APPENDIX 1

Borough of Poole

Business Transformation

Third Draft Programme Definition

Personalisation and Efficiency – Adult Social Care

Version 3.1

August 8 2008

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Contents
/ This Programme Definition contains the following topics:
Topic
Background
Programme Vision
Programme Blueprint
Business Case
Benefits Profile
Organisation Structure
Project Portfolio
Stakeholder Map
Risks & Issues

Background

In December 2007, Government published a concordat entitled “Putting People First”. Signatories included relevant Secretaries of State but also the LGA, the Chief Executive of the NHS, regulators, professional bodies and organisations representing independent sector care providers. The concordat sets out a vision of a fully-integrated Health and Social Care system achieved not by structural reform but by organisations coming together to re-design local systems around the needs of citizens. In particular, the paper (and the more detailed circular ‘Transforming Social Care’ published in January 2008) envisages a personalised Adult Social Care system of which the key elements are:

  • Local Authority leadership accompanied by authentic partnership working with the NHS, other agencies and providers to create a high-quality care system which is responsive to the individual needs of those who use services and their carers.
  • The care system will be based on shared outcomes – agreements between social care agencies and their customers about what it is that people want to achieve. These will ensure that people are supported to live independently, exercise maximum control over their own lives and participate as active and equal citizens. They will have the best possible quality of life and retain dignity and respect.
  • System-wide transformation, covering the following objectives:

-A Joint Strategic Needs Assessment with PCT and NHS providers, accompanied by an integrated approach to achieve specific outcomes on particular issues, including fall reduction; hospital discharge; intermediate care; management of long-term conditions; Community Equipment Services; and universal information, advice and advocacy.

-Commissioning which incentivises and stimulates quality provision.

-A locally-agreed approach which informs the Sustainable Community Strategy

-A common assessment process with great emphasis on self-assessment and with Social Workers spending less time on assessment and more on support, brokerage and advocacy.

-A Person-Centred approach leading self-directed support as a mainstream service delivery framework.

-Personal budgets for everyone eligible for publicly-funded Adult Social Care support.

-Direct Payments utilised by increasing numbers of people.

-A transformed Community Equipment Service.

-Support for at least one local user-led organisation.

-Local Workforce Development Strategies.

Timescales

The concordat makes it clear that such transformation of Adult Social Care, because it is so radical, will require time. It expects by the end of the CSR period in March 2011 significant progress in all Local Authorities. Incremental progress should be evident over a shorter period of time and the new National Indicator set contains measures designed to monitor progress. Poole’s targets include:

Indicator / 2007/8 Baseline / 2008/9 Target / 2009/10 Target / 2010/11 Target
LAA Stretch Target 4: Direct Payments / 145 / 250 / 350 / -
NI 14: reduction of avoidable contact / - / In Development / - / -
NI 124: People with a long-term condition supported to be independent and in control of their condition. / - / PCT target - tbc / - / -
NI 127: Self-reported experience of social care users. / - / Deferred to 2009 by HMG / - / -
NI 128: User reported measure of respect and dignity in their treatment. / - / Deferred to 2009 by HMG / - / -
NI 130: Social Care users receiving self-directed support / 145 / 250 / 450 / 650
NI 134: Numbers of bed days per head of weighted population / 0.38 / 0.36 / 0.35 / 0.34
Programme Vision
The end
goal of the programme
/ By March 2011 Adult Social Care Services in Poole will be characterised by the following:
  • It will be a customer-focused organisation which ensures that people with whom it comes into contact are provided with the services they require and prefer, without delay and based on the fullest possible information being available to those people.
  • In particular, as many queries and service requests as possible will be dealt with at the first point of contact and - wherever possible - by self-assessment or guided self-assessment.
  • Services will be provided to promote independence and avoid admission to hospital and residential care. They will seek to maximise resources available to people from within their local communities and focus on providing immediate service.
  • They will focus on early intervention and reablement, solving people’s customer requirements rather than resolving them via provision of long-term service.
  • Necessary longer-term support will be provided and case-managed through complex care services which are integrated with NHS provision.
  • Informal and family carers will be given the help they need to continue in the caring role where they wish to do so, and will be entitled to services in their own right.
  • Services will be personalised and person-centred, provided as the result of a Common Assessment Framework and a self assessment tool which automatically calculates the funding available to people (this is known as the Resource Allocation System, or RAS).
  • These will lead to a care and support package (developed by the customer with support from professionals or independent ‘brokers’ where necessary) which has to be signed off by the care manager on behalf of the Council, and in turn to a Personal Budget (which may be delivered as a Direct Payment or as a virtual budget held by the Council or other third party and spent as directed by the customer).
  • Provider services will see themselves as competing for business from budget-holders who are either self-funders or the holders of Personal Budgets. In practice all will become customers whose needs have to be met flexibly and promptly.
  • Customers, whether Personal Budget holders or self-funders, will be assisted to develop their own care and support packages by staff. These may be social workers in the integrated ‘complex-care’ services, enabled to obtain Best Value and quality by means of a Brokerage Service, or they may be completely independent staff working in either the private or not-for-profit sectors.
  • All contacts will be underpinned by a fully customer-focused service involving the corporate Customer Services Centre, internet access, direct face-to-face access and co-ordination with a range of Council services (including housing) and delivered in partnership with DWP and PCT colleagues.
  • All services will be outcome-focused: what do people want to achieve and how will they do so?
The Programme will influence and contribute to other priorities:
  • Supporting Children and Young People by ensuring that transitions from Childrens’ to Adults’ services are achieved smoothly and in ways that promote choice and control for young people and their families.
  • Dynamic Economy by enabling people to play their full part in the local economy either as employers and or as employees, returning to work.
  • Strengthening Our Communities by participating fully as citizens in community life without barriers.
  • Improving Efficiency and Effectiveness by achieving efficiency savings throughout, but particularly in conjunction with Customers First Stage 2.
  • Health and Wellbeing by promoting the independence of Older People in particular through enabling full choice and control, including full engagement with the strategy work on housing for Older People, and by increasing customer satisfaction in all adult customers through personalisation.
The risks to the Programme include:
  • The impact of change on the workforce of both Assessment and Provider services, and the consequent need to plan staff engagement, training and HR actions
  • The challenge of providing a skilled and motivated provider workforce, 30% of which originates outside the UK
  • The managing of expectation as the difficult balance between financial controls and client choice and control is achieved.

  • Key outputs from the Programme will link to the Local Area Agreement targets and the National Indicator set:
  • LAA Stretch Target 4: Numbers of people receiving Direct Payments
  • NI 14 Reduction of avoidable contact
  • NI 124: People with a long-term condition supported to be independent and in control of their condition.
  • NI 127: Self-reported experience of social care users
  • NI 128: User reported measure of respect and dignity in their treatment.
  • NI 130: Social Care clients receiving Self Directed Support
  • NI 134: Numbers of bed days per head of weighted population

Equalities
It is a fundamental aspect of the Programme that an Equality Impact Assessment will carried out on it as a whole. In addition, not only will users and carers be represented on the Programme Management Board, but also individual project plans will be expected to address equality issues and, where possible, be co-produced with service users and carers.

Programme Blueprint

Capabilities
of the organisation in the future, delivered as a result of the programme
/ The key things that need to be in place to deliver the strategy are:
  • The corporate Customer Service Centre which incorporates a specialised knowledge base which can deliver answers wherever possible to information requests and service requests, without further recourse to Adult Social Care officers.
  • Strong links to alternative information sources in the third sector and links with NHS and Housing information providers.
  • Development of website to incorporate regularly-updated information on a wide range of social care services.
  • A web-based Self-Assessment Tool for relevant services.
  • A guided Self-Assessment process, to be delivered either through the Customer Service Centre or face-to-face.
  • Development of the existing Poole Intermediate Care Service (PICS) to ensure that synergy exists between the Customer Service Centre and PICS. Robust processes must be in place to make sure that there is no possibility of people falling through gaps, either between these two services, or between PICS and any long-term Complex Care services.
  • Development of Brokerage to offer direct specialised advice to Personal Budget holders and their support teams, as well as a direct Brokerage and information/advice service to people funding their own residential and domiciliary care.
  • A workforce which is fully committed and trained to deliver customer-driven, personalised services. These will involve development of new skills in care navigation and supporting people to develop their own definitions of outcomes (or things they want to achieve) and de-emphasise gatekeeping roles.
  • Modernised provider services, both in-house and independent, which are focused on flexibility and adaptability. Management of those services to be located in the most appropriate sector to deliver the required outcomes.
  • A re-defined and re-specified long-term Home Care Service which is commissioned on the basis of outcomes rather than tasks and which is charged for on a “per minute” basis via electronic home care monitoring rather than on a time block basis.
  • New services to be commissioned as a result of customer demand.
The initial plan is that the blueprint will be achieved by means of 11 projects, some of which have several strands (see pp, 12-16 below). All of these will be formally project-managed, each with its own project timetable and mechanisms for accountability and sign-off. Each project will need to consider training and other HR issues, financial control and legal matters as part of the project planning; relevant Service Units will need to be involved in the development of these project plans.

Business Case

Balance of benefits against the costs and risks.
/ Changes in public health and changes in society mean that we are living longer. While communities are becoming more diverse, people have higher expectations of what they need to meet their own particular circumstances, wanting greater control over their lives and the risks they take. They want dignity and respect to be at the heart of any interaction so they can access high-quality services and support closer to home at the right time, enabling them and their supporters to maintain and improve their well-being and dependence, rather than relying on intervention at the point of crisis.
The Office for National Statistics expects the number of people over 85 in England to rise from 1.055m to 2.959m between 2006 and 2036. Equally, the number of people with dementia is expected to double from around 560,000 over the same period. People with learning disabilities over 50 are projected to rise by 53% between 2001 and 2021, while more children with more complex needs are surviving into adulthood. In Poole, the number of people over 85 is expected to rise by 74% between 2004 and 2025.
Research based on the Self-Assessment Surveys indicates that, in recent years, services have been concentrated on those with greatest need, whereas emerging evidence from the Partnership for Older People Projects indicates that earlier interventions will be more cost-effective for the health and social care system whilst providing better outcomes for individuals. The same point has been made by the Office for Disability Issues with respect to minor adaptations. It is clear that on the other hand the number of people able to care for and support family members is reducing as a result of both demographic and attitudinal change. Additionally, there is substantial structural change in responsibilities between the NHS and Local Authorities as commissioning for Learning Disabilities moves to Councils, people with Learning Disabilities move on from Hospital Living to supported settings in the community, and the NHS funds a higher proportion of ongoing care needs under the Continuing Health Care guidance. In addition, the PCT itself is redefining the relationship between its commissioning and provider functions.
All this indicates that the current system of social care delivery will need to fundamentally re-engineer itself and modernise to respond to the various pressures on the system, the increased expectations placed upon it and do so within the context of more efficient use of financial resources. The Government’s approach has been to make the case in two stages: ‘Putting People First’ and ‘Transforming Social Care’ set out the principles on which social care is to be based going forward, while the detailed financial projections and proposals are the subject of consultation ahead of a Green Paper on Future Funding Options for Adult Social Care, to be published in 2009. Once this is to hand, refinement of this Report and of the projects will be necessary.
In the particular Poole context, however, it almost certain to mean that increases in demand can only be met in the period of the Medium Term Financial Plan by radical change to service patterns, generating significant sustained efficiencies in both Adult Social Care units alongside increased customer satisfaction.

Organisation Structure

Roles & responsibilities for directing, managing and delivering the programme.
/ Sponsorship Group - endorsement of and commitment to the programme and sign off on closure.
Programme Management Board to be established, consisting of representation from service users and carers, Elected Members, Senior Management Team, Heads of stakeholder Service Units, and key partners.
Senior Responsible Owner - overall responsibility for directing the work of developing the programme definition, governance arrangements and plans. Provides the interface to the Sponsoring Group and other key stakeholders. Manages and monitors any strategic risks facing the programme.
Jan Thurgood, Strategic Director.
Programme Definition Team - assists the Senior Responsible Owner to define and capture all the information about the programme.
John Dermody, Head of Adult Social Services Commissioning.
Charlie Sheldrick, Head of Adult Social Care and Well-being Unit.
Supported by joint Adult Social Care Service Management Team.
Programme Manager - responsible for establishing and managing governance arrangements. Manages and monitors progress against the Blueprint, Programme Plan and Business Case. Manages risk and issue resolution.
Nick Molland.
Business Change Managers - maintain business as usual during the change, provide input to project checkpoint reviews, manage the transition of project outputs into the business and take responsibility for managing the delivery and realisation of benefits.
Heads of Service and Principal Officers, together with other key Service Units and partners including Bournemouth and Poole Teaching Primary Care Trust.
Corporate Change Programme Function - providing a strategic overview of all programmes and interdependencies, reporting to senior management, providing consultancy support to project teams at initiation and through the lifecycle of the programme, maintaining a common approach across projects and programmes, sharing good practice.
Business Transformation Team.
Project Managers - responsible for defining and delivering project activity within the scope of the programme mandate.
Shelley Bambrey, Project Manager
  • Jo O’Connell, Project Manager
Di McLaughlin, Strategic Commissioning Manager
Peter Coghlan, Programme Manager, ICT.
Externally commissioned time limited project work.

Project Portfolio

List of projects and related activities involved in the programme /

Project ID

/ Project Senior Responsible Owner (Executive) & Project Leader / Project Description & Key Deliverables / Target Delivery Date
PER01
/
SRO: Nick Molland (NM)
PL: Shelley Bambrey (SB) /
Cultural change in Adult Social Care
Consultation workshops
Team Visits June 2008 onwards (repeated as necessary)
Training Days
‘Transformation Update’ Newsletter July 2008 onwards
Develop joint approach to customer-focussed cultural change with Customers First (CF), to include communication strategy / 6/2008
12/2008
As req’d
8/2008
2/2009
PER02
/
SRO: NM
/
UNIVERSAL INFORMATION, ADVICE AND ADVOCACY
/
9/2010
PER02a
/
SRO: NM
PL: SB
PL: SB
PL: Karen Davies /
Scope potential of Customers First Stage 2 to deliver same
Ensure synergy with CF blueprint so that process design, ICT and information architecture, and organisational design enable both Adult Social Care and CF to achieve objectives corporately.
Ensure Implementation Phase of CF meshes with that of Transformation Programme and is co-funded where advantageous (NM/Jason Price).
Ensure all developments in Helpdesk are in line with developing thinking re CF / 11/2008
2/2009
4/2010
PER02b
/
SRO: NM
PL: SB
PL: DM (Di McLaughlin)
PL: SB /
Universality of service
Develop joint service with Third Sector, LinKs, PCT, Healthpoint, Poole Hospital via leading role of LSP
Ensure information available to self-funders via 2a
Update and develop existing information in web-based format in partnership with CF / 4/2010
4/2010
4/2010
PER02c
/ PL: Peter Coghlan (PC) /

Information availability