Care Services Efficiency Delivery Programme Transforming Community Equipment Programme Keynote...

Care Services Efficiency Delivery Programme

Transforming Community EquipmentProgramme

Keynote speech

Lynne HornNational Implementation Manager

NAEP Conference 25th – 26th June 2008 Blackpool


Where are we now


Agenda

■ Policy context

■ Who are we working with

■ Fears and Concerns

■ Moving forward


Policy Context– enabling people to live as independently as possible,

– enabling people to exercise choice and control over the support they

receive,

– the promotion of high quality safe services; and

– Supporting equality, human rights and social inclusion

Ministers have committed themselves to

– personalised social care and health services,

– giving power and control to people to shape the services they need,

– working with commissioners, providers and regulators of services to

implement policy,

– improving the status of services and of the workforce in health and social

care,

– developing and sustaining a vibrant and innovative third sector; and

– ensuring value for money

The new model is aimed at the total population, not just those who are supported by the state

The new model is aimed at the total population, not just those who are supported by the state


Model designed to deliver policy

Policy documentRecommendations relevant to the Programme

Included by programme

Our health, Our care, Our say: a new direction for community services (‘OHOCOS’)

People assessed as needing equipment can choose to buy the equipment that meets their needs through a direct payment. In the future, this may be part of Individual Budgets in the event of national roll out.

People should be helped to live at home (e.g. through provision of community equipment) where possible.

OHOCOS built on the Green Paper (Independence, Wellbeing and Choice) commitment that local authorities should, in considering strategic needs, take into account the care and support needs of the whole population, including those who have the ability to pay for the services themselves

‘Improving the life chances of disabled people’ - PMSU

Piloting Individual Budgets to pull together funding streams, including funding for community equipment and Access to Work, to give people more say in the services they receive.

Programme dependency

Equipment must be updated and maintained

Use centres for independent living to give disabled people greater say

Better information and advice, particularly on transition services (e.g. moving from children to adult services)

Key desired outcomes:•Increased ability to live independentlyChildren and their families able to lead ‘ordinary’ lives•Young people and their families supported throughout transition•More disabled people in employment

Services should be personalised and be available at times so people can get to work



Policy document Recommendations relevant to the Programme Included by programme

‘Improving the life chances of disabled people’ - PMSU

By 2012 the DH should work together with DfES and ODPM (CLG) to deliver equipment and adaptations that meets needs, is personalised, involves disabled people and acknowledges them as experts about their needs, maximises choice, minimises disincentive to seek employment or move locality and uses existing resources to reduce social exclusion.

In 2006 the DH should assess whether the community equipment services, communication aids provision and wheelchair services are able to deliver NSF recommendations on children’s equipment. If not, make recommendations for improvement

Standard eight: disabled children and young people and those with complex health needsThese children and young people should “receive co-ordinated, high quality and family-centred services which are based on assessed needs, which promote social inclusion and, where possible, which enable them and their families to live ordinary lives”. The NSF states that children and young people will need to have increased access to therapy and equipment services and social services and that organisations should undertake ‘multi-agency transition planning’ to support disabled young people entering adulthood.

National Service Framework for Children, Young People and Maternity Services

Standard three: children, young-people and family-centred servicesEnsuring services are co-ordinated around the need of the child and family.

Standard two: person-centred careAllow older people to make choices about their care package, regardless of traditional health/ social care organisation boundaries. E.g. through single assessment process, integrated commissioning and integrated community equipment and continence services.



The new model has included all the policy requirements above The new model has included all the policy requirements above

Policy document Recommendations relevant to the Programme Included by programme

National Service Framework for Older People

Standard one: rooting out age discrimination in health and social care

Standard eight: promotion of health and active life. NHS should lead a programme to promote good health amongst older people, supported by local councils.

Quality Requirement 7: Equipment and accommodationPeople with long term conditions should receive equipment (e.g. wheelchairs) and housing adaptations when they needs them, to help them lead independent lives and lead health lives.

National Service Framework for Long Term Conditions

Following should be considered when assessing people for equipment:For complex needs, provide specialist professional assessment with community equipment/ ATEquipment requirements to be part of the integrated care planConsider providing equipment on trialTraining on how to use equipment for users and carersConsider how to respond to changing needs, e. g. frequent reassessments/ reviews and flexible provision of equipment for people with rapidly progressing conditionsResponsive collection and repair and loan, where equipment breaks downConsider changing needs of carers, e.g. due to illness, paid employment.

Sir Peter Gershon ‘Releasing Resources to the front line’

Although this is not a policy requirement, both LA’s and PCT’s are required to meet efficiency targets, and we have identified efficiency release as part of the Financial case below.


Who have we been working within the North West?

Lead Partners

Current Micro Site

Macro Sites

Live Micro Sites


Pre shadow running concerns and fears


Early feedback from Practitioners

Q6 I would like to see this in my Local Authority or Trust

0% 20% 40% 60% 80% 100%

1

Q6 Strongly agree Q6 Agree Q6 Neutral Q6 Disgaree Q6 Strongly disagree

Q4 A supply market driven by 'choice' rather than state funding - this is good for:

0% 20% 40% 60% 80% 100%

Users

Practitioners

Commissioners

Providers

Suppliers


Q9 I would give up the following to make this happen:

0% 20% 40% 60% 80% 100%

CE store

Assessment process

In-house service


In house service

Q3 Open access to needs assessment w hich makes full use of therapeutic skills of practitioner - this is good for:

0% 20% 40% 60% 80% 100%

Users

Practitioners

Commissioners

Providers

Suppliers


Assessment process

CE Stores

Early messages from Oct – Dec 2006 showed positive view of policy – but not in my back yard!

Early messages from Oct – Dec 2006 showed positive view of policy – but not in my back yard!


Concerns

■ Older people do not want choice■ Frail and vulnerable people prefer professionals to select

items for them■ Older people are incapable of understanding what to do

with a prescription. Our clients are housebound and can’t visit a retailer

■ Practitioners would have to spend more time on assessments because of the need to revisit the user

■ Unscrupulous retailers will sell vulnerable users equipment they don’t need

■ The model is wasteful as it does not encourage recycling


Evidence from shadow running


EvidenceOlder people do not want choice:

57

72

21

17

2

24

13

6

53

% Very good % Fairly good % Neither good nor poor% Fairly poor % Very poor % Don't know

The Importance of Choice

How important, if at all, do you feel it is that patients . . .

Base: 102 Patients, October 2007 - April 2008

are offered a choice of retailers to go to for their aids/

equipment prescriptions

have the opportunity to make a choice about the aids/equipment

they receive.

75% - 90% of Users believed in the importance of having a choice of aids they receive and retailers to go to for their aids

75% - 90% of Users believed in the importance of having a choice of aids they receive and retailers to go to for their aids


EvidenceFrail and vulnerable people prefer professionals to selectitems for them:

61%

29%

5%3%

Importance of topping up

Fairly important

Very important

Neither/nor (1%)

How important, if at all, do you feel it is that patients are able to ‘top-up’ their prescriptions in this way. Would you say it was…


Not important at all (1%)

Not very importantDon’t know

An overwhelming majority of Users (90%) valued the ability to ‘top up’An overwhelming majority of Users (90%) valued the ability to ‘top up’


EvidenceOlder people are incapable of understanding what to do with a prescription. Our clients are housebound and can’t visit a retailer:

84%

7%9%

Who Redeems the Prescriptions?

For myself

On behalf of someone else -Carer

And can I just check, for your recent prescription are you redeeming this for yourself or on behalf of somebody else? And are you that persons carer or not?


On behalf of someone else - Other

All Users surveyed had redeemed their prescription with over 80% redeeming it for themselves

All Users surveyed had redeemed their prescription with over 80% redeeming it for themselves


EvidencePractitioners would have to spend more time on assessments because of the need to revisit the user:

Lead Partners:

■ Experienced a reduction in the average number of days from referral to assessment from 18 to 9 days (a reduction of 50%) and from assessment to case closure from 45.5 to 27.5 days


76

71

13

19

2

31 7

4 4

% Very satisfied % Fairly satisfied % Neither good nor poor% Fairly dissatisfied % Very dissatisfied % Don't know

Satisfaction with the Retailer

How satisfied were you with the . . .


Length of time it took for your aid/equipment to arrive once you had

presented your prescription

Individual retailer you used for your aids/equipment prescription

48%

25%

11%

13%

2%

Advocacy of the Retailer

Neutral Speak highly without being asked

Don’t know/no opinion

Be critical if asked

Speak highly if asked

Be critical without being asked (1%)

And which of these phrases best describes the way you would speak about the individual retailer that provided you with your prescription? Would you…


EvidenceUnscrupulous retailers will sell vulnerable users equipment they don’t need:

Over 90% of Users were satisfied with the service received from retailers and as many as 73% would speak highly of them

Over 90% of Users were satisfied with the service received from retailers and as many as 73% would speak highly of them


EvidenceUnscrupulous retailers will sell vulnerable users equipment they don’t need:

Patients’ views on Topping up

Aware% Yes % No

44%56%

Topped up

7%

93%

Were you aware that you are able to ‘top-up’ your prescription for an aid or equipment that better suited your needs?

Did you ‘top up’ your prescription?

Base: 102 Patients, October 2007 - April 2008Base: All who are aware they were able to ‘top up’ their prescriptions (45)

Reassuringly, although Users had limited awareness of their option to ‘top up’, there was no attempt by retailers to exploit this concept

Reassuringly, although Users had limited awareness of their option to ‘top up’, there was no attempt by retailers to exploit this concept


EvidenceThe model is wasteful as it does not encourage recycling:

■ Case Study available■ Template that you can complete yourself to understand

true cost of refurbishing simple aids to daily living


Implementation


We are working with 70 organisations across England

x6 - Retail model active

x30 - Phase 1 implementation – Business Case prep

x34 - Key Decision Makers Meetings


The Minister’s decision – to implement the model across England

■ He is considering writing, jointly with David Nicholson, NHS Chief Executive, to all LA/NHS partnerships to encourage implementation

He has asked me to■ Recruit national implementation team■ Support local authorities and their health partners to

implement■ Continue to evaluate more effective options for complex

aids to daily living

The implementation plan has been completed and is under review

The implementation plan has been completed and is under review


We will support LA/NHS partnerships to implement

These tools and techniques are available and being used nowThese tools and techniques are available and being used now

SPONSORHIP

PROJECT MANAGEMENT

PROJECTRESOURCING

PROJECT PLANNIN

G 1

23

4

Start up readiness assessment packs

Partnership agreement

Project management toolkit

Local business case template

Initial Contact

NeedsAssessment

Local Financial Model

(Impact on budgets: Loan store overheads,

equipment and back office budgets)

Retail Model

Back Office

PrescriptionIssue

DemandMgmt

Refurbishment case study and template

9 x pulses (how to transition packs)


Thank You

Care Services Efficiency Delivery Programme Transforming Community Equipment Programme Keynote...

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