Agenda item

Nathan Atkinson, Assistant Director Strategic Commissioning, and Scott Clayton, Performance and Quality Team Manager

Further to Minute No. 20 of 28^th July, 2016, Nathan Atkinson, Assistant Director Strategic Commissioning, presented the Q2 Local Measures performance together with the 4 existing Corporate Plan measures.

The report set out the current performance challenges as at 30th September, 2016, which included:-

LM01 – Reviews

LM02 – Support plans % issued

LM03 – Waiting times assessments

LM04 – Waiting times care packages

LM05-07 – commissioning KLOE’s

LM08 (CP2.B3) – Number of people provided with information and advice first point of contact (to prevent service need)

LM09 (CP2.B5) – Number of carers assessments (only adult carers and not including young carers)

LM10 (CP2.B7) – Number of admissions to residential rehabilitation beds (intermediate care)

LM11 (CPS.B9c) - % spend on residential and community placements new measure 2016/17

Discussion ensued with the following issues raised/highlighted:-

-          How would the model currently being put together link into budget pressures and budget savings?  If the performance improved what kind of budget savings would that give against requiring the same amount of investment?  If so, would you be able to re-direct that investment across Adult Social Care or would it have to be shared across all the portfolios? In terms of re-investment, a purpose of the consultation was to look at where finances needed to be realigned.  Investment would need to be moved around but there was not much slack in the system.  The savings were challenging but were deliverable, therefore, it had to be ensured that the intelligence and knowledge arising from the Performance Team and Liquid Logic were used to ensure that any issues were addressed quickly.

-          If performance was falling where would that sit against the budget pressures within the model and into 2017/18 and beyond?  The key for performance was improved assessments/re-assessments.  In order to make any change in Social Care it was reliant upon re-assessment and the review process formed part of that.  The Service needed to ensure there were good quality assessments that were strength based, considered all the options, and not just statutory services, and ensure that they had longevity and were of good quality.  In the past there had been a tendency to look at numbers rather than quality. 

Care Act assessments were a much longer process than previously, if done properly, looking at the person centred approach with long conversations with the individual about what they required, what the person could do rather than what they could not do as well as a built-in time period for reflection.  There was a need, from a workforce point of view, for considerable development in embracing and embedding the principles.  Online Care Act training had been purchased as well as further workforce development initiatives.

There also had to be good solutions and services for people.  Some of the work being doing around the strategies was developmental but the challenge was that in some areas there was not a great amount of choice.  There were things out there that may be a more community focussed than perhaps a statutory service.

-          What was LM04 (waiting times care packages)?  It was tracking those customers who were on a package of care and whether they had been reviewed at least once in a year.  Currently it was tracking at just below 21% opposed to the target set of a minimum of 75%.  Ordinarily there would be approximately 6,000 people on service during a year.  LM04 looked at the sub-set of those 6,000 which had been on service for longer than 12 months and asked how many had been reviewed.  The figures revealed that the Service was not getting through the pace of those numbers as it had been in the past some of which was due to the process of the Care Act and the length of time that took but also the changes in the Service and having the Teams and resources in the right place at the right time which had not happened as quickly as anticipated.  Liquid Logic had also had an impact with staff having time out to learn the new systems.

-          Was there an action plan in place for LM04?  It was clear that the Service would not reach the 75% aspiration target but it was hoped to achieve 40% by year end.  It was hoped that some of the improvements being put into place referred to earlier, better demand management and meeting needs in other ways, would result in a reduction in numbers.  It was hoped 2017/18, when Liquid Logic had been embedded and the new structure settled, would see improved performance.

-          We need to be assured it would happen and when it would happen?  In terms of the slippage, there was now improved project management by the Adult Social Care Development Board where the majority of the data would be scrutinised.  It did not mean that customers were not getting services but not ensuring people received the right service through the assessment.

-          What was LM10 (number of admissions to residential rehabilitation beds (intermediate care)?  It was a measure that looked at the activity throughput of intermediate care as a joint service with the CCG.  The numbers were increasing but in line with what had been provided in the past.  It would suggest that the provision rate was right for meeting the current level of demand.

-          It had been stated that with regard to meeting assessment targets that there may be other ways used to conduct an assessment other than face-to-face.  In the days of more and more people using Services that were not inhouse, using Direct Payment to employ someone or even reliant upon family to provide care, if there was not that face-to-face contact some quite serious safeguarding issues might be missed.  What exactly was being done to address that?  For clarity any opportunity for remodelling some of the delivery and not being face-to-face contact would primarily refer to people on review.  For a new person coming into the Service it would almost certainly come from the single point of assessment, contact be made and be seen by a worker face-to-face.  If moves were made to discontinue face-to-face contact, it would have to be ensured that the relevant safeguards were in place to avoid the situations highlighted.

-          There were times when a person they might be able to say something to a Social Worker in a private context or a Social Worker might see something.  The lack of face-to-face contact would take that away that opportunity –  The Service would devise a range of different models to actually undertake the number of reviews.  They would have to carefully select which target groups were suitable for that range of different models and also put in place the fallback positions of when people felt that they needed to refer back into Service that they were seen, followed up and receive face-to-face contact.  Previously, when consideration had been given to options, the Service put mechanisms in place whereby sometimes either provider reviews or telephone reviews had been done.  The next step would always be that the next year the person would be seen face-to-face so there was not a continuum of that particular model of delivery.  It may have to be included in the quality assurance side of any model proposed if moving away from face-to-face 100%.

-          That would be more acceptable if the person had a telephone review in November/December and was then seen face-to-face at the beginning of the new financial year rather than waiting a full year without seeing anyone.  This would be fed into the Service as a suggested model for consideration.

-          LM05 and 6 (commissioning KLOEs) – how were these measured and what evidence supported the improvements?   It was a self-assessment so open to interpretation.  In terms of the standards there were 3 themes and within that a number of domains:-

(1)  Person centred and outcome focussed provision

- Is the work you are doing starting with your outcome and working backwards and is it person centred?

- Is it being co-produced with Service users, carers and the wider community?

In the past a lot of the focus had been devising a specification with a small select group of officers, not spending time co-producing it with those in receipt of services and interested parties and losing sight of the outcomes.  Some of the recent activity around Learning Disability and the work embarked on Autism, Carers and start of discussions with Older Peoples’ Groups about developing an Older Person’s Strategy, all pointed towards a move to co-produced models and very much part of the mission within Commissioning to ensure that it was embedded in everything it did.

The person centred approach was not only mandatory through the Care Act but also a moral duty.

(2)  Well-led

The direction of travel on leadership was coming from Elected Members, the Chief Executive through the SLT, the Strategic Director of Adult Services and Housing, Assistant Director of Commissioning and the Head of Health and Wellbeing, and staff appreciated that there was a lot more clarity about what the Services was trying to do.  Commissioning was more prominent in people’s knowledge in terms of the role it played and what was required to get good quality services for people.  It was a whole system approach about how it interacted with other services.

Evidence bases – As funding became tighter it had to be invested wisely so consideration was being given to developing new services.  If other authorities had something working well in their area, with evidence behind it, it would be considered. 

(3)  Promotes sustainable and diverse market

At the moment Rotherham did not have a diverse market and in some areas the sustainability was questionable.

Developing and providing for value for money.  It was known that some of the Authority’s legacy services did not offer value for money and needed to renegotiate prices and think about what to/what not to invest in.

The Authority had historically been good at engaging with providers and had been embedded within the Commissioning function for some time.  However, it had been limited to certain disciplines and cohorts, mainly learning disability and older people.  It would be looked to widening it out to all the people supported in the Borough.

-          Concern that the Leadership Team in 2015 judged itself practically as being in the “red” and the Leadership Team in place as of now judged itself as being in the “green”.  It did not seem to be the best measure.  – When the Assistant Director for Commissioning had first come into post, a self-assessment had taken place.  At that time there had not been any current commissioning strategies, no market position statement and very limited information on the people it supported.  Within the proceeding period quite significant progress had been made.  It was a matter of debate whether “amber” or “green” but certainly in a much better place than when the initial assessment was conducted in June/July, 2016.

Resolved:-  (1)  That the report be noted.

(2)  That quarterly reports are submitted to the Commission for information and decision as to whether any immediate further scrutiny was necessary.

(3)  That performance on measures LM01-04 for October to December be reported to the Commission in January as part of the update on the Adult Social Care transformation.

(4)  That the minutes of the performance clinic held in July be circulated to Select Commission Members.