Transcript Document 7260770

Re-engineering
Community Support Services
for Elders
Mrs Carrie Lam
Director of Social Welfare
28 August 2002
Purpose
• To introduce the Re-engineering
Framework and Working Parameters
• To invite eligible NGOs to participate in the
Re-engineering
• To appeal to NGOs for understanding and
support to make the Re-engineering a
success despite the constraints
2
Background
Community Support Services for Elders
Centre-based
Home-based
Oct 2000
HKU Centre on Ageing Consultancy
Study on Review of Community
Support Services for Elders
Revamp new Home Help Teams into
Home Care and Meal Service
Contracts
1999-2000
April-May
2001
Endorsement of Consultancy
Recommendations by Elderly
Commission and LegCo Welfare
Panel
Introduction of Enhanced Home and
Community Care Services
April 2001
2001-02
onwards
Implementation of the integrated
mode in new elderly projects (NEC,
DECC, mini-D/E, etc.)
Announce intention to upgrade half
of 139 existing Home Help Teams
Oct 2001
13 June 2002
Endorsement of Re-engineering Proposals in respect of centre-based and
home-based services by Elderly Commission
25 June 2002
Briefing of NGOs on Re-engineering Proposals
8 July 2002
Endorsement of Re-engineering Proposals by LegCo Welfare Panel
July-August
2002
Detailed consultation with NGOs on parameters
Specifications on Re-engineering Community Support Services for Elders3
A SWOT Analysis in Support of
the Re-engineering
Strength
• Policy consensus emerging from the 2000
Consultancy Study
• High level endorsement, namely
Elderly Commission and LegCo Welfare Panel
• An environment more conducive to change
– LSG becoming mainstream subvention
– Enhanced DSWO role in district planning and coordination
4
A SWOT Analysis in Support of
the Re-engineering (cont’d)
Strength (cont’d)
• An environment more conducive to change (cont’d)
– Fiscal stringency pushing greater drive for costeffectiveness
– Service rationalisation and integration in family
and youth services
• Successful experience gained through the 15
new integrated projects with 35 NGOs taking
part in the quality-based allocation process
5
A SWOT Analysis in Support of
the Re-engineering (cont’d)
Weakness
• Fiscal stringency – no earmarked additional
funding dedicated to re-engineering
• Adverse employment situation, hence greater
need to safeguard jobs and honour obligations to
existing staff
• Adverse emotional reactions from end users - the
elders – if not managed carefully
• A very complicated scene and heterogeneous
group of operators – big and small NGOs which
affect their capability to re-engineer (81 NGOs
operating 35 M/Es and 213 S/Es)
6
A SWOT Analysis in Support of
the Re-engineering (cont’d)
Opportunity
• Putting in effect the desired integrated
service mode on a much larger scale
• Addressing problems in the existing system
as highlighted in Consultancy Study
• Laying a service infrastructure to meet
growing and changing needs of elder –
current generation and next
7
A SWOT Analysis in Support of
the Re-engineering (cont’d)
Opportunity
(cont’d)
• Creating room for further service integration
beyond elderly welfare services e.g.
between elderly and family, between health
and welfare
• Opening up opportunity for greater use of
information technology
• Demonstrating further collaboration and
partnership between SWD and NGOs
8
A SWOT Analysis in Support of
the Re-engineering (cont’d)
Threat
• Community Chest’s funding reduction would
directly hamper the continued operation of
some M/Es and S/Es
• Inability to meet challenges from an ageing
population
9
Guiding Principles Adopted by SWD
in Developing the Re-engineering
Parameters
• Simplicity, clarity and certainty
• Participation is entirely voluntary
• Bottom-up, instead of top-down
• Focus on district and service user needs, no
disruption to existing service users as far as
possible
• Driven by co-operation and mutual
understanding, rather than competition
• No staff redundancy
10
General Parameters for
the Re-engineering
• No price bidding and minimal competition
amongst NGOs
• In-situ expansion and/or upgrading of services
• Subvention and not time-defined
• Eligibility:
 NGOs opted/will opt for LSG in 2003-04;
 open to Chest and non-Chest members;
 small NGOs to form consortium under one
principal agency
11
General Parameters
(cont’d)
• Quality proposal: to demonstrate the agency’s
vision, synergy of resources and value-added
services. No vigorous vetting of proposal
• No moving goal posts: service details, output
and outcome indicators and funding level
follow closely to those new integrated elderly
projects commissioned
• NGOs are expected to take care of their
respective catchment needs as far as possible
12
Scope of Re-engineering
Centre-based
• Multi-service Centres for the Elderly (M/Es)
to District Elderly Community Centres
(DECCs)
• Social Centres for the Elderly (S/Es) to
Neighbourhood Elderly Centres (NECs)
13
Scope of Re-engineering
(cont’d)
Home-based
• Home Help (HH), Home Care (HC) & Meal
Teams (MT) to Integrated Home Care
Services Teams (IHCSTs)
– upgraded to take care of elders of moderate to severe
level of impairment (frail cases)
– expanded to serve more elders with
no to mild impairment (ordinary cases)
– existing HC and MS teams will be
disbanded upon contract expiry by
end March 2003
14
Philosophy and Values
• Community-based integrated services
• Partnership and co-operation
• Caring community
• Healthy ageing and empowerment
• Family responsibility
• Client-focused care
• Innovation
• Effectiveness and efficiency
15
I. Re-engineering of
Centre-based Services
16
Objective of DECC and NEC
• DECC: Provides a full range of efficient and
quality support services in in integrated
manner to healthy, vulnerable and frail
elders living in the community and family
carers.
• NEC: Serves as a neighbourhood base for
community network of informal support
and formal social services provided to the
elders and the community at large.
17
Costing and parameters
• Reference cost– (by referring to Shan King
DECC, Fu Tai NEC & Tin Yuet NEC)
DECC: $3.50 Mn
NEC : $1.18 Mn
• Existing subventions–
M/E : $2.91 Mn
S/E : $0.72 Mn
18
Cost of Transformation
• M/E to DECC: $0.59 Mn ($3.50 Mn - $2.91 Mn)
• S/E to NEC: $0.46 Mn ($1.18 Mn - $0.72 Mn)
• The cost will be met by:
– pooling of existing subventions by NGOs
through rationalisation/closure of existing S/Es
or deletion of posts in other elderly day
services with good justification; and
– additional resources injected from SWD
19
Transformation Formula (on an
agency basis)
Total cost for transformation (no. of
M/Es and S/Es to be transformed) =
X
Total savings secured through
service rationalisation (no. of S/Es
to be closed and other subvention
resources to be pooled) =
Y
New resources
to be injected by SWD (X – Y) =
Z
20
Prescribed Minimum
Requirement of Pooled
Resources for Transformation
$ 0.18 million for each S/E to NEC and M/E to DECC
transformation
This may come from:
• closure of S/E ($0.72 million per centre, partial
savings not acceptable)
• rationalisation/EPP in other elderly community
services (partial savings in terms of subvented
posts acceptable, to be calculated on LSG basis,
i.e. salary mid-point + 6.8% PF)
21
Consequential Arrangements
Upon transformation
DECC
NEC
100% subvented
Provision to meet PF requirement and TOG of
“snapshot” staff will likewise be granted on
100% basis
22
Alternative Usage of the Closed Centre
• Return to the landlord (SWD, GPA, HD)
• NGOs are welcome to operate elderlyrelated services at no cost to SWD
• Subject to proven need, SWD is prepared
to meet the rent and rates of the premises
• Priority will be given to usages that
promote self-help and organisations by
elders themselves
23
Analysis of NGOs Operating S/Es
79 NGOs
(213 S/Es)
71 LSG
(198 S/Es)
16 operate
M/E and S/E
(80 S/Es)
8 non-LSG
(15 S/Es)
55 operate
only S/E
(118 S/Es)
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operating
>1 S/E
(89 S/Es)
5 non-Chest
member
(9 S/Es)
3 Chest
member
(6 S/Es)
29
operating
only 1 S/E
(29 S/Es)
17 non-Chest
member
(17 S/Es)
12 Chest
member
(12 S/Es)
24
Assistance to Small NGOs
• For single-service NGOs operating S/E only
who are Chest members and unable to pool
resources to join the re-engineering exercise,
SWD would
– Revert to the Chest for possible assistance
– In case of failing a positive response from Chest,
may consider picking up the 20% funding deficit
for such S/Es to stay put as S/Es.
25
II. Re-engineering of
Home-based Services
26
Objectives
• The upgraded home help teams will be
renamed as “Integrated Home Care Services
Teams” (綜合家居照顧服務隊)
• They should enable individuals, including
elders, disabled and needy families to
– Stay in the community
– Achieve and maintain an optimal level of
functioning and independence
– Acquire the necessary skills to adapt to changing
health status
27
Objectives
(cont’d)
• Service operators are expected to meet
increasing demand within existing
resources as far as possible (as in the case
of HHT at present serving an average of
over 110 cases as opposed to 60 in the
FSA)
• We welcome agencies’ innovation in
further re-engineering their respective
upgraded teams on a district basis
28
Catchment Area & Allocation of
Additional Cases and Resources (1)
• 9 districts with HC and MS (25 teams):
– Islands (1 team)
– Southern (2 teams)
– Sham Shui Po & Kowloon City (4 teams)
– Kwun Tong & Sai Kung (4 teams)
– Wong Tai Sin (3 teams)
– Kwai Tsing & Tsuen Wan (4 teams)
– Yuen Long (2 teams)
– Tai Po & North (2 teams)
– Sha Tin (3 teams)
29
Catchment Area & Allocation of
Additional Cases and Resources (2)
• Service Operators will take up cases now
served by HC and MT contracts through:
(a) upgrading: to serve cases suffering from
moderate to severe level of impairment or
disability (frail cases);
(b) in-situ expansion: to serve cases from no to
mild level of impairment or disability (ordinary
cases)
30
Catchment Area & Allocation of
Additional Cases and Resources (3)
• Allocation of cases will be made on an
agency basis and district basis
• Allocation of frail cases will be made on
blocks of ten places each
• Allocation of ordinary cases will be made
with reference to the proportion of frail
cases taken up by each agency within the
district
31
Catchment Area & Allocation of
Additional Cases and Resources (4)
• Maximum cases to be allocated within each
district is pre-set taking account of
resource availability and projected number
of cases served by existing HC and MT
contractors
32
For Districts without HCTs & MTs
• 4 districts without HCTs & MTs
– Central & Western
– Eastern & Wan Chai
– Yau Tsim Mong
– Tuen Mun
• Allocation on basis of 5 districts (Eastern
and Wan Chai as two separate districts)
• Only frail cases to be allocated. Allocation
of cases similar, i.e. on an agency and
district basis
33
Admission into Service
• For elderly cases at moderate and severe level of
impairment/disability, service users referred to
Operators in accordance with the 18 District
Council districts by SCNAMO(ES)s
• For ordinary cases, existing HC and MT service
users referred to Operators according to service
boundaries of HCTs & MTs. Operators may
directly admit new users
• Re-defining the service boundaries may be
required in consultation with DSWOs to allow
flexibility
34
Cost Provision
• Unit cost for cases of moderate or
severe level of impairment/disability:
$3,382 per month
• Unit cost for ordinary cases: $500
per month
35
Hypothetical Re-engineering Plan (1)
Existing service provision
• Agency currently operates 4 M/Es, 8 S/Es and 8
HHTs in the following 6 districts
1
2
3
4
5
6
District
M/E
S/E
HHT
Eastern
Kwai Tsing
Tsuen Wan
Kwun Tong
Sai Kung (including
Tseung Kwan O)
Sha Tin
Total
2
1
1
2
2
1
1
1
5
2
1
4
1
8
8
Hypothetical Re-engineering Plan (2)
Centre-based service (1)
The 3 S/Es in Kwun Tong, Sai Kung and
Sha Tin districts will be closed having
regard to adequate coverage by other
NGOs in the district.
All the 4 M/Es and the remaining 5 S/Es
will be upgraded to DECCs and NECs
respectively.
37
Hypothetical Re-engineering Plan (3)
Centre-based service (2)
Description
Funding
(A)
Total cost for transforming
4 M/Es to 4 DECCs and 5
S/Es to 5 NECs (A):
$4.66 Mn
(B)
Total recurrent resources
pooled from service
rationalisation (B):
(C) Top-up funding from SWD
(C) :
Remarks
i.e. (0.59 Mn x 4
DECCs to be formed)
+ (0.46 Mn x 5 NECs
to be formed)
$2.16 Mn -Recurrent subvention
to each S/E is $0.72
Mn.
-can meet prescribed
minimum requirement
of $1.62 Mn ($0.18
Mn x 9)
(C) = (A) – (B) for
$2.5 Mn
upgrading 4 M/Es to
(i.e.$4.66 MnDECCs and 5 S/Es to
$2.16 Mn)
NECs
38
Hypothetical Re-engineering Plan (4)
Home-based service (1)
 Agency proposes to upgrade all its 8 HHTs in Eastern,
Kwai Tsing and Tsuen Wan districts to IHCSTs.
 Agency applies for a total of 80 frail cases in these
districts:
District
Eastern
(without HC & MT)
Kwai Tsing
(with HC & MT)
Tsuen Wan
(with HC & MT)
No. of cases of moderate to
severe impairment/disability
level to be available for
allocation in the district
Agency’s
application
80
50
90
20
40
10
39
Hypothetical Re-engineering Plan (5)
Assuming the Agency’s application is fully accepted,
allocation of cases and additional resources to the
Agency will be:
District
Frail Cases
Ordinary Cases
Additional resources per year
Eastern
50
Nil
Kwai
Tsing
20
38
$2.03 Mn
($3 382 x 50 + $500 x 0)x 12
$1.04 Mn
($3 382 x 20 + $500 x 38)x 12
Tsuen
Wan
10
13
Total:
$0.48 Mn
($3 382 x 10 + $500 x 13)x 12
$3.55 Mn
40
Hypothetical Re-engineering Plan (6)
Summary of Agency’s outcome of re-engineering:
• Operates 4 DECCs in three districts supported by Agency’s
own NECs (5) and other NGOs’ NECs in the district
• Upgrade all 8 HHTs into IHCSTs serving ordinary and frail
cases
• Receive total additional subvention of $5.71 million a year
($2.16 Mn + $3.55 Mn under HHT upgrading)
• Propose to retain/swap S/E vacant premises to set up subbase or elderly-related services on self-financing basis in
the relevant district(s)
• Ensure no staff redundancy
• No longer requires to rely on Chest or raise fund to meet
funding gaps in respect of its M/Es and S/Es
41
New Scene Achieved through
Other Government Re-engineering Residential care services
offices:
for elders:
Housing Dept., Police,
Social Security Field
Units
Educational
bodies:
RCHE, respite,
dementia services
NEC
NEC
NEC
Home-based services for
elders:
DECC
lifelong learning
institutes
NEC
NEC
Home Help Teams,
Integrated Home Care
Service Teams, Enhanced
Home and Community
Care Services
NEC
Specialised services:
Elder abuse
prevention, elder
suicide prevention
Medical and health
services:
Elderly Health Centres,
hospitals and clinics
42
A New District-based Planning
Mechanism Achieved through
Re-engineering
District
Planning
District Social Welfare Office
DECC
NEC
DE
NEC
IHCS
HH
NEC
Sub-district Coordination
DECC
NEC
HH
IHCS
NEC
DE
NEC
Sub-district Coordination
DECC
NEC
NEC
NEC
NEC
NEC
IHCS
Sub-district Coordination
43
Implementation Schedule (1)
28 August 2002
Full briefing to NGOs concerned
Sept – mid Nov
2002
NGOs in consultation with
DSWOs in preparing the
re-engineering proposals
NGOs to submit proposals to
DSWOs
15 Nov 2002
mid Nov – Dec
2002
Vetting of proposals by SWD
44
Implementation Schedule (2)
January 2003
Announcement of results
Feb/ Mar 2003
Commencement of
re-engineering of services by
phases; transitional arrangement
Full commencement of new
service provision by IHCSTs
April 2003
April 2003
onwards
Gradual transformation of M/Es
into DECCs and S/Es into NECs
45
Thank you
46