Implementation of the Care At Home Strategy

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Implementation of the Care At Home Strategy

• Vareta Bryan,
• Assistant Director, Home Care Community Based
  Services
• Gloucestershire County Council

2
Objectives

• Context and drivers for change
• Revised service model
• Outcomes

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Gloucestershire
Cheltenham Tewkesbury
Population of the County 564,559 Over 65
population 98,017
Cotswolds
Gloucester Forest
Stroud
4

• CONTEXT
• Domiciliary Care in Gloucestershire ?April 06
• Mixed economy 45 in-house
• Long term care provision, task and time specific
• Locality managed in house provision
• Cost and volume contracted provision
• 22,000 hours care delivered per week
• Waiting lists
• Delayed transfers of care
• Care at home strategy implementations stalled
• Post April 06
• Countywide service
• Re-tendered contracts
• Focus on CAHS implementation and capacity
  building in provider sector

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DRIVERS FOR CHANGE (1)

• Demographic growth and demand for services
  12-15 growth by 2010
• Budgetary constraints
• Partnership working/maintaining whole systems
  approach
• Managing expectations/services are not always for
  life

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DRIVERS (2)

• Closure of hospital beds and reduction in length
  of stay
• Prevention of emergency admissions to hospital
  and residential care
• Cost of service in comparison to other providers
• Provision of effective and responsive services
• Better outcomes for service users

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Care At Home Strategy

• Modernised Service - enablement model
• -
  electronic monitoring
• Increased capacity to meet demand
• Rebalanced market share 20/80 ratio
• Gershon targets
• Reduced unit costs
• Standardised core processes

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Revised Service Model

• Leaner structure and new roles
• Electronic Rostering and Monitoring
• One office base for each locality
• Renegotiation of carers contracts
• Focus upon enabling and increasing independence
• Emphasis on short term provision

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Home Support Officer

• To support care workers in the field
• To undertake first visits and risk assessments
• Availability required between 7am and 8pm Monday
  to Friday and 8am and 4pm at weekends

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Generic Long Term Model
Enablement Model
DG/C Hospital
  DG/C Hospital
Hospital Discharge Teams
      Enablement Teams
Purchased Care  
Purchased Care
Intermediate Care
  Generic Long Term Care
Intermediate Care
Palliative Teams
Community Cases
  Community Cases
Complex/ Unstable Long Term Cases
Palliative Teams
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Relationship to Intermediate Care

• Patient Pathway
• Acute Care Primary Care Social Care
• Rehabilitation
  Intermediate Care Enablement

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Outcomes

• Leaner management structure
• Smaller service (reduction of 100 HCA posts)
• Increased contracted provider capacity
• 37 increase in block provision via
• Reduction in spot provision
• Transfer of cases from in house
• Improved partnership working
• Procurement and implementation of
• e-rostering system

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Outcomes (cont)

• Training programme in enablement skills devised
  and delivered
• Revised policies and process
• Integrated countywide service Enablement focus
• 7day service provision, available 7am 11pm
• Waiting lists reduced to single figures
• gt40,000 hours per week care delivered