Transforming Domiciliary Care

The Service User Comes First

With domiciliary care under the spotlight, an innovative new approach to care brokerage is helping Herefordshire Council ensure its users are receiving the full care it pays for. Rather than squeeze suppliers and put new obstacles in the way of care workers, this is a solution designed to stimulate and grow a mature market by helping partners improve service levels and develop best practice for carers. Ultimately though, it is the service user who will come first, with numerous enhancements over previous provision and cost-efficiencies that will enable new investment.

When looking to put the service user first in Hereford’s Adult Social Care service, Wendy Fabbro, Head of Integrated Commissioning at Hereford Council recognised that specialist skills needed to be brought in to deliver the substantial change programme required. She turned to Tom Bright, a Senior Consultant at Practicus, as someone experienced in providing support to local authorities and the NHS, and who could help her find someone with the skills needed to drive this initiative in an increasingly difficult environment.

The relationship between Herefordshire Council and the local independent service providers had begun to degrade because of the scale of proposed change, and someone with extensive experience of promoting co-operation and improving service provision in Adult Care was required. Tom quickly identified Martyn as the ideal person for this project, who was then engaged to investigate three core areas around continuous improvement, increased capacity and a review of the brokerage process to ensure value for money was being achieved.

Working with internal experts across the Council, Martyn agreed three project strands with Wendy that focused on Care Brokerage, Fair Pricing Tools and Electronic Monitoring Systems. It was agreed that if the Council could make progress with local providers in these areas, there would be benefits realised by all parties involved.

What happened?

Martyn initially concentrated on improving the relationship with external providers, which had suffered due to the high levels of uncertainty and fear around the direction domiciliary care might take. This was soon resolved through a series of workshops that brought together providers and council employees to discuss the issues they shared, and provided a forum in which they could air problems and solve them together rather than letting them fester through lack of communication. Through a simple approach to project management everyone was able to more definitively identify their role, and this injected some real energy into the project. Indeed, this proved to be a critical part of the project – a renewed enthusiasm and passion was instilled in everyone involved from strand leads to local providers.

An investigation into other local authorities’ pricing strategies revealed a fair pricing tool provided by the Home Care Association, and six local providers worked with the council to test the tool and highlight areas where improvements could be made. This entailed a significant amount of trust as local providers operated an open book approach enabling the council to see all of the internal workings of their businesses.

Two providers of Electronic Monitoring Systems, Panztel and CM2000, were engaged to provide a trial which would see four providers work with their Service Users, their Care Workers, the Council and providers’ own staff to see what improvements in service provision could be achieved. This effectively meant that internal processes would be reviewed at local providers with rostering being a possible improvement area. It also meant that ‘call cramming’ would not be encouraged as carers would highlight their arrival and departure from service users’ houses through simple systems. In short, Herefordshire Council and the providers could satisfy themselves that the service user was receiving the service required in terms of time that carers also had lone worker protection and that providers were paid for what they delivered. Additionally, CACI were given the opportunity to highlight how their system might be applied through site visits to Barnsley Council and their offices in Twickenham.

To address the issues associated with Care Brokerage, providers and council brokerage teams worked together to redesign the processes which take place in the provision of a care package. This involved the development of a matrix which considered how independent providers were seeking to develop their business and specialisms, how they developed their staff, and more importantly, how they assessed quality and sought to improve it. Additionally, working with the Commissioning Manager and Broker it was possible to identify how to improve processes to save a day in the commissioning cycle, with real possibilities and real time placement in future. Capacity identification on a weekly basis was also agreed, and although not by any means easy, three providers agreed to trial the new processes over a three month period.

One of the key elements of the work commissioned by Wendy was that the project was designed to improve partnership working and enhancement of services for users, and not to squeeze the local market. Although considerable savings were made, they were not at the cost of providers or service users.

What were the results?

Through Practicus’ and Wendy’s assessment of the council’s requirements, Martyn was quickly able to work with both the Council teams and local providers to build trust and respect, and to focus on the most important group affected by the project – the service user.

Herefordshire Council and the providers have now reached a situation where they have three trials in place that will enable them to deliver an improved service to users. This project has delivered several sustainable benefits, including a more trusting and professional relationship between council and provider, a re-invigorated local health economy and improvements around service delivery, operations management and delivery of care packages.

Wendy has experienced the difference between consultancy and interim management, and has seen the benefit of carefully researching, articulating and implementing the needs of the project. More importantly, Wendy has demonstrated that putting the service user at the heart of everything is the most important factor in the success of initiatives in Adult Social Care.

You can find more information on our work with this organisation and on similar initiatives by contacting us.