant; I have no problems, I get on very well and I m happy. 3.0 Assessment Process 3.1 The Social Work Service has a statutory responsibility to provide a needs assessment to any individual who requests it. We receive all new requests for a needs assessment at the customer contact centre. Referrals for needs assessment can come from the individual themselves, their family or other professionals or agencies. 3.2 In order to ensure that there is a professional approach to dealing with new referrals we have deployed a number of registered, qualified social workers; qualified occupational therapists and home care assessors to the contact centre. Any referral from an individual who is already known to the social work service is passed to their social worker/ occupational therapist / home care manager who will ensure that appropriate arrangements are made to deal with any changes to their circumstances. 3.3 All new referrals for the Social Work Service are assessed at the first point of contact ie the customer contact centre. The worker receiving the referral will apply their professional judgment and consider risk, urgency and need to determine the appropriate outcome which could be a number of actions eg it could be providing advice with no further action, it could be diverting to other services or agencies, or it could be confirming that the individual requires a further more comprehensive multi agency assessment of need. In addition simple services can be arranged at this point. 3.4 Where a comprehensive multi agency assessment of need is required, the worker will do 2 things: Co-ordinate the other agencies responses to contribute to the needs assessment/welfare of the service user Will consider how best to deploy Social Work Service resources, and how quickly. 3.5 The worker will use their professional judgment and the eligibility criteria to inform their decision about deploying Social Work Service finite staff resources in a way that targets those most vulnerable whilst also recognising lower levels of need to support independence. 3.6 The eligibility criteria in Fife is based on the national eligibility criteria and waiting time standards for personal and nursing care. The bands are as follows: Critical Substantial (High) Moderate (Medium).

4 3.7 In relation to eligibility criteria I would refer you to the report presented to the Social Work and Health Committee on 16 March 2010, when Committee considered and approved the amended eligibility criteria. 3.8 Whilst people are waiting for their comprehensive multi agency assessment to commence, we keep in touch with them routinely to ensure that their circumstances have not changed and that they require a more urgent response. Where the referral is from another agency, the expectation is that the referrer will continue to keep in touch with the individual to monitor any changes in their circumstances and advise us accordingly. 3.9 It should be noted that any referral to the Social Work Service, where adult, child protection or critical risk is identified, a same day response is made, unless the risk assessment determines a different response The number of people awaiting an assessment fluctuates daily depending on demand for service and availability of staff. Critical cases including end of life and people delayed in hospital who require an increase in their community care package to return home are critical cases for allocation and are assessed within 5 days. We assess substantial cases within 4 weeks and moderate cases within 10 weeks The Home Care Service currently receives approximately 15 new referrals each working day seeking an assessment. We would prefer that no one waits for a service to be provided, but this is necessary to meet the demands we receive within the resources available. Service response is based on professional judgement of risk and need and priority for service is not based on date order On 17 th February 2012 there were 331 people in the process of moving to the next stage of their assessment, of this number 32% will be seen within 5 working days, 32% will be seen within 4 weeks, 36% will be seen within 10 weeks which is in line with the agreed standards as detailed in Home Care Changes 4.1 As detailed in the report to Committee on 24 th January 2012 the Home Care redesign approach has resulted in an organisational restructure and re-consideration of job overviews to ensure that the appropriate skills, knowledge and experience are in place to take the service forward in the future. 4.2 The Service Redesign will see the Home Care Service align with the Community Health Partnership boundaries of Dunfermline and West Fife; Kirkcaldy and Levenmouth; and Glenrothes and North East Fife. 4.3 The Home Care Service redesign includes the development of a Reablement service across 3 areas, Dunfermline and West Fife, Kirkcaldy and Levenmouth and Glenrothes and North East Fife. In addition, for people who continue to require a service following a period of reablement, there will be mainstream Home Care Teams in each of the 3 areas. 4.4 Reablement is essentially an approach to providing care and support which focuses on maintaining or developing an individual s skills to assist them to live as independently as

5 possible. By building on independence rather than dependence, people are empowered through support and encouragement to achieve a good quality of life living at home. 4.5 The implementation of the Home Care Reablement approach has been supported through the Reshaping Care for Older People Change Fund which has enabled the recruitment of 150 new home carers providing almost 4000 additional home care hours and extending carers contracts to 7 day working. 4.6 The Dunfermline and West Fife and the Kirkcaldy and Levenmouth Reablement Teams have already started and the Glenrothes and North Fife Team will be in place by April Early indications are that up to 30% of people do not require a home care service following Reablement. 4.7 The Social Work Service has employed two additional Home Care Assessors within the Contact Centre to support the assessment of all new referrals coming into the Service. 4.8 These posts are seen as vital in the Home Care Service redesign as they provide dedicated staff reflecting our commitment to respond effectively to the first contact in the process leading to multi -disciplinary assessment and, if appropriate, on to service provision, as detailed in section 3 of this report. 4.9 The Home Care Assessors are responsible for assessment, determining the appropriateness of referrals against Service Eligibility Criteria and providing the information to signpost individuals to other services as necessary, liaising with other agencies including GP, Housing and Voluntary Sector The introduction of Direct Access for certain services that currently require an assessment, for example, Community Alarms and Meals on Wheels will improve the speed of access for service users and promotes self determination of needs and outcomes. Direct Access will commence in Spring Breakdown of Service Provisions 5.1 The breakdown of service provision for care at home services in Fife is detailed in Table 1. Table 1 Hours All Local Authority Care@Home % Local Authority Supported Living % Voluntary Sector % Private Sector % Total % Clients All Local Authority % Voluntary Sector % Private Sector % Joint Packages % Total %

6 5. 2 The private and voluntary sector provision is commissioned with providers accepted on to Fife s Care at Home Framework to provide personal care and support to people of all ages, as the in-house service does. There are currently 35 providers on the Framework which is detailed in Appendix A report was presented to the Social Work and Health Committee on 15 th November 2011 detailing the contract monitoring which is in place to ensure the quality monitoring of contracted care services. In addition all care services are registered and monitored by the Care Inspectorate. 5.4 The Care at Home Framework is a framework that allows staff to commission services as they are required. All contracts for individual care and support are subject to review and may cease at the point when the package of care is no longer required. 6.0 Conclusion 6.1 The Home Care Service provides a valuable support to people of all ages to enable them to live safely at home and achieve the individual outcomes they want for their life. The Home Care Service has and will continue to adapt to respond to changing demographics, policy guidance and individual needs and aspirations. 6.2 The Service operates to maximise available budget to direct service provision whether provided in-house or purchased from the private and voluntary sector. The foundation of effective service provision is on-going assessment and review of individual need and targeting support to those in greatest need. List of Appendices: 1. Scottish Government circular CCD5/2003 definition of Personal Care 2. Staff Structure roles and responsibilities 3. Fife s Care at Home Framework Background Papers: Scottish Government circular CCD5/2003 on Personal Care Report Contact Rona Laing Head of Service, Older People s Service Rothesay House, Glenrothes Telephone: rona.laing@fife.gov.uk

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8 Appendix 2 Home Care Staff Roles and Responsibilities 1. Home Care Managers (41 full time equivalent) Assessment & Reablement (18) - responsible for the assessment of need, risk management and reablement goal setting, care planning and review and developing support plans for those service users requiring an on-going home care following reablement. Directly manage Reablement Home Carers. On-going Care Management and Support (17) - responsible for the day-to-day management of the on-going service to service users and directly line manage Home Carer staff. The Home Care Managers have responsibility for the review and amendment of care packages to ensure that the care arrangements meet the service users needs. Commissioning and Review (4) responsible for the commissioning and review of care packages within the independent and voluntary sector for Older Peoples Services. Contact Centre (2) responsible for initial screening of all new referrals into Service. 2. Occupational Therapists (4 full time equivalent) These posts are located within the Assessment and Reablement Teams. The OT undertakes assessments of need and contributes their professional expertise to developing realistic goals for service users which promote independence. They work directly with service users with the most complex needs and access or arrange equipment to facilitate maximum independence. 3. Home Care Co-ordinators (27 full time equivalent) Are responsible for the co-ordination and support of the Home Care staff. The Co-ordinators are community based and are responsible for oversight and monitoring Home Care staff care practices and overseeing the work as determined by the Home Care Manager/OT. They provide first line supervisory support for Home Carers. 4. Schedulers (15 full time equivalent) Are responsible for the input, maintenance, allocation and dissemination of information from the Webroster Scheduling tool to ensure that Home Carers work is scheduled appropriately to maximise the hours available. 5. Home Carers (1100 on contracted hours) Provide high quality personal care based on the reablement approach, focussing on the service user s strengths and abilities to promote independence where possible.

9 APPENDIX 3 Private and Voluntary Sector Providers on the Care at Home Framework Name of Organisation ACasa Care Limited Allied Healthcare Group Alzheimer Scotland Ark Housing Association Assured Care (Scotland) Limited Autism Initiatives UK Avenue Scotland Limited Benore Care Centre (ACS Care at Home) Capability Scotland Carewatch Fife Cornerstone Craigmillar Social Arts & Enterprise Centre (SPACE) Deaf Action Elite Care at Home (St Andrews) Elite Homecarers (South Queensferry) Fairfield Care Scotland Ltd (Positive Options) Gibson Training & Care Limited Gowrie Care Limited Hanover (Scotland) Housing Association Limited Hazelhead Homecare HRM Homecare Services Ltd Independent Living Services Kenylink Services Ltd Kingdom Housing Association Leonard Cheshire Disability LinkLiving Momentum Scotland Newcross Healthcare Solutions Options for Independence (British Red Cross Society) Paramount Care Penumbra PULSE Real Life Options Social Care Alba Limited The Richmond Fellowship Scotland