INFORMATION ONLY REPORT 2
BOROUGH OF POOLE
COMMUNITY SUPPORT & EDUCATION SCRUTINY COMMITTEE
16TH NOVEMBER 2004
REPORT OF THE HEAD ADULT OF SOCIAL SERVICES (COMMISSIONING)
PROGRESS ON THE INTEGRATED COMMUNITY EQUIPMENT SERVICE (ICES)
1.SUMMARY
1.1This government initiative is a major development with Health and Social Services in the recognition of the contribution that equipment and minor adaptations services make to the lives of disabled adults and older frail people.
1.2Community Equipment is equipment for home nursing, usually provided by the NHS, such as pressure relief mattresses and commodes, and equipment for daily living such as shower chairs and raised toilet seats, usually provided by local authorities. It also includes, but is not limited to:
- minor adaptations such as grab rails, lever taps;
- equipment for people with sensory impairment such as hearing loops and flashing door bells;
1.3This service plays a vital role in enabling disabled people of all ages to maintain their health and independence, and to prevent inappropriate hospital admissions. Modernisation of community equipment service therefore supports policy initiatives such as : promoting independence for disabled people; intermediate home care services; the reduction of falls by older people; and support for carers.
1.4This report provides an update on the progress on the implementation of this new integrated service.
2.RECOMMENDATIONS
2.1It is recommended that the Committee note the contents of the Report.
3.BACKGROUND
3.1The Department of Health Circular, HS2001/008 LAC(2001)13"Community Equipment Services", requires health services and social services to develop an integrated community equipment service.
3.2The Department of Health Circular was issued on 27 March 2001 and a "Guide to Integrating Community Equipment Services" a short while later. This Guide set out a challenging and detailed action plan for health and social services.
3.3The Circular informed Health and Local Authorities of the actions required of them in respect of community equipment services. It also provides definitions of what constitutes community equipment and defines what criteria an integrated service must meet.
3.4Additional funding for improving community equipment services has been included in the intermediate care allocations for the NHS. Nationally this was £11.7 m in 2001/2002, £28 m and £64 m in 2002/2003 and 2003/2004 respectively. The NHS funding is subject to conditions:
- Joint plans showing what health and local authorities are contributing.
- The pooling of funding using Health Act flexibilities (1999) by March 2004 at the latest.
3.5The Government ring fenced local authority funding for community equipment within the Access and Systems Capacity grant. Adult Social Services Commissioning’s allocation for 2004/2005 is £102k. The total budget for community equipment and adaptations for Adult Social Services in 2004/2005 is £411,000.
3.6The purpose of the Government’s initiative for integrated services is to ensure that the service user/patient is at the centre of service provision, that it runs efficiently within clear standards, provides best value and is co-ordinated seamlessly across agencies.
3.7An integrated community equipment service (ICES) has been established covering the old Dorset Health Authority boundary, which includes the following partners :
- Poole Social Services;
- Dorset Social Services;
- Bournemouth Social Services;
- South West Dorset Primary Care Trust;
- North Dorset Primary Care Trust;
- South East Dorset Primary Care Trust;
- Bournemouth Primary Care Trust;
- Poole Primary Care Trust;
- Bournemouth & Christchurch Hospital Trust;
- Poole Hospital Trust.
3.8The ICES contract is managed on behalf of the partners by Dorset County Council Social Services department.
4.PROGRESS
4.1The partnership agreement has been signed by all the partner chief officers.
4.2A pooled budget has been agreed and set up in line with the Health Act flexibilities and outlined in the partnership agreement.
4.3The ICES Steering Group which developed the service specification has developed to become the ICES Partnership Board which oversees the management of the service and the pooled budget at a strategic level. Its role is to:
- Support the implementation of the new service.
- Oversee the delivery of the service and the management of the pooled fund using management information reports provided by the project manager.
- Provide strategic guidance and direction for the service and any associated developments.
- Receive feedback from the ICES Equipment Review Group and the Finance Group to ensure that any issues regarding service are appropriately actioned.
4.4The benefits that accrue from the new service include:
- A more responsive and supportive service which will reduce the numbers of delayed discharges from hospital and improve the efficiency of health and social services practitioners releasing their time for other duties, eg undertake more assessments;
- A more accessible service through the phased introduction of electronic ordering, including the facility to view equipment on-line;
- Improved purchasing power for community equipment achieved through economies of scale;
- Improved availability of equipment;
- Improved equipment recycling;
- Improved maintenance resulting in longer working life of equipment, with a reduction in the number of items written off and new purchase;
- Improved cleaning equipment and protection against cross infections;
- Improved provision in robust and timely management information to support budget performance management.
4.5The service specification formed the basis of a formal tender process which took place between June and September 2003. The tenders were based on the assumption that current budgeted expenditure is committed by all the funding partners and the contract based on an indicative volume based on current levels of expenditure.
4.6Outcome of the tender evaluation is that one provider, Huntleigh National Care, of Oxford, was identified as the preferred provider. Huntleigh operated home equipment services in Bedfordshire, Oxfordshire, Bristol City and six London boroughs.
4.7The equipment store premises are located at St Leonard’s Hospital site.
4.8The new service “went live” as required by the Government on 1 April 2004.
4.9Dorset Social Services successfully recruited a project manager to monitor the new service.
5.BEDDING IN
5.1While the Partnership Board and the service provider agreed a number of contingency arrangements prior to “going live” to anticipate potential challenges to the services, which included an increase of stock to cope with demand, a number of challenges have caused delivery problems and have required early intervention by the Project Manager and the Board as services started.
5.2The greatest concern is in the correct equipment being delivered promptly.
5.3An increased number of prescribers and the lack of robust management on stock requirements and deliveries have added to the difficulties in the service running effectively.
5.4To reduce potential hospital discharge problems Poole Social Services expanded the use of its own peripheral store in delivery of equipment as a reaction to our lack of confidence in the new service.
5.5Collection of equipment is another important part of the service as a 65% recycling rate has been agreed in the contract as part of providing a cost effective service. This has been severely affected as the priority was placed on deliveries while leaving collections waiting. This is now being addressed by the provider.
5.6Trying to communicate across primary care trusts, acute trusts, and social services departments has proved to be problematic. Over a thousand prescribers are using the ordering systems and these staff are provided with personal identification numbers (PIN) in order to order equipment. The preferred, most efficient and cost effective form of communication is through electronic systems, however, electronic ordering system in the first five months was difficult to operate. Communication with the store via telephone and fax continues to be difficult.
5.7Information bulletins have been sent out to staff across the partnership to inform them of progress, explain the pressures, difficulties and causes, and also to remind staff how to use the service most effectively.
5.8Performance management information that has been kept by practice supervisors in the Unit and has identified a marked decrease in performance for the key national performance indicator which is the delivery of equipment within seven working days. In 2003/2004 the Unit’s performance was 72% delivered within this time. The first five months of this financial year the average performance has decreased to 30% which is equivalent to the lowest performance band nationally.
5.9While the picture painted may appear to be one of unreliability and poor quality the committee can be reassured that commissioners in the Partnership Board and the willingness of Huntleigh as a provider to work together on an improvement action plan is resulting in the service gradually improving in it’s performance. In September 52% of equipment was delivered within 7 working days.
6.FINANCIAL IMPLICATIONS
6.1The financial model is designed to work on the “prescriber pays” principle, after the first year, through a pooled budget arrangement, and it is therefore important that appropriate management control arrangements are in place within commissioner organisations to react to the monthly management information produced by the service provider to help manage spend within the pooled fund. To assist the commissioners, “notional” budget allocations have been identified for partners to work within and to track expenditure. Poole Social Services notional budget allocation is £223,280.
6.2Current budgetary position of pooled ICES budget is a projected overspend of £685k. Contingency sums are held within ASSC budgets, from Government grant, sufficient to meet Poole's contribution to an ICES overspend.
6.3It is worth noting that the overspend is related largely to the purchase of equipment, with Health partners spending far more than anticipated. By the end of this financial year, based on current activity, the number of people receiving equipment could have increased by 40% compared to last year's activity.
6.4Through active management there has been a reduction in the monthly equipment expenditure. Furthermore it is expected that more effective collection of equipment will result in lower net expenditure on equipment in the future.
6.5Work is being carried on to reduce agencies overspending on equipment and partner agencies will have to decide how spend is funded in 2005/2006.
JOHN DERMODY
HEAD OF ADULT SOCIAL SERVICES (COMMISSIONING)
16TH NOVEMBER 2004
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