Adult Care and Health Cabinet Panel - Thursday 11 November 2010 at 10.00Am Item 4 - Performance
HERTFORDSHIRE COUNTY COUNCIL
ADULT CARE AND HEALTH CABINET PANEL
THURSDAY 11 NOVEMBER 2010AT10.00AM
ADULT CARE SERVICESPERFORMANCE MONITOR – Q2 - 2010/11
Report ofthe Director of Adult Care Services
[Authors: Iain MacBeath, Assistant Director, Performance & Business Support
Tel: 01992 556363
Greg Hewitson, Head of Performance
01438 844483]
Executive Member:Richard Smith(Adult Care and Health)
1.Purpose of the report
1.1.To allow the Panel to review the overall performance of Adult Care Services (ACS) for the second quarter of this year(Julyto Sept 2010). This includeskey departmental priorities, remaining national performance indicators, major projects and adult safeguarding information.
2.Background
2.1.This performance monitor has been changed to reflect the revised Care Quality Commission performance framework for 2010/11, which has been reduced from seven ‘domains’ to three. In addition, a significant number of national key performance indicators have been deleted.
2.2.A further section monitoring the delivery of transformation projects is also included, reflecting the ACS priorities as part of ‘Council for the Future’.
2.3. The detailed ACS Management Boardquarterly performance report can be found on Compass under ‘Adult Care Service / Plans and Reports’ on the performance hub.
3.Recommendations
3.1. The Panel is invited to note the report and comment on the performance monitor for Adult Care Services.
101111 Adult Care & Health Cabinet Panel
Item 4 – Performance Monitor Q2 2010-11
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4.Outcome: Improved Health and Wellbeing
4.1. CQC expectations: “People in the council area have good physical and mental health. Healthier and safer lifestyles help lower their risk of illness, accidents, and long-term conditions. Fewer people need care or treatment in hospitals and care homes. People who have long-term needs and their carers are supported to live as independently as they choose, and have well timed, well-coordinated treatment and support.”
Summary of Key Projects
4.2 A detailed review of preventative services funded by ACS, including grants provided to the voluntary sector, is underway. Stakeholder events have started with a view to making savings by either decommissioning services – or investing more in prevention in order to reduce on-going care and support services.
4.3A draft Information and Advice Strategy, required by the Department of Health, will be published by the end of November for full implementation by 1 April 2011.
4.4 A project has begun to work with the Customer Service Centre staff to ‘simplify the customer journey’ in ACS under workstream 1 of the Council for the Future programme. This involves ensuring that more clear and up-to-date information is available to well trained CSC staff - and developing online self-referral mechanisms.
4.5 The jointly funded Falls Project with the East of England Ambulance NHS Trust is expanding to north and east Herts using negotiated health monies.
/ NATIONAL PERFORMANCE INDICATORS:People being ‘Helped to Live at Home’
Indicator / Comment / Local target / Result
Successful intermediate care services / Measure is people are living independently at home three months after receiving intermediate care services. A higher figure is better. / 80% (would be top quartile) / 79.4
Delayed discharges from acute wards aged 18+ / Low delayed discharges and a very low number of these are attributable to ACS. A lower figure is better. / 6.6 average delays per wk (would be top quartile) / 5.8
Permanent care admissions of younger people / Current projection:100new permanentresi placements for younger adults to be made with LD, MH or PD (target 83). A lower figure is better. / 1.5 per 10,000 pop. (would be 2nd quartile) / 1.8
Permanent care admissions of older people (65+) / Projection:888new permanent resi placements for older people to be made this year (target 924). A lower figure is better. / 70 per 10,000 pop. (would be 2nd quartile) / 61.2
Percentage of care packages reviews / This includes scheduled care reviews and unscheduled changes to packages. / 80% (would be top quartile) / 78%
Health and Wellbeing Related Projects
Project / Description / Progress update / Status
Prevention, Wellbeing & Carers Strategy and Action Plan / Strategy to promote the health, wellbeing and independence of vulnerable people and their carers. Promote resilience in communities to support themselves and reduce, where possible, the demand on statutory services. / First Contact Community Agents launched in July 2010 have already made over 2,500 contacts, working with various partners, including PCSOs on prevention advice. A user-led organisations meeting was held in September to explore potential business cases for Big Society projects. Crossroads Care are now operating an online ‘Book your own breaks’ sitting service - 74 carers already registered with 248 breaks booked as at end of September. / On target
Customer Services Centre Improvements / To Simplify the Customer Journey – examining the ACS call centre offer, ensuring clear and early eligibility protocol, advance information about charging for services, self-referral facilities, easily accessible information and updating of the call handling protocols. / A project team has been formed in partnership with Vertex, the current CSC operator. Baseline data gathering, research and surveys including one-off focus groups are underway with a final report to ACSMB in January 2011 for all work to be undertaken and implemented by April2011. / On target
JointFalls Project with East of England Ambulance Service / An emergency response vehicle with theambulance service, to respond to older people who have fallen at home, is to be extended to North and East Herts using health monies. A 50% target of people preventedfrom unnecessary conveyance and admission to hospital has been set. People are enabled to remain at home with simple aids, adaptations and small packages of care, making savings to both the health and social care economy. / Current prevention of conveyance rates are currently 65.66%, with only 8.27% admitted with fractures or acute medical problems. Calls have increased from an average of 2 in July to 4.5 a day in September. The Strategic Health Authority has agreed to fund the expansion to East and North Herts. / On target
5.Outcome: Increased Choice and Control
5.1.CQC expectations: “People who use services and their carers are supported in exercising control of personal support. People can choose from a wide range of local support. Advice and information helps them think through support options, risks, cost and funding. People who use services and their carers are helped to assess their needs and plan personalised support. People who use services and their carers can contact service providers when they need to. Complaints are well managed.”
Summary of Key Issues
5.2.Self-directed support indicator NI130 - has further increased in the first two quarters of this year to 44.7% of people with a personal budget. Hertfordshire is in the top five local authoritiesnationally.
5.3.Direct Payments have continued to increase with 1,533 recipients at the end of September – with a notable increase in younger people with physical disabilities taking direct control of their care and support needs.
5.4.The indicators measuring the timeliness of assessments and care packages have been deleted nationally and are no longer reported to CQC. ACS will still monitor these PIs as a measure of workload pressures in Referral Management Teams.
5.5.The numbers of items of equipment delivered in the first two quarters have fallen after stricter prescriber limits and authorisations; the performance on timely deliveries has increased.
/ NATIONAL PERFORMANCE INDICATORS:Indicator / Comment / Local target / Result
Direct payments / Numbers are increasing. Good individual budget arrangements may limit progress on this. On target. / 220 per 100,000 pop.
(2nd Q) / 187.0
Self-directed support (new) / % of people with a personal budget in place for their care. On target. / 50%
(1st Q) / 44.7%
Assessment waiting times (complete in 28 days) / Under-achieving due to waiting lists at the start of the financial year – now improving. / 84% (1stQ) / 72.4%
Carers receiving an assessment leading to a service / Nationally rated as ‘good’. Better accurate recording practice needed. On target. / 30%
(1st Q) / 28.2%
Equipment delivered in 7 working days / More items of equipment are being prescribed which has led to a fall in performance and pressure on the budget. / 90% (2nd Q) / 91.5%
‘Having Your Say’ feedback forms from service users and carers in Q2 for 2010/11indicates that:-
- 91% satisfied with their care plan
- 89% people said they ‘were offered choice’
- 93% satisfied with way they were treated.
Increased Choice and Control Related Projects
Project / Description / Progress update / Status
Older persons housing related support (HRS) / To develop a new service delivery model for older people’s HRS that ensures fair access across Herts linked to a wide range of other service provision – to prevent need for care and support services later. / Consultation meetings held with various providers and stakeholders across the county. Notice given to providers of the intention to vary existing contracts to deliver a non-tenure low level maintenance service for older people. On target to deliver savings and reprovision and in 2010/11. / On target
Positive Moves Project for people with Learning Disabilities / To develop a range of robust, creative, flexible and sustainable community support and housing solutions for people with learning disabilities moving from long-term NHS campus accommodation. / Minor delays due to recruitment of staff. Five people out of 19 have recently moved into new accommodation in local communities. / Minor Delays
Implementing enhanced enablement services / Providing early services which enable people by allowing them to gain or regain independent living skills through community and bed-based provision. Achieve 40% cessation in on-going care packages after service completion. / HCC / Goldsborough Homecare contract agreed & signed off. Staff co-located at Farnham House. New service launched from Lister and QEII hospitals on 23 August, with 56% of service user’srequiring no service after 6 weeks and a care reduction in 20%. / On target
Telecare implementation / Raise staff and partner awareness of Telecare equipment and increase take-up – particularly linked to integration with enablement services above. / Take-up increased by 24%;Telecare presentations underway across Herts including Goldsborough staff. / On target
Self-directed support project / To ensure all people who are assessed as eligible for care services are offered a personal budget, know the cost of their care and know they have choice over how it is provided. / The project has now been closed down – and the use of personal budgets has been formally incorporated into ACS’ assessment and care management policy as ‘business as usual’. / Completed
6.Outcome: Maintaining Personal Dignity and Respect
6.1.CQC expectations: “People who use services and their carers are safeguarded from all forms of abuse. Personal care maintains their human rights, preserving dignity and respect, helps them to be comfortable in their environment, and supports family and social life. Family members and carers are supported and treated as experts and care partners.”
Summary of Key Issues
6.2.A series of independent safeguardingauditscontinue to be commissioned for 2010/11. The audit for Q2 is currently underway with 25 files sampled for quality of care practice and outcome for service user.
6.3.ACS has focussed on completing Continuing Health Care check-lists for all people with significant health needs as well as and social care needs. If health needs outweigh social care needs using the criteria, the PCT pay for the total cost of the care – and the service user does not have to contribute towards the cost of care. 253 new cases were awarded CHCin Q1 – which is still low in comparison to other councils in the region.
6.4.There have been five‘serious concerns about care providers’ in Q1 of 2010/11 and one concern in Q2. There are 8 ongoing serious concerns investigations. This is an overall drop on the previous year.
6.5.The use of new screening tools in the adult safeguarding process has reduced the number of alerts which turn into formal referrals and investigations (see table opposite).
/ SAFEGUARDING ADULTS ACTIVITYActivity / Care Group / 2007/08 / 2008/09 / 2009/10 / 2010/11
Q1 / 2010/11
Q2
No of referrals
(alerts raised for 2010/11) / Older People / Physical disability / 89 / 265 / 308 / 27 / 13
Learning Disability / 172 / 233 / 275 / 30 / 29
Mental Health 65+ / 75 / 105 / 169 / 35 / 23
Mental Health / 47 / 105 / 143 / 41 / 41
TOTAL / 383 / 708 / 895 / 133 / 106
Totalfor half year: 239
7.Transformation Programme
7.1.Adult Care Services is contributing to the ‘Council for the Future’ transformation programme with projects in five of the nine work-streams with savings identified totalling £41.5m in 2014/15.
Project / Objective / Progress update / StatusReview of ACS Transport Policy and Provision / To review the assisted transport policy in ACS, enforce the eligibility criteria, consider innovative new ways of providing transport to and from day services, reduce costs and improve delivery. / Analysis of journeys (approx 2,000 journeys per week), routes (153 vehicles), staffing and charging to be completed in Nov. Consultations arranged with staff from both CountyTransport and in ACS. Recommendations due to Cabinet in December 2010. / On target
Creation of a Local Authority Trading Company (LATC) / To develop a high level financial business case on the creation of an LATC to operate ACS in-house day services, supported living and respite services, Work Solutions Team and transport. / Business case has been drafted with discussions having taken place with in-house managers, corporate departments and ACS Management Board. Recommendations due to Cabinet in January 2011. / On target
Consultation on charging for non-residential care services / To consult with the public and stakeholders on five potential changes to the charging policy through public meetings, questionnaires to service users and voluntary organisations. / Consultation closed on 11 October. 10,400 questionnaires sent out; 1,218 responses (11.72%)received with 700+ telephone calls. Report to Panel on 11 Nov and on to Cabinet on 29 November. / On target
Money Advice Unit Review / To achieve efficiencies through simplified customer journeys, partnership working with District Councils and voluntary sector and DWP. / Review completed with potential savings of £400K identified. Report to Adult Care & Health Panel on 11 Nov and on to Cabinet on 29 November. / On target
OLM Costing and Negotiation Project / To examine all residential and supported living packages over £850 per week and negotiate with providers to bring costs down, based on a value for money analysis. / Target for 10/11 (£2M) has been exceeded, with 90% of the 1,050 cases to be completed within this financial year. Remainder to be completed in April / May 2011. / Minor Delays
LEAN Business Process review / To look at ACS assessment and care management to reduce paperwork, bureaucracy and streamline business processes with a view to achieving staffing efficiencies. / Approach agreed at ACS Management Board with events for managers arranged for mid-November. Project team in place to support staff. / On target
101111 Adult Care & Health Cabinet Panel
Item 4 – Performance Monitor Q2 2010-11
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