Elaine James Service Manager, Strategic Commissioning Adults Health and Social Care Calderdale Case Study Commissioning Home Care & Developing ISFs

1 Since ancient Egypt (about 3000 BCE or 5000 years ago), there have been about 250–300 human generations; of these, there have been only four to five generations with life expectancies of 60 years or more; of these, about three to four generations have offered prospects of retirement for the average person; and just two to three generations have experienced retirement in good health’ (Ansello, 2012).

Commissioning Home Care Is there a universal magic formula? Is anybody any good at algebra?

Home Care Commissioning Issues Highly prescriptive, short, task oriented visits commissioned which militate against providers’ ability to respond flexibly to the changing needs of service users Inability to promote or maximize independence Need for greater autonomy for providers so that the relationship between providers and individuals becomes paramount rather than the relationship between providers and purchasers which tends to marginalise service users System is so demotivating and dissatisfying for staff that could well be contributing to the current crisis in staff recruitment and retention Lewis J, Sawyer L, 2001 Rediscovering the Community Care Approach. 3

Managed Home Care Market Position 12 Care Providers; 6 preferred providers and 8 spot providers 11,044* weekly home care hours. Slight increase from October, total hours stable at around 11,000 since April ,070* weekly service users. Number of service users increasing; 42 more since April Average care package reduced down to 10 hours 19 minutes. Average package sizes reduced by 27 minutes since April * included people in extra care 4

5 People accessing Home Care & Support

A future model of Support at Home….? Combined community capacity: home care, assistive technology, equipment, housing options, adaptation and some personal care skills Some enhanced health capability, (knowledge of medical risk, medication, ‘fast track’ when needed) Focus on improving mobility (physiotherapy, Occupational Therapy, personal trainers) Focus on improving diet and nutrition (dental?) Delivering social contact to maintain networks of friends/family Welfare benefits and income maximisation 6

Personalisation Engagement Consultation 7

932 People Visited

Personalisation Engagement Team Why the team was set up To tell people that the home care contracts would be changing How this may affect them What options were available to them to take control of their situation. To find out what is important to them about their support From their perspective what makes a good life

What did people tell us? Continuity of Carer Carers arriving on time Being informed when there are changes to my care Being able to easily contact my care provider Feeling in control of my care Other 11

What did people tell us?

Mental Capacity Act 2005

Impact on Micro- Commissioning Behaviours 15

ISF Hourly Costs ISF Hourly rates range from £13 up to £20. However of the 614 clients on an ISF only 21 are paying more than £14 per hour. Home Care standard rate is £13.08

External Home Care and ISF Hours The total number of weekly Home Care And ISF hours commissioned as of June 2015 was 11,538 hpw. 2,875 hpw (25%) were commissioned as managed service provision and 8,663 hpw (75&) through ISF’s

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What are the benefits of the ISF approach? 20

Meet Gary Gary knew what he needed to make him feel safe and happy.... He just didn’t know how to change things.

Collaborating for Better Outcomes 22

Peer Review for Commissioning for Better Outcomes Jan 2016 Clear vision and purpose for social care Mental Capacity Act (2005) is embedded into the culture Commissioning approach is visionary and has at its heart improved outcomes Multiple systems for reablement/ intermediate care/ crisis can be confusing and should be reviewed with health partners ISF is a “jewel” but imperative engage all stakeholders to evolve ISF Version 2 23