Future Council Restructure - Adults Assessment and Care ... · 3.10 As a contribution to the drug and alcohol savings, the DAAT reviewed the services commissioned. Phoenix Futures

Cab. 11.3.2015/7.2

BARNSLEY METROPOLITAN BOROUGH COUNCIL

This matter is not a Key Decision within the Council's definition and has beenincluded in the relevant Forward Plan

Report of the Executive DirectorPeople

(11th March 2015)

Future Council Restructure - Adults Assessment and Care ManagementBusiness Unit 2 People Directorate

1.

!.

1.2

2.

2.1

2.2

2.3

2.4

2.5

3.

3.1

3.2

Purpose of Report

The purpose of the report is to inform members on the new Target OperatingModel (TOM) in Adult Services and seek approval for the new structure ofAdults Assessment and Care Management (A&CM) as part of the work ofFuture Council.

To seek approval of the proposed restructuring of social care posts in theintegrated Mental Health service in line with the requirement to identify£500,000 in savings in Mentai Health and Substance Misuse.

Recommendations

That the TOM is endorsed with an implementation date of 13* April 2015.

That the structure for Adults A&CM service as part of Business Unit 2 is agreedwith an implementation date of 1 April 2015..

That the restructure of social care posts attached to the Mental Health servicebe agreed to facilitate the change to the new four stepped Framework forMental Health being implemented by South West Yorkshire PartnershipFoundation Trust (SWYPFT) which is in progress.

That there is agreement that the 2 social worker posts that were attached tothe Memory Service are deleted.

That the social worker post based in Phoenix Futures is deleted.

Introduction

Assessment and Care Management (A&CM)

Members will be aware that the Directorate have been working on a new modelfor the delivery of A&CM to assist the service to manage the increasingdemand on the service due to the demographic pressures of an expandinggroup of older people and the transition of young people who have complexneeds and high cost packages of care.

The current model as depicted is largely based on a traditional model ofrationing via eligibility criteha, ie Use of Fair Access to Care Criteria (FACS) in

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social care. As demands inevitably increase and budgets reduce, theresponse will lead to ever tightening eligibility criteria (as already experiencednationally) plus waiting lists growing, with less people receiving supportservices, culminating in an unsustainable system struggling to provide only forthose with the highest level of need.

3.3 The service has been under considerable pressure since the reduction ofresource due to the savings that were delivered in 2014 in respect of the KLOEACA/A/08 (CR215) which were identified during the development of the modelprior to the implementation.

3.4 The service will have a greater focus on maximising Independence includingmaking it easier for customers to access the service, proportionate assessmentwnicn wiii reauce assessments earned out Dy social workers.

3.5 Implementing and promoting digital services so that customers can do more forthemselves will increase as the model and technology develops. Within thenew structure there will be:

. A new customer access team that will be able to support the serviceuser/customer at the initial point of contact before they require escalationinto the assessment and care management teams ie East, West, Disabilityand Transitions.

. A new brokerage service that will specialise in working with those with thehighest level of need in planning, finding and implementing support.

. A new Transitions team that will focus on the needs of those aged between14-25.

. Disability team which consolidates learning disability and physical disabilityteams.

s Emergency Duty Team covering out of hours,

Mental Health

3.6 It was identified by the Audit Commission report that whilst other service usergroups in Bamsley were funded in the bottom quartile, Mental Health funding isfunded in the top quartile. In considering where savings should come from inthe Adult Social Care (ASC) budget, this factor was key to determining theKLOE AJ/JC/16 in Mental Health (CR213).

3. 7 On 16 October 2015, SWYPFT committed to a 4 Step Model for Mental Healthacross the organisations. Barnsley Business Unit are in the process ofdeveloping their transformation project and designing the model for Barnsley'sMental Health Service with key objectivos in the fore. The service should:

. Be Safe and person centred.

. Encourage greater control for individuals.Emphasise recovery and positive outcomes.

. Improve quality at reduced cost.

. Increase links to alternative community based services, promotingpartnership working.

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. Optimise the use of technology.Use evidence based best practice.

. Reflect the organisation's quality priorities.

3.8 SWYPFT are in the middle of their transformation programme and havedeveloped a model for Mental Health which they are setting up project andgovernance process to deliver the project. In order to meet the savingsidentified by BMBC from the Mental Health contract, it was decided to exploreand determine the social care staff resource required for the model at an eariystage, though the work to implement the model is not yet complete.

3. 9 SWYPFT have a Clinical Commissioning Group (CCG) contract to deliverMemory Services in which 2 BMBC social workers are attached which is alegacy of the previous Partnership in Action (PiA) arrangements. I he MemoryService contract has changed and SWYPFT has found it necessary to reviewthe skills and roles needed to deliver the outcomes of the contract. Soda! workroles are not considered to be appropriate and are no longer required whichhas affected the two staff attached to the service who have returned to BiviBCand are being considered in the A&CM redesign.

Substance Misuse

3. 10 As a contribution to the drug and alcohol savings, the DAAT reviewed theservices commissioned. Phoenix Futures specification was reshaped and thesocial work post attached to Phoenix Futures was identified as a saving as itwas not considered necessary to deliver the outcomes. This has affected onemember of staff attached to the service who will be considered in the A&CMredesign.

Integrated Personal Commissioning

3. 1 ! he CCG and the Counci! sought to develop Persona! Health Budgets (PHBs)which was submitted as part of the Pioneer submission to maximize the sharedlearning and joint working. A Head of Service post was seconded to the CCGto take a lead on its development. On 9th July 2014 there was a launch of theIntegrated Personal Commissioning Programme described as "radical newoption in which individuals could control their combined health and social caresupport". The prospectus for the programme, published in September 2014with the Local Government Association, Association of Directors of Adult SocialServices (ADASS) and Think Local Act Personal, set out the vision andrequirements in more detail.

3. 12 The overall goals are that:

. People with complex needs and their carers have better quality of life andcan achieve the outcomes that are important to them and their familiesthrough greater involvement in their care, and being able to design supportaround their needs and circumstances.

. Prevention of crises in people's lives that lead to unplanned hospital andinstitutional care by keeping them well and supporting self-management asmeasured by tools such as 'patient activation' - so ensuring better value formoney.

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. Better integration and quality of care, including better user and familyexperience of care.

3. 13 The programme itself aims to develop and test a new commissioning approachwhich blends health and social care funding for individuals and allows them todirect how it is used. It consolidates a shift in power to people who use theseservices to help them to shape care that is meaningful and effective in theirlives. Doing this will be complex and difficult, technically and culturally, butpotentially transformational,

3. 14 The PHB Head of Service has been seconded to CCG to promote and deliverthis joint working initiative.

4. Consideration of Alternative Approaches

4. 1 For the A&CM functions within the Counci!, research was undertaken to identifybest practice from around the country to include in the collaborative workshopsto develop a service operating model and service design specific to Bamsley'ssituation, priorities and values.

4.2 The service, having taken account of best practise, has developed a modelwhich is evidence based and also takes account of the principles of the TOMapplied in A&CM.

4. 3 In respect of the Memory Service, SWYPFT have restructured the service tomeet the contract outcomes and are now meeting the targets specified in thepilot in respect of the diagnosis rate. In respect of Phoenix Futures, the servicehas restructured to meet the contract outcomes.

Proposal and Justification

Whilst the growth in the numbers of older people, wno are also living longer,plus younger people with significant health and social care support issomething to celebrate, it represents a significant challenge as the currentmodel in Adult Social Care and level of service provision will not be able tocope. Add to this the additional reduction in resources due to national austeritymeasures, and it is clear that efficiencies and technological improvementsalone will not balance the equation.

5.2 The TOM has been developed alongside Future Council and supports theCouncil's priorities and vision. The design contributes to changing therelationship with communities from "doing" to "doing with" and assisting peopleto heip themselves.

5.3 The now TOM is underpinned by an agreed set of design principles whichhave been developed using:

A collaborative approach involving a wide range of stakeholders internaland external to the Council.

Staff and service user engagement.

. Quantitative analysis, the identification of gaps and the development of

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5.

R 1

recommendations for the way forward

. The values and vision of the Council.

5.4 The model is focused on early help and support with universal information andadvice, early intervention and prevention, self-help and redirecting people tonon-statutory sector services where it is appropriate. The model enables theprovision of low level support, short term targeted interventions to prevent longterm support giving capacity for community teams to focus on individuals withmore complex long term conditions.

5. 5 The features of the future operating model are as follows:

. An asset-based approach to people in need supporting them to managetheir own health and care.

» Developing community capacity rather than state paternalism anddependency.

. Developing a new relationship with our communities and citizens based onco-production and reciprocity.

. Facilitates ability to integrate pathways and a range of flexible customerfocussed provision.

. Focus on better information, advice and signposting to alternative andpreventative services, early intervention and reablement.

5.6 The model heralds a radical shift from the traditional approach. It meansmoving away from eligibility criteria and the 'professional gift' model, toembrace a more customer focussed, citizenship and community empowermentapproach and provide the platform for the implementation of the Care Act 2014requirements. The anticipated benefits of the new model is that it will:

. Free up capacity of the workforce by removing unnecessary activities andimproving processes.

. Reduce demand through enabling greater online use and proportionality toassessment and review.

Enable more streamlined ways of working.

. Improve service user experience, reducing fragmentation and duplicationfor individuals.

. Make the best use of resources, personalised, individually focused aligningaround the person and the complexity of their needs whilst targeting tothose most at risk.

5. 7 The mode! for the delivery of Mental Hearth Ssr.'ice :s a '4 Step Framework'with integrated Pathways with clear analysis of what resources need to beassigned to patients at each level of identified need and consistent withnational evidence base practice. The aim of the model is to deliver:

. Right Care, Right place, Right time

. A balanced service:o Reactive v Proactive

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o Flexibleo Assertive

. A" Improved interfacee A model which is Co-produced. Recovery focussed care and support. The least restrictive option. Best use of technology. Improved outcomes and reduced costs

A brief summary of the '4 Step Framework' and the anticipated model for theservice is as follows.

5. 8 There will be a Single Point of Access which will operate as the front door andact as the gatekeepers for secondary service ensuring people receive the right

care, at the right place and at the right time which is consistent with the TOMfor A&CM. The Care Pathways are intended to be integrated and areorganised in steps:

. Step 1: The Primary Care pathway.

. Step 2: The Core pathway where the aim is to identify those who need onlya brief period of intervention. For example- 6-12 sessions of therapy, ormedication titration and the individual is then discharged to appropriateservices. Robust links with primary care will be developed to help patientswith stepping up and stepping down.

. Step 3: Enhanced Pathway - this is for complex patients needing a Multi-disciplinary Team approach comprising of Nurses, Social workers,Psychologists, Support workers and Psychiatrists etc.

. Step 4: Acute Care Pathway which will be Admission to hospital beds or analternative to admission as the least restrictive option where there will be aplan for every patient to support early discharge with in-reach fromcommunity teams.

5.9 The Recover/ College has been established as a pilot and working to shift thefocus from symptoms to Quality of Life which is a positive move towardsempowering patients/service users. The will be a cultural change to bothservice users and professionals. The Recovery College will have an importantrole to educate people of mental illness working closely with other pathways toprovide recovery focussed work.

Social Care Workforce - Mental Health

5. 10 Work has been undertaken to identify the roles and numbers of staff needed inthe service. As with A&CM, the social care staff will be employed to theservice to enable flexibility to meet the demands of the service. It has beenidentified what roles are required with the professional social work competenceframework. Social work family and the Council's job profile work taken intoaccount. The roles required that BMBC staff currently occupy are:

. Advanced Social Worker 3

Experienced social Worker 7

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Social Worker

Support time & Recovery roleAdministrative Assistant

Recovery Support WorkerCaretaker/cleaner

5. 11 Staff attached to Mental Health have been involved in the consultation eventsfor Future Council Business Unit 2 A&CM, SWYPFT stakeholder events andjoint Consultation in December 2014. There is a reduction of 2 Social Workposts which has been able to be achieved by holding vacancies to enable thereduction. The role that is not required in the future model is the CommunitySupport Worker role because it has long been identified that this role no longerfits a modem Mental Health service. As staff in these roles have left theAuthority, they have not been replaced. This has meant that there are now twostaff in these roles which have been served with At risk letters and will be dealtwith through the Council's Managing Change Policies.

5. 12 Aii other staff attached to the Memai Health Service have been assimilated.

5. 13 In the Memory Service, the social work roles are a legacy of the previous PiAarrangements in that staff applied for posts in the Memory Service that werenot traditionally social work roles.

5. 14 Due to the arrangements that were in place at the time, social workers weregiven equal status in applying for posts in what was then the Primary CareTeam/Care Services Direct and the agreement that BMBC would employ socialworkers to ensure the professional responsibilities were met applied at thattime.

5. 15 With the development of Transforming Community Services, it was agreed thatSWPFT/BMBC would maintain arrangement in the interests of staff, whilst theywere able to do so. However, now the contract for Memory Services hascnanged the social work roles are not considered to be appropriate and are nolonger required.

5. 16 Staff have been consulted as part of the reconfiguration of the Memory Serviceto meet the requirements of the contract. This has affected the two social workstaff attached to the service who have been issued with 'At Risk' letters, havereturned to BMBC and are being considered in the A&CM redesign under theCouncil's Managing Change Policy.

5. 17 In respect of Phoenix Futures, staff have been consulted as part of thereconfiguration of the service to meet the requirements of the contract. Thishas affected the a social worker attached to the service who has been issuedwith an At Risk letter, and is being considered in the A&CM redesign under theCouncil's Managing Change Policy.

6. Implications for Local People/Service Users

6. 1 Local people and service users will have one point of contact for adult serviceswhere their customer journey will be:

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6.2

6.3

6.4

6.5

6.6

7.

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. Personalised, streamlined, customer focused. right time, right place, rightprovider.

* improved customer experience - supporting customers, iess duplicationremoved, and appropriate resources targeted to those most at risk.

. Connected to resources in their community.

. Supported to be more independent.

. Empowered with improved choice and control.

A representative group of service users/carers and their supporters attended aday of sessions on the new TOM which was well received. There wereanxieties focused on the online facilities in the model which will come on line as

the technology is developed. Service users were advised that support wouldbe given to those that needed help and that there were other options availableto access the service. See Appendix D - results of service user/carer day fromiUivi.

The Model for the delivery of Mental Health Service is a '4 Step Framework'which has been developed with SWYPFT holding a number of stakeholder andEngagements events across the SWYPFT region. It is anticipated that therewill be further events as plans for their transformation are progressed andimplemented.

Service user feedback from stakeholders recorded what people/service userstold SWYPFT is important:

. "I want services which keep me in the centre and which focus on mypotential.

. If I choose to make use of technology, want it to be available.

! want all organisations, both big and smal!, to work together, so don't seethe joins.

. I want people to recognise early on that am beginning to have problemsand to help me.

. I want you to offer me as much choice as possible and help me understandthose choices.

. I want you to support my family and carers.

There has been a reduction in social care posts in Mental Health that willinevitably have some impact on service users/carers. However, it is anticipatedthat there would be some efficiencies in developing the new model whichseeks to avoid duplication and delivers the right service at the right time and inthe right place.

There has been a reduction in substance misuse of a social work post attachedto Phoenix Futures. The service has responded to the specification to meetthe required outcomes

Financial Implications

71

7.2

7.3

7.4

7.5

8.

8.1

8.2

8.3

8.4

8.5

8.6

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The structure for A&CM is within the resource envelope identified by FutureCouncil. The cost of the proposed structure is £4, 942, 000 compared to the costof the current structure of £4,886,000 resulting in a minor cost increase of£56,000. This minor cost increase will be contained within the overaii resourceenvelope of Adults A&CM (Business Unit 2).

The Council currently has a contract with SWYPFT for Mental Health servicesamounting to £1,491, 000. Part of this proposal is to reduce the contract sum toSWYPFT to £1, 191,000 resulting in a cost saving of £300, 000 which willcontribute to the existing Mental Health saving proposal.

There is no impact on the medium term financial position as the savings formpart of the current budget proposals. Financial implications are detailed atAppendixADD n.

The social care elements of the Mental Health Structure contributes £200, 000to the KLOE reduction for Menta! Health with £100.000 from the RecoveryCollege and £200, 000 on the purchasing budget which will be delivered bymaintaining the principles of recovery and ensuring that needs are not beingover provided for, as well as ensuring placements in the community aremeeting people's needs and value for money.

There is a deletion of a social work post in substance misuse that contributesto required savings on the DAAT commissioned services.

Employee Implications

Current A&CM staff have been heavily engaged in developing the model. Staffwill/can be employed in any team in the service and will be flexible to enablethe service to meet service user need and demand.

Unison and GMB representatives have been consulted throughout the servicedevelopment and any concerns have been satisfactorily resolved during theprocess.

Formal consultation has taken place, Job profiles have also been created fornew roles in structure (Customer Experience/Access Team) and staff havebeen assimilated or have preferenced to posts. Vacancies will be recruited toon approval of the structure.

As the efficiencies of the model were identified early in its conception savingsand post reductions were delivered in 2014 (KLOE ACA/A/08 CR215).Therefore there have been no redundancies.

Staff have also been consulted on the changes in Mental Health services andthere are 2 staff in the Community Support worker roles who have been servedwith 'At risk letters' and will be dealt with through the Council's ManagingChange Policies. All other staff attached to Mental Health Service have beenassimilated.

Staff have been consulted as part of the reconfiguration of the Memory Serviceto meet the requirements of the contract. This has affected the two social work

staff attached to the service who have been issued with 'At Risk letters', have

returned to BMBC and are being considered in the A&CM redesign under theCouncils Managing Change Policy,

8.7 Staff have been consulted as part of the reconfiguration of Phoenix Futures tomeet the requirements of the contract. This has affected the a social workerattached to the service who has been issued with an At Risk letter, and is beingconsidered in the A&CM redesign under the Council's Managing ChangePolicy.

8.8 In respect of the PHBs Head of Service, this is a time limited post which isfunded by the CCG until March 2016. At the appropriate time, the personpreferenced to this post, who is aware of its temporary nature, will be managedunder the appropriate BMBC HR poiicy.

S. Consultations

a) Chief Executive, 3MTb) Assistant Chief Executive, Human Resources, Performance,

Partnerships & Communicationsc) Assistant Chief, Executive, Finance, Property & Information Servicesd) Assistant Chief Executive, Legal & Governancee) Trade Unionsf) Staffg) Service Users and Carersh) Adults & Communities Directorate Management Teami) SWYPFT, Barnsley hospital Barnsley Clinical Commissioning Group

10. Community Strategy and the Council's Performance ManagementFramework

10. 1 The TOM is consistent with the Community Strategy and PerformanceManagement Framework

11. Tackling Health Inequalities

1. 1 Under the Care Act 2014, the inclusion of a national eligibility threshold ratherthan FACS may contribute to reducing health inequalities by focusing more onprevention and eariy intervention. The provision of more available advice andinformation and the new first contact team being able to give advice in realtime.

12. Climate Change & Sustainable Energy Act 2006

12. 1 Not Applicable

13. Risk Management Issues

13. 1 Staff and resource consistently in wrong team - review model and resource atappropriate time.

13.2 The staffing numbers and skill mix have been developed using a combination

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of anticipated activity levels and Heads of Service input. This will need to bereviewed post implementation to ensure that the balance between the numbersand skill mix are apD rooriate to meet the new way of working.

13.3 There is a risk in the short term that the business will not be able to deliver aseffectively as expected during the transitioning period. This will be mitigated byrobust stakeholder management, work force development and robust transitionplanning.

13.4 The successful transformation of Adult Social Care (ASC) and full realisation ofbenefits will not be achieved in isolation. The redesign of A&CM is fundamentalin determining the manner in which ASC is delivered in the future, however,this is part of a whole systems approach to ensure an improved customerjourney, better outcomes for individuals who use our services and heip enableorganisation across the system to manage demand. This has been recognisedas part of Barnsley Pioneer.

13.5 In Mental Health there :s a risk of socia! care staff not being located in theservice in the appropriate place to ensure that the council's statutoryobligations are met, for example in relation to The Care Act 2014 and MentalHealth Act 1983, particulariy with reduced capacity. This will be mitigated byinvolvement of the Team Manager and Head of Service in the transformationprogramme.

14. Health & Safety Issues

14. 1 None

15. Compatibility with the European Convention on Human Rights

15. 1 The proposals are compatible with the ECHR.

16. Proinoiina Eauaiity & Diversity and Social Inciusion

16. 1 A full Equality Impact Assessment (EIA) in relation to the proposed TOM hasbeen completed and includes an assessment of access channels to thereconfigured A&CM service, taking into account the specific communicationneeds of particular groups, eg Deaf community, people with a learningdisability, people with English as an additional language etc - see Appendix E.All staff involved in the First Contact Team will receive training aroundawareness of communication needs and how these can be addressed (bothattached).

16.2 Service user and carer engagement nas been carried out, with the majority ofrespondents being in favour of the new way of working, provided that change isproperly managed and staff have received full training in all aspects of theservice (see Appendix D).

16.3 The new service will be available to all members of the community includingcarers; take-up and outcomes will be monitored to ensure that all groups canaccess the service equally and receive the same quality of service.

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17. Reduction of Crime & Disorder

171 Not applicable

18. Conservation of Biodiversity

18. 1 Not Applicable

19. Glossary

19. 1 A&CM - Assessment & Care ManagementADASS - Association of Directors of Adult Social ServicesASC - Adult Social CareCCG - Ciinical Commissioning GroupDAAT - Drug & Aicohoi Action TeamE1A - Equaiity impact AssessmentHR - Human Resources

PHBs - Personal Health BudgetsSWYPFT - South West Yorkshire Partnership Foundation TrustTOM - Target Operating Model

20. List of Appendices

20. 1 Appendix A Financial InformationAppendix C TOM diagramAppendix D Service User feedback Session for TOM Staff RecommendationsAppendix E Equality Impact Assessment

21. Background Papers

Proposed Changes to Staffing StructureProposed Structure Charts

CR213 - Implementation of KLOE AJ/JC/16 in Mental Health - Kyra AyreCR215 Implementation of KLOE AC,'VA/08 in Assessment & CareManagement and Professional Support to achieve savings for 2014/15 - GlynnShaw

CR212 The Adult Care and Support reform implementation Jan 2014 - KeithDoddCR230 The Implementation of Care Act Jan 2015 - Keith DoddCab. 15. 1.2014/6 Dec 2013 Our Future Council - Diana Terris

Office ContactKath Harris

Tel. No:775650

Date:17 February 2015

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Appendix A

Report of the Executive Director of Finance and Executive Director Adults and Communities

FINANCIAL IMPLICATIONS

Assessment and Care Management Service Re-sh-ucture

i) Capital Exnenditure

2014/15(t)

2015/16w

2016/17m

Total

(i)

To be financed from:

ii) Revenue Effects

Current Costs - EmployeesCurrent Costs - SWYPFT Contract

Proposed Costs - EmployeesProposed Costs - SWYPFT

Variance

To be financed from:

Minor cost increase to be contained within the overall resource

envelope fur AUulis Assessment and Care Management (BU2)

Savings - Reduction in MH Contract FPeonle 51

2014/15

)4, 886, 0001,491,000

2015/16

)2016/17

If)

Impact on Medium Term Financial Strateey

There is no impact on the medium term financial position arising -from this proposal.

Total

)4,886,000 4,886,000 4,886,0001,491,000 1,491,000 1,491,000

6,377, 000 6,377, 000 6, 377, 000 6, 377, 000

4, 886,000 4,942, 000 4,942,000 4,942,0001,491,000 1, 191,000 1, 191,000 1, 191,0006,377, 000 6, 133,000 6, 133, 000 6, 133, 000

0 -244,000 -244,000 -244,000

0 56,000 56,000 56,000

0 -300, 000 -100, 000 -100, 000

0

Agreed by: ......

5 February 2015

t-lAttR SMOOC> .On behalf of the Executive Director of Finance

Target Operating Model

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Appendix 'D'

Purpose

The purpose of this event was to inform the public about the progress so far to the assessment and

care management re-design. Further the event sought to consult with the public regarding them

having an input into the delivery aspect of the service.

Backeround

BMBC are facing significant changes with regards the way service are provided. There are a few

reasons for this, less finances, making the service fit for purpose and new legislation, hence the re-

design of assessment and care management.

Over forty people attended the event service users and carers, care providers, Healthwatch and

BMBC staff

Interactive votine system.

In order to assess what people already know regarding the Future Council and support that they

receive we asked a series of questions prior to the main workshops and after the workshops.

Questions prior to the main workshops:

Do you know anything about how thecouncil is changing?

YesNoTotals

Responses

27 65.85%14 34. 15%41 100%

34.2%

Yes -No


Do you have any support from AOUIISocial Care at the moment?

YesNoTotals

Responses

132740

32.5%

32. 50%67.50%

100%

Yes No

Are you happy with this support?

YesNoTotals

Responses

9

4

13

67. 50%32.50%

100%

32. 5%

Yes No

Questions at the end of the event:

Do you think that after today you knowmore about how the council is changing?

16.7%

Responses

YesNoTotals

204

24

83.33%16.67%

100%

Yes No


Do you feel happy that Adult Social Carewill meet your needs in the future? Responses

31. 2%

YesNoTotals

115

16

68.75%31. 25%

100%

Yes No

Do you feel happy that Adult Social Carewill meet your needs In the future? Responses 43.5% 43.5%

YesNo

Don't Know

Totals

103

1023

43.48%13.04%43.48%

100%

Yes No Don't Know

Do you think that Adult Socia! Care willhelp you to become more independentand able to do more things for yourself inthe future?

21.7%

Responses

YesNoTotals

18 78. 26%5 21.74%

23 100%

Yes No


Do you think that Adult Social Care willhelp you to become more independentand able to do more things for yourself inthe future?

33.3%

Responses

YesNoDon't Know

Totals

142

8

24

58. 33%8.33%

33.33%100%

83%

Yes No Uon't Know

Will you tell friends/family about whatyou have heard today? Responses 13%

YesNoTotals

203

23

86.96%13.04%

100%

Yes -- No

Have you found today useful?

YesNoTotals

Responses13%

203

23

86.96X13.04%

100%

Yes


Questions for the main workshops

We held three workshops throughout the day. Customer Contact, Assessment and Care

Management and Maximising independence; everyone had the opportunity to contribute to

each workshop. In each workshop using empathy maps we asked:

1, How do you feel about the offer?

2, what difference will it make good or bad?

3, what impact will this have on your life?

4. can you see the advantages and disadvantages of this model?

5, what chances can this create for you to be more independent?

(1) The workshop focus was, Maximising Independence - Re-ablement,

Assistive Technology

Provides a range of services to meet different levels and type of needs with the aim of helping

customers maximise their independence. Key objectives include:

. Cohesive and integrated services

. Provision of a range of services that enable independent living

. Wider provision of services tu meet different levels of needs

Workshop (1) responses

There is not enough information already out there about the options, we should be able to

get more information for ourselves, and this approach will enable us to have more choice

and involvement in support planning. Fantastic idea but in reality will there be enough

money and facilities? If it works it will be good. This is about getting the assessment stage

and tools right, pitching the information at the right level and at the right point. We need a

central point to find out local information. We need better information sending out to the

GPs and other voluntary organisations

Further comments and questions

Carers are integral to the assessment process so should be involved, is there a training need

for practitioners? Information needs to be simplified and practitioners should have anassessment tool kit. Socially isolated people may benefit from the changes. Individual

budgets work better when they are on a temporary basis and when extra care is needed.There should be a flagging option on the system if the contact is not successful; this should

be followed up to make sure information provided was adequate.


(2)The workshop focus was. Assessment & Care Management

This layer of support focusses on people who have more complex and specialist needs that

have not been resolved at an earlier stage in the individual's contact with us.

Assessment and Care Management teams are responsible for helping individuals to

maximise their independence and access support. This wilt be delivered in a personalised

approach, using Personal Budgets and Direct Payments for those who are eligible for some

help to arrange and pay for their care and support services.

. Provision of services in the most efficient and effective way possible;

Have a clearer view of the patient / service user's needs, enabling them to provide abetter, more personalised service


People need to be more involved in the assessment process, change is a two way process, it will be

good if it works, once the market is developed and people have more choice about the support they

have. It's not good or bad its about development, we have no choice there has to bo change


The system should be used first; surveys should be done to collect feedback, then changes made

accordingly. We are glad we have been informed. Its ambitious and confusing but will be better

once we are used to it. Carer needs to get support then it will be better for everyone.

(3) The Workshop focus - Customer Service Area

With our new model for customer services, people will have one contact telephone number

for our new centre, and will be able to receive personalised information from a social care

professional at their first point of contact.

We will further develop our website and a range of self-help tools for people to be able to

access 24/7 information about health and social care.

This means that people will be able to make much more informed choices about any

services that they need to access, from a range of health, social care and community

partners

. Providing customers with information, advice and guidance° Directly approving more services to customers at first point of contact- Gathering more comprehensive information from customers at first point so that

there is less repetition (Telling your story once)It will also provide support and encouragement to customers that want to benefitfrom using digital technology to interact with the Council



People felt that this was a rea!!y good idea as they would only have to tell their story once, it

was the right thing to do we should have a single point of access, should make it moreefficient and it could be really good if it works. The main thing is that people are listened to

and the people at the other end of the line understand need.


People need options; will there be an out of hour's number? Will reviews be carried out asnormal? Don't know if this service will enhance independence. Staff will need training on all

of the options and interventions; would there be enough staff to undertake this role? will

there be a separate safeguarding line?

if staff members are manning the phones won't that take them away from the front line?There should be a trail run first before anything is approved. Could contact centre deal with

changes in short term care? Will people with long term needs, need a new assessment? LDpeople need consistency will they have the same named person?

What about people who can access the contact centre? Or use the website? The website ishard to navigate through, slow, frustrating and what about those who cannot access theinternet? Will there still be a walk in facility; we are worried the care teams won't exist

anymore.

Common themes

People felt on the whole things had to change, however they were concerned about specificgroups slipping through the net and not receiving ihe support they should. People wereconcerned that everything was going to be internet based and not everyone had the skills or

access to a computer.

GP needed to be more involved and have an understanding of support in order to sign post

people. In all workshops staff training and knowledge was something that needed to betaken into consideration.

Other issues on the day

There was no where to drop off in the TaxiThere was not enough car parking for disabled at the town hall

. The hoist was no charged

. Why does the local account not have financial information in it?

. Not everyone knew about today's events and they feel that everyone is informedfissues and careers) - Carlton Manager

. Times - accurate on e-mails and paperwork etc.

For a full list of responses please refer to the appendix


Appendix

Assessment and care manaeement workshops

Advantages/ disadvantages

The changes may have to be in model. May not be perfect to start with but will progress.

Change is a two way process.

Benefit is the quality of service user/ Carer input.

Changes to be more independent

. Needs to be very understandable.

. More involved in assessment process

. Staff training/ do they know everything

. Help people to have a clear vision of the support that will meet there needs.

The offer

. Ambitious

. Single points of contract and good idea.

. The right thing to do.

. Confusing to start with but will be less so when we get used to it.

. Good if people get more choice about the support they have.

Smarter.

Good) if it works)

. Need to test the system out first.

. Glad to have been informed.

The difference

. Need to use the system first.

. Quality surveys-feedback.

. Not about good or bad, but about development

. No choice. There has to be a change.

* People are individuals; The support will be the best option for them.

If Carers get good support, then better for everyone.Good once the market is developed.

Correct format, easy read. Also specifically for deaf/ blind community.

If carers get good support then be better for


A choice to have a P.A from a group of P.As from a group of P.As instead of having to

enjoy people, customer calls at beginning of week or month TO request hours if a P.A

is available for those hours then ok if not then, an alternative set of times is given

Help for the carer they save Billions

Personal care handlers

CUSTOMER CONTACT

B. M. B. C -Want a named person who knows about her- don't want to explain things over

again.

. Could be an issue re training people on other end of phone- Staff needs to be able toanswer Questions.

. Could contact centre deal with short term change in care. Told financial implications-

Long term need a new assessment

Mencap- will people get s named worker this is 3 concern from L. D Perspective.Need consistency

. Worried that care teams wont exist

. Will reviews be carried out as normal?

. Connect to care difficulty find P.A but unsuccessful for short hours.

. Too much info gets complicated need to be simplified ends up Google it

. Staff find it complicated

. Will front door be duty officer?

. Will there be a separate line for safeguarding issues ------ - - -

. Need out of hours service

. What effect will contact centre staff been taken away from teams make. Don t want

calls stacking up and not been dealt with.

. Worry that care TO connect is a choice but you don't know what yout choosing from.Needs a review site Eke trip advisor.

Don't know if this service will enhance independence

Wants to make sure people are listened to and understanding of needs

. B. M. B. C- Concerns R. E Safeguarding info on system

. How we can build into the system What info is available at the first point ofcontact

. Could start with a black screen for first contact. If we look further any S.G

issue would be flagged but not discussed

. How do you know who is calling and who information is given to PASSWORD?

. Staff training needs to be robust.

. People don't know about Connect service

. Need simpler ways of communication

. Info needs to be given at relevant point I.E hospital discharge, front door orwherever in a format that is accessible to individual


Worried about info overload

Working for better referrals with neaith and social care services

Make sure connect to support C to B are relevant and up to date

Consider test service.

Advantage/ disadvantage

. Should be more efficient

. Should work well

. Only telling story once is good.

. The night Tiling tuduiiiigle point of access good idea,

Staff-Will it work? Needs testing

SU Thinks it will be on reason for ringing

What will be on ca!! centre screen Will staff have the time to read historyand understand

circumstances

Told would be two teams and a contact team please clarify

If known to P. D teamwou!d you go to them or contact system - concern.

. Will there be enough trained staff doing that work.

. Has anyone thought about a call back system

. Need to think about people who cant afford to use credit phones or cant get to the phone

Safeeuardine texting service possible.

. B. M. B. C online not easy to use. If you haven't access online or cant use it.

. Will there be a walk in facility were will it be?

. Concerned that most vulnerable do not slip through the net and get the help they need

when they need it

. Couid voiunteers be firsi poim of contact

Need to communicate to people about the changers before they happen in differentformats.

Customer needs education re system and how it works need to trial it first

Website has old info need designated, person to update

Care to connect slow, frustrating. Need to be easy.

Want a service that is effective given resources available.

People need options.

. Could hp really gnnd if it works.

. Could we use tablet for people to sign other languages e. t. c. SN

Maximising Independence

. Pitching the information for the person at the right stage/ level

. LA have a website and a directory, contact point!

. Getting the assessment stage right

. General consensus in one point of contact will be good- to be able to ting one number.

. Sounds great but in the end will be down to budget

10


. It would be good to have access to facilities as and when needed.

. Fantastic idea - bui in reaiitv radiities need to be available

Service might not be appropriate

Hope that the individuals budget is flexible enough

Length of time for assessment

. The more information the better the quality

. Some service users had not heard of independent living at home services

. Some service users have the flexibility to use their personal individual budget

. Personalisation and" in control" only works if the person knows what there is to use for

support.

The determination of need can only be assessed by the quality of.......

. Need the provider to understand the persons needs

Each person needs are different provider needs to understand this better.

Single Point of contact - will be of benefit

Easier for others to explain to each other

. Not aware that access to social service can be undertaken by a carer

. Are G. Ps aware of where to signpost to ? Earlier interventions-Preventative measures

. Six - eight weeks to get adaptations are unacceptable

. 'Little' access to directory of servicers.

. Not enough information out there

. Can be anonymous (phone contact) if the person wants it to be

. Access via the GPs

. One contact number for N. H. S etc.

Carers integrator assessments

Training gap R. E. :- Practitioners

Ensure assessment tools are adequate to capture details.

. New design - get a referral from contact centre

. Will be really good to just be able to ring for advice and information.

. Flagging system if contact is not successful, and for feedback to check information wasadequate.

Creating more independence

. Will help us to be more independent

. Able to have more choices and involvement in support planning

. Able to get some information ourselves,

How do people access the HART service?

ILAH

Better sign posting to all services available (PERHAPS AT DIAGNOSTICS(N.H.S) or upon startof benefits

Combine services) ACCESS TO) info one contact i. e. one person Deals with customer but can

direct relevant services when required.

Better communication between authorities - more info available in g. ps surgeries, hospitals

etc.

11


Clearer records.

The carer shouiu be treated as they roo have the condition i. e the carer lives with it and

perhaps may have a deeper understanding of a persons condition

I. B worked better when extra care is needed and the temp basis. Maximising independence

without using ILAH.)

Personalise the ILAH to meet individual need.

Service providers to 'tap' into the new service

Socially isolated people who are vulnerable may benefit from new services

A chance for voluntary organizations to work more closely with service users.

Simplified information

A decent tool kit for professionals to make use of

IT the new service works it will be good.

Need a centrai point to find out iocai information.

Plan may be to use the service when people need to escalate the support they need forwhile.

Work with G. Ps to work with this service. E.g. leaflets in the surgery.

12

CR275-APPENDIX E

To identify whether a service change will impact on all sections of the local communityequally and agree what action can be taken to better understand the impact and to reduce

any inequalities.

:Nam® of Servicei-. ^'. ..,.. '.~^.. ^ . :'9, :^'_i^^i^.

Assessment and Uare Management

Name of Officer responsibie for Margaret EssexEIA

What outcomes does this servicedeliver for customers or the

public?

Provision of Adult Social Care Services

Why is the service changing? To incorporate the requirements of TheCare Act 2014To reflect changing demographicsTo meet demand across the whoie health

and social care systemMake working practices more efficientImprove customer journeyStreamline business processesFinancial constraints

How/ ft the s&n/tee Changing /likely to change?

The service Target Operating Mode! providesthree main service areas:

. Maximising lndependence(EarlyIntervention and prevention)

. Customer Contact

. Maximising Independence(Reablemerrt/Assistive Technologies)

. Care Management

CR275-APPENDIX E

This will mean:

A single point of access for customersseeking Adult Social Care services

. Resolving more queries and requests whenyou first make contact

. Able to contact us on line. Provide a rangeof services that support you to be moreindependent

. More provision of information and advice,probably through digital media

t3 rgetoperatingmDde120140902. pdf

What will this change mean for theservice's outcomes for customers

^thejputilic?

Provide an offer/services to more peopleand not just those we have deemed eligibleLook at ways how to support people bemore independent keeping out of the formalsocial care system (telecare). Only for thosethat need it.

Improve how people access servicesGiving people better and more info andadvice that is co-ordinated and connected.

Improve choice and control for peopleLook at what communities have to offer andmake better use of these resources

Connect people to resourcesLook at services provided by healthrehabilitation, intermediate care, falls/stroke services. Supporting people to regaintheir skills to maintain independent living.Support people to adapt their lifestyle(health coaching)Those that need on going formal supportthat they have a personal budget to managetheir needs

When will this tie taking place(start and finish}?

December 2013 - April 2015(First phaseimplementation)

CR275-APPENDIX E

f"-' .'.-."u- e" t~"<:,{'. »».»";-Service feedback:

What do you already know about theequality impact of the service? Thiscould be from consultation,complaints / compliments,stakeholder feedback, staff anecdotalevidence etc.

Data:

What evidence is available about

equality impact of the service areaand what does it tell you? This couldbe service performance monitoringdata, it could demographic data (asshown in ward profiles), etc.

See report from A&CM SU event

SU& CarerEngaement event rep

. Adult Social Care Pertormance MonitoringDoH data

Currently, a cohort of disabled and older peopleare in receipt ofA&CM services, under therequirements of the Care Act 2014, the newservice will be for the whole community, withparticular emphasis on carers

Previous EIA's:

Has there already been an EIA on allor part of this service before, or arelated service? If so, what were themain issues and actions it identified?

See attached - the EIA focused on access needsand how these would be addressed

Community ImpactAssessment vl 0. doe

CR275-APPENDIX E

Protection from unlawful discrimination is provided by the Equality Act in relation to thefollowing characteristics:

DisabilityAgeGender reassignment

Pregnancy, Maternity,BreastfeedingRace

Religion and BeliefSexSexual Orientation

.An "equal" service is one where those who need to use the service the most cto use theLservice the most.

what do you Know about the extent to which the above groups need to use your service?What do you know about the extent to which they do use your service? And is there a gapbetween the two? How will the service change affect this?

Per the requirements of The Care Act 2014:

. National eligibility criteria

. Focus on early intervention and prevention

. Improve information and advice

. Maximise independence

There will be a broader offer than as current

An "equal" service is one where people are equally likely to receive a good quality ofservice, and one where the service leads to good outcomes for the customer.

What do you know about the quality of the service people receive (e.g. fair decision-making, waiting times, etc)? What do you know about the outcomes your service achievesfor customers or the public? How will the service change affect this?

Service is for all community members - no evidence to currently suggest that there is anunequal service.

An "equal" service is one where people can find out about it, apply for it and use itaccessibly and independently.

What do you know about the accessibility of the service? How will the service changeaffect this?

There wili be a single point of access, with improved enquiry resolution and moreavailable information and advice.

See attached for accessibility for different groups

CR275-APPENDIX E

'Which of the following have you identified a potential inequality for? Is this currently the'case, or after the service change, or both?

1 Please indicate the degree of potential inequality- (H - high, medium, L- low, N -;none)

Group Now After Details

MenN N

WomenN N

Disabled oeooleM N

No longer need to be FACS eligible. Nationaleligibility criteria

BME psop'eN N

LGP peopleN N

Trans peopleN N

Young PeopleN N

Older peopleM N

No longer need to be FACS eligible. Nationaleligibility criteria

Faith groupsN N

Pregnancy/maternity N N

Other:Eg carers,homeless,military, lowincomes

M

Wide provision for Carers in Care Act 2014

N

CR275-APPENDIX E

To improve you knowledge about the equality impact

Actions could include: community engagement with affected groups, analysis ofperformance data, improve equality monitoring, stakeholder focus group etc.

Action taken so far: Lead Officer Completion date

Service User and Carer event held Margaret Essex October 2014

Action we will take: Lead Officer Completion date

Deaf community event Margaret Essex February 2015

To improve or mitigate the equality impact....^'-^.A^-.^".

Actions could include: altering the policy to protect affected group, limiting scope of servicechange, reviewing actual impact in future, phasing-in changes over period of time etc.

Action taken so fan Lead Officer Completion date

Comms materials prepared Emma O'Grady Ongoing to March2015

Workshops with service users/carers andstaff

Margaret Essex October 2014

Action we will take: Lead Officer Completion date

Changes to policies and procedures Margaret Essex March 2015

Staff training revor Hewitt March 2015

r'-?-~r3-, '.'^

As a result of this EIA how have you demonstrated due regard to the need to:

Eliminate unlawful discrimination, harassment orvictimisation?

Yes

Advance equality of opportunity between people whoshare a protected characteristic and those who do not?

Yes

Foster good relations between people who share aprotected characteristic and those who do not?

Yes

CR275-APPENDIX E

Please summarise the main findings and next steps identified in this EIA.

The outcomes of this EIA must be summarised in the cabinet report or delegated decisionreport which approves the proposed service changes. You could also include the EIA asan appendix to the report or reference it as a background paper.

You must also record how you will inform all stakeholders of the outcome of this EIA. Inpractice this is usually best achieved when reporting the service change itself.

Summary ofequality impact

See Appendix D attached

Summary ofnext steps

Work to increase accessibilityEngagement events ongoingRevised/new policies and proceduresStaff training

Howstakeholders

will beinformed

Engagement events and workshops

Letters regarding changes as a result of the care Act 2014

Flyers

Presentations

How Cabinetwill be

informed

Members briefingsSMTBLTPl Board

Documents

Future Council Restructure - Adults Assessment and Care ... · 3.10 As a contribution to the drug and alcohol savings, the DAAT reviewed the services commissioned. Phoenix Futures