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From Home Adaptations to Accessible Homes - redesigning services using business processes 31 st May 2012 Tom Gilchrist.

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Presentation on theme: "From Home Adaptations to Accessible Homes - redesigning services using business processes 31 st May 2012 Tom Gilchrist."— Presentation transcript:

1 From Home Adaptations to Accessible Homes - redesigning services using business processes 31 st May 2012 Tom Gilchrist

2 Rapidly growing city – 430,000 Fastest growing 0 – 10 age group in England Economically successful City of contrasts – greater income range and pockets of significant deprivation Housing profile; social static (19%); owner- occupation in decline; rapid rise in social/Private renting Background to Bristol

3 40% increase in service demand since 2008, will rise further 20% forecast increase in 85+ population by 2021 60% increase in disabled children over 40 years Older and Disabled People

4 Multi-tenure service (from 2006) Unit costs competitive Fast-tracking (within adaptations team) Demand-led Budget increases – waiting lists still increasing lagging behind demand New RP protocol in place (2010) Top-up funding available for DFG’s 2 delivery agencies – in-house and HIA Background to the Home Adaptation Service

5 High satisfaction: Large no. of complaints! Long waiting times and growing waiting lists Service split between 3 directorates and 2 organisations (very disjointed) Inconsistency in waiting times between tenures Drivers for Change - Organisational

6 Drivers for Change - external Increasing demand Political pressure to reduce waiting times Policy issues: hospital discharge community care Falling resources (PSRG) removal 2011 Threat of Audit Commission ‘red flag’ due to waiting times: Private sector 15 months (standard priority) Landlord sector 18 months (standard priority)

7 Approach LEAN systems/BPR Learn from customer experiences (journey mapping) Learn from staff Manage as a project with board Use business analysis techniques External Project Manager; Process Maps

8 2 completely separate services (assessment and delivery) and 4 different processes Little understanding of customer types Professional and organisational barriers Focus on product, not on need Needs assessment/specification divorced from budget decisions What Did We Discover?

9 What Else Did We Discover? Only 20% of staff time was spent with customers Separate queues Too many home visits (surveyors and OT’s) Poor management reporting 4 different IT systems; no interfaces Average length of process too long

10 And More…… Professional silos Day-to-day focus No understanding or ownership of whole process Inward looking Not outcome focussed; waiting list driven Heavy reliance on public funding Lack of customer involvement Tendered contractors - profit driven

11 Changes Re-design and simplification of whole process, eliminating organisational and professional boundaries Process designed around customer journeys Outcome-based performance measures Strong emphasis on diagnostics and triage at beginning – better training Greater efficiency by reducing home visits and less hands-on contract management

12 How We Are Doing It Now Case-workers are at the centre of the new process Strong diagnostic, based on need, by OT/OTA Diagnostic carried out at ‘assessment centre’ which is co-located with WOE Home Improvement Agency Emphasis on meeting needs with simpler/cheaper solutions Reconfiguring IT systems (little cost saving: improved reporting) More emphasis on self-funding and re-housing Standing customer-focus panel Demand management - new assessment criteria and better information to customer


14 Consequences Average ‘end-to-end’ times reduced (new cases) 71 to 30 weeks (7.5 months), many resolved within days. Will reduce further as new process becomes ‘the norm’ Different processes used for backlog/new cases One manager with an integrated team of caseworkers, surveyors and OT’s Capacity increased (assessment centre seeing 6 cases/day) Lower cost solutions increasingly used – budget stretched Net revenue savings over 6 years of £609k Mobile working by OT’s and surveyors Savings re-invested in IT improvements, more caseworkers and specialist re-housing OT

15 What Does This Mean for Real People? – Mrs. K Diagnosis at Assessment Centre Small number of aids (bath board & toilet frame) met her needs and were issued Interested in self-funding a new shower; she tried out various options at the centre 4 months later she returned aids having had shower installed at her expense Outcome: Quick resolution to immediate needs More choice Avoided long wait during which time her condition would have deteriorated Deflected from taking DFG

16 Mrs. C Seen at assessment centre within 8 weeks (over Christmas period) Assessed for bath lift and step. Provided bed and armchair raisers, toilet grab rail and lever taps All equipment was demonstrated to her Equipment delivered within a few days of assessment. Outcome: Able to take a bath unaided for first time in years High risk of fall avoided Mrs C very pleased

17 Mrs C Client suffers from Inflammatory arthritis, bowl disease, falls, social isolation and anxiety and depression. Property accessed via steps to front door and up 18 steps to first floor Client unable to use bath and perching stool unusable. Family unable to provide support. Homecare costs incurred. Projected costs for adaptation £7K (access improvements and intercom) plus monthly pendant alarm. Support provided to bid for house and handholding/support throughout move. Minor adaptations installed and small incentive towards move costs (total cost £1,250) Better outcome achieved: more usable property found (level access, equipped shower room which can be used independently) no further homecare costs. Client closer to family who call in daily to call daily to provide support Time from initial enquiry to move: 16 weeks

18 Unable to manage stairs to first floor RP flat Applied for re-housing but placed in lowest band HIA assisted them to have health assessment Banding increased and successfully bid for 1 bed sheltered RP bungalow Now very happy; able to go out more, able to hang out washing, reduced risk of trips Mr. & Mrs. J

19 Top Tips Take a customer-centred view: not all customers are the same! Senior managers/directors need to own the change Take an end-to-end view of all processes Get objectives agreed; measure progress against them Spend time understanding what’s going (As Is) Be forensically analytical If possible capture system-wide costs and benefits Engage all key stakeholders If possible test out new processes by piloting Implementing’s not the end of the story, use ‘process ownership’ and benefits realisation to ensure its working

20 What Next? Process Ownership Board: multi-agency –change management –benefits realisation –outcome tracking Re-commissioning of HIA –sub-regional –integration of Assessment Centre with HIA Introduce IT integration Continuation of process mapping – re-housing

21 Questions 0117 352 1975

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