CARE AT HOME SERVICE IMPROVEMENT PLAN UPDATE

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1 HEALTH AND SOCIAL CARE COMMITTEE: 29 NOVEMBER 2012 POLICY AND RESOURCES COMMITTEE: 6 DECEMBER 2012 CARE AT HOME SERVICE IMPROVEMENT PLAN UPDATE Report by Director of Social and Community Services PURPOSE OF REPORT: To update Members on service improvements and outcomes of regulatory inspections for the Western Isles Care at Home Services. COMPETENCE 1.1 There are no legal, financial or other constraints to the recommendations being implemented. 1.2 Continuous improvement and self-evaluation are key themes applied by the Care Inspectorate, set against the Regulation of Care (Scotland) Act 2001 in its scrutiny of the Social and Community Services Department s Care at Home and Housing Support Services. This update on the Social and Community Services Department s Service Improvement Plan (SIP) for 2012/13 seeks to highlight the progress made, measuring this against the external scrutiny outcomes of the Care Inspectorate. SUMMARY 2.1 At the December 2011 Committee series it was agreed to give an update on the progress and achievement of the SIP for 2012/13 by the November 2012 Committee series. 2.2 The Best Value Review Report to the September 2011 Committee series considered the background of several themes that hindered both operational and strategic outcomes. The SIP for 2012/13 identified these and provided interventions that would meet these challenges, with a timescale for delivery. 2.3 The service has a revenue budget of approximately 5m and employs nearly 400 staff, working across 365 days of the year. These services are a significant frontline resource that reaches all parts of the Islands and has a crucial role in being able to support people to remain at home, support the capacity of care home respite and reduce unnecessary hospital admissions, whilst supporting safe hospital discharge. RECOMMENDATIONS 3.1 It is recommended that the Comhairle note: a) the update Report on the Service Improvement Plan for 2012/13 for the Care at Home service; and b) that a career pathway initiative, delivered through the Older People Change Fund, to support workforce developments that will lead to opportunities for the modernisation and sustainability of the Care at Home service. Background Papers: 1 Best Value Review of Care at Home Service Improvement Plan Contact Officer: Paul Dundas

2 BACKGROUND PDR45CMK External inspection and self-evaluation continues to provide a significant element for quality assurance and measurement of service outcomes. The SIP highlighted a range of areas that were identified during the course of a Best Value Review in June 2011 and are now being incorporated within the plan for 2012/13. Local service improvement plans operate through the registered manager of services and will be developed to enable the views of service users and staff to contribute and participate with these. 4.2 Service Improvement Plans are submitted to the Care Inspectorate as part of the self-evaluation process which enables local solutions to be found to address local issues. SERVICE IMPROVEMENT PLAN - UPDATE 5.1 Significant progress has been made since the implementation of this Plan. Importantly, the localisation of management for the Uist and Barra and Lewis and Harris services is now in place and the early benefits of these arrangements are being realised. Summary Update of Progress Action Points Service Improvement - Update Progress Achieved 1. Reducing paperbased systems 2. Implementing standard templates 3. Reassessment of service user need. Reliance on paper based trails is being changed by the implementation of a new scheduling and monitoring system. The dependency on timesheets and the workload of care coordinator, home care worker and management has reduced. A revision of this work has taken place. Care Diaries are being replaced. Traffic light system approaches to Risk Assessment and Care Plans have been created. Work with staff is required to embed and roll out these new documents within the newly created personal case file. In Uist and Barra, all service users have received a reassessment/review of need. In Lewis and Harris, all complex care packages were reviewed by Occupational Therapy services, supported by the Change Fund. In Lewis and Harris, a significant number have been undertaken although staffing shortages within the Assessment and Care Management Team delayed the completion of this. It is a priority of the Assessment and Care Management Team. 2

3 Action Points Service Improvement - Update Progress Achieved 4. Workload management for care coordinators 5. Workforce registration. 6. Workforce training. 7. Supervision and Management of Care at Home Staff. 8. Management of timesheets and expenses. 9. Managing mixed contract workforce not fixed to a regular pattern of work. No tool has been developed. There is not a comparative mechanism that applies to this area of work. The recruitment of relief staffing allows for the workload to be spread, which it was not at the time of the Best Value Audit. Localised Management is now in operation for Uist and Barra and Lewis and Harris. There is an indication from Scottish Social Services Council that they will likely bring forward the registration year from 2020 to A strategy is being written by the Learning and Development Services Manager to meet this deadline for staff. Work in partnership with Lews Castle College is in place to support this timeline. A concurrent Report to the November Committee series will present this service improvement requirement. The Learning and Development Services Manager is currently undertaking a strategic report for the delivery of all care at home staff mandatory requirements, which will be finalised in an operational training plan, which will take into account the cost implications and report its findings to Committee. Significant development has taken place. Local management arrangements have been implemented and comply with a 100% improvement in supervision contact. Revision of a Supervision Policy is currently being undertaken, Changes to this were implemented to reduce needless time implications whilst a new system was being installed. Work is ongoing to streamline the benefits of CallConfirmLive (home care scheduling and monitoring system) to make this effective with regard to human resource time factors and accuracy of collation of information and award of payment. No change to this area of work can occur at present. The full implementation of the CallConfirmLive system and that of the initial findings of the Career Pathways Project requires to be in place. 3 Work in Progress

4 Action Points Service Improvement - Update Progress Achieved There is a need for the re-contracting of the workforce, but this can only achieved by the gathering of all current and projected service need to inform the need for service planning. How this will look in operation will be influenced by the data gathered. 10. Care at Home Business Continuity 11. Improved budget management 12. Developing a change culture to how care at home is provided. The Social and Community Services Department is working to complete its Business Continuity Plan, which will cover the Care at Home section and will be completed by March The arrangements for localised management and employment of relief care coordination is moving towards a significant improvement in these arrangements. Work is continuing to realise the business implications. CallConfirmLive will realise a significant improvement in managing the commitment of a service on the system from Assessment and Care Management Team and highlight, from the Care at Home service, the costs of providing this. This will work towards greater clarity in budget accountabilities and in a later exercise strengthen the benefits of applying task based contracts for staff. This is a significant area of work that will become more evident as the Scottish Government s agenda for Integration between Adult Health and Social Care develops. The Comhairle and NHS Western Isles have made respective responses to the consultation process, and partnership working events recently have indicated a commonality in each organisation s position in this regard. Developing the service and how it functions will be open to changes within integration. No early deliverables UPDATE ON SCHEDULING AND MONITORING SYSTEM 6.1 The Department has commenced a pilot to install CallConfirmLive! (CCL), which is a workforce scheduling solution to manage the schedules of home care workers. 6.2 CCL has been developed by the software supplier, CM2000 as a dynamic, fully hosted web-enabled solution which allows care co-ordinators to allocate the most appropriate home care worker for each service user, or visit, based on a number of 4

5 parameters, including how often the carer has visited before, their availability, their location, their skills and the service user s needs and preferences. 6.3 Drag and Drop functionality (which acts as a pick-list ) makes visit allocation easy and a fully integrated mapping function allows planning and calculation of travel time and mileage. By using the system s planning and visit screens, a care coordinator can see a home care worker s availability and schedule visits. 6.4 The system also shows how the service is performing in real time, and allows for immediate action to be taken to reschedule visits if a risk to care starts to be delivered late or visits are missed. CCL removes the need for paper timesheets by utilising patented AURA (Advanced Unanswered Ringback Application) technology, linked to service users land line telephones, to record arrival and departure times from service users homes. It also allows for quicker and easier communication between care co-ordinators and home care workers working out in the community. 6.5 The Department is piloting the use of CCL in the three home care patches which operate within the Stornoway area. This involves 80 home care workers, including those on fixed hour and variable hour contracts and 180 service users. All home care workers involved received training in the use of the system and have benefited from ongoing support, including one-to-one meetings with their care co-ordinator during the operation of the pilot. 6.6 All the service users were visited by a member of staff from the Department to inform them of the change to working practices and seek permission to use their land line telephones (at no cost to them). A recent evaluation of the pilot showed very high levels of satisfaction amongst service users in the pilot area. 6.7 Having tested the system, the Department is convinced that it offers significant efficiencies in the allocation of home care workers to service users and provides, for the first time, information on home care workers attendance and punctuality at a service user s home and the length of each care visit delivered. 6.8 The Department is currently investigating how best to link the information provided by CCL to other Comhairle systems to provide a payroll function. Once this has been determined, and tested successfully, the Department intends to roll out the use of CCL to the rest of the home care service early in It is anticipated that this roll out will be completed in Lewis by the end of February 2013, Harris by the end of March 2013 and Uist and Barra by the end of May REGULATORY INSPECTIONS OF SERVICE 7.1 Updates to the Care Inspectorate via online self-evaluation and service annual returns have all been completed and returned. Evaluation will take place against these during the upcoming inspection. 7.2 An unannounced inspection of this service is currently taking place. Feedback to the Department regarding the inspection of care at home services will take place during November 2012, and a verbal update on this will be provided to Committee. 5

6 SELF EVALUATION AND QUALITY ASSURANCE 8.1 There is an increasing responsibility upon all care services to ensure they are able to evidence that compliance is being achieved, that continuous service improvements are being worked towards, and that the service is able to demonstrate the importance of service user participation within the delivery of individual outcomes. 8.3 The Social and Community Services Department has been focussing on the development of this area, with a redesign and evaluation of service management to create the role of Learning and Development Services Manager. A significant remit of this person s responsibilities will be to develop and produce a strategic overview of workforce planning, quality assurance management systems, training and qualification planning for all staff and, importantly, focus on registration of the workforce with the Scottish Social Services Council by EXTERNAL FACTORS 9.1 The Scottish Government s consultation on the integration of Adult Health and Social Care was responded to by the Comhairle and NHS Western Isles in September Future workforce arrangements, and potential for doing things differently, will be considered within this context and could have implications for frontline services. A concurrent review of Mobile Overnight Support Services to the November 2012 Committee series, and the report to February 2013 Committee on the delivery of a community meals service, will influence how staff are deployed and the way in which the home care service is provided. CONCLUSION 10.1 Significant ongoing service improvements have taken place, with much of the focus being on the planning and structural management of the service. The demand for, and provision of, home care has grown rapidly, with the service becoming the highest deliverer of free personal care per capita in Scotland While this achievement has had significant service user benefits in enabling people to remain cared for at home for longer, the management and systems standards did not grow at the same pace to meet Care Inspectorate standards for the registered service, and the operational scale of the service required to be re-visited. Strategic planning and service improvements continue to be reported to the Home Care Member Officer Working Group. 6