BETTER LIVES The Ealing Way

Transcription

1 Appendix 1 BETTER LIVES The Ealing Way Keeping residents physically and mentally healthy, active & independent September 2017 HASSP 1

2 Key Questions What was the Challenge why do we need to change? What are we trying to do? How did we develop these plans? How will we assist Ealing residents to have Better Lives? What will Better Lives look like? 2

3 Background Adults Services has a strong track record in delivering change Care Act, Personalisation and Integration 7,000 residents in the care and support system Increasing challenges require transformation of how we work Financial pressures on social care nationally recognised Increasing demand hospital discharges, deprivation of liberty, people living longer Wider statutory responsibilities Care Act Inflation pressures national living wage, market supply Demographic pressures ageing population, complex care needs 3

4 Development of the Plans We reviewed the steps in the customer journey to see how we could improve outcomes for our residents: Benchmarking against our neighbours Case reviews of 57 cases across Older Adults, Learning and Physical Disabilities Observations across a range of services: Contact Centre, Homeward, Hospital Assessment Team, Learning Disabilities, Physical Disabilities, Reablement identifying good work and areas for development Review of the customer journey Cross cutting work on: data, communications, culture change, commissioning Identified opportunities to influence avoidable demand 4

5 Opportunity Areas Ealing has system intervention opportunities at each step of the customer journey Community Offer Front Door Hospital Discharge Early Help Assessment, Review, and Support Planning Stronger precontact to reduce demand coming into the Contact Centre and reduce hospital admissions Diverting and resolving more contacts at Contact Centre Better management of health routes into ASC to ensure more appropriate support for clients, and best use of Using OT and AT to substitute for and reduce long term care packages Increased use of early help and short term solutions, including reablement, to prevent/delay/ reduce care packages Outcomes focused service planning which better leverages community assets Client reviews target maximising independence 5

6 Aims of the Programme Better Lives is a cultural and behaviour focused change programme designed to address the underlying demand that is contributing to the overspend in the service, and so return Adult Social Care to a sustainable financial footing whilst improving outcomes for residents. At each stage of the customer journey, we will focus on the outcomes people want to help them remain physically and mentally healthy, active and independent as possible. Our staff will concentrate on enabling people to live as independently as possible in their own communities. We will listen to people to understand their strengths and aspirations, and we will support their families and carers where it is needed. 6

7 How will we change Adults Social Care to deliver Better Lives the Ealing Way? COMMUNITY CONNECTIONS FIRST CONTACT EARLY HELP ASSESSMENTS ONGOING SUPPORT KEEPING IN TOUCH We will work together to build a stronger, more Connected Community which enables people to be physically and mentally healthy, active and independent We will strengthen the skills and expertise available in First Contact and improve our response, providing better signposting, quality advice and guidance and linking people to the Community We will provide Early Help where possible to keep people physically and mentally healthy, active and independent and connected to their Community We will do straightforward assessments of people s strengths and needs to inform the provision of appropriate support. We will provide Ongoing Support which responds to people s strengths and goals, working with carers and Community Connections to enable them to be active and independent. We will Keep in Touch more frequently to make sure people are getting the right support at the right time to remain active and independent as their lives change. 7

8 Strengths Based Assessment is at the heart of Better Lives 8

9 Strengths Based Assessment is at the heart of Better Lives 9

10 Pilot/Innovation Staff survey: At the end of the three weeks staff had experienced an improvement in the majority of areas in both their confidence and frequency of working in Strengths- Based Approaches 10

11 Key messages 11

12 Key messages 12

13 Changes in Volume and Flow Better Lives has set the following level of ambition 5% increase in uptake of community offer services 7.4% reduction in contacts to Front Door 18.7% reduction in referrals 5% reduction in referrals from hospital to assessment 10% reduction in unit cost of assessments (i.e. assessment takes less time) 52.5% increase in reviews 13

14 Changes in Cost Better Lives has set the following targets: The level of ambition set is to reduce spend by 16m by 19/20. Continue to save 3.3m through other non demand led activities Estimates 4m of investment spread over three years to deliver this change. On current modelling which includes demographic change, there remains a forecast 7m variance to budget by 19/20. Still need to explore more options 14

15 Indicative Investment Areas Area Staff capacity External consultancy support for programme Potential Investment requirements Temporary or permanent staff may be required to create sufficient capacity to enable changes (either during transition period, or longer term to free up senior capacity for scrutiny and support). Existing budgeted vacancies will be included in this assessment. Provide expertise and capacity to support delivery of this transformation programme from September 17 to August Commissioning services new Ongoing cost of newly commissioned services, such as expanded community and low-level support offer and the pro-active front door Programme Management Office Finance and performance monitoring resource Workforce development and HR support IT input (e.g. form development) Resource required to run the programme management office during the programme, building on existing business support in place. Development time / IT resource for new forms; extra staff resource to enhance finance and performance monitoring and reporting function. Workforce planning; additional resource for training; recruitment to new posts; continuing professional development resource to enhance and maintain staff skills around strengths based assessments Development of new assessment forms; new processes at front door, assessment and review; further systems changes to allow greater efficiency and effectiveness of decision making. 15

16 Better Lives Workstream Leads Corporate and Member Oversight Better Lives Programme Board (Chaired by Executive Director) Programme Managament & Enablers Adenike Tileray Community & Low-Level Suport Front Door Assessment & Review Health Interface Commissioning, Brokerage & Finance Kim Carey Kim Carey Cheryl Batt Jacky Yates Cath Attlee 16

17 Better Lives Phasing 17

18 Better Lives Programme Delivery 25 Projects, organised into the 6 workstreams Phased delivery from September 2017 Each project managed through four phases Co-design and planning - Identifying scope, planning, baselining and defining benefits realisation framework Deployment - Early implementers, trial and adaptation, evaluation and go/no-go decision Scaling - Roll out, scale up and embed Exit End of project and transition to business as usual. 18

19 Workstreams and Projects Community Connections Front Door Assessments and Review Health Interface Commissioning/ Brokerage & Finance Programme Management and Enablers Maximise use of existing offer Setting expectations Forms and Process D2A & DTOC Commissioned capacity The Ealing Way Develop the offer Effective Front Door Behaviours & Tools TBC with CCG Income - Financial assessment and debt recovery Financial Grip Expand reablement and low level support Efficient Front Door Targeted review programmes Reducing avoidable admissions Cost management Programme Management Proactive Front Door Improved carer support Provider management & outcome based commissioning Finance and Performance IT / Systems / Digital Workforce Communications 19

20 Better Lives Programme Monitoring The indicator set is built to show the influence of each workstream on the eventual outcomes in terms of finance and client experience Programme Indicators Flow Indicators Volume Indicators Financial Indicators Outcomes Indicators Quality & Behaviour Indicators 1. Programme Indicators show progress against key programme activities and milestones 2. Flow Indicators show the current flow of demand into and through the system, and how the programme is changing this 3. Volume Indicators show the effect this has on the total number of packages, which is the biggest cost driver in the system 4. Financial Indicators show the effect this is having on costs for the Council 5. Outcomes Indicators show the effect this is having on service users 6. Quality & Behaviour Indicators show the change in quality of work and staff engagement 20

21 Better Lives Success Factors The model sets a level of ambition The model includes some assumptions and exclusions - Influenceable demand - Assumptions about demographic growth - Project trajectories achieved - What the baseline will be by the end of the year - Excludes inflation on cost of care Strength of the wider community offer/connections Culture and behaviour sustaining change in practice How much influence we can have on existing long term support Managing NHS pressures / agendas to support swift and effective discharge in conjunction with demand management Capacity to deliver large scale programme Ability to track progress, impact on financial position and outcomes Further actions to balance the budget Mitigate risk of unintended but counterproductive impacts of other programmes/agendas 21

22 Current Priorities and Next Steps Programme approval Governance structures Launch event end of September Stakeholder engagement Programme management Building on the trials undertaken over the summer Project planning and resourcing Developing the Finance and Performance Measures Early mobilisation of priority projects: Community support Forms review Behaviours around assessment Hospital Pathway Review programmes 22