SUPPORTING PEOPLE TO STAY AT HOME –DOING IT DIFFERENTLY IN WILTSHIRE

Improving outcomes for customers and reducing costsby improving the way we work

• Midsized unitary authority• More than average older people• Pockets of deprivation• 3 acute hospitals• Large number of self funders• 1300 domiciliary care customers• 3000 sheltered housing tenants• 1000 care staff

The Geography of Wiltshire

Voice of the CustomerTop 15 Statements from EVOC

3.45 3.50 3.55 3.60 3.65 3.70 3.75 3.80 3.85 3.90 3.95

I want to speak to someone at the right time for me

I want to keep as active as I can

I want to go outside my home

I want the right to choose how I live my life

I want a simple way to access information and advice

I want to know how much it will cost me

I want to see and talk to people

I want to be able go to the toilet independently

I want good quality information that is easy to access

I want to speak to someone face to face

I want to feel safe

I want to stay at home as long as possible

I want you to be honest with me

I want to be free from abuse

I want help when I am in a crisis

The Customer

Ranked ‘top six’ themes

DESIGN PRINCIPLES

• Fewer providers = strategic partnerships• Developing the workforce = making care work a

valued profession• All services jointly commissioned with the NHS• Assumes most people want to be independent• All services available to the whole population• Support planning – a provider responsibility

MORE DESIGN PRINCIPLES

• All care time limited• Commissioning outcomes not hours• Simplification of processes = reduction in back

office costs• Most people want to stay at home• Strategic partners access care management

database

Help to Live at Home Programme – key elements

• Care and support service• Integrated equipment service• Telecare and response service• Independent support planning and brokerage

service• Right information at the right time

STEP 1Referral &

ContactTake ‘request for help’ and decide how to proceed

STEP 2Statutory

AssessmentCouncil carry out Person centred

assessment, proportionate to level

of need

STEP 3‘Working with You’

Help to manage on their own or what needs to be done together to get them

more independent. Provider delivers initial intensive support and reviews customer

on pre-agreed date against identified outcomes

STEP 4Support Planning

Planning what to do with you and how we can help you.

Provider develops plan with customer, accessing local

community resources

STEP 51st Care Package

Working with you to achieve what was planned. Provider delivers agreed support and will review at

the agreed end date of package

RA

S

HTLAH - High Level Process Overview

• Does this person need a statutory assessment

• Handle Self Assessment

• Would Telecare remove / reduce cost of support?

• Does this person require intensive support?

• Will this person need to contribute to support?

• How many hours would this person need to achieve their outcomes and for how long?

• Does this person just need equipment and be referred to equipment provider?

• What progress is being made towards the agreed outcomes?

• Can we reduce the level of support?• Will this person need another

package of support?

• How can support be delivered for less than the indicative amount?

• When should the next review point be?

• What support is available if a crisis occurs at any point within the plan?

• Would this customer need support out of hours?

• Do we need to adjust level of support / review customer as customer has improved / got worse?

• Can we identify alternative ways to support customer to reduce cost of support?

• How well is the Provider delivering cost effective support plans?

• How well is Provider reducing need for on-going support and achieving outcomes?

• How well is Provider reducing need for on-going support and achieving outcomes?

Council Performance and Contract Monitoring

18,000 10,000

Signposting & Advice

8,000

Equipment6,000

2,000 1,000

No Service Required1,000

Complex Services & Residential Care

2,000

1,000

Care and Support Service - scope

• Personal Care• Reablement including in house service• Housing related support• Intermediate care• Preventive services• Older people and other vulnerable people who

need support to stay at home

EQUIPMENT, TELECARE AND RESPONSE SERVICE• 5 equipment contracts down to 1• Retail outlets and access for self funders• Telecare to replace paid for care where

appropriate• Commissioning telecare response service

Crisis Response, Equipment & Out of Hours Response

CouncilH2L@H Provider

EquipmentProvider(Trusted

Assessors)

Out of HoursCare &Support

CrisisResponseCall Centre

Customer

VCS Retail Outlet(Trusted

Assessors)

Lead Provider owns 24/7 care and support for customerCrisis Response provides the mandatory facility for managing all crisis calls and Telecare triggersEquipment Provider is the mandatory provider for assessing, procuring, delivery, installation and disposal of all equipment (including telecare)Out of Hours care and support for when a visit is required – either a single team managed by Crisis Response or managed by Lead Providers

WHERE WE ARE NOW

• 120 providers down to 4• Transferred 800 customers to new providers• Transferred support planning function to

providers• Appointed equipment provider• Appointed telecare response provider

CURRENT POSITION• Working with strategic partners to develop Help to Live

at Home as a service• Saved £2.6m from procurement• Shadow implementation of payment by outcomes• Electronic monitoring• Independent support planning and brokerage service• Independent financial advice

NEXT STEPS

• Information and advice services• Transfer remaining customers• Promotion and marketing• Residential care