THE Herefordshire Council directorate with the biggest budget issues is making strong progress in transforming the way it works.
A newly released review of adult social care says “clear vision” and “strong leadership” is driving the directorate through major change.
The review was undertaken as a “peer challenge” by experts including heads of service from other authorities.
Evidence gathering interviews ranged from service users to senior health and care managers taking in councillors and the council’s chief executive.
As reported by the Hereford Times, adults and well-being is the council’s biggest budget concern with latest forecasts already predicting a year-end over-spend against budget of nearly £1 million.
The directorate has a target of £5.5 million in savings to deliver in 2014/15 and the majority of transformation and project plans are underway to address these efficiencies.
Of the £5.5m savings target, the main shortfalls in delivery relate to £1.1 million in management savings and £900,000 that was assumed to be delivered from reassessments leading to exits from care.
But the main area of risk remains the overall growth in adult social care, specifically residential and nursing home admissions.
The peer challenge came with a substantial re-integration of adult social care back into the council underway at the end of a contract with Wye Valley NHS Trust.
Against this background the challenge identified good progress in developing a vision for adult social care, transformation programmes and related structures, clear vision and leadership from the director, strong political support and “buy in” from staff.
There was a need for stronger links with service users, carers, staff and partners to deliver market shaping that extends care and support options, better commissioning processes, effective care management and creative support planning.
Areas identified for “further focus” are safeguarding, user/carer engagement, integration with the NHS, community capacity building and performance/financial reporting systems.
Amongst key strengths emerging out of the re-integration was the “clear feel” of a brand new directorate driven by “strong” leadership of staff “up for the challenge” and “good support” from lead members and the chief executive.
Helen Coombes, director for adults and well-being, said the “welcome” findings of the review confirmed a need to involve service users more in the process of change.
“Since the review we have appointed a participation worker who uses adult social care services himself and will help us engage better with other adult service users through our Making it Real steering group,” she said.
The peer review did not include adult safeguarding which will be subject to a separate report in March next year following an improvement programme the council is currently working on.
MAKING A DIFFERENCE – TWO CASE STUDIES FROM THE ADULT SOCIAL CARE PEER CHALLENGE
1. Direct Payment
The experience of service users with a direct was described very negatively to the review team.
Users said they felt “dictated to” by the Council on what they could spend the sum on.
Examples were given of an apparent inflexible approach to spending with service users saying they were “scared” to spend the money with advice on appropriate spending “inconsistent”.
Also, the audit of direct payments by the council was “too formal” with the records kept by service ice users being rated by auditors.
The challenge team recommends that the council reviews its policy and approach to direct payments with further guidance on appropriate spending and an approach that offers flexible use of monies.
The team was told that the council had “clawed back” £929,000 of unspent direct payments in 2013/14.
Given the comments by service users that they were scared to spend and received nconsistent advice, there was a risk that this money, at least t in part, could have been used to meet appropriate needs.
The team recommends that the underlying reasons for the “claw back” be assessed and action be taken on any findings.
The team was told that service users and carers were not always involved in care assessments and support plans.
Users, or their representatives, should always have a copy of their assessment and contribute fully to their support plan, which should reflect the outcomes they aspire to.
The review recommends council considers how it can ensure that service users and carers receive a copy of their assessment and that they contribute fully to their support plan.
2. Integration
The challenge team was made “acutely aware” of the history surrounding health and socialcare integration and the recent end of a related contract with Wye Valley NHS Trust.
The trust had managed services including adult social care.
However, the Care Act requires integration is progressed by local health and social care partnerships - although no particular model is prescribed.
The review team found it “essential” that integration options and models be explored in Herefordshire.
These models - explored with local health organisations - should be built around improving the access and care support services for users and the outcomes they experience.
The review recognised severe demand pressures at Hereford County Hospital, specifically on A&E services, and recognises that no alleviation of these pressures can occur without a joint strategy and approach as envisaged by a new Health and Social Care Transformation Board.
It is accepted by the review that alleviation will take time, but there were opportunities to work with trust to examine any impact from the recent changes of re-integration of services back into the Council.
The council is recognised as having made “very good progress” on the re-integration of adult social care back into its fold.
There was “consistent and strong” cross-party support for adult social care complemented by equally strong support from the chief executive.
The challenges facing adult social care were said to be “well understood”.
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