The need for care and support is minimised and the escalation of need is prevented, whilst ensuring that the best possible outcomes for people are achieved
Putting individuals at the heart of our Older People services
Our Older People Domiciliary Care project is still underway, with the aim of ensuring that the services we commission are more outcome-focused and promote the principles of voice, choice and control for the service user. As part of this work we also want to support and build a more robust domiciliary service for the future and enable a more integrated and supported working approach with our providers. We are therefore moving away from commissioning services that are time- and task-focused to commissioning services which are outcome-focused and more person-centred.
To support our teams we have produced a staff guidance document to explain and support the delivery of the new model, and a new policy in relation to positive risk-taking which sets out our approach to strengths-based and person-centred practice.
A series of joint training sessions were arranged for internal commissioning staff and for external care provider staff to increase and ensure a joint understanding of outcome-focused working. We’ve also undertaken a review of all our internal processes, from referral to quality standards and assurance. As a result, we have made some improvements to our client information system processes, making them more efficient, lean, and fit for purpose.
This new commissioning model will be rolled out across all of our community resource teams (CRTs), one by one. Each area will be assigned a group of preferred providers who will be paid on a block contract basis, rather than with spot contracts. The size of the block contracts will be based on current commissioning activity and will be increased or decreased as necessary. A new, refined Service Specification document has been created in consultation with the providers who will become an intrinsic part of the CRT. They’ll have access to the multi-disciplinary team to discuss cases, and seek support when issues or problems arise, to prevent escalation of problems. The invoicing process has now been simplified, as providers need only submit one invoice weekly or monthly for the block amount, not multiple invoices for each client.
Since the first phase of the roll-out of the project only occurred on 29 January 2023, it is too early as yet to report on specific case studies, but the progress of the first roll-out will be subject to regular and robust monitoring and reviewing.
What were the challenges?
The current staffing pressures across the whole care sector have made this project challenging, and the go-live date for the proposed changes has slipped several times as a result.
Whilst there is a lot of support and enthusiasm for the proposed changes in the domiciliary care sector locally, it is fair to say that, despite everyone claiming to already be working in an outcome-focused way, actually putting the theory into practice will prove challenging, both for commissioning and provider staff.
As referenced previously, the plan is to roll out the model via a phased approach on a CRT by CRT basis.
The Abergele CRT went live on 29 January 2023 and progress will be reviewed on a regular basis. Once the model is established there, we will then move on to the next CRT area.
Preventative work within our Community Wellbeing Service
This service comprises a number of teams who work with individuals at an early stage to help them keep their independence, access community-based service and activities, and stay safe in their own homes.
Our Occupational Therapy Intake Team have continued to visit people with lower level needs at home, to provide equipment and minor adaptations, such as grab rails. These items help to prevent falls and support people to continue living independently at home, lessening the likelihood of reliance on long-term services.
The Telecare service now provides an online form where people can sign up for the service easily and quickly. Having a Telecare Service which is connected to the monitoring service, Galw Gofal, gives people, and their families, peace of mind that they can call for help should they need to.
In light of the cost of living crisis, the Welfare Rights Team have attended Warm Welcome events and been proactive in advising people regarding winter fuel payments and other benefits in a bid to help people maximise their income sooner rather than later. The team has also helped people with unpaid carer grant applications, in particular those who are unable to access the internet when online applications have been the only option. The team continues to assist Conwy residents in maximising their income by ensuring they are claiming the welfare benefits they are entitled to.
The Community Wellbeing Team have continued to work within our communities to ensure our residents over 65 years of age have a voice in developing the activities offered in their geographical area. The team continues to assist people to increase their activity and reduce isolation, thus enabling them to live happier, healthier lives.
The Community Equipment Stores have continued to provide a five-day week service to Conwy residents, including throughout the pandemic, helping to reduce or delay hospital admissions and enabling hospital discharge. This is a key function for the team to ensure the Authority is responding to the regional pressures on hospital, wider health, and ambulance services.
Our Single Point of Access Team (SPoA) continue to provide a front door service for Adult Social Care. Processes are continually appraised and adapted to meet demands across many referral sources. This year these have included a change in how to manage requests for carers’ assessments to reduce the pressure on our internal Carers Team. We have also spent time assessing the essential daily tasks within the team to reduce the risk of backlogs occurring in any one specific area of work. We have adapted our daily rota to ensure all tasks are covered sufficiently and determine which tasks take priority when staffing capacity is below the minimum required. These changes have resulted in better management of the inbox and phone lines.
What were the challenges?
Demand on our service and teams is often greater than what we are able to deliver. When there is a waiting list of people wishing to access our services, we always prioritise the most vulnerable people first.
Staffing capacity throughout the section due to both long- and short-term absences and vacancies have added significant pressure to remaining staff and managers, and we have increased line manager and human resources support during this time.
Fixed-term contracts due to grant-funding cause stress for staff awaiting the outcome of future funding decisions. This creates the risk of losing experienced staff to permanent roles elsewhere.
The introduction of hybrid working, where staff work partly from home and partly from the office, has caused pressure for managers dealing with staff who are reluctant to return to the office for a portion of their working week. We continue to work with these staff to encourage their return.
We will be looking to further integrate our Occupational Therapy Intake and Telecare functions to develop more resilience in times of staff leave, or when we have vacancies.
We’ll review the other teams within our Information, Advice and Assistance section and identify areas for improvement, especially in terms of resilience.
We’ll continue to support our staff to manage absence and start to work from the office again.
Upgrading our Telecare equipment
During this year the Telecare Service has worked closely with Community Equipment Stores to progress the provision of digital monitoring units to customers who have new digital telephone connections. We have continued to provide some ‘smart’ and specialist equipment to help support people at home using technology. For example, GPS devices can help people with early-onset dementia, and epilepsy alarms can give peace of mind to people living with the condition. In many cases these devices can give people independence and the confidence to continue living at home and accessing their communities.
What were the challenges?
We have faced some challenges around staff shortages in both our administrative and installer teams, but we’ve continued to prioritise urgent referrals and faults for people most at risk.
We need to understand how the digital agenda will be fully implemented in Conwy. Regional and national discussions are taking place regarding logistics and funding.
The coming year will see the Conwy Telecare Team continue to roll out the digital monitoring units in a phased and controlled way, keeping a close eye on any issues that arise so as to provide appropriate devices according to people’s needs, according to best practice.
We are currently developing an assessment flat with the disability Early Intervention and Prevention Team which will eventually be a place where service users can see Telecare and Smart technology on show in a ‘similar-to-home’ environment. This will give people the chance to try out the equipment and see if it is something that would help them at home; in effect a ‘try before you buy’ approach.
Helping people with learning disabilities to live independently
In 2017 we launched a progression project, funded by the Integrated Care Fund, to provide individuals with learning disabilities with a specialist occupational therapy assessment. The emphasis was to be on support around skill development and progression towards more independent living and self-value, both at home and in the community. The objective was to help reduce long-term reliance on traditional care services and/or family carers, and embed an approach that focuses on progression and supporting the individual to overcome barriers to complete tasks they wish to undertake, as independently as possible.
It required the individual and their support network to take responsibility for working towards their personal outcomes within an agreed timeframe, and in some instances, for developing their confidence in positive risk-taking.
The project supported individuals to realise their full potential, developing their independence within their own homes, and becoming more independent and active in their communities. In many cases the project enabled individuals to move to more independent living with the right sized care and support. This has meant that citizens developed their confidence in living more independently, and having more control over how they lived their lives, using assistive technology and other aids and adaptions to manage risks.
What were the challenges?
It was sometimes difficult to maintain the focus on progression once the Occupational Therapist had completed their assessment and care and support plan. The Covid-19 pandemic meant we were no longer able to offer face to face assessments and it changed service pressures significantly, meaning the progression service came to a halt at the beginning of the pandemic.
We are pleased to say that we’re re-launching the Progression Service, which will now be funded under the Regional Integration Fund. An Occupational Therapy Assistant post has been introduced to facilitate some of the post-assessment monitoring of progress, and to develop a technology specialism within the service.
The project reflects a shift away from long-term, support-focused delivery of services. The focus will be on short-term interventions, adhering to a detailed plan, supporting individuals to develop new skills to achieve their pre-agreed outcomes.
A new location has been identified where functional assessments of activities of daily living can be completed within a suitable environment. Specialist aids and equipment will be available to support citizens to develop a plan on how to achieve their personal outcomes as independently as possible. We aim to promote the use of modern assistive technology in meeting personal outcomes, promoting independence and in managing risks within the home.
Demonstrating the use of modern equipment and assistive technology will help inform citizens and professionals alike about innovative ways of meeting outcomes and managing risks, in a way which maximises individuals’ strengths, reduces the reliance on informal and paid support, and where long-term support is needed, will inform assessments to ensure we promote the right level of support.
Developing our Connected Persons Team
Our Connected Persons Team has seen big changes during 2022 with five posts implemented, inducted, trained and upskilled to cater for the needs of connected persons carers. During the Covid-19 pandemic connected persons support groups were facilitated by an independent charity who amalgamated Conwy, Gwynedd and Ynys Môn together. Following feedback from Conwy-based connected foster carers, we set up a group for Conwy only, with the help of a new team manager, and the Kith and Kin Group was established.
Special Guardians are individuals who can apply to look after a child when they cannot live with their birth parents, and adoption is not right for them. In Conwy our Special Guardianship offer continues to thrive with support from a dedicated coordinator who monitors the Special Guardianship Support Plan. With a now-established relationship, they are able to provide early intervention support, review support plans and review payments, all helping to prevent breakdowns in the arrangements, and strengthening the active service of Special Guardianship support.
Connected Persons is also a strand of the ‘eliminate profit’ agenda introduced by the Welsh Government. By strengthening the Connected Persons fostering service and providing effective Special Guardianship support we facilitate a successful and realistic move-on plan through foster care to Special Guardianship. Within our grant application we identified that a second Special Guardianship Coordinator would support the ‘eliminate profit’ agenda, the Special Guardians themselves, and proactively strengthen the core offer in the Special Guardianship plans.
What were the challenges?
As all five members of staff started within the same month, this was a challenging period.
Connected Persons training has been developed, and this needs to be delivered to the wider childcare teams to strengthen their understanding of the assessment process, share knowledge and skills, and ensure greater awareness of the Special Guardianship support provided. All of this will strengthen our offer of support.
We’ll also be recruiting to the new Connected Persons Coordinator post.