Transcript National Care Homes Conference and Exhibition

“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Scottish Care Conference
Marriott Hotel, Glasgow
31st May 2013
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Reforming and Improving Commissioning
Care at Home
A. There is no blueprint for success but we can ask
intelligent questions!
B. What are the big issues and how must we tackle the
problems differently?
C. Should we try to improve what we’ve got or should
we go for major reform and transformation?
D. What would the measure of success be?
E. And how would we recognise it?
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Level of Current Satisfaction with
Commissioning Effectiveness
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Level of Current Satisfaction with
Commissioning Effectiveness
1.
2.
3.
4.
5.
Don’t know because
not involved in service
usage or service
provision
Not at all satisfied
Quite satisfied but
think there is scope for
improvement
Satisfied (most of the
time)
None of the above
53%
25%
11%
8%
3%
1
2
3
4
5
Levels of Commissioning Effectiveness
 Political and collective leadership
 Executive leadership and strategic commissioning
 Senior Manager/Head of Service level of commissioning
 Front-line operational commissioning and contracting
CAVEAT
 Is there a mismatch between the roles and functions of
commissioners and their skills and experience to do it ?
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Commissioning/Leadership
LevelsHealth and Well-being
Whole Communities
Focus
on
Health
Inequalities
& Health
Outcomes
for Communities
Collective Leadership
at Board Level
Commissioning
& Leadership
Senior Executive
Managers
Commissioning
& Leadership
Senior Managers
Commissioning
& Leadership
Facilitating
Whole
System
Lead Organisation
Partnerships
IntegrationSolutionsWin/Win
Some of the many
skills needed
Whole systems thinking; political skills;
Inspirational, adaptive and collective
leadership
Pan Organisations & Cross
Shaping markets;
relationship building,
Boundaries
integrated strategic commissioning; executive
decision making; community based solution
finding; organisational leadership; political
Risk Management skills.
Shaping Quality
Markets
Markets
offering choice and
personalised quality solutions
Communities of
Interests
(geography, client group, condition,
Market management; relationship
age etc.)
Evidenced Based
Outcome Focussed
Customer Segmentation
Team Leadership
Different Enterprises
High Customer Satisfaction
Predictive Modelling
Integrated Solutions
building; integrated strategic
commissioning; empowering
creative managers and staff.
Person Centred Co-ordinated Care
Focus on individuals &
with support for carers
Individual and family focus
familyRisk based
assessments;
Co-production
Customer led – risk management
empowering customers;
Commissioning
Direct payments
Outcome Focussed
creative solution finding;
& Leadership
Personalised commissioning
Respect
and
Dignity
review and evaluation;
Personal Budgets – Health & Social Care
Empowering Approach contribute to evidence
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Front Line
Practitioners
Aesop
base.
© SBreen
Thinking Differently
Skills in implementation and execution
- how to ensure people get the training they
need to do the job they’re asked to do
- willingness to take risk
- being prepared to experiment
- learning from other businesses, sectors,
countries
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Still Thinking Differently
Good innovation v. slow adoption
- reverse innovation examples
- promoting change for good not for change
sake
- distinguishing what is worthwhile and what
is not
Preparing for the Future
-starting with the demographics
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Demographic change for population aged 65+ Scotland
Potential impact on specialist care services 2007-2031
Community Care - Impact
200000
94
%
N of people
160000
1-9 hrs
Home care
120000
26
%
80000
10+ hrs
Home care
40000
Care
Home
0
Cont
h/care
(hosp)
Actual
2007
2011
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
2016
2021
2026
2031
Projection
P Knight Scottish
Demographic change for population aged 65+ Scotland
Potential impact on emergency bed numbers 2007-2031
16000
84%
61
%
14000
12000
41
%
24
%
9%
Beds
10000
8000
6000
4000
2000
0
Y/E Mar 2007
Projected
2011
Projected
2016
Projected
2021
Year
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Projected
2026
Projected
2031
Calendar year ’07
estimate
P Knight Scottish
Government
Working age against total population
Macroeconomic Impacts of Demographic Change in Scotland: A Computable General Equilibrium Analysis
©see
AESOP
Consortium 2011 | www.aesopconsortium.co.uk
http://ftp.iza.org/dp2623.pdf
Rapid growth of over 65s in next 10 years
% increase in older people in England
<10% Increase
10%-18%
18%-26%
>26% Increase
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
34% of the population were 50+ in 2009 –
with concentrations in ‘retirement areas’
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
By 2029 over 40% of the population will be over 50 -
and
virtually everywhere in the country will look like current ‘retirement areas’
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Time to Think Differently
The demographics alone should make us stop
and think
Do you think that current methods of
securing care will sustain in the future?
Do you think that they’re designed to help
support innovation and change or do they
militate against improvement?
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Experience of different levels and forms
of contracting – choose one
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Experience of different levels and forms of
contracting – choose one
1.
2.
3.
4.
5.
Self Directed support/personal
budgets/direct payments
Spot Contracts
Call off Contracts(block contract
with a ‘meter-ticking’ maximum
16%
number of hours or contract value)
Block contracts with guaranteed
contract value
None of the above
1
28%
26%
20%
9%
2
3
4
5
Let’s examine the current arrangements
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Let’s examine the current arrangements
Do you think we should continue with the hierarchy of
current contracting arrangements – spot, cost-andvolume, block etc
1.
2.
3.
4.
5.
58%
No opinion because not directly
involved
No, there not really working in
everyone’s best interest
Possibly but they might need
modification
Yes, there’s no clear idea yet of
what could replace them
None of the above
23%
10%
5%
1
2
3
4
3%
5
Some examples of thinking differently
1. Reverse Innovation at a macro and strategic
level
2. Commissioners’ behaviour modification in
terms of their relationship with providers
- An example from the South Coast
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Learning from a South Coast example
 Commissioners were looking for economies and also
for improvements in quality
 Commissioners were also driven to reduce avoidable
admissions and speed up safe discharge
 A considerable budget was split between 5 different
services working in this area
 The commissioners shared the problem with the
providers and tasked them to come up with a
solution
 The only rules were they had to speak with one voice
and they had to deliver efficiencies
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
The partners in £ hierarchy
Local Acute Trust
Community Trust
Roving GP
Vol Sector
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Local
Authority
Private
Nursing
Home
A more equal partnership
Acute
Comm-
Local
Authority
Personcentred
Voluntary
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
unity
Private
Achieving a ‘Single Service’
 No requirement or will to merge formally
 Common purpose and common agreement
 Complementary and collaborative
 Realistic about milestones & measurements
 Influencing the specification
 Delivery and performance criteria
 Assessing impact on funding, capacity, resources and
systems
... And this is where some cracks started to appear ...
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Outcome ??
 Successful launch 9th April 2013
 Pitfalls along the way
 Forming and storming a Partnership Management
Board
 Norming the close day-to-day working of
complementary services
 Developing the trust to share data, issues, problems
 Becoming mutual and solution-focused
 Clarifying the combined offer
 Delivering the efficiencies
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Is it time to do things differently?
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
Is it time to do things differently?
1.
2.
3.
4.
5.
Don’t know
Nothing wrong with what we’re
doing now
Some improvements are
necessary
Very Definitely otherwise we wont
be here tomorrow
None of the above
86%
12%
1%
1
1%
2
1%
3
4
5
Thank you
Janet Crampton – 07540 503030
[email protected]
© AESOP Consortium 2011 | www.aesopconsortium.co.uk
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Multidisciplinary
Phone a Friend: Preventing Infection
in Care at Home
Sarah Freeman
Educational Projects Manager (HAI)
NHS Education for Scotland
Quality Education for a Healthier Scotland
NHS Education for Scotland (NES)
Multidisciplinary
• Special Health Board - April 2002
• Undergraduate, postgraduate, continuing professional
development
Our priority is education training and workforce development,
supported by research, which helps to deliver improvements and
benefits in health for the people and communities of Scotland.
Quality Education for a Healthier Scotland. Strategic Framework 2011-14
Quality Education for a Healthier Scotland
Health Protection
Scotland
Multidisciplinary
Scottish Care
Care Inspectorate
PIIC@Home
Greater Glasgow
Council
NHS Education for
Scotland
Quality Education for a Healthier Scotland
Resource Development
• Curriculum Advisory Group (CAG)
• 2 Focus Groups – “How to keep people we care for safe and
how to keep me safe”.
• Simple short messages based on the SICPs
- Hand Hygiene
-
Personal Protective Equipment
Respiratory Hygiene & Etiquette
Patient Placement
Management of blood and body fluid spillage
Occupational Exposure Management
Safe Disposal of waste
Control of the Environment
Safe Management of Linen
Management of Care Equipment
Quality Education for a Healthier Scotland
Multidisciplinary
Standard Infection Control Precautions
Multidisciplinary
Media App
Pocket Guide
Quality Education for a Healthier Scotland
Question 1
Quality Education for a Healthier Scotland
Multidisciplinary
How many elements are there in standard
infection control precautions?
1.
2.
3.
4.
2
5
8
10
84%
9%
2%
1
2
5%
3
4
Multidisciplinary
Quality Education for a Healthier Scotland
Find me at your app store
Multidisciplinary
Quality Education for a Healthier Scotland
Question 2
Quality Education for a Healthier Scotland
Multidisciplinary
What is the missing word? Infection Control
is *********** business.
1.
2.
3.
4.
97%
The Chief Executive
The Care Manager
Everybody
Care Staff
2%
1
1%
0%
2
3
4
Phone a friend about Infection Risks
Multidisciplinary
Home Page
Infection Risks
Specific Risk
Quality Education for a Healthier Scotland
Phone a friend about SICPs
Multidisciplinary
Home Page
SICPs
Specific SICP
Quality Education for a Healthier Scotland
Educational Governance Structures
New Course Launch
1 month after launch
User statistics and student
feedback collected and given to
Project Lead.
6 months after launch
Project Lead reviews statistics and
feedback and makes the necessary
changes.
18 months after launch
Full review of product by Project
Lead.
3 months thereafter
User statistics and student
feedback reviewed.
Quality Education for a Healthier Scotland
Multidisciplinary
Question 3
Quality Education for a Healthier Scotland
Multidisciplinary
How much does Healthcare Associated
Infection cost (in financial terms) in Scotland
per year in NHS?
1.
2.
3.
4.
£183m per year
£18m per year
£8m per year
£1.8m per year
52%
37%
7%
1
2
3
4%
4
Other resources available
Multidisciplinary
Quality Education for a Healthier Scotland
Multidisciplinary
Contact Us
Further Information
[email protected]
http://tinyurl.com/ok42
hdg
Quality Education for a Healthier Scotland
Question 4
Quality Education for a Healthier Scotland
Multidisciplinary
You arrive at a client’s house and there is a
spillage of urine. You are unsure what
personal protective equipment to put on.
What do you do next?
1.
2.
3.
4.
Do nothing
50/50
Phone a friend
Ask the audience
0%
1
0%
0%
2
3
0%
4
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Self-Directed Support – moving ahead for the
Care at Home sector
Dr Donald Macaskill
2013 is a key year
• Bill passed its final stage November 2012.
• Became an Act January 2013.
• Regulations and Statutory Guidance published –
April 2013.
Consultation – 12 weeks to early July 2013.
• Enactment and implementation – April 2014.
• People and Partners consultation process
• Collaborative event 6th June, Dunfermline
Question
Which of the following is true:
1.
2.
3.
4.
I did not know the SDS Regulations and Guidance
had been published.
I knew they were out but haven’t got round to
reading them.
I have read them in brief.
I have read them in some detail.
Which of the following describes your understanding
of the current status with SDS……
40%
1.
2.
3.
4.
I did not know the SDS
Regulations and Guidance
had been published
I knew the SDS Regulations
and Guidance were out but
haven’t got round to reading
them
I have read them in brief
I have read them in some
details
30%
18%
12%
1
2
3
4
What have been the main issues
and concerns during our
Consultation?
Some key questions keep arising.
• Can we be sure of a real outcomes focused assessment
process?
• Will there be real choice or only a partial menu?
• Will there be enough resources?
• What will enable local authorities to provide independent
information?
• Will people be at more risk of harm with SDS?
• How will local authorities ‘promote’ market diversity?
Outcomes focussed assessment.
• The Guidance says:
Assessment is important because it helps to set the tone
for what is to come.
Not a tick-box and form-filling exercise …. But in the right
way – based around the person’s assets and personal
outcomes –
Question
If you were receiving a service would you like your care at
home provider to facilitate you to:
1.
2.
3.
4.
Remain as independent for as long as possible?
Keep in contact with family and friends
Be able to engage in activities and social events
Keep me safe and healthy
If you were receiving a service would you like
your care at home provider or housing
support providers to facilitate you to:
1.
2.
3.
4.
5.
Remain as independent for as
long as possible
Keep in contact with family
and friends
Be able to engage in activities
and social events
Keep me safe and healthy
All of the above
An outcome is a result or effect of an action. Personal outcomes are the things
that matter to the supported person such as:
•
•
•
•
•
•
•
being as well as possible
improving confidence
having friendships and relationships
social contact
being safe
living independently
being included
It is essential that personal and collective outcomes
are ingrained in the culture and approach of social
care services,
Senior managers must believe in the merits of this
approach and they must support their staff to do the
same. The organisation must invest the necessary time
and effort to support a culture based on outcomes.
Will there be enough resources?
The “resource question” should not be about financial resource – money – alone.
The professional should consider all of the possible resources available
• the person’s attributes and assets (their skills, knowledge, awareness,
background, decision-making skills and contacts);
• the person’s well-being and inner strength;
• the person’s extended family, close friends, work colleagues and community;
• the budget or funding which the person can access to meet their eligible needs;
Is there an over-reliance on networks and assets which older people in
particular may not have?
Is there not a major challenge which SDS poses to acute services?
Question ….Looking at Picture A and Picture B
Which would you prefer?
A
B
Looking at picture A and
picture B which would you prefer?
1.
2.
A
B
The four options:
Option one|: A direct payment
Option two: The person getting
the support directing the support
and having a budget but not the
money
Option three: The local authority
organising the services that the
person wants
Option four: A combination of the
other options – ‘mix and match’.
Will there be real choice or only a partial menu?
• Will choice be real or limited?
• How can we ensure independence of information? (Duty
under Act: Section 9) where a local authority has in-house
provision?
• Challenge re marketing and communication of uniqueness
of services for sector.
The professional should explain the options in a
clear and accessible way. They should tailor any
communication to the communication needs of
the individual. They must provide the individual
with an explanation of the “nature and effect”
of the options available to them under the law
Risk and adult protection
The identification and management of risk is fundamental to any assessment
and support planning process.
… The supported person should be fully involved in considering their risks
and how they will be managed.
The principles of involvement, informed choice and collaboration are helpful
aids to this approach.
The two parties should take a proportionate approach… The professional
should seek to enable positive, informed and proportionate risk taking.
Is all that enough?
Question
Which do you think best ‘promotes’ market diversity?
Which do you think best ‘promotes’ market
diversity?
1.
2.
3.
A framework aggreement with a
selected list of providers on it
A website run by an independent
organisation
A refreshed Care Inspectorate
website which listed criteria to
look out for in a service as well as
gradings
People as Partners Project
http://www.scottishcare.org/peopleas-partners/
Dr Donald Macaskill
[email protected]
Tel: 07545 847382
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
Care
12.15
x
Mins
Times
Actual
arrival
times
Planned Care
Unpaid
break
15
Client in
hospital
Carer used own unpaid break to make up time and
to avoid running late
Client
H
30
11.30 12.00
11.34
Meal preparation for lunch, assist with continence
management
Client
A
30
12.00 12.30
12.10 12.40
Meal preparation for lunch, assist with continence
management
Quality or Compromise
• Mel has been out from 06.30 to arrive at her
first call at 06.45
• Starting early and working through unpaid
breaks ensures she just makes all her visits on
time – today was a good day
• During her lunch she will now – drop off a
sample to GP surgery, and pick up a
prescription
• No additional payment for travel /fuel of 16
miles during the morning
• and for 5.25 hrs. direct contact time, Mel has
been out for 6.5 hours her gross pay before
deductions is £33. 80
Should all care staff regardless of sector/ employer be
paid the living wage of £7.45 then we can address
time to care, time to travel/fuel payments
1. Yes
2. No
3. Don’t Know
90%
6%
1
2
4%
3
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013
“Home is Where the Care is”
Annual Conference and Exhibition
Glasgow Marriott Hotel
Friday 31st May 2013