Lasting Legacy for PPF

DH West Midland’s Putting People First (PPF) development programme has ended.

Set up in April 2008, DH specialists helped councils implement a raft of changes needed to transform adult social care, with emphasis on prevention, early intervention, personalisation, and provision of information.

Councils have been left with a legacy of fresh thinking and new approaches to the way services are delivered in the region, giving them a strong basis on which to build care services for the future.

The following summary includes an overview of progress so far; the challenges councils face, and tips for continuing the transformation of adult care:

Carers

• All councils have an online staff training course designed to raise awareness of carers needs and how best to help them
• NHS organisations need to be involved at strategic level in the engagement of carers
• There is need for carers strategies and the implementation of personalised care to be coordinated.

LINKs

• Achievement of LINKs – the  local involvement networks where individuals can air their views and influence health and social care services - is variable
• Healthwatch – the new government initiative to provide people with a single point of contact for seeking advocacy, information, or wanting to express their views, will supercede LINKs.  Rapid implementation is required but the new scheme is not fully understood locally
• Councils have lead LINKs officers who monitor existing contracts. Transition to Healthwatch may need extra or different types of resources.

Dementia

• Take up of benefits for people with dementia is still low and needs to be increased
• Support for the independent and third sector organisations is needed to help them deliver personalised care and reablement services
• Greater use of telecare and touch screen technology is required as part of intervention, prevention and reablement of dementia sufferers
• Precision training of social workers to ensure the right people have appropriate skills for working with people with dementia, is needed

Dignity

• A more concerted effort is required to mobilise 3000 dignity champions in the region to support delivery of:

          -personalisation

          -telecare

          -safeguarding

          -commissioning services to support the dignity programme

          -LINKs/Healthwatch

Valuing People Now

• Investment in employment support leading to paid work for people with a disability, has proved to be financially efficient

• An employment toolkit is available on the Valuing People Now and BASE websites  
• Ensure people with a learning disability are fully represented in Joint Strategic Needs Assessments, with particular attention to areas such as young people in transition, people with complex needs requiring bespoke housing solutions, and people living with older family carers

Safeguarding

• Councils are urged to set up mechanisms for regional coordination of safeguarding practices and procedures
• Continue with close collaboration between staff responsible for personalisation and safeguarding
• Develop risk assessment and risk management policies that incorporate positive risk taking
• Ensure continued collaboration with health authorities
• Make safeguarding the vehicle for continuation of the dignity programme, and implementation of the Mental Capacity Act and Deprivation of Liberty.

JIP projects prove their worth

The initial results from the automated pill dispenser pilot project, shows over £2,000 of savings per person receiving a service; while latest figures for savings from use of the care funding calculator (CFC) exceed £5million.

The calculator is a free Excel spread sheet based tool, used to gauge prices and negotiate the cost of residential and supported living care. 

Use of CFC will be extended to mental health teams in the area, starting with South Staffordshire, North Staffordshire, Worcestershire and Warwickshire PCTs. Work is also underway to develop and implement Care Funding Calculator tools for Special Educational Needs (SEN) placements and residential placements for children.

The automated pill dispenser has an alarm which is set to remind people when to take their medication.  The pilot has been set up to build a business case for increased use of the dispenser by local authorities and PCTs in the region.

The first 64 users who have completed their pilot period have generated savings in social health and care services of £144,000, the equivalent of £2,257 per person, per year. 

The scope of the pilot will be broadened to include newly formed pathfinder organisations, as well as Memory Centres in the region.

For further information about the Care Funding Calculator Project, contact Mihir Trivedi, mobile: 07977 160 163, email:  mihir@hb21.co.uk

For further information about the Automated Pill Dispenser Project, contact Andy Jackson-   mobile: 07815 073611, email: andy.jackson@ntlworld.com

JIP priorities agreed

The JIP’s priorities for the next two years have been agreed and will focus on promoting quality, performance and efficiency.

The decision was made following the announcement by Improvement and Efficiency West Midlands to keep a revamped partnership going until April 2013.

From now on the JIP will act as the strategic link between local authorities and the NHS.

The old steering group will be replaced by a network of local authority assistant directors, who will be responsible for implementing regional projects. They will also provide development opportunities for practitioners, and peer support. 

Priority areas are:

The NHS’ Quality, Innovation, Productivity and Prevention (QIPP) programme, for assisting clinical staff and NHS organisations to improve the quality of care they provide, while making efficiency savings.

The partnership will work on initiatives to:

• Enhance recovery times of patients who receive non-emergency treatment, by providing appropriate reablement services
• promote prevention and early intervention care services for people with dementia
•  encourage early intervention in mental health
• reduce out of area placements.

Efficiency, specifically:

•  expanding use of the  Care Funding Calculator
• integrating assistive technology into care, with emphasis on learning disability and dementia placements
• optimising reablement services 
• improving systems and processes in work and services
• responding collectively to financial challenges emerging from year two of the Comprehensive Spending Review.

A detailed business plan will be produced over the coming weeks.

The JIP is a programme board for Improvement and Efficiency West Midlands (IEWM) which is the name of the Regional Improvement and Efficiency partnership (RIEP).

Contact: Matt Bowsher, Regional Transformation Lead; telephone: 0121 245 0170, email: mbowsher@westmidlandsiep.gov.uk

Developing a culture of personalisation in Staffordshire

Key to Staffordshire County Council’s strategic plan is that ‘people are able to make decisions about their own care and are given choice’.

This led to a commitment to achieve personalisation in the widest form possible, extending beyond the development of a Resource Allocation System (RAS), to getting practitioners to think and act differently, and creatively.

A six and a half day training programme has been implemented for every front line staff member, including health colleagues, and this is being extended to service users/carers, private & voluntary agencies, and other colleagues within the Council.

The aim is to embed a sustainable culture change which has independence, choice and control at its heart, and to actively empower staff to secure imaginative, innovative personalised options for individuals.

The personalisation, finance, performance and safeguarding teams have all worked together to achieve a position where personalisation is now at the heart of performance management, induction and a newly developed competency framework.

The support planning process does not rely on the completion of a template. A Staffordshire support plan is unique to the individual and is presented in that person’s preferred format.

The service has successfully piloted the employment of Support Brokers to work with assessors to find ways to meet individuals’ needs. This innovative approach has resulted in people being able to use their direct payments to achieve better outcomes and challenge practitioners’ traditional methods.

Significant work has been undertaken with the private, voluntary and third sector to ensure that the personalisation agenda and direction of travel is understood, allowing them to be in a strong position to respond. The council now funds a number of user-led and third sector organisations to provide advocacy and peer support for people with a Direct Payment or a Personal Budget and/or their carers.

The council believes that the journey embarked upon is within the true spirit of personalisation, avoiding the pressure to be driven by narrow statutory targets so it can be confident that outcomes are genuinely being improved.

Case Studies:

Trudy has Parkinson’s disease and lives with her husband. Despite GP intervention she finds it difficult to manage her pain and suffers from depression. The support broker worked with Trudy and established that her desire was to be free of pain - this was only achieved when Trudy was painting. She described this activity as making her feel normal. She also wanted to give her husband a break, ensure consistency of her home care workers, and to have a standard morning routine.

Trudy now has her chosen routine and consistent workers - this part of her package is delivered through a personal budget managed at her request by the local authority.

She also receives direct payments and employs an art tutor for 4 hours per week This allows her to paint, feel free of pain, and allows her husband some time to himself. The weekly cost of this package is £60 less than her indicative budget, and far less than other traditional opportunities. This frees up funding, thereby benefitting other service users.

Paul requires 24/7 support following a road accident. He receives his Personal Budget via a direct payment and has a pool of Personal Assistants. Paul is skilled in computing and has completed his own support plan in writing and on DVD. His outcomes are to socialise with friends, have a holiday, obtain a motorised wheelchair and set up his own business to assist people with support planning. A Support Broker is currently helping Paul make this happen and has found him some business advice.

Tamworth case study in Staffordshire

A service user in Tamworth with dementia was living in her own home. She was prone to wandering and had experienced episodes of abuse in her neighbourhood. Money had been going missing, the police were involved, and there was evidence of self neglect. Her family were very distressed and concerned about her, and had expressed strong views that they wanted her to move into residential care for her own safety.

The local Community Mental Health Team had also advised her needs would best be met in residential care.

Following a period of emergency respite care (after another incident in which she had gone missing and the police had been involved), the social work assessment concluded that her needs could be met in an extra care environment (sheltered housing with a substantial care package).

The service user was able to express her preference not to move into a care home. The social worker rose to the challenge of advocating for the person against all odds, winning cautious agreement from her family and others to give this person a chance to try to keep living in the community with the right support. Everyone acknowledged the additional risks of disorientation by moving to sheltered housing, but that was managed by a mix of care and technology.

The initial intensive support package included:

• the support of the scheme manager within sheltered housing
• the ‘Just Checking’ assistive technology service
• a night sitting service
• domiciliary care during the stay
• a mental health support worker (from the social work team) to help her adjust to living in her new environment as she was disorientated, and to monitor her health and wellbeing
• a ‘Buddi’ GPS tracking device so that her whereabouts and movements could be monitored in order to ensure her safety if she wandered outside.

Boundary areas were set for the Buddi system, so that if the service user wandered beyond the agreed boundary, the alert would be sent to the call centre and relevant people could be informed and respond.

Eighteen months on, the service user remains in her own home. She no longer needs to use the Buddi, as she has settled in and recognises where she is as home. Her behaviour has changed and she does not wander. She has achieved what she wanted – to stay in her own home; and her family were won over by the reassurance they gained from the management of risks and the thoughtful support provided.

The device was successful, due to support from the care team who ensured it was worn when she went out and it was charged regularly.

As this case has shown, the Buddi can be used alongside other assistive technologies and does not have to be a long-term part of a person’s support package. There is no cost to the individual or their family.

Contact: Alison Hasdell, Practice Lead, Tamworth Adult Care Team, 01543 308707

Creative use of technology in Staffordshire

Use of the Buddi GPS tracking device and other assistive technology aids is helping vulnerable people in Staffordshire to live a better quality of life, independently and in their community.

The Buddi is worn by individuals whose movements and location can be monitored via a call centre or directly, online, by health and social care professionals or family members.


The Tamworth Locality Adult Care Team in Staffordshire is using five of the devices to monitor people with early-onset dementia who are prone to wandering.

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