Care Market Strategy ‘Whole System Event’

21 August 2017

Workshop Output

1Vision and Principles: Final Comments

1.1Vision:

  • Too complex- doesn’t capture ‘helping people get on with their lives’;
  • Doesn’t read well for Adults;
  • Nothing about prevention;
  • Asset not clear;
  • Asset – remove unclear – has different meanings for different people
  • Risks of mixed view on ‘assets’;
  • Remove ‘assets’ from the vision;
  • Needs to be explicit and mention carers;
  • Is there enough on carers – could make more explicit
  • Would be better to have a vision more from the Service User perspective. One vision?;
  • If we need a vision for service users and a vision for the system, then we are probably doing it wrong;
  • Why separate visions? One;
  • Make plain English – one version for market and users
  • Should not have two versions- vision is a vision (use word ‘people’)
  • If we have two visions, the SU one should have less ‘wordy words’;
  • ‘Meet their outcomes’- not sure what it means to the man/ woman on the streets;
  • What does the vision mean when it says: ‘meet the outcomes’? ‘Live a good life’, ‘Be happy’, Or something else entirely?
  • Use language that makes sense to all- plain English;
  • SU development;
  • ‘Facilitate’ infrastructure – what does it mean and who takes responsibility? Use ‘Enable’/ ‘Support’; Encourage’ instead. It must include investment (especially in rural areas and making most of assets), workforce (how do we ensure coverage in rural areas); transport;
  • Cannot see ‘sustainability’ which is part of the Care Act;
  • Need to share the vision with the public, so they know what to expect;

1.2Principles

  • Use language that makes sense to all- plain English;
  • Too wordy- lengthy;
  • Do they need to be that wordy? – open to interpretation;

1.2.1Safe

  • Clearer definition of what you mean by ‘safe’;
  • What does safe mean? Common definition and understanding;
  • Safe when they go out? What happens if they leave their home? What happens if they don’t have family?;
  • Too ‘wordy’ , too generic; Elaborate process, record keeping, communication, criteria;
  • ‘Ability’ rather than ‘strength’;
  • ‘Safe’ to include monitoring delivery; Need to ensure citizens know their role in quality monitoring;
  • Safe- concise
  • Safeguarding – woolly, could be more explicit about what we want to do

1.2.2Outcomes focused

  • ECC ISPs are time/task, so how focus on outcomes?;
  • Practically need to be supported by e.g. contingency hours instead of SVO (too bureaucratic);
  • What does ‘social value’ mean?
  • Talks about social value- what about health value?
  • ‘Want to achieve’ → ‘need to achieve’

1.2.3Innovate

  • ‘Savvy’ → be ‘aware’ of risks;
  • ‘Savvy’ – wording?

1.2.4Collaborate

  • IP provision is no longer the driver - how will you find the money to evaluate the outcomes of individuals?;
  • Starts with ‘no longer’ – negative text. Should be ‘ we will’;
  • Could get rid of the whole first line;
  • ‘In partnership’- interpretation in practice- how will this develop? Could be also covered in outcomes section;

1.2.5 Engage

  • Coproducing= partnership;
  • Citizens appear passive or at least somewhat secondary. To ‘be committed to listening to’ still puts the system in the lead and the citizen as a supplicant. Co-production works best when it happens on a level playing field;
  • Remove ‘deeply’ from ‘deeply committed’;

2Responding Locally

2.1What a localised approach might look like and what would need to happen to start to make it happen?

2.2Group F

  • Why?
  • Would drive community spirit
  • Encourage working between non care organisations- more holistic approach
  • Dis-benefits
  • SUs might not want local arrangements
  • Could restrict local provider choice
  • Barriers
  • Transport- rural
  • Engagement with GPs – such large catchment area- lack of time
  • How do we inspire GPs to work differently – not paid to do it/ culture is an issue
  • To change culture- money needs to go to communities
  • How do you create conditions for it to work?
  • Community assets being used: pubs/ centres/ garden centres/ schools
  • Current way of commissioning is about one user/ not joined up locally
  • Social media could be enabler in formal networks
  • Need to learn from other cultures
  • Affordability is a barrier
  • Who facilitates and what do they need to do?
  • Local action groups – key for infrastructure support/ enabler (role of CVSs/ fire/ police/ library)
  • Peer to peer – data protection could be a barrier
  • System is risk averse
  • Need opportunities to connect locally

2.3Group A

  • What does working locally mean?
  • Can commission the building block to enable
  • Can commission things that foster resilience-
  • E.g. local means you have credibility- understand local needs and connections
  • Local means different things in different contexts
  • People will have needs- need to connect to providers locally
  • Examples of enabling locally:
  • DC- providers come from towns within districts usually, mapping of local services- what is already there- lots are hidden, i.e. church is working to support homeless
  • There is a view that there is untapped resource
  • Map exists- ability of people to read it is the issue (key to accessibility- local connectors can help, i.e. connect well champions)
  • Local providers know their area
  • Often people are pointed towards tax payer funded services- need to ensure it is to all resources locally
  • Care provider perspective
  • Don’t expect them to find a solution- should expect them to be receptive to VCSs connecting with them (don’t have time/ capacity). Example- work with CCG to connect people, opportunities with friends and neighbours networks
  • Need to be away of having ongoing two-way dialogue- locality meeting for care providers was the stimulus
  • Too many meetings- not enough time for the right collaboration opportunities
  • Communication – key to improve is to be better organised locally, ECC/CCG often need to have a facilitative role
  • Quality- can often put in place barriers locally, unreasonable expectations on small providers can be a barrier
  • Knowledge locally about quality remains important
  • LD provider perspective
  • Look to recruit locally- people who can read the maps and those who use services can actually give views back
  • To build connections locally- need to ask providers, i.e. homecare how they will connect locally
  • Building relationships key- providers and partners, social care workers
  • Local hubs need to understand local areas- could be town or smaller; need to embrace and share learning from elsewhere
  • Facilitation key but sometimes needs resources and does need VCS coordination

3Developing Service User Involvement

3.1Group B

  • Applies to all adults with disabilities – it is about capturing the widest range of insight;
  • Join up of FOIs, complaints, etc.;
  • Look more holistically at data and what it is telling us;
  • CQC requirements – capture view of service users – reports produced and available for anyone to read them. No forums to share with ECC at the moment – received but not used;
  • Service user engagement – make changes based on this but not always feedback to service users. Would be useful for ECC. Capture info on how services and outcomes are improved for people;
  • Data is captured but not used – need to improve how ECC use it;
  • Safeguarding referrals – no feedback, also limited record keeping if referrals don’t meet threshold;
  • Link up of insight and communicating back;
  • Awareness of processes – particularly safeguarding – could ECC offer training? Promote ESB training;
  • Barrier to sharing change is the fear that it will result in request for a direct saving;
  • Build participation into service specs – also not captured because we haven’t asked for it;
  • Accommodation and planning board - Embed service users in assessment process / quality assurance – ECC trialling now. Providers could also involve service users;
  • Existing insights - Make better use of lessons learnt and reviews (home closures);
  • Make better use of existing data capture by providers – understand what providers already capture- don’t ask for additional info when they may already be producing better information for others;

3.2Group E

  • Partnership approach – who else should be on local collaboration groups?;
  • Feedback – how does info from local action groups feed up insight? Currently looking at how we do this;
  • Getting multiple issues discussed is completely different to LD – total redesign to existing format;
  • Think broadly about sharing experience – photos and tagging;
  • Providers – complaints and compliments, service user boards – capture info – how can we use this;
  • Lived experience – ECC needs to use the info it already has – We need to collate and understand what we already have and feedback to those who provide it;
  • Ongoing process – we need to keep the conversation going – don’t only ask the question once;
  • Give service users more of an active role on boards – more active role throughout the process;
  • Currently different metrics for each service;
  • CQC information is more detailed and more nuanced. “You said, we did” ECC don’t ask for enough / right stuff;
  • Big Data – don’t have to generate it each time, make the connection, access as needed;
  • Cost / quality balance in contracts affects info provided;
  • Sharing info – there is a need to share data across the system that gives up to date insight on person’s needs;
  • Local action group – chairs’ values are more important than where they are from – there is a need to be clear what we want from the groups and shape the role profile accordingly - pay people to attend – more focussed on specific work – output of groups need to be acted upon. Bespoke projects;
  • Power relationship – creates a challenge if ECC is asking questions of providers – may need to be an independent reviewer;
  • Structured interviews on particular issues are useful and feel worthwhile for providers;
  • It’s about having the right people – process less important;

3.3Key themes from both tables

  • Need to make the best use of existing information – we ask for information from providers that doesn’t help us and that we don’t use. The information they provide for others, such as the CQC may be more useful;
  • Need to close the feedback loop and make sure we let people know how we are using information;
  • Lived experience needs to be a key component throughout commissioning and delivery – important for providers and ECC.

4Advancing Innovation to Improve Care (Group C and D)

4.1How can we better share and utilise examples of good practice and innovations across the system?

  • Partnership working/collaboration to share solutions with others
  • Care provider forums in each locality;
  • Annual events to celebrate success (e.g. Active Essex);
  • Remove commercial tension;
  • Technology culture change- everybody needs to align;

4.2What are the areas for more innovation and why are these not being pursued?

  • Limited knowledge about what is needed and available; Need to know the gaps in each locality, e.g. directory per locality;
  • It is not always in provider’s advantage to share innovation- competing;
  • Technology vs cost – providers have to run things in parallel which is expensive;
  • EHM- resistance of care workers;
  • Enable Service Users to communicate in a better way- flexibility;
  • Progress trusted assessor;
  • Regulation= constraints
  • Innovation constrained by access to finance and financial risk as well as access to training;
  • Time constraints for providers to get together
  • Right skills needed for all workforce;
  • Practice innovation- multidisciplinary approach to risk taking;

4.3What system wide actions would the group recommend should be taken next in this area?

  • Technology- better communication, joint training, care provider forums in each locality;
  • Sharing information/ one system for data management;
  • Regulators must be involved in system wide discussions;
  • Communicate the rollout of broadband access across Essex;
  • Use support directory and care provider hub to introduce technology & share ideas, use webinars;
  • ECC to lead system wide collaboration on innovation and create innovative environment in which trial and error as well as risk are recognised and accepted and duplication in the system is identified; Creating innovative environment should include investment of money and resources;
  • Improve transport system in rural areas;
  • Look at innovative ways to collaborate on sharing care staff and what the mechanism could be/who will own it;
  • Develop trust and commitment to working together- continuity and monitoring;
  • Commissioners need to innovate to ensure sustainability and capacity;
  • Use providers from the start of the commissioning cycle to use their expertise- ECC are not delivering services, so how can it design them?

5Managing Quality in a World of Increased Personalisation

What actions might be taken to develop a quality management approach that will meet the needs of: Adults and Carers, Care Providers, Commissioners; and Safeguarding Teams?

5.1Group C

Adults and Carers / Care Providers
  • Support directory (like check at trade)
  • Kite quality mark
  • *What are service users looking for?
  • How is experience captured?
  • carehome.co.uk
  • Recommendations
  • Self-auditing
  • SU surveys
  • Mechanism for SUs who do not/ cannot use technology
  • Quality means different things for different people- link to personalisation
  • Don’t mix up basic standards with quality
  • Role of brokerage
/
  • Measure of control
  • Could be different by client group
  • Taster days
  • Point to Facebook, Twitter, Instagram to see the actual experiences
  • *Can providers work together to offer more holistic services?
  • Role of council and health
  • *Improvement projects
  • PROSPER- accreditation (capacity restrictions)

Commissioners / Safeguarding
  • *With direct payments- where does accountability for service quality end?
  • *POET survey of SUs gives limited information
  • Working with providers to get SU feedback
  • Relative to type of service
  • The time for homecare slots makes it difficult because in 30 mins - itstask oriented
  • *24hr care planning to capture total needs across partners
  • Commission joined up care plans
  • Joined up working between suppliers
/
  • *Need to improve feedback to providers
  • *LA and health safeguarding could work better together

5.2Group D

Adults and Carers / Care Providers
  • Support directory
  • *Technology not suitable for everyone
  • Resident survey (POET)
  • Results captured on Essex website
  • *SU understanding and expectations
  • *Role of the family important
  • Other portals CM2000 allow punctuality data, etc. to be published
/
  • Double handed care- footprint in home, dignity
  • Recruitment with different skills
  • Assistive technology
  • Media- focus on reporting good stuff
  • *Examples of patient journey important
  • Do providers know what the positive outcome looks like?
  • Make it easy for suppliers to meet accreditation

Commissioners / Safeguarding
  • *Complexity of need overtime to look at how services are developed
  • Challenge to join up care providers/needs
  • Need to go back and look at care needs- focus on what’s there/ how rather than what it could be
  • Firefighting put in package and need time and resource to right size this
  • If commissioners have less of a role then need to define the roles and relinquish some control
  • *Commissioning need to engage with social workers to understand frontline
/
  • Internal comms- safeguarding/ procurement/ SPT – quality
  • Comms with providers on root cause- good examples
  • Individuals/ voluntary groups- how monitored?
  • Direct payments not being spent, leading to neglect

6Personalisation for Integrated Care and Support

6.1Group B

  • Effective IAG- people trust
  • Good practice- clear assessments, reflecting ‘I-statements’
  • Infrastructure to deliver right person, right place, right time- ASSESMENT
  • Pooled budgets
  • Effective brokerage
  • Clear pathways - not there!
  • Effective upstream assessments to prevent escalation

6.2Group E

  • Pooled budgets
  • Talk to each other across system
  • Buy outcomes not hours
  • Trust
  • Market - rates equalised between PBs and DPs= sustainable
  • Trusted assessor model with right safeguards / complexity model
  • Workforce development
  • Proportionality

7Personalisation for OP

7.1Group F

  • Capturing knowledge / the use of the knowledge from the workers on the ground
  • Providers part way there with self-funding SUs
  • Providers would like the ability to bank hours
  • More flexible support plans
  • Provider to speak to SU and then tell the LA what is required by SU, basically turn it on its head, provider assessing and putting the plan in place, settling for a week, then social worker comes to review if it is working and plan is accurate/ suitable
  • Assessment is done when the SU is at home and settled and used to having care
  • Different types of providers not working together e.g. domiciliary care and residential care providers
  • Increased knowledge and information available to SUs, either directly, through GPs or the care provider
  • Involve local retailers in community interactions
  • More trust- added value for service users, true providers, etc.
  • Include SU family needs because they might be struggling too
  • How do we engage community interaction between SU and the community
  • Educate SU on the possibility of change in care/ not continuity of the same service or carer, e.g. carer absence
  • Identify care provider skills to relate to the SU
  • Voluntary service to help SUs make social connections
  • Try to change the view of day centres
  • Expanding what is happening in your local area newspapers to add information for the local SUs
  • Social assessment to capture things SU might want other than actually going out, e.g. phone, Facebook, buddy, etc.
  • Promote local activities in the community to drive community update of activities
  • Encourage SU to join social media, Facebook, etc. with neighbours

7.2Group A

  • Persons and people not service user- makes partners recipients and not partners in their care- agreement across the table it is emblematic and symptomatic of a system that doesn’t recognise people
  • If they want it, we make it happen
  • Having a conversation that touches specific points even if it isn’t in the same order – having a conversation and not assessment every time to make every contact count
  • Person is forgotten in clock watching
  • Infrastructure in place to help the volunteers fill the gaps, i.e. identify the solutions but there have to be solutions to sign post to
  • Changing culture for professionals, so Social Workers, carers in treating person as a person not juts SUs
  • Change of behaviours and practice on how we deliver service, i.e. a change of approach
  • The ‘I- Statements’- to include advocacy and not just decision making
  • Better map readers to improve the disconnect between services and people
  • Maturity to recognise the best person to deliver the service not just what we offer, can someone else do it better?
  • Early entry into residential care is an issue- personalisation shall reduce this
  • Social interaction includes transport-who will pay for it? What happen if you cannot bring people in and out of the community?
  • Change the community, i.e.