ITEM 6 Home Support Service
North Lanarkshire Council · 21 August 2024
Back to IJB Performance, Finance and Audit Committee — 21 August 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 Item No: 6 SUBJECT: Home Support Service TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser, Chief Officer Adult Social Work Services NL HSCP Author(s) of Report Karen Workman, Senior Manager Adult Social Work DATE: 21 August 2024 1. PURPOSE OF REPORT 1.1 In North Lanarkshire there has been a sustained approach to supporting people to live safely and independently at home, connected to their family, friends and local community for as long as possible. Whilst we have a range of social care supports available to support people in North Lanarkshire, the Home Support Service is key to ensuring that people can remain at home and contributes to the sustained efforts to maintain a positive balance of care in the North Lanarkshire. 1.2 This report will inform the progress on the implementation of the redesign of the Home Support Service which was approved in 2018. It will outline the work that has been undertaken following the recovery from the pandemic focusing on areas such as demand, complexity of support, workforce challenges, new models of delivery from acute setting and changing demographics. This will demonstrate that the model approved in 2018 remains fit for purpose and aligns with the current aims and objectives of the Strategic Commissioning Plan. 1.3 This paper is coming to the Integration Joint Board Performance, Finance and Audit Committee, For Approval: ☐ For Endorsement: ☐ To Note: ☒
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2 2. ROUTE TO THE BOARD This paper has been: Prepared By: Donna Bridges Karen Workman ☒ Reviewed By: Diane Fraser ☒ Endorsed By: ☒ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB PFA Committee: 3.1.1 Acknowledge the developments within Home Support Service and the progress being made to implement the approved operating model. 4. VARIATIONS TO DIRECTIONS? 4.1 This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required. 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 The Health and Social Care Partnership are committed to ensuring individuals who are referred for a needs-based assessment to enhance their daily living get the right support, at the right time and in the right place. To maximise an individual’s independence and resilience, reablement and rehabilitation services are key to this process. 5.2 The plan for the new operating model to deliver Home Support was agreed by the IJB in March 2018. The model was based on the outputs of the Cross−Party Working Group, the advice from support officers and wider officer research, the proposed new model focuses on five major elements: Integrated Model (Discharge to Assess in Localities) Same Day Response/Reablement/First Support (Intensive and time limited) Specialist Teams (e.g. supporting people with frequently changing needs and end of life / Palliative Care) Ongoing Paid Support (allocation of an individual budget to deliver individual outcomes as part of SDS) Quality Assurance (improving standards of care) Yes ☐ No ☒ N/A ☐
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3 5.3 The plan outlined that the Home Support Service was to be a functional model based on two elements; assessment and planning (overall assessment and planning activity or the service) and long-term service delivery which will be referred to as the Living Well Service (providing support to those with complex health and social care needs). 5.4 The implementation of the new operating model commenced prior to the pandemic which included the centralisation of the management and administration of the service. Although elements were progressed, the pandemic had a significant impact on the Services’ ability to fully implement the model. 5.5 In response to the pandemic a number of changes had taken place to enable the service to operate during very challenging circumstances. Social care provision faced considerable workforce challenges as well as significant changes to the way care and support was delivered. To support recovery there was significant investment which was reported through the Winter Planning and Enhanced Support Business Case. The investment in a range of activities including Home Assessment, Reablement and Rehabilitation was key to delivering key elements of prevention and early intervention which accelerated elements of the Home Support model. The success of the new model is also predicated on the investment and delivery of new systems Mosaic and dynamic scheduling system to modernise the service. Following this period of recovery, a review was agreed in 2022 to ensure that the model agreed in 2018 remained fit for purpose. 5.6 This report will outline the work undertaken to engage staff and those who receive services as well as the partnership work that has been undertaken with Home Support Workforce Assessment and Planning Living Well Service Enabling Approach
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4 the Care Inspectorate to improve the quality of service being delivered in North Lanarkshire to improve outcomes for people who need support. 5.7 Report 5.7.1 The service currently supports 2,235 individuals. Data gathered and used to inform changes highlights the significant growth in multi worker visits whereby 33.5% of all visits require two or more workers to support service users at each visit. This upward trajectory (Graph1) displays evidence of some of the challenges that are currently facing the service. Work is in the early stages of exploring single handed care, which will be of significant benefit to the service once this is fully embedded and supported in the future. Graph1 5.7.2 Over the last financial year, the service received 3,800 requests for assistance from people not known to the service. The number of care hours delivered has risen steadily since the pandemic (Graph2) and remains significantly higher than the hours delivered pre covid.
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5 Graph2 5.7.3 Despite the increase in the hours provided, the number of service users have fallen in the corresponding time frame. The service users that are now supported present with more complex health and social care needs. As the number of individuals in the community with complex care needs continues to rise, the requirement for specialist provision becomes more apparent. 5.7.4 North Lanarkshire has, for many years, had a positive balance of care, a term which is used to refer to the balance of support and care available within the community- based settings compared with support within residential settings. This is supported by the continued investment in community – based supports and a long standing commitment to self-directed support. This is underpinned by community support which is co-designed with individuals and their carers/ families. This approach has resulted in a high proportion of individuals remaining at home. 5.7.5 Local Government Benchmarking Figures 2022/23 report that 65% of individuals over the age of 65 with long term needs receiving 10 or more hours of home care per week which is above the Scottish average of 61%. Along with other providers, NLC Home Support Service is a key resource within North Lanarkshire to enabling individuals to remain at home and retain a positive balance of care.
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6 5.7.6 In line with the five key elements outlined by the cross-party working group integrated care remains a priority. The operating model for localities in UHNL HSCP is underpinned by an enabling approach which is being embedded through robust screening, assessment and resource allocation. This approach will ensure that individuals, carers and families have a support plan that is co- designed, with good information, utilising local resources and alternative support which is proportionate. 5.7.7 Assessment and Planning The development of an integrated approach through the establishment of Home Assessment Team working closely with Reablement and Integrated Rehabilitation Team builds on the work to deliver discharge to assess and same day response. This aligns the home support workforce with locality health and social work teams and will provide a range of resources to facilitate assessment and planning. By adopting this approach, it will ensure that when someone needs longer term support it is based on thorough assessment and support planning. This will be for people whose needs are more complex, including end of life care, within their own home. 5.7.8 The performance of both the Home Assessment and Reablement Team demonstrate that consistently more than 50% of people leave without ongoing support. In the last quarter 58% of people left reablement with no services or a reduction. The growing evidence highlights that short term assessment and reablement increases independence and reduces dependency on further care and support. 5.7.9 This work has also contributed to the improved discharge planning at both University Hospital Monklands and University Hospital Wishaw. Ongoing actions to maintain flow are essential to reduce readmissions and demand for long-term care and support, including the sustainability of the Home Support Service. A shift of focus to same day discharge and assessment and rehabilitation at home will improve outcomes and support quicker recovery. 5.7.10 Living Well Service When people need ongoing paid support, it is essential that waiting times are minimal and people have options as to how this will be delivered. Following assessment and support planning, individuals will have the option of NLC home support delivered by the Living Well Service. Supported people can consider how their support is delivered through the 4 options as outlined in the self- directed support legislation. At the point of review, options will be discussed including individual budgets or direct payments which can be used flexibly to meet identified outcomes.
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7 5.7.11 The home support workforce in North Lanarkshire, provides essential support and care to individuals, carers and families. The Living Well Service will continue to provide care and support to individuals who require longer term, planned support. Due to the changing demographics and complexity of individuals requiring support, the workforce will be able to provide a responsive, flexible approach to those with fluctuating needs. 5.7.12 The workforce establishment and structure need to be finalised to allow for the model to be fully operational. This work will be ongoing with business partners and trade unions. 5.7.13 Workforce There are approximately 1,387 staff employed by NLC Home Support Service, with a worker profile of 6% male, 16.99% age 60 and over and 6.48% age 30 and under. This includes Home Support Workers in Reablement, Home Assessment Team, Intensive, Community Alarm and Living Well Service. The management and support roles were reviewed, and a new structure implemented in 2019. These roles support with scheduling visits, carrying out reviews, supervision and training. 5.7.14 Recruitment of Home Support Workers remains a challenge due to the high turnover of staff. However, the recruitment of staff to assessment and planning has been prioritised to support the operational model. 5.7.15 The need for a competent, confident workforce which is supported by a sustainable learning and development programme is key to ensuring safe, high- quality practice by motivated staff. The service has invested in dedicated staff to support learning and development through training, including refresher cycles, and investment in workforce development to provide high quality care. 5.7.16 An overall training plan has been created and has been made available to managers within the service. The plan ensures key activity is progressed including monitoring mandatory training for Home Support Workers as well as. highlighting registration requirements for all staff to deliver quality driven service offering flexibility and focused on service user outcomes. The below Graph 3 provides information relating to the increase of staff members undertaking core training.
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8 Graph 3 5.7.17 The service has been reporting higher levels of absence over the past 12 months which has an impact on service delivery. There is ongoing work with Employee and Policy Officers to review the current situation. 5.7.18 It is important to note that the agreed model intended to deliver a more financially viable service. The budget allocation for 2024-2025 is £48.083m. The shift of resources to focus on prevention and early intervention is essential to assist in managing demand to ensure people get the right support at the right time. There are a number of key actions for the service to create efficiencies and they include the introduction of a dynamic scheduling tool which is a key development. 5.7.19 Dynamic scheduling system Individuals regularly request support and care at key points in the day and this can place pressure on the service. The current shift patterns of staff do not always match with the demand. The dynamic scheduling tool will assist with this but due to the number of different shift patterns that exist it will be necessary to consider how we address this to ensure a more efficient service. 5.7.20 A key aspect of service efficiency and improvement is the implementation of a dynamic scheduling tool to benefit Home Support Workers in the community and for those who schedule and plan work. It is an essential development to aid back-office staff to efficiently and effectively schedule support and adapt quickly with changing needs. The tool is vital due to the current contract with
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9 Advanced/Kirona expiring on 31st October 2024, with no further option to extend as the current product is end of life. Following a procurement exercise Access CM were awarded the contract. 5.7.21 The contract to provide a dynamic scheduling tool will offer a wider range of benefits to staff and service users alike with the ability to produce accurate reports which will help to inform future demand upon the service. The tool will improve consistency, reduce missed visits, and incorporate travel time accurately. For the first time, the service will be able to monitor care delivery in real-time and monitor quality indicators such as punctuality, continuity and service duration. The tool will demonstrate how person-centred support improves quality of life and measures the effectiveness of care delivered. 5.7.22 Work patterns for frontline staff require to be reviewed. This will be essential to ensure any efficiencies arising from the implementation of a dynamic scheduling tool can be implemented. The workforce workstream have identified gaps in service provision that require to be addressed through the review. 5.7.23 Ongoing work continues for data cleansing and transfer as well as identifying training programmes in preparation for the new tool including the implementation of Mosaic (new case management system). 5.8 Engagement 5.8.1 An important aspect in the review of the service model was to involve both staff and individuals who use the service by offering opportunities for them to shape the service by active participation. 5.8.2 Consultation with the workforce and stakeholders was undertaken through a series of events including face to face meetings across all locality areas and surveys to capture views and experiences of the current and future model. During each consultation event operational issues were captured and addressed which included ‘You Said, We Listened’. 5.8.3 Staff highlighted areas for improvement and issues that impacted on their work. They also had the opportunity to explore various options. Common themes reported by staff: Not having enough travel time. Having difficulty contacting their managers. Waiting time for the Out of Hours Service and not always having enough time to undertake required tasks. Impact of current work pattern on continuity and consistency of care including, lack of staff working backshifts, downtime at various points in the day and not having enough staff at peak times resulting in over time being utilised to ensure service delivery.
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10 5.8.4 The engagement with supported people and their cares/ families highlighted recurring themes and included the need for continuity of care with consistency of carers and timing of visits however many reported that carers were respectful and courteous. 5.8.5 Following consultation with the workforce and stakeholders, benchmarking was undertaken with eight local authorities including Renfrewshire, East Dunbartonshire, South Lanarkshire, Inverclyde, Falkirk, Fife and Glasgow to gain a more in-depth knowledge and understanding of other Health and Social Care Partnerships, how they operate and manage Care at Home and Home Support provisions. This included gathering data across key areas of service delivery including preventing hospital admissions, facilitating hospital discharge, managing demand, cost and system. 5.8.6 The information collated has allowed the service to identify best practice and useful learning from others to develop a structure for the Home Support Workforce. A workforce plan is being finalised. 5.9 Improving Quality 5.9.1 The proposed changes will ultimately ensure people have a high quality, safe and compassionate care and support, which is sustainable and maintained across all localities. 5.9.2 The service continues to work closely with the Care Inspectorate to meet requirements and make the improvements that have been identified through the inspection process. Challenges from staff absence and recruitment of appropriately skilled individuals have previously impacted on direct delivery and management teams, however, the service is starting to see an improving picture.
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11 5.9.3 The key issues and risks now arising from inspections are lack of consistency of support, system issues relating to the recording of missed visits and incorporating travel time, lack of training in developmental areas and outdated reviews and personal support plans. Good progress has been made in four of the teams, with two teams being high-risk areas for staffing and performance, particularly in relation to outstanding reviews and personal support plans. Improvement plans have been devised to progress the significant work, which is overseen by the Senior Social Work Manager. The full implementation of a dynamic scheduling tool will reduce missed visits, incorporate accurate travel time (both walking and driving) and improve consistency of scheduled care. 5.9.4 A demonstration has been provided to all Inspection Officers to give an overview of the main project benefits/goals, modules involved and examples of reduction in missed visits, improving efficiency and stronger continuity of care which have been consistently highlighted by the Care Inspectorate as areas for improvement. 5.9.5 The new inspection year commenced in April 2024 and the service has been advised each team will receive a full inspection during follow up visits, and will now involve three inspection officers, with a lead officer identified for each team. In addition, there are plans to conduct a separate review of recruitment processes during 2024, distinct from the ongoing inspections in localities. 6. CONCLUSIONS 6.1 This report outlines the progress that has been made to implement the operating model for the Home Support workforce establishing a functional model. This will focus the workforce on distinct areas and ensure a delineation between assessment and planning and provision. 6.2 The impact of change detailed in the report will improve the quality and consistency of care and support, improve recruitment and retention, address impaired staff morale, improve Care Inspectorate grades and maximise efficiencies and capacity within the service. This will be supported by good governance, clear infrastructure, a skilled workforce and improved culture and environment. 6.3 There has been an incredible amount of work undertaken to ensure that the operating model is fit for purpose and can adapt into the future as we respond to whole system changes. A further update will be provided with the finalised operating model and associated workforce establishment.
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12 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES. Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) The following measures of success have been identified: 7.2.1 Improving the wellbeing of supported people’s outcomes. 7.2.2 Evidence of reablement reducing service users’ dependence on long term home support, working collaboratively with the Assessment and Planning teams to ensure that we continue to support individuals’ independence and rehabilitation. 7.2.3 Improved discharge response from Lanarkshire and Glasgow Hospitals. 7.2.4 Prioritised resources for ongoing longer-term support which will include the upskilling of the home support workforce to support service users with complex health and social care needs within their own homes. 7.2.5 A flexible and responsive service with evidence of improved quality of care, support and service delivery resulting in increased Care Inspectorate grades, staff, and service user satisfaction. 7.2.6 A competent and confident workforce, fully staffed teams with minimal turnover. 7.2.7 Ensure a sustainable financial model.
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13 7.2.8 Have a service which can respond to future demand, with a workforce that can provide a flexible, responsive, outcome-based approach to supporting people at home. 7.3 FINANCIAL 7.3.1 Currently working with Finance Business Partners to determine any financial implications to implement the operating model and associated structure. This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Choose an item. 7.5 ENGAGEMENT & PARTICIPATION 7.5.1 Engagement and participation with all stakeholders are of utmost importance for this piece of work. As such a detailed communication and engagement plan is being developed to ensure that all stakeholders are kept informed throughout the remainder of this project. 7.5.2 Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Events to be arranged for staff, service users and all relevant stakeholders. ☒ Provide stakeholders with information on how to get involved Information leaflets to be issued/ quarterly information bulletins. ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Questionnaires will be issued. ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Information will be provided bi- monthly in the form of newsletters
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14 ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Tablets are available at the events where a survey can be completed (QR codes available). ☒ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A 8. BACKGROUND PAPERS N/A 9. APPENDICES None. Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Karen Workman, Service Manager Adult Social Work. workmank@northlan.gov.uk
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15 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-06 2 Report Title Home Support Service 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed