Appendix 1
EAST AND NORTH HERTFORDSHIRE PCT AND
WEST HERTFORDSHIRE PCT AND
HERTFORDSHIRE COUNTY COUNCIL
TRANSFORMING COMMUNITY EQUIPMENT SERVICES
Background
The Hertfordshire Equipment Service (HES) was established in 2004 under the Department of Health (DoH) funded initiative ICES (Integrated Community Equipment Service). This partnership initiative between Hertfordshire County Council (HCC) and the Hertfordshire Primary CareTrusts brought together the Social Care HomeAbility Service and two Hertfordshire Health Equipment Services (East and North Hertfordshire and West Hertfordshire) and was designed to support and promote integration of Health and Social equipment in such a way that would: -
- Enable Health &Social Care Equipment Services to operate as a single service under one manager operating within a pooled budget.
- Increase by 50% the number of people benefiting from the service
- Increase efficiency by modernising purchasing, supply and recall systems
- Extend the use of tele-care technology to support frail and vulnerable people
HESis managed by Hertfordshire Business Service (HBS)and has continually being developing and improving its service delivery since 2004. Currently HESnow delivers, collects cleans, re-uses, maintains and services a variety of simple equipment (under £100) and complex equipment (over £100) which includesitems such as beds, mattresses hoists, suction machines etc. in addition to a wide range of specialised equipment for adults and children.
HES currently operate a 5 day per week service (Monday to Friday) from Mundell’s in Welwyn Garden City,employing 47 whole time equivalent staff with 23 equipment delivery/collection vehicles. The ongoing development of IT into this area means that Health staff are able to order equipment on-line via the web based catalogue, whilst ACS staff use the latest digital pen technology.
Budget
The pooled budget (please see Table 1at the end of this paper for details of contributions) has joint contributions from the Primary Care Trust’s, Adult Care Services and Children Schools and Families and the overall budget for 2008/09 totals close to £4 million with 51% apportioned to equipment purchases and 49% to running the service.
Performance
During financial year 2007/08, HES delivered over 56,000 and collected and reissued over 25,500 pieces of equipment which included nearly 1,100 bed deliveries and 750 collections.
The current national Key Performance Indicator (KPI) target for equipment delivery is:
Health – 90% of prescribed equipment be delivered within 7 working days (priority is given to hospital discharges and every effort is made to ensure urgent cases receive a ‘next day service’).
- Actual KPI for 2007/08 was 91%
Social – 85% of equipment be delivered within 7 working days
- Actual KPI for 2007/08 was 87%
The HES Board have recently written to HBS identifying service enhancements to be made by HES during 2008 to assist in delivering the new DoH integrated strategies which will ensure that care is provided closer to an individual’s home. In addition to this the new strategies and enhanced service will also assist in returning patients to their home more speedily following hospital care and assisting with prevention of admission to hospitals. The changes requested by the HES Board are that: -
- Effective from July 2008 equipment required to enable a person to be discharged from hospital, or prevent admission to hospital, should have the (KPI) target reduced from 7 days to 3 days and patients receiving palliative care should receive a ‘next day’ service (This is now operational and being closely monitored).
- Effective from October 2008 HES should increase from a 5 day per week delivery service to a 6 day per week delivery service (this is currently under design).
Proposed New DoH National Equipment Delivery Model
The DoH iscurrently rolling out a newnational equipment delivery model whereby ‘simple’ equipment with a value under £100 (high volume/low cost) will be provided through national local retail outlets. Clients will be assessed in the normal way but then given a prescription which can be redeemed at a local accredited outlet for equipment. Clients will also have the option to ‘top up’ their prescription to enable them to have what they really want rather than what the state can afford.
The DoH is also currently developing a national Home Equipment Loan Delivery Service for ‘complex’equipment, such as beds, hoists, mattresses etc. and it is proposed that this could be provided through a regional distribution network which will fully utilise the investment in specialist logistics IT order management, warehouse and fleet management systems and therefore increase efficiency and enable a wide range of performance metrics to be introduced.
Proposed Benefits of New Model as Identified by the DoH
■An open retail market will drive more product innovation and greater choice
–The top-up option will allow users to get what they really want, not just what the state can afford
■Better information will sign-post users and carers to the right point for assessment and equipment purchase. i.e.
–State assessment
–Self assessment (self-funders)
–Assessment by an independent needs assessor (self-funding)
■There is an efficiency saving on the cost of the existing service which has been validated by ADASS Resources Committee
–New marketplace with retailers and prescription handling fee
–National supply chain arrangements for home delivery of ‘big kit’
–Cessation of existing arrangements
■It is one of the 14 objectives of the Concordat (Putting People First) – Commitment from Ministers and supports Government Policy (Choice, Independence, Enablement and Prevention)
■It provides a quality improvement for users – all users, both state funded and self funders
■The DoH hasindicated that within the ‘Hertfordshire Financial Model’ savings of £1.2m are achievable within the HES Service Level Agreement (SLA) budget if both elements of the new model were to be adopted (simple and complex equipment). If only the simple equipment model were to be adopted (provided through retail outlets), and the HES operation downsized to provide the complex equipment only, then the DoH indicate that savings of £593k could be achieved within the SLA budget. See Appendix 1.
Feasibility Study
This model is fully supported by ministers and it is therefore essential that a feasibility study is conducted to examine the above proposed benefits identified by the DoH in addition to any impact the new model may have on patients, intermediate care, delayed discharges, Key Performance Indicators and other aspects of the service such as children’s equipment and special equipment which is not currently identified within the new model.
The DoH have developed a project plan to assist in guiding interested Local Authorities through a feasibility study for adopting and implementing the new model. It is proposed that Hertfordshire will assign a full time project manager to work alongside the DoH in undertaking this feasibility study which will,in addition to the above, explore the following key areas: -
Key Area / Detail / Time ScaleSimple equipment (under £100) to be made available on prescription from accredited local retail outlets. / This will involve the project manager working with the DoH support in delivering a 3 month feasibility study to include signup by all sponsors, identifying and developing retailers in the market place, establishing contingency plans and measurement tools, and finally going live if results prove positive / 3 month project
Implications for HBS / HES for complex equipment (over £100) / If new retail model were to be adopted this would result in a downsizing, if HES were to continue to provide complex equipment or possible closure if complex equipment were to be outsourced. However, HBS / HES may choose to complete for the position of regional distributor for complex equipment thereby remodelling it’s existing resources to service a much wider geographical area e.g. North London, Essex, Cambridge, Bedfordshire etc. In addition to this they may also consider developing a shop front within the warehouse facility and become an accredited retail provider for the simple equipment. / Regional model to consider its position from April 09 onwards.
Hertfordshire Action on Disability (HAD) / HAD is currently a voluntary organisation, core funded by HCC, which provides community equipment. This would be a suitable opportunity for HAD to consider its expansion within the market place and become a Social Enterprise. / Ongoing development alongside local retailers
Key Decisions and Timescales
Decision is required by CLG and PCT Boards for HES contributing Partners to proceed with feasibility study to enable an outline business case to be produced if appropriate.
Table 1HES Budget 2008/09
Total SLA Budget / £1,934,190
Total Equipment Budget / £2,043,464
Total Pooled Budget / £3,977,654
Contributions to pooled budget
Total Contribution / %
PCT / £1,334,557 / 34%
ACS Area / £2,250,981 / 57%
ACS Sensory / £85,963 / 2%
CSF Area / £213,063 / 5%
CSF Special Educational Needs / £93,091 / 2%
TOTAL SLA & Equipment Budget / £3,977,654 / 100%
Joint Report prepared by Barry Fearon, Commissioning Manager, Strategic Commissioning September 2008
Appendix 1
1 / 2 / 3 / 4 / 5Simple Aids to Daily Living (SADLS) / Complex Aids to Daily Living (CADLS) / Total / Estimated
Retail Model - benefits compared to curent service
45 / Level 1 benefits - cashable
46 / Reduction in Logistics spend / £592,987 / £615,030 / £1,208,017 / £1,208,017
47 / Total level 1 benefits / £592,987 / £615,030 / £1,208,017 / £1,208,017
48 / One-off cash release from running down stock based on recovering 50 % of stock value / £51,952 / £187,832 / £239,785 / £239,785
49 / Product Saving to be Re-Invested to Support Demographic Growth (after allowing for the additional cost to purchase ADLs previously refurbished) / -£117,243 / £415,453 / £298,211 / £298,211
(a) Items 43 and 54 - Stock on hand figure in stores at 31/03/07. Asssumed 50% of the value of this stock can be realised when sold.
50 / Year 1 - National Cost Benefits
51 / Total benefits including one-off cash release / £527,696 / £1,218,316 / £1,746,012 / £1,746,012
52 / less Transition Costs / -£236,999 / -£224,051 / -£461,050 / -£940,619
53 / Total Year 1 - level 1 cashable benefits / £290,697 / £994,265 / £1,284,962 / £805,393
54 / Year 2 onwards - Recurring benefits
55 / Total annual level 1 cashable benefits / £592,987 / £615,030 / £1,208,017 / £1,208,017
Product Saving to be Re-Invested to Support Demographic Growth (after allowing for the additional cost to purchase ADLs previously refurbished)
56 / £415,453 / £298,211 / £298,211
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