The Vale of Glamorgan Council

Healthy Living and Social Care Scrutiny Committee: 15th May 2018

Report of the Director of Social Services

'Your Choice' - A New Approach to Commissioning Outcome-Focused Care and Support at Home

Purpose of the Report

To update Scrutiny Committee on the progress of the 'Your Choice' Pilot.
To seek support of the planned extension of the 'Your Choice' outcome-focused care and support at home pilot to encompass all domiciliary care agencies within the Vale of Glamorgan.

Recommendations

It is recommended that Scrutiny:

Notes the progress of the 'Your Choice' pilot.
Support the roll out of the 'Your Choice' outcome-focused care and support at home to all adults who use domiciliary care services in the Vale of Glamorgan.

Reason for the Recommendations

1&2 The Vale of Glamorgan Adult Services division set up a pilot in January 2017 to test an approach to commissioning care at home, focused around personal outcomes rather than a traditional care timetable. Through the Vale of Glamorgan domiciliary care providers' forum, we identified a single local domiciliary care agency to provide the care to facilitate the pilot. Throughout the pilot we have seen:

benefits to the wellbeing of the people using the service, as they have more control over the care that they receive to meet their needs in a manner that matters to them;
that people have used 'Your Choice' in very discerning and creative ways that have unlocked new opportunities for them at no additional cost to the authority;
benefits to the social work teams in terms of a reduced administrative burden due to less minor changes being required to care timetables;
benefits to the care agency in terms of job satisfaction for the care workers leading to improved staff retention.

Background

The Social Services and Wellbeing (Wales) Act 2014 places a duty on Local Authorities to work in partnership with citizens and/or their representative to identify their eligible needs and then to plan and meet their needs in a manner that matters to them. This is called Outcome Focused Practice.
Prior to 'Your Choice', a social worker would have an outcome focused conversation during the assessment, and produce a Care and Support Plan that would meet the person's needs and personal outcomes in that moment. This is then set for up to 12 months until the annual review. This did not allow for any flexibility in the way the care is delivered, particularly when a person's needs changed as that required a social work review to produce a new Care and Support Plan and potentially requiring a new care provider. This activity can take a number of weeks to organise and create uncertainty for the person receiving the care.
'Your Choice' enables greater flexibility so that a person can choose to amend their care to meet their outcomes from week to week in negotiation with the care provider. 'Your Choice' focuses on the personal outcomes rather than particular care tasks which can be negotiated between the person receiving care and the care provider without social work involvement. This is achieved by the social worker developing a 'Your Choice Care Bundle' rather than a care timetable (previously outlining times and tasks).
The 'Your Choice Care Bundle' consists of the total number of weekly hours that the social worker has assessed that a person will need in order to meet their eligible needs for care and support at home, in a manner that meets their personal outcomes. It is important to note that the 'Your Choice Care Bundle' of hours is not designed to deliver services that sit outside of an individual's eligible need or risk assessment.
'Your Choice' sets up a more equal and trusting relationship between the person receiving care, the social worker and the care agency Introduction Meeting. To this end, 'Your Choice' provides an 'Introductory Meeting' between all three parties where the person's eligible needs are reiterated, personal outcomes are confirmed and the Care and Support Plan is completed to inform the ongoing care.
In line with domiciliary care regulations, 'Your Choice' provides for a 13 week monitoring programme, where a senior social worker or social work manager will meet with a linked care agency to review all the people receiving care from that agency. The purpose of this meeting is to authorise any changes to the care bundle with an 8% tolerance and to provide an early warning for people whose care needs are not being met within the care bundle due to a change in need or circumstance. In this instance the person will be prioritised for a re-assessment.

Relevant Issues and Options

With the intention of removing barriers to flexibility, 'Your Choice' introduces a 'blended hourly rate' for care at home that entirely replaces previous differential rates for part hour care calls, full hour care calls and weekends/bank holidays. The blended rate is an average of the different rates extrapolated over the care agency's case load.
To support the roll out to all domiciliary care agencies in the Vale of Glamorgan, Adult Services has commissioned an E-learning module that will be accessible via internet or mobile app to all care-workers working in the sector across the county. The E-Learning module will raise awareness of outcome-focused practice and support positive risk assessments to develop care-workers' competence in creative and inspirational outcome focused conversations.
'Your Choice' has also been shortlisted for a Social Care Wales National Accolade.

Resource Implications (Financial and Employment)

Domiciliary care forms a significant proportion of the overall spend that the Vale of Glamorgan Council makes in the provision of Care and Support to adults. Although we would strive for this initiative to be cost-neutral, we recognise that the domiciliary care sector would anticipate an increase in rates. We have completed financial modelling based on UK Home Care Association recommended hourly rates that would mean an increase in overall community care commitments.
Throughout the pilot, we have seen that as people take more ownership of their care hours they have become more discerning in their use of care. In fact throughout the 15 months of the pilot the total number of care hours needed has reduced, which is in contrast with the wider population receiving traditional domiciliary care where it has increased.

Sustainability and Climate Change Implications

There are no sustainability or climate change implications of this Policy.

Legal Implications (to Include Human Rights Implications)

Your Choice is delivered within the spirit of the Social Services and Wellbeing (Wales) Act 2014.
Your Choice promotes people's Article 8 Human Rights.

Crime and Disorder Implications

There are no crime and disorder implications as a direct result of this Policy.

Equal Opportunities Implications (to include Welsh Language issues)

It is anticipated that all adults living within the Vale of Glamorgan with eligible needs for care and support at home will be able to access Your Choice Care at Home.

Corporate/Service Objectives

The work outlined in this report addresses the following corporate objectives outlined in the Corporate Plan 2016-2020:

Wellbeing Outcome 4: An Active and Healthy Vale.
Objective 8: Safeguarding those who are vulnerable and promote independent living.

Policy Framework and Budget

This is a matter for Executive decision.

Consultation (including Ward Member Consultation)

There are no matters in this report that relate solely to an individual ward.

Relevant Scrutiny Committee

Healthy Living and Social Care.

Background Papers

'Your Choice' Policy

Your Choice Social Care Wales Accolade Application

Contact Officer

Andrew Cole, Operational Manager - Localities

Officers Consulted

Suzanne Clifton, Head of Adults Services

Gaynor Jones, Operational Manager - Commissioning and Information

Carolyn Michael, Operational Manager - Accountancy.

Responsible Officer:

Lance Carver, Director of Social Services