Effective partnerships are in place to commission and deliver fully integrated, high quality, sustainable outcomes for people
Supporting Conwy’s residential homes throughout the pandemic and beyond
We have continued to provide a vital channel of communication between care homes and the Local Authority, Health Board and other agencies. With the Covid-related pressures on care homes continuing during 2021-22, we have provided support to them on a regular basis and fostered a culture of information-sharing. We hope to develop that support further in 2022 by extending it to other types of provider.
Quality-assuring our commissioned services
The new Regional Quality Assurance Framework (QAF) for Commissioned Services has been set up with the aim of driving excellence with our commissioned services across North Wales. All stakeholders, including the six Local Authorities, the Police, CIW and BCUHB will ‘commit to work together to achieve the best outcomes for individuals in receipt of commissioned services’. The QAF is underpinned by key principles which will:
- Ensure that provider services are safe, personal, effective and continuously improving.
- Ensure the right quality mechanisms are in place so that standards of care are described and effectively demonstrated.
- Ensure that quality outcomes are monitored and reviewed, and action is taken if the quality of a service is found to be compromised.
- Establish a governance structure to monitor quality and safety including the analysis of personalised care, effectiveness and safety.
- Use patient and family feedback to inform the quality agenda along with complaints and concerns.
- Support the Sector by ensuring the provision of timely access to clinical multi-disciplinary and organisational team support.
- Support providers to innovate and deliver evidence-based practice to continuously improve.
- Ensure that we put individuals at the centre of care planning and delivery.
- Ensure effective communication and engagement through a wide range of accessible mediums both digital, social media, teleconferencing and events.
A partnership approach to commissioning older people’s services
The project that we are undertaking to review and modernise the commissioning process around older people’s services is a multi-disciplinary approach. Its success will depend upon the contributions of various teams, both internal and external. The challenges facing the domiciliary care sector have been well documented over the years, and have been worsened by the Covid-19 pandemic. The Social Services and Well-being (Wales) Act 2014 requires us to adopt an outcome-focused and person-centred approach to care commissioning and delivery. At the moment we are still basing it on time and task, and we are aware that an outcome-focused approach will require a culture shift across the sector.
Our providers are facing challenges around recruitment and retention and this is affecting their ability to deliver the care packages we need to commission from them. With the number of people over the age of 65 expected to rise in Conwy over the foreseeable future, we can expect demand for older people’s services to increase too, along with the number of complex cases.
We will be looking at simplifying the processes we use to bill individuals for the services they receive, and how we conduct financial transactions with our providers. Our aim is to introduce:
- More flexible care packages which take into account what matters to the individual and how they wish to achieve their personal outcomes.
- Locality-based brokerage of care packages.
- A more streamlined invoicing process with our providers.
- Consistent delivery of outcome-focused care.
These new initiatives will provide more security for our providers and support better working conditions for staff recruitment and retention. We will work together with our commissioned providers as partners, ensuring that our services are modernised, efficient, and help vulnerable individuals in Conwy to remain in their own homes for as long as possible.
Community Services Transformation Programme
The Community Services Transformation Programme was established in 2019 to continue the development of the established Community Resource Teams (CRT). The programme was funded through the Integrated Care Fund (ICF) and a Transformation grant.
The first phase of the Transformation Programme was to identify and provide evidence of the organisational and systemic barriers that were constraining further integration between Health and Social Care services. Through a number of interconnected work streams the programme will inform a plan for the longer-term development and sustainability of CRT areas and deliver on the vision for integration and place-based care, as set out in A Healthier Wales.
What we plan to do
There are six themed work streams:
- To understand the whole of the Health and Social Care systems to get a complete and intelligent picture of demand, capacity, flow and cost.
- To develop a competency-based workforce strategy that is designed to meet the ambition for seamless models of care.
- To develop and deliver a programme of engagement, allowing citizens, carers and communities to share their experiences and take an active part in shaping future services.
- Through consultation and case audit, analyse the effectiveness of our current ways of working, identifying good practice and the elements of redesign needed to support new seamless models of care.
- Establish an integrated Health and Social Care management entity that will create the conditions in which the community resources of Health, Social Care, Third Sector partners and the local community can work together to meet and support needs and improve health and wellbeing (to include digital transformation and co-location).
- Agree a service model and framework for integrated care delivery that is focused on the person, considers important aspects of their lives, their goals, and what matters to them.
What have been the main achievements in implementing the programme?
The six themed work streams are reaching their conclusion and findings are now being collated to inform the next stages of the transformational plan for change. The key achievements of the programme are:
- Insights into the Health and Social Care systems that provide a picture of system constraints, demand, capacity, flow and cost.
- A cultural assessment and appreciative enquiry of partners and direct services to evaluate readiness for change and appetite for partnership working.
- An accountability framework and role template for Care Co-ordinators, Integrated Health and Social Care Support Workers and Administrators.
- Insights into the experiences of citizens, carers and communities to ensure their voice is heard and influences the shaping of future services.
- A method of multi-agency case audit has been devised to analyse the effectiveness of our current ways of working, identifying good practice and the elements of redesign needed to support new seamless models of care.
- Integrated Health and Social Care localities have been formed with members from Health, including primary care, Social Care and the Third Sector. These locality bodies will plan for local leadership, governance, commissioning and the deployment of resources.
- A leadership development programme for senior leaders focused on leading change, collaborative and relational practice skills.
- The programme team are utilising Office 365 and assessing how it can support integrated team working.
Continuing to support the development of the CRTs
- We will be facilitating workshops to complete a maturity matrix, which will inform the development of action plans.
- We’ll be coordinating the CRT Focus Group meetings
- All CRTs are now co-located
- The National Development Team for Inclusion will provide workshops for Conwy CRT staff to take stock and consider how the team is working, the experience of the last two years, and how things have changed or improved moving forward.
- A rotation of occupational Therapists from the Health Board is to be introduced to support continuous professional development.
What were the challenges?
The ongoing demand for services to respond to the pandemic has continued to constrain workforce and manager capacity throughout the duration of the programme which has impacted on planned activities and the extent of engagement. Also, getting information governance agreements into place delayed the start of some elements of cross-matching data.
What’s next?
The findings of the first phase of the programme are being collated and will inform the plans for change and resourcing its implementation by means of the new Regional Integration Fund.
Feedback from our Community Resource Teams
The Community Resource Team (CRT) model allows for co-location of colleagues from Social Care, Health and the Voluntary Sector at five locality offices across the county. We once again asked team members how they felt the partnership was working, especially in light of the fact that Covid restrictions have prevented a physical presence in the office for many.
In total, 59 individuals responded to the survey, 78% of whom work for Social Care. 76% of respondents stated that they were happy or fairly happy about working within the CRT, and additional comments suggested that, even with Covid restrictions in place, there is still the ability to forge good working relationships across the organisations.
Happy to have access to the team and utilise the contacts and knowledge of different members that can be specific to my role. Also having access to individuals and teams to ask advice or request help.
However, working from home due to the pandemic has, for some people, affected the ability of the CRT to function as a cohesive team.
Due to the current pandemic and working from home, it’s been difficult to fully work within the CRT ethos.
59% of respondents were positive about the ability of the CRT to facilitate and improve their own learning and knowledge of other professions/services, with only 7% stating that there was no benefit at all.
74% of respondents agreed that collaborative working within the CRT has improved the service for citizens, with many feeling that working together streamlines the process and promotes access to services which may have otherwise been overlooked.
I have become more aware of services within the wider CRT such as the Family centre and Pharmacy, and how we can work together in a preventative manner.
Thanks to shared knowledge and expertise between the professionals, citizens can learn about and access support and community provision conducive to wellbeing, all of which impacts [positively] on the levels of hospitalisation and necessity for extra care.
It speeds up referrals. Information can be exchanged more quickly between services and relayed back to citizens and can create a smoother flow of are and services which can be very helpful, particularly when health and wellbeing are at stake.
When asked about whether the Community Resource Teams support each other, there was a mixed response, with 39% agreeing that this happens some of the time. There were a couple of reasons for this, namely the separation brought about by working from home, and the feeling of there being less support within the business support sphere, than between practitioners. There is certainly some work to be done in this area once more regular attendance at the office resumes, but where respondents offered further comment, many were positive.
Undoubtedly there is a great level of mutual/collective support.
We asked the team members how they felt about working in the CRT going forward, and 62% stated that they felt positive or very positive about it. There is acknowledgement that there are improvements to be made around IT provision for seamless working, but many feel that the CRT is merely an official title to an already-established method of working. Working in the office when it is safe to do so will increase opportunities for collaboration and shared visits, as well as allowing the organic communication which takes place in a shared setting.
Working within a CRT is a very important aspect of my role. Working alongside the CRT has been especially important since working from home. I feel that good communication with the CRT has remained in place and in turn provided individuals I support with a good service. I am happy about working within a CRT in the future and feel it is an essential part of my job.
The potential of the CRTs is yet to be fully realised, but it is most definitely moving in the right direction.
Developing our Occupational Therapy teams
As previously mentioned, we would like to support the continuous professional development of our Occupational Therapist teams at the CRTs and have looked more closely at three areas for development:
Recruitment and retention of OTs
Individual organisational recruitment strategies have led to a competitive approach to recruit OTs within each organisation in North Wales. An integrated workforce development plan in relation to recruitment and retention of newly qualified BCUHB, Conwy CBC and Denbighshire County Council Occupational Therapists is required and is now an urgent priority.
Conwy CBC and Denbighshire CC currently do not have equal access to newly qualified OT graduates from Glyndŵr University. Having equal access to new OT graduates will be essential going forward to recruit to vacant posts in the CRT. BCUHB have offered to include a Local Authority placement as part of the BCUHB Band 5 OT rotation in Conwy and Denbighshire CRTs. Including a social care placement as part of the BCUHB Band 5 rotation will provide newly qualified OTs an opportunity to develop knowledge and skills in Local Authority settings. Having knowledge of social care settings is essential to apply for a post with a Local Authority.
The hope is that Conwy and Denbighshire Councils will commit financial and supervisory resources to ensure new OT graduates employed by BCUHB gain experience of working in Local Authority settings.
Integrated training for BCUHB and Local Authority OTs
At present each organisation commissions training providers to meet the professional requirements of OTs in each establishment. However, several areas of professional practice overlap between the different organisations, such as manual handling. Having an integrated training plan would avoid unnecessary handovers, silo working and promote more efficient use of OT resources in the CRTs.
We hope that BCUHB, Conwy CBC and Denbighshire CC managers agree to develop an integrated training plan for BCUHB and Local Authority OTs working in the Community Resource Teams.
Areas of overlap between the Health Board and Local Authorities
There are significant areas of overlap between the teams, however different organisational cultures and processes have ensured that there has been little discussion between practitioners about what roles and responsibilities could be shared. For example, a person in need of review following a hospital discharge or a major adaptation will be seen by a BCUHB OT or a Local Authority OT on the basis of organisational funding responsibilities. This operational criteria does not take account of the available OT resources in each CRT and the capacity of those resources to respond in a timely manner.
We hope that managers across the Health Board and Local Authorities agree to review existing professional competence documents and develop an integrated professional competence framework for OTs working in the Community Resource Teams.
Bron y Nant respite facility
We are progressing with work to deliver the new services to be delivered at Bron y Nant Disability Respite Centre and Complex Care day Resource Unit in 2022-23. This is a significant piece of work, involving a number of officers from within the Disability Service, our partners in Health and across the department. Once open, the resource will offer improved purpose-built accommodation for people having respite services in Conwy.
As part of the development we plan to work with a social enterprise to deliver a café and shop on site. This will not only provide employment opportunities for people in the local community, but will also provide work experience for disabled people. The service will form part of our local strategy to improve access to employment for disabled people.
Additional Welsh Government funding
Welsh Government have made additional funds available to Local Authorities to relieve the financial burdens imposed by the pandemic. In terms of social care the Hardship Fund allowed for additional costs for continued support for in-house and commissioned adult social care provision across domiciliary care, residential care and supported living. It also allowed us to support providers to address market stability pressures such as ‘voids’ and unpredictable or emergency expenses across the sector. In Conwy we have claimed £4.3 million for social services, almost half of which was paid to care homes and domiciliary care providers via uplifts in care fees.
The Recovery Fund was allocated to us to help the social care sector meet the ongoing pandemic-related challenges, with money set aside for extending the carers support fund, tackling loneliness in older people, investing in the social care workforce’s wellbeing, and in residential services for care-experienced children. Conwy’s allocation was £2.4 million, with £800K spent on independent placements for children, £890K on care providers and £703K on day services, transport, IT, equipment , Direct Payments, training, and more.
What were the challenges?
Allocating Hardship and Recovery funds to the independent sector has been a time-consuming process where applications were encouraged and received from care providers who had experienced unexpected additional costs directly related to the Covid pandemic.
What’s next?
The funding ends on 31 March 2022 as we move out of Covid response mode. We have fees paid to the care sector, taking account of financial constraints upon the Local Authority alongside the increased costs of delivering care in the current climate. All fees will increase from 1 April 2022 and will incorporate the real living wage being paid to staff. At the same time we are contributing to the national discussion and white paper around rebalancing care and support in Wales.
