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“Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013.

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Presentation on theme: "“Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013."— Presentation transcript:

1 “Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013

2 © AESOP Consortium 2011 | Scottish Care Conference Marriott Hotel, Glasgow 31 st May 2013

3 © AESOP Consortium 2011 | 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?

4 © AESOP Consortium 2011 | Level of Current Satisfaction with Commissioning Effectiveness

5 1.Don’t know because not involved in service usage or service provision 2.Not at all satisfied 3.Quite satisfied but think there is scope for improvement 4.Satisfied (most of the time) 5.None of the above

6 © AESOP Consortium 2011 | 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 ?

7 © AESOP Consortium 2011 | Commissioning/Leadership Levels Individual and family focus with support for carers Personalised commissioning Co-production Customer led – risk management Empowering Approach Respect and Dignity Focus on individuals & family Direct payments Personal Budgets – Health & Social Care Person Centred Co-ordinated Care Outcome Focussed © SBreen Front Line Practitioners Commissioning & Leadership Shaping Quality Markets Senior Managers Commissioning & Leadership Communities of Interests (geography, client group, condition, age etc.) Outcome Focussed Markets offering choice and personalised quality solutions High Customer Satisfaction Predictive Modelling Customer Segmentation Evidenced Based Integrated Solutions Pan Organisations & Cross Boundaries Senior Executive Managers Commissioning & Leadership Facilitating Whole System Solutions Health and Well-being Collective Leadership at Board Level Commissioning & Leadership Focus on Health Inequalities & Health Outcomes for Communities Partnerships Integration Win/Win Risk Management Whole Communities Different Enterprises Aesop Some of the many skills needed Shaping markets; relationship building, integrated strategic commissioning; executive decision making; community based solution finding; organisational leadership; political skills. Whole systems thinking; political skills; Inspirational, adaptive and collective leadership Market management; relationship building; integrated strategic commissioning; empowering creative managers and staff. Risk based assessments; empowering customers; creative solution finding; review and evaluation; contribute to evidence base. Lead Organisation Team Leadership

8 © AESOP Consortium 2011 | 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

9 © AESOP Consortium 2011 | 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

10 © AESOP Consortium 2011 | Demographic change for population aged 65+ Scotland Potential impact on specialist care services hrs Home care 10+ hrs Home care Care Home Cont h/care (hosp) Projection 26 % 94 % P Knight Scottish Government Community Care - Impact

11 © AESOP Consortium 2011 | 9% 24 % 41 % 61 % 84% Calendar year ’07 estimate P Knight Scottish Government

12 © AESOP Consortium 2011 | Working age against total population Macroeconomic Impacts of Demographic Change in Scotland: A Computable General Equilibrium Analysis see

13 © AESOP Consortium 2011 | % increase in older people in England Rapid growth of over 65s in next 10 years

14 © AESOP Consortium 2011 | 34% of the population were 50+ in 2009 – with concentrations in ‘retirement areas’

15 © AESOP Consortium 2011 | By 2029 over 40% of the population will be over 50 - and virtually everywhere in the country will look like current ‘retirement areas’

16 © AESOP Consortium 2011 | 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?

17 © AESOP Consortium 2011 | Experience of different levels and forms of contracting – choose one

18 1.Self Directed support/personal budgets/direct payments 2.Spot Contracts 3.Call off Contracts(block contract with a ‘meter-ticking’ maximum number of hours or contract value) 4.Block contracts with guaranteed contract value 5.None of the above

19 © AESOP Consortium 2011 | Let’s examine the current arrangements

20 1.No opinion because not directly involved 2.No, there not really working in everyone’s best interest 3.Possibly but they might need modification 4.Yes, there’s no clear idea yet of what could replace them 5.None of the above Do you think we should continue with the hierarchy of current contracting arrangements – spot, cost-and- volume, block etc

21 © AESOP Consortium 2011 | 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

22 © AESOP Consortium 2011 |

23 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

24 © AESOP Consortium 2011 | The partners in £ hierarchy Local Acute Trust Community Trust Roving GP Vol Sector Local Authority Private Nursing Home

25 © AESOP Consortium 2011 | A more equal partnership Acute Comm- unity PrivateVoluntary Local Authority Person- centred

26 © AESOP Consortium 2011 | 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...

27 © AESOP Consortium 2011 | Outcome ??  Successful launch 9 th 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

28 © AESOP Consortium 2011 | Is it time to do things differently?

29 1.Don’t know 2.Nothing wrong with what we’re doing now 3.Some improvements are necessary 4.Very Definitely otherwise we wont be here tomorrow 5.None of the above

30 © AESOP Consortium 2011 | Thank you Janet Crampton –

31 “Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013

32 Quality Education for a Healthier Scotland Multidisciplinary Phone a Friend: Preventing Infection in Care at Home Sarah Freeman Educational Projects Manager (HAI) NHS Education for Scotland

33 Quality Education for a Healthier Scotland Multidisciplinary NHS Education for Scotland (NES) 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

34 Quality Education for a Healthier Scotland Multidisciplinary Care Inspectorate Health Protection Scotland Greater Glasgow Council Scottish Care NHS Education for Scotland

35 Quality Education for a Healthier Scotland Multidisciplinary 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

36 Quality Education for a Healthier Scotland Multidisciplinary Standard Infection Control Precautions Media AppPocket Guide

37 Quality Education for a Healthier Scotland Multidisciplinary Question 1

38 How many elements are there in standard infection control precautions?

39 Quality Education for a Healthier Scotland Multidisciplinary

40 Quality Education for a Healthier Scotland Multidisciplinary Find me at your app store

41 Quality Education for a Healthier Scotland Multidisciplinary Question 2

42 What is the missing word? Infection Control is *********** business. 1.The Chief Executive 2.The Care Manager 3.Everybody 4.Care Staff

43 Quality Education for a Healthier Scotland Multidisciplinary Phone a friend about Infection Risks Home PageInfection RisksSpecific Risk

44 Quality Education for a Healthier Scotland Multidisciplinary Phone a friend about SICPs Home PageSICPs Specific SICP

45 Quality Education for a Healthier Scotland Multidisciplinary Educational Governance Structures New Course Launch User statistics and student feedback collected and given to Project Lead. 1 month after launch Project Lead reviews statistics and feedback and makes the necessary changes. Full review of product by Project Lead. 6 months after launch 18 months after launch User statistics and student feedback reviewed. 3 months thereafter

46 Quality Education for a Healthier Scotland Multidisciplinary Question 3

47 How much does Healthcare Associated Infection cost (in financial terms) in Scotland per year in NHS? 1.£183m per year 2.£18m per year 3.£8m per year 4.£1.8m per year

48 Quality Education for a Healthier Scotland Multidisciplinary Other resources available

49 Quality Education for a Healthier Scotland Multidisciplinary Contact Us Further Information hdg

50 Quality Education for a Healthier Scotland Multidisciplinary Question 4

51 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.Do nothing 2.50/50 3.Phone a friend 4.Ask the audience

52 “Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013

53 Self-Directed Support – moving ahead for the Care at Home sector Dr Donald Macaskill

54 2013 is a key year Bill passed its final stage November Became an Act January Regulations and Statutory Guidance published – April Consultation – 12 weeks to early July Enactment and implementation – April People and Partners consultation process Collaborative event 6 th June, Dunfermline

55 Question Which of the following is true: 1.I did not know the SDS Regulations and Guidance had been published. 2.I knew they were out but haven’t got round to reading them. 3.I have read them in brief. 4.I have read them in some detail.

56 Which of the following describes your understanding of the current status with SDS…… 1.I did not know the SDS Regulations and Guidance had been published 2.I knew the SDS Regulations and Guidance were out but haven’t got round to reading them 3.I have read them in brief 4.I have read them in some details

57 What have been the main issues and concerns during our Consultation?

58 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? Some key questions keep arising.

59 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 – Outcomes focussed assessment.

60 Question If you were receiving a service would you like your care at home provider to facilitate you to: 1.Remain as independent for as long as possible? 2.Keep in contact with family and friends 3.Be able to engage in activities and social events 4.Keep me safe and healthy

61 If you were receiving a service would you like your care at home provider or housing support providers to facilitate you to: 1.Remain as independent for as long as possible 2.Keep in contact with family and friends 3.Be able to engage in activities and social events 4.Keep me safe and healthy 5.All of the above

62 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

63 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.

64 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?

65 Question ….Looking at Picture A and Picture B Which would you prefer? AB

66 Looking at picture A and picture B which would you prefer? 1.A 2.B

67 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’. The four options:

68 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.

69 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

70 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?

71 Question Which do you think best ‘promotes’ market diversity?

72 1.A framework aggreement with a selected list of providers on it 2.A website run by an independent organisation 3.A refreshed Care Inspectorate website which listed criteria to look out for in a service as well as gradings

73

74 People as Partners Project as-partners/ Dr Donald Macaskill Tel:

75 “Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013

76 12.15 Care 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 Meal preparation for lunch, assist with continence management Client A Meal preparation for lunch, assist with continence management

77 Quality or Compromise Mel has been out from to arrive at her first call at 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

78 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

79 “Home is Where the Care is ” Annual Conference and Exhibition Glasgow Marriott Hotel Friday 31 st May 2013

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