BOROUGH OF POOLE

COMMUNITY SUPPORT AND EDUCATION SCRUTINY COMMITTEE

TUESDAY 22nd FEBRUARY 2005

REPORT OF THE

HEAD OF ADULT SOCIAL SERVICES (COMMISSIONING)

THE PAN-DORSET INTEGRATED COMMUNITY EQUIPMENT SERVICE
  1. PURPOSE OF REPORT

1.1To update members on the progress of the Recovery/Improvement Plan for the Pan-Dorset Integrated Community Equipment Service (ICES).

  1. ACTION REQUIRED

2.1Members to note that National Care (Nottingham Rehabilitation Supplies) is unable to attend the 22 February meeting. A further invitation has been extended for the Company to attend the 26 April meeting. Attendance confirmation is awaited at the time of writing.

2.2Members to note the report and to devise the questions they consider should be put to National Care (Nottingham Rehabilitation Supplies) at the April meeting.

  1. 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.

3.2An integrated community equipment service (ICES) was established in April 2004 to serve the geographic Dorset (the old Dorset Health Authority area). The following have entered in to partnership to commission the service

Poole Social
Services
Dorset Social
Services
Bournemouth
Social Services / Poole Primary Care Trust
South West Dorset Primary Care Trust
North Dorset Primary Care Trust
South East Dorset Primary Care Trust
Bournemouth Primary Care Trust / Poole Hospital
Trust
Dorset Healthcare
Trust
Bournemouth &
Christchurch Hospital
Trust

3.3The ICES contract (originally awarded to the Oxford based company, Huntleigh National Care, (HNC)) was purchased by National Care (formerly Nottingham Rehabilitation Supplies) in November 2004. The partnership and contract are hosted and managed by Dorset County Council’s Social Care & Health Directorate.

3.4The Head of Adult Social Services Commissioning updated this Committee on 4 January 2005, on the reported poor performance of the previous Contractor (HNC) to November 2004, and the recovery plan being implemented by the new Contractor (National Care/NRS) from December 2004.

  1. CURRENT SITUATION

4.1The Dorset Integrated Community Equipment Partnership Board agreed on 24 January to continue the pan-Dorset ICES contract with National Care (NRS).

4.2Feedback to the Partnership Board meeting on 24 January indicated the service under National Care (NRS) had improved significantly.

4.3The Board agreed to continue with one pan–Dorset memorandum of agreement for 2005/06. The new agreement will detail the planned levels of investment for each locality as agreed by local partners.

4.4Information regarding the new Contractor’s performance in achieving the key service targets for 2004/05 is summarised below,

All stock items to be provided as per the service spec. /
Improvement reported In terms of the items supplied. Stock control is improving. Complaints in January had reduced to 7 as compared to 25 received in December. Further work is being done to guarantee 100% availability of all stock items on demand.
All equipment under £1,000 to be delivered within 7 working days / The new Contractor has improved delivery arrangements. In December, 77% of requests were delivered on time. Further improvements are planned. New customer feedback systems have been introduced.
To meet, in 2004/05, the Government target of increasing by 50%, the number of people supported at home with equipment. / The number of people receiving equipment across the Dorset area, this year, has increased by 40% (compared to last year's activity). The contract estimated 42,000 activities in the year, however at least 70,000 activities are now predicted by the end of March 2005.
Year on year improvements in retrieval and recycling rates. / The reported ‘year to date’ monthly average in November 2004 had improved to 58%. Given the reported service improvement, the retrieval and recycling target of 65% is now achievable. A Dorset-wideEquipment Collection Campaign to encourage the public to return unwanted items is beingplanned by the Board and will be publicised shortly.
Increased efficiencies/ cost-effectiveness in sourcing new items to minimising scrapping. / The actual reported scrapping level April-December 2004 was 6.20% and within the predicted Contract level of 7% for 2004. However, the scrapping rate increased to 9% during the three months to December 2004 as improved recycling began to retrieve inferior quality items purchased and issued by the previous Contractor in the first six months of the contract. The Partnership Board and new contractor are currently working to agree products of sufficient quality and durability to guarantee increased repeated recycling. This should eliminate most of the cost pressures generated by the previous company’s purchasing policy.
To comply with legislation and guidance on cleaning and maintenance. / New cleaning arrangements have been introduced. There is clear evidence that ‘recycled’ equipment is now, in the main, being cleaned to a generally accepted standard prior to re-issue.

4.5Summary data regarding reported delivery performance to Dec 2004.

  1. RECOVERY/SERVICE IMPROVEMENT

5.1The new Contractor (National Care) is continuing to implement their Recovery/Service Improvement Plan to address the following.

Objective / Methodology/Action (& Outcome(s) to date)
To ensure delivery of equipment within agreed timescales / Improved service management arrangements at the point of delivery.
(ASSC staff are reporting a marked improvement in delivering within agreed timescales)
To improve access for referrals / Improved customer services functions to receive and process the volume of initial requests and enquires from prescribing partners.
(ASSC staff report reliable access to much improved polite and helpful customer services)
To improve stock management and recycling of retrieved items.
To improve the rate of retrieval / New stock management arrangements to optimise performance in terms of stock availability and usage to meet demand within agreed timescales.
(Work to improve the system’s ‘recycling capability’, given overall increased service activity will continue.)
To provide clear management information and feedback on service performance, to enable partners to accurately formally report performance against local and national service targets) / New Information & Communication Technology systems to support the above and provide much improved management information on service performance for each partner/locality.
(The Board and National Care are working to agree management information reporting using new ICT.)
Continued Service Improvement / Improved training and staff development support for existing/new ICES employees.
(Training courses now planned to enable ICES staff to ‘go live’ with new ICT systems, and to improve technical expertise in provisioning and fitting items of equipment.)

5.2It is currently anticipated that all key systems will be in place and fully operational by the end of March 2005, subject to completion of ICT hardware and software installation and completion of staff training programme.

  1. FINANCIAL SITUATION

6.1Poole Social Services notional budget allocation is £223,280.

6.2Protracted and determined negotiations with the previous contractor (HNC) have improved the budgetary position of the pooled ICES budget.

6.3The projected Partnership overspend of £899,000 has been reduced by negotiation to £699,000; it is expected that this figure will reduce further as measures to restrict prescribing and improve collections take hold across the partnership. Contingency sums are held within Adult Social Services Commissioning (ASSC) budgets, from Government grant. These are sufficient to meet Poole's 9.91% contribution to the projected ICES overspend.

6.4It is important to note that the remaining overspend is the result of health partners across Dorset spending far more this year than was anticipated in their original contributions to the pooled ICES budget for 2004/05.

6.5Five ‘locality panels’ (North Dorset, West Dorset, East Dorset, Poole, Bournemouth) are now operational to monitor and control local spending.

6.6 In Poole the panel has representation from ASSC, the Primary Care Trust, Poole Hospital Trust and Dorset Health Care Trust. The Panel is currently determining the local ‘pooled funding’ arrangements for 2005/2006.

6.7The Locality Panels will also monitor and report to the pan-Dorset Partnership Board on contract performance during 2005/06. Local prescribing patterns are also being monitored more closely by these Panels, to ensure efficient/equitable deployment of equipment in line with locally agreed policy and eligibility criteria.

6.8The ICES scrapping procedures have been continually monitored via the Project Manager and a study was carried out as part of the external audit in October-November 2004.

6.9The audit found that the scrap policy had been wrongly applied from April to July but after the application of a revised protocol in August, the report concluded scrapping was being applied and maintained correctly. The reason the rate of scrapping increased during the 3 months to December 2004 was the increased retrieval of poor quality items unsuitable for recycling (i.e. items purchased earlier in the year by the previous contractor). Section 4.4 above has further information.

6.10The ICES Project Manager (employed by Dorset County Council for the Partnership Board) has confirmed these findings.

6.11The Project Manager visit’s the ICES store on a weekly basis to observe the scrapping practice and discuss and formally authorise the scrapping of higher cost items.

  1. CONCLUSION

7.1It has been a difficult first year for the Integrated Community Equipment Service.

7.2The service is now progressing and improving. The new Contractor has clearly improved the service to an acceptable level and is busy continuing to implement a range of necessary changes.

7.3The Partnership arrangements have been tested and the lessons learnt have informed development into 2005/06.

7.4Strenuous efforts by Borough of Poole ASSC operational staff and managers have maintained actual service performance during the course of the year. Extra effort by all has been required to achieve this.

7.5No adverse effects have been reported locally in terms of the increased emergency admission or delayed discharge of Poole residents to/from Hospital.

7.6The Borough of Poole, in real terms, has succeeded in continuing to meet the needs of its residents requiring equipment support.

7.7Further planned service improvements will build on the recovery achieved in the third and fourth quarters of the current financial year.

JOHN DERMODY

HEAD OF ADULT SOCIAL SERVICES (COMMISSIONING)

11th February 2005

Contact Officer: Chris Jones, Acting Principal Officer,01202 633621

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