North Wales Domicilliary Care Development Workshops Report by Scarlet Design International Ltd.

North Wales Domiciliary Care: Development Workshops Venue Cymru, Llandudno 16 - 17 March 2015

For more information please contact: Maria Bell, Adult Commissioning & Integrated Working North Wales Social Services Improvement Collaborative (NWSSIC) Email: maria.bell@denbighshire.gov.uk Lead facilitator: Fran O’Hara (‘Working With Not To’ Co-production project) with Pam Luckock (‘Working With Not To’ Co-production project), Huw Thomas (Sglein) and Anne Collis (Barod).

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Contents Introduction.............................................................................................Page 3 Domiciliary Care Workshop 1: ‘Delivering personal well-being outcomes: What needs to change?’..Page 4 - Session 1: Changing to an outcomes focus.....................................Page 5 - Session 2: Well-being outcomes......................................................Page 7 Domiciliary Care Workshop 2: ‘Value for money: How do we achieve social, environmental and economic outcomes?’.....................................................................Page 9 - Session 1: Social, Environmental and Economic Impact...................Page 10 - Session 2: Unison Ethical Care Charter............................................Page 14 Domiciliary Care Workshop 3: ‘Co-production of domiciliary care, what’s the story?’..........................Page 18 - Session 1: Changing to an outcomes focus approach.....................Page 19 - Session 2: Creating a domiciliary care & support services plan.........Page 21 Next Steps and Workshop Information................................................Page 22 - Participant Workshop Feedback......................................................Page 23 - Attendees........................................................................................Page 24 - The Team.........................................................................................Page 26 - Photostory.......................................................................................Page 27 Appendix 1 - Pen Picture of Llew..........................................................................Page i - Pen Picture of Mabel........................................................................Page ii - References......................................................................................Page iii

Appendix 2..............................................................................................Page iv

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Introduction This report is a summary of the outcomes from three Domiciliary Care Development Workshops held in March 2015. These were commissioned by the North Wales Social Services Improvement Collaborative (NWSSIC), with the aims of developing the domiciliary care market and ensuring that care & support services provided in people’s homes: • • • •

Are person centred, Focus on achievement of service and individual outcomes Deliver community benefits, and Involve service recipients and/or their representatives in service design and delivery

This report is designed to be read and used by everyone, by assessors (including social care workers and nurses); people who commission or regulate care and support services; those that provide it and people supported by domiciliary agencies. NWSSIC have a collaborative project intending to modernise domiciliary care commissioning and explore ‘outcome based’ commissioning and delivery. Key messages from the workshops will influence the region’s future commissioning approach. We have used the ‘visual minutes’ images drawn at the event to highlight important messages. We would like to thank everyone who attended the workshops and contributed, and hope you find this useful. We welcome your feedback, please email me at maria.bell@denbighshire.gov.uk

Maria Bell Project Manager - Adult Commissioning & Integrated Working, North Wales Social Services Improvement Collaborative (NWSSIC).

16 March 2015

Domiciliary Care Development Workshop 1 ‘Delivering personal well-being outcomes: What needs to change?’ Anticipated learning outcomes We will be developing a shared understanding of:

• How does ‘the system’ need to change to enable outcome based domiciliary care to become a reality?

• What an outcome based service specification may look like for Domiciliary Care.

Agenda 1.00pm

Registration and refreshments

1.30pm

Introduction to well-being outcomes - Maria Bell.

1.35pm

‘Who’s in the room’? Participant introductions - Fran O’Hara.

1.50 pm Introduction and aims Introduction to well-being outcomes: Population, Service & Individual - Alwyn Jones, project sponsor and head of service, Angelsey County Council. 2.15pm Activity 1: Designing & delivering home care services which support individuals to achieve their well-being outcomes - Fran O’Hara. ‘Achieving well-being for people like Mabel and Llew’. What would a successful outcome-based service specification look like for Domiciliary Care? What should we do, not do, and do in partnership? 3.15pm BREAK 3.30pm Activity 2: Supporting individuals to achieve their well-being aims. We want to transform the commissioning and delivery of domiciliary care services to support individuals to achieve their well-being outcomes. What barriers could stop this happening? What could help/enable this to happen? - Fran O’Hara. 4.45pm

Summing up, thanks and evaluation.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 1

Session 1: Changing to an outcomes focus Each table was provided with a fictional 1 page pen-portrait of Mabel or Llew (see Appendix 1)* and a large sheet template. They were asked to discuss and record their responses on the sheet in three areas: what should we do, not do and do in partnership. The partnership aspect provoked the most discussion. This activity was designed to stimulate thinking around what the person needed to achieve THEIR outcomes, what mattered to THEM, and the support they would require. One table challenged whether Mabel actually needed a Care Plan and perhaps actually needed a short term plan to enable her to re-establish her independence. With the group feeding back ‘if we do the outcomes focussed approach properly Mabel shouldn’t need a Care Plan’, contrasting this to the current system where she would have automatically been given support. *During workshop 3, people fed-back that having this one page portrait of the person helped them to visualise the person better, and recommended that it could be included in a person’s care plan.

What should we do?

• Put the person at the centre. This means listening, discussing how they want to achieve

what’s important to them, and asking permission before talking to family/friends.

• Have flexible contracts, so you can provide flexible support • Identify what people can do for themselves, and help them take control of their support • Provide information and advice. Make sure it is easy to understand. Make sure you know

about local community support. Know how to get someone a welfare rights assessment.

• Make sure the care plan has clear outcomes • Build a relationship of respect and dignity. See yourselves as partners, and communicate clearly.

• Think about risks and find ways to manage them, for example support to map regular routes if someone gets lost

• Know how to share information • Think about mental capacity, and whether something like sensory impairment might be behind an apparent lack of capacity.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 1

What should we not do?

• Do not assume – don’t assume you know someone’s needs and don’t make • • • • • •

assumptions about someone’s capacity to make decisions.

Do not assume others will have done what they said they will do Do not break someone’s links with their community Do not give false hope or set unrealistic outcomes Do not be rigid and prescriptive Do not proscribe choices and options Do not take over. This could include excluding someone from decisions, disabling through over-supporting, doing things for someone that they could do for themselves, over-caring, dictating, bombarding or setting outcomes on behalf of someone.

• Do not be vague. In particular be time-specific in the plan. What should we do in partnership? Partnership working needs to be: • Flexible

• • • •

Explore options Knowledgeable – otherwise potential partners get missed Clear about how to measure outcomes Well planned, including looking at who is involved in the person’s life and what part each person or service can play

• Allowed to take managed risk

Once the focus is on outcomes, domiciliary care will need to work with a wide range of other services, including: • General community services and activities

• Memory services • Volunteer–led • • • • •

services

Welfare rights GP District nurse Local pharmacy Occupational Therapy

• Day care services • Hairdresser • Care and repair • Fire service • Telecare services

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 1

Session 2: Well-being Outcomes Domiciliary care will need to focus on well-being outcomes. People considered some of the barriers and some of the enablers to making this culture shift.

Barriers

As with everything, some people felt trust was key, particularly for commissioners to trust domiciliary care providers. Six major barriers were identified. 1. Current commissioning practices Some current practices were seen as barriers to focusing on well-being outcomes: • The focus on time and tasks • Prescriptive commissioning and contracts • Set hours • Contractual restrictions • A focus on re-ablement as a six-week activity 2. Culture and expectations Cultural issues focused on rigid systems, rigid commissioning and a “time and task culture”. Some providers felt there was a ‘Big Brother’ atmosphere, with one person saying “sometimes it’s like going to the head teacher. You get your work marked by commissioners and CSSIW”. There were issues around public expectations, for example: • families tend to be risk-averse • not wanting to be independent but to be looked after • belief that someone deserves services Several people expressed a need for help managing change, for example one person asked “How do you make people aware of changes and help them accept changes?”

3. Language People referred to the importance of providing services in people’s language of choice. In addition to providing services in Welsh and English, using clear, everyday language. 4. Resources In general, lack of resources (including money) were seen as a major barrier to becoming outcome-focused. 5. Current system The current system was felt to be designed for a time and task focus, with different professionals working “in silos”, agencies not working together and a financial motivation to encourage dependency. 6. Staff and skills Barriers were largely around recruitment, training and retention. One person commented “we need a diverse workforce to meet diverse requirements”.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 1

Enablers People identified many enablers: • Having the right conversations

• • • • • •

Listening to what people want Enough time Creative, flexible ways to provide support and measure outcomes Clarity about what domiciliary care can do Commissioning outcome-focused services, with time allowed to talk and listen A culture of trust, courage, flexibility, motivation and caring

• Asking rather than making assumptions • Having evidence and examples of what works

• Sharing experiences and good practice • Support to pilot new ideas • Sharing information, particularly through improving IT systems

• Providing services in the language of each person’s choice

• Understanding the difference between outcomes and tasks

• Partnership working, including pooled budgets

• Knowing about other community services • Skilled, motivated staff with the right attitudes

The Social Services and Well-being (Wales) Act was seen as a major enabler. Also being given permission to try new ways of working, you need it and sometimes things do not work but you can learn from these. People wanted support to be creative, and to use the workforce and assets creatively. They also recognised there was an element of risk, and that this would need to be managed. Some specific services were seen as enablers for outcome-focused work:

• • • • • • • •

Therapeutic work Men’s sheds Intergenerational work Locality hubs Telecare Signposting Access to aids and adaptations Community safety partnership

17 March 2015

Domiciliary Care Development Workshop 2 Value for money: How do we achieve social, environmental and economic outcomes?

Anticipated learning outcomes We will be developing a shared understanding of: • How can Domiciliary Care services contribute to social, environmental and economic outcomes?

•

How can procurement processes capture these outcomes?

Agenda 8.45 am

Registration and refreshments

9.15 am

Summary of learning points from workshop 1, Maria Bell.

9.25 am

‘Who’s in the room’? Participant introductions, Fran O’Hara.

9.40 am

Introduction to People, Profit & Planet, Anne Collis, Barod.

10.00am

individual and group activities, exploring ‘People, Profit & 3 Planet’ - the ‘triple bottom line’.

10.45am

Feedback to room insights from activities, Fran O’Hara

11.00am

BREAK

11.15am

nison’s Ethical Charter aims (stages 1 and 2) U - How can we achieve this?

12.20pm

Summing up, thanks and evaluation.

- What will help / enable us to be successful - What can prevent us?

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Session 1: Social, Environmental and Economic Impact.’ Introduction to the ‘triple bottom line’ of People, Planet, Profit What’s the triple bottom line about? 1. It’s about sustainability - leaving the world in a better state than you found it 2. It’s about accounting - measuring and showing the positives and negatives, gains and losses, benefits and costs It started as a way to account for your social, environmental and economic impact. The phrase was coined by John Elkington in 1994.

People, Planet, Profit Often, the triple bottom line is summarised as the 3Ps. While catchy, the 3Ps hide some of the wider meanings so when working on the exercises during the workshop, try to remember to think Social, Environmental and Economic.

What’s included? The triple bottom line can be as narrow as calculating a social and an environmental bottom line then presenting them alongside the profit or loss bottom line of your financial accounts. Or it can be as broad as looking at your social, environmental and economic impact. Everything that any person or organisation does has a social impact, environmental impact and an economic impact, even if you don’t think of what you do that way.

Triple bottom line and commissioning Part of the commissioning process involves lining up the commissioner’s priorities, the provider’s way of operating and the provider’s way of evidencing their triple bottom line.

The workshop is a chance to think about priorities in terms of the triple bottom line, ways of working in domiciliary care and ways of evidencing your triple bottom line. Good news: there are no standard measures or ways to evidence Bad news: there are no standard measures or ways to evidence Good news: you will get a chance to think together of good ways to evidence the triple bottom line for domiciliary care.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Session 1: Social, Environmental and Economic Impact People were asked to think about the impact of domiciliary care on the social, environmental and economic aspects of sustainability - the ‘triple bottom line.’

Aspect 1. Social People recognised that domiciliary care impacts more widely than simply those providing and receiving a service. Those affected include: • Families

• • • • •

Commissioners NHS staff Occupational Therapists Volunteers and voluntary organisations The local community

Examples of how domiciliary care and the local community affect each other included: • Community support networks

• • • • • •

Social activities More places for people to go Exercise classes Volunteering opportunities Keeping families and neighbours together Building networks in the community

Several people noted it was important to use local workers who know the area, organisations working there and social activities.

Domiciliary care has a direct impact on people’s health, well-being and re-ablement. It is an important preventative service, enabling people to remain in their home and out of hospital or residential care for longer. Domiciliary care also plays an important role in keeping people safe. Domiciliary care directly impacts on its staff. There were issues of low pay and inability to pay the living wage. Many people talked about the sharing that is part of providing domiciliary care services:

• • • • • •

Sharing information Working with other organisations Partnerships Developing ideas Sharing good practice Sharing training

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Changing perceptions of Domiciliary Care Although domiciliary care was seen as a low pay job, people were keen to see workers gain more skills and benefit from training. This was seen as good for the workers, good for retention and good for people receiving a service. Throughout the three workshops people repeatedly suggested that they want to change the perception of the profession so it would be seen as a career, rather than a temporary job. This would impact the quality of service and provide continuity. Better and more training would support this to happen. Many people wrote about the support aspects of domiciliary care, using words like: • Protects

• • • • • • •

Re-ables Personal care Caring Support Preventing dependency Assist Improving well-being

Ways of working included: • Continuity

• • • • •

Availability Sustainability Promoting self-responsibility Tackling disenfranchisement Inclusion based on rights and values

Tasks might include:

• • • •

Collecting newspapers Shopping Personal care Day care

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Aspect 2. Environmental Perhaps unsurprisingly, the biggest negative environmental impact of domiciliary care was seen as travel. The main suggestion to reduce this impact was to have a local workforce, with one person talking about a “one carer, one street” model. Other suggestions were to combine journeys, for example doing several people’s shopping on the same journey. There were suggestions around reusing and recycling, particularly around equipment and office space. Technology was seen as having a role, for example electronic rotas to reduce paper use and telecare to reduce travel.

Aspect 3. Economic Several people felt there was a conflict in that actions with a positive social and environmental impact are likely to have a negative economic impact. A particular example was pay and general terms and conditions for staff. Localism was the main suggestion for having positive impact across the board, followed by creative use of technology. Sharing resources, working together and pooling budgets were all seen as ways to reduce waste and costs. A few issues were raised about commissioning, such as unit costs, allowing adequate time per person, allowing innovation and support to re-model service delivery.

Comments were made about the need to reinvest any surplus or profit, rather than distribute profit to owners. A number of comments referred to parts of the not for profit sector. Domiciliary care was seen as having an “invest to save” role through keeping people at home for longer and reducing demand for hospital stays.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Session 2: Unison Ethical Care Charter The Unison Ethical Care Charter includes elements of social, environmental and economic sustainability. www.bit.ly/EthicalCareCharter This has particular relevance for North Wales as Wrexham County Council has used it in a recent framework agreement tender asking Providers to have due regard to staff terms and conditions and as a minimum should comply with stages 1 and 2 of the Ethical Care charter. “The Ethical Care Charter lists the standards we want local authorities to adhere to when they come to commission homecare services in the future” People were invited to consider any barriers or enablers that might affect a domiciliary care provider’s ability to meet the first two stages of the Unison charter.

What will prevent us being successful, barriers? • • • • • • • • • •

Status quo in people’s minds Lack of trust Cost Turnover of staff Subcontracting Zero hour contracts Getting mandatory training done Thinking it’s a spare time job More demand, reduced funding People at the workshop might not have authority to drive things forward in their local authority

• Attitudes and resistance to change • Systems - costings, pensions • Task focus

Four main categories of barrier were identified from the written comments. Barrier 1: Resources People felt there were resource implications for meeting the Unison standards, such as: • Cost of releasing staff for meetings and training

• Extra “talk time” with clients • Cost of travel time, pensions and moving towards paying the living wage. One

provider commented “the unit cost and terms & conditions make it unsustainable for us to pay the living wage at present”

• Providing extra domiciliary care services to make up for other service cuts (for example fewer community and preventative services)

• Local authorities not paying retainers, meaning providers offering zero-hour contracts so they can remain sustainable

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

Barrier 2: Commissioning and care plans that focus on tasks This was raised as a barrier by many people. A specific example was feeling pressured to rush and being instructed “not to talk” to the person being supported. One person described being told explicitly “you should be working, not talking”.

Barrier 3: Culture and expectations Current culture and a need to change culture were seen as barriers. Examples were: • Poor innovation

• Differences in cultural expectations between services, for example services being commissioned differently depending on age or client group

• Some services being publicly celebrated (eg foster care) while domiciliary care is not • Attitudes of some people who use services of “you owe us” • Public misconceptions of what domiciliary care is, and misplaced expectations of what can be provided

• Families and providers having a different perspective about safety and risk Some people commented on knowing where they were and where they wanted to be, but lacking the capacity to develop a clear route plan to get there. Poor leadership was also seen as a barrier to culture change and innovation.

Barrier 4: Staffing Particular barriers included: • limited access to training

• staff recruitment and retention • zero hours contracts

There was an overarching need mentioned by several people – the need for increased trust between all those involved in domiciliary care.

What will help us be successful, enablers? • • • • •

Trust Confidence Belief it will work Buying into the new concept Going back to the old ways of Wales - what can you do to help yourself and those around you

• Guarantee to domiciliary care workers of enough work to be sustainable • Appropriate funding to allow for team meetings, flexible working, robust contracts • Speed dating - ask what people want their services to look like; lonely older people wanted speed dating for friendships and activities then domiciliary care might not be needed because of combining assets

• Be able to make domiciliary care a career with progression

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

• • • •

Promote the sector Registration of carers Chance to trial new ideas Bringing people accessing care and support services and directors into meetings – holding whole system meetings around a common purpose

• Outcomes focus and self-assessment

Seven main categories of enabler were identified from the written comments.

1. Being person-centred These enablers revolved around listening, holding the right conversations and engaging people accessing care and support services in the process. There were several mentions of self-assessment.

2. Commissioning practices Commissioning would be enabling if it: • allowed providers to offer different types of contract to their staff

• • • • •

supported providers to test a new idea allowed funded time for staff to do everything in the Unison charter allowed providers to allocate workers to meet outcomes provided retainers for care package made more use of the third sector

3. Community focus A community focus would enable domiciliary care to meet the Unison standards. Examples given included: • Think about natural social groupings, not just individuals

• Have a local area coordinator to address isolation and loneliness • Recruiting from the local community, with local staff who know what is available locally and can facilitate people to get involved

4. Examples of good practice

People valued hearing examples of good practice during the workshop. They wanted more examples of good practice, and opportunities to share knowledge across local authorities. A few examples given were: • Training staff while waiting for references and DBS. This saves time and staff are paid for their training once they formally start work.

• Using an electronic intranet where each client has a notes section where managers record issues, follow up and resolution.

• Communication passports • A single point of access in Denbighshire • Offering all staff, even relief staff, contracts. This has helped with staff retention.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 2

5. Culture and leadership A key feature of an enabling culture was summed up as “remember that people are not robots”. An enabling culture requires ambition and strong leadership. Small providers in particular may value support in how to tender.

6. Partnership working This included a strong emphasis on co-production. It include the idea of a provider alliance. Agencies would value being able to access local authority training.

7. Staffing Training is an important enabler. It can be hard to find times for training and provide continuity of carer to people. Training needs to go beyond mandatory training. A few people suggested a register of domiciliary care workers with a continuous professional development requirement. Several suggested sharing training between providers to increase consistency, reduce training delays, share good practice and share resources. Improving recruitment and reducing turnover would help providers to meet the Unison charter standards. One route would be to employ support staff on a shift basis, not a call rota, and make domiciliary care work a career option.

Staff need the opportunity to be part of regular team meetings.

17 March 2015

Domiciliary Care Development Workshop 3 ‘Co-production of domiciliary care, what’s the story?’

Anticipated learning outcomes We will be developing a shared understanding of:

• The meaning of Co-Production and the difference between traditional front line services and co-produced ones - in terms of organisational culture change as well as challenges to traditional council processes, policies and procedures.

• A range of engagement and planning methods that could be used with stakeholders.

Agenda

1.00pm Registration and refreshments Introduction, aims and summary of learning points from workshops 1 and 2. 1.30pm 1.35pm ‘Who’s in the room’? Participant introductions - Fran O’Hara 1.50 pm Session 1: What is Co-production? - Pam Luckock, ‘Working With Not To’ Co-production project Overview of the topic including Changing roles and responsibilities. 2.10pm Doing things differently - How will the new requirements and an outcome- based model change how we will do things? For the commissioner… For the assessor… For the provider… 3.15pm BREAK 3.30pm Session 2: Co-production in action – Maria Bell. Creating a plan for care and support services provided in people’s homes which: - are person centred - focus on achievement of service and individual outcomes - deliver community benefits, and - involve service recipients and/or their representatives in the service design and delivery. 4.45pm

Summing up, thanks and evaluation.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 3

Session 1: Changing to an outcomes focus approach This was understood as being a very different way of working, which would require people to perhaps feel uncomfortable, take risks and work with a range of people in new ways and to ‘think differently’. This was welcomed by many as they felt that involving citizens earlier would result in better services and services that ‘made sense’. People fed-back that they were ‘ready willing and able’ to make changes, and that they all wanted the same outcomes. These themes continued to emerge over the three workshops. This demonstrates that people recognised that how they worked was going to have to change, and that with permission and support people would be able to achieve this new way of working. Changing to an outcomes focus means commissioners, assessors and providers ALL need to make changes. This was a major theme throughout the three workshops, raising issues around culture and trust and how people could change their existing relationships.

1. Commissioners Changing to an outcomes focus means redesigning contracts and commissioning. Among other things it means changing how contract compliance is monitored and permitting more flexibility. People fed-back that there was limited or no flexibility in the current system. There will be culture changes for commissioners, and leaders will need to understand and support this way of working. A few people said that commissioners will become more like facilitators. This highlighted a need for improved communication.

Commissioners will also need to think about sharing power, making commissioning more led by what services people say they want, and allowing providers, staff and assessors to have a say. Several people highlighted “invest to save” approaches to commissioning domiciliary care in the future, particularly as a way to delay or prevent more costly hospital or residential services. It would make domiciliary care more expensive, for example by including more ., but this would be more than offset by later reductions in use of considerably more expensive services. The Social Services & Well-being Act places a requirement on people to work in partnership with the people we support. There will be a greater need for partnership working and possibly partnership agreements rather than service contracts. Overall, the future will need more trust between commissioners and providers.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 3

2. Assessors and assessments Again, this needs a change in culture, including more flexibility, creativity and a focus on outcomes. One person summed up the shift to person centred assessments as “looking at people’s needs through their own values”. The assessor will need a new relationship with both commissioner and provider, of trust, transparency and clarity. Assessors will need new skills and hopefully get increased job satisfaction. There were a range of opinions about whether and how the provider should be involved in the initial assessment. There was full agreement that the person, their family and their friends should be involved in the assessment.

3. Providers Providers will need to change culture too. Staff will need training to adopt an outcomesfocused, person-centred approach. Much was said about relationships with assessors and commissioners, particularly about trust and a more partnership style of working. More clarity will be needed about roles, responsibilities and ways to measure outcomes. This was viewed as a real ‘whole systems’ change. People would need support to work in this new way, and to identify ways to measure outcomes. There will also need to be more flexibility built into contracts so that staff can work in an outcomes-focused way. Staff will need more and different training. One person commented that providers need to “make it clearer to staff that they are able to make a real difference to people’s lives”. Systems will need to be less bureaucratic. One person suggested standardising paperwork across North Wales.

Providers felt they needed to be more involved in the initial assessment.

DOMICILIARY CARE - DEVELOPMENT WORKSHOP 3

Session 2: Creating a domiciliary care & support services plan The group were asked to consider a draft template of an ‘integrated community care and support plan’.

This document aims to describe how all people providing care & support or therapeutic interventions (including self-care, and support from unpaid Carers, volunteers, care & support services, nursing, therapists etc) contribute to achieving an individual’s personal outcomes. The Group was asked if the draft care & support plan was fit for purpose and: - Person centred - Focuses on service and individual outcome achievement - Delivers community benefits - Involved the person being supported and/or their representative in service design & delivery

Feedback on the draft care & support plan was used to finalise a version for piloting. A new ‘system’ is being designed, in which we aim that: - Providers will be given outcome based assessments and a care and support plan which details all of the people involved in contributing to the personal outcomes. - Providers will then be asked to develop timed delivery plans detailing how and when outcomes will be achieved with individuals

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Next steps and workshop information

Next Steps Key messages from the workshops will influence the region’s future commissioning approach.

• The current agreement (contract) is in place until April 2016, as is the existing (closed) Approved Provider process.

• Local Authorities are therefore considering their future procurement approaches and whether they will continue to operate on a regional or sub-regional basis.

• The implementation of the Social Services & Well-being (Wales) Act in April 2016 will require care and support services to contribute to the achievement of personal wellbeing outcomes.

• The performance of services will be measured in accordance with the National (Wellbeing) Outcomes Framework.

• The regional collaborative project has reviewed brokerage processes and the

existing contract (service) specification and has identified notable outcomes based practice elsewhere in the UK.

• It is clear from this project and these (March 2015) workshops that further

development workshops will be beneficial.

• It is also clear that a collective and strategic approach to workforce development will be required to ensure that suitable, competent and qualified individuals are attracted to and retained within domiciliary care services.

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Participant Workshop Feedback There were 47 feedback sheets in total from the 3 workshops. 23 feedback forms came from managers. 16 came from people with a commissioning or contracts role. 6 forms came from practitioners. 2 feedback forms came from CSSIW. Co-production Five forms said their current service was fully co-produced. Five forms said their current service was not co-produced at all. The remaining 37 forms all said their current services were partly co-produced. Learning 44 out of the 47 forms said the person had learned something. Only three people said they hadn’t learned anything new and of these, two said they had gained confidence to continue what they were doing. The learning can be categorised as:

• factual, for example about the Social Services and Well-being (Wales) Act • learning about new approaches, for example the outcome focus and to see things • • • •

from other perspectives hearing examples

deepening existing knowledge planning for the future becoming more comfortable and confident to work as partners

27 forms said that people would do something new. These could be categorised as: • Co-production

• • • • •

Working with others Planning or thinking Sharing what they have learned or arranging training for staff Communicating better Changes to their systems (eg starting to use one page profiles)

Future updates and information Most people wanted future updates and information through emails, newsletters and followup workshops. People wanted opportunities to share examples and good practice and information General feedback on the workshops People found the workshops informative and productive. They particularly liked the opportunities to talk, listen and share ideas. People valued the breadth of experience and roles of people at the workshops. There was some disappointment that the workshops had not included people who use domiciliary care. People spoke warmly about the organisation of the workshops and the facilitation. There was praise for the Welsh-speaking table and Welsh facilitation, the graphics and the range of different approaches. Two people commented that they had not really understood the social, economic and environment workshop. One person had hoped for more practical tools to take away for co-production.

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Attendees Name

Organisation

Job Title

Aimee Jones

Gwynedd Council

Contract Monitoring Officer

Alwyn Jones

NWSSIC

Head of Adult Services, Ynys Môn / Chair of North Wales Adult Services Heads

Anita Williams

Conwy Council

Procurement & Contracts Officer

Arwel Evans

Gwynedd Council

Corporate Procurement Manager

Bella Jones

Cartrefi Cymru

Area Manager Domiciliary Care

Ben Chard

Wrexham Council

Contracts Officer

Bethan Jones Edwards

NWSSIC

Regional Collaboration Officer

Carol Davies

Procare Wales

Area Manager

Carys Archer

Gwynedd Council

Contracts Manager

Ceri Cartwright

Flintshire Council

Monitoring Officer

Christy Jones

Flintshire Council

Planning & Development Officer

Claire Owens

Conwy Council

Principal Practitioner Health & Social Care Services

Debbie Liddell

Conwy Council

Section Manager

Fiona Dennison

Conwy Council

Section Manager, Adult Social Care & Community Services

Fran O’Hara

‘Working With Not To’ Project

Director

Gary Major

Denbighshire Council

Procurement Officer

Huw Thomas

Sglein

Partner

Jane Thomas

Mencap Cymru

Area Manager

Jennie Millington

Just One

Manager

John Daniel

Wrexham Council

Contract & Monitoring Officer

Karen Wylie

K L Care Limited

Registered Manager

Kate Peirce

Conwy Council

Senior Practitioner Occupational Therapy Housing Renewals Service

Kevin Ayriss

Denbighshire Council

Senior Practitioner

Lisa Jones

Conwy Council

Principal Practitioner, Adult Social Care & Community Services

Lynne Kent

Deevale Home Care Services

Registered Manager

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Name

Organisation

Job Title

Maria Bell

NWSSIC / Regional Collaboration Team

Project Manager

Marian Hankin

Conwy Council

Service Manager Older People, Conwy Council

Marian Jones

Gofal Bro

Manager

Meinir Roberts

Conwy Council

Team Manager, Adult Social Care & Community Services

Nicki Salter

Flintshire Council

Contracts Team Manager

Pam Luckock

‘Working With Not To’ Project

Director

Phillip Molyneux

Molyneux Care Services

Rachael Hannaby

Q Care & Special Care Limited

Registered Manager

Rob Gofford

CSSIW

Area Manager

Sandra Fisher

K L Care Limited

Deputy Manager

Sarah Watkins

Isle of Angelsey CC

Project Manager

Sharon Eyre

Betsi Cadwaladr University Health Board

Rural North District Nurse Team Manager

Sian Wyn Jones

Conwy Council

Principal Practitioner Older People/ Hospital Social Work Team

Sue Millington

CSSIW

Area Manager

Susan Cunnington

Denbighshire Council

Commissioning Officer

Susan Hart

Anheddau Cyf

Homecare Manager

Tasha James

Just One

Deputy Manager

Tesni Hadwin

Conwy Council

Service Manager - Vulnerable People

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

The team Maria Bell Project lead

Maria is currently facilitating a portfolio of collaborative projects for NWSSIC - including the development of integrated approaches to assessment, care planning and review; developing and improving well-being services, extra care housing and direct payments policy and practice. Maria has extensive experience of health and social care services across sectors, in England and Wales – having been both a commissioner and service provider. maria.bell@denbighshire.gov.uk

Fran O’Hara Lead facilitator

Fran is Director of Scarlet Design International, a consultancy specialising in visual communications and facilitation, training and design. We work with a range of local, national and international clients to create new communication tools for the new workplace. Using strategy, design, training and visual facilitation to bring clarity and to create engaging and inclusive communications. Including: visual facilitation, strategic illustration, workshop design and delivery, coaching, consultation, world café, brand strategy and development, corporate identity, print, infographics, vision maps and toolkits. Fran is also co-Director of the ‘Working With Not To’ Co-Production Project: a pan-Wales ‘grassroots up’ project growing coproduction and well-being. www.FranOhara.com www.WorkingWithNotTo.com

Pam Luckock Facilitator

Pam is a currently a coach, mediator, World Café host and action learning facilitator, networker and enabler with a strong belief in social justice and the potential in each person to bring about a positive change. In her former NHS role she gained wide experience of strategic management and leadership development to effect culture change and create positive working environments. She currently works as a consultant with Fran O’Hara as part of the Scarlet Design team, co-designing and delivering the ‘Working With Not To’ project and workshops. www.WorkingWithNotTo.com

Anne Collis Facilitator

Anne a director of Barod, a one-stop shop for accessible information, inclusive research, and advice, evaluation and quality checking on making sure people with learning disabilities are able to access services and products. Anne is also owner of the Social Interface, and in this role writes reports, guides, handbooks and articles; making information easier to understand. She also undertakes research; facilitation, training and consultancy on social policy issues, particularly foster care and learning disability. www.barod.org

Huw Thomas Bilingual facilitator

Huw is partner at Sglein and a training and facilitation professional with over 10 years’ experience of tailoring and delivering engaging and effective training for a wide range of clients across the sectors. He also facilitates diverse groups from school pupils and FE/HE students to business groups at CEO and Director level. Huw has a broad range of contacts gained through creating and delivering business events and leads the field in bilingual delivery and bilingualism in business. www.sglein.co.uk

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Photostory

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Appendix 1 Pen Pictures of Llew and Mabel

Llew Pen picture: Llew is 78, an ex Gresford Colliery man and lives alone since his wife moved into a care home following a stroke 3 years ago. Llew is not in the best of health himself, having Chronic Obstructive Pulmonary Disease (treated with inhalers) and has the early stages of dementia. Llew is increasingly short of breath and his GP is considering whether to prescribe oxygen but concerned about the risks due to his smoking and memory problems. Llew visits his wife twice a week and is able to share a meal with his wife at the care home. On other days Llew ‘forgets’ to eat or drink and has been admitted to hospital a few times with urinary tract infections. Llew can’t bear going into hospital as he misses his visit with his wife and gets very grumpy because he can’t have a cigarette when he wants one. The staff at Llew’s wife’s care home have told his wife’s Care Manager that he doesn’t seem to be taking care of himself (has lost weight, doesn’t change his clothes as often as he should and is often unshaven). Llew is a proud man who doesn’t want to ‘let his wife down’ by not looking after himself.

Llew also enjoys ‘meeting up with the boys’ on a Saturday afternoon to have a pint and watch the sports. His ‘local’ is only a few streets away and he has always walked but recently he got lost on his way home and since then he hasn’t been so confident and so he has been finding excuses not to go every week. Llew is worried about what will happen when his memory gets really bad. What is important to Llew: • Seeing his wife twice a week • Meeting up with the boys for a pint every week • Stopping his wife from worrying about him • Maintaining his memory and independence for as long as possible • Going away for a weekend break with his wife What is important for Llew: • Maintaining his dignity & personal care (hygiene, appearance, diet) • Medication • Giving up smoking • Health & safety at home if and when he requires oxygen

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Pen Pictures of Llew and Mabel

Mabel Pen picture: Mabel is 84-years old and lives alone in a bungalow in Abergele; she has been having a few falls and recently had quite a bad one, resulting in her attending hospital for treatment, where they were worried that she was a bit confused. Mabel has problems hearing and hasn’t been going to her eye appointments - despite her eyesight failing. Mabel has one son, who she doesn’t see as often as she would like because he works long hours. Mabel has some help around the house from her son’s girlfriend and she enjoys it when the hairdresser comes to the house each week because they have a good old natter and catch up about what’s going on in the village; Mabel is worried because her hairdresser is pregnant and she doesn’t think the hairdresser will continue working. Mabel used to knit blankets for any new babies in the village but got frustrated when she couldn’t see so well; so has stopped knitting. Mabel’s energy bills are high because she has electric heating; these take up a lot of her pension each week. She won’t let her son’s girlfriend do her shopping as she is embarrassed that she doesn’t have much ‘housekeeping’ money and can only afford the basics.

Mabel hasn’t been out much in the last 2 or 3 years, saying that she has lost interest. When she was earning a bit of money from baking for the local cafe, she used to enjoy going out to play darts and see her friends. Mabel has had some re-ablement support to get back on her feet but isn’t eating well and her GP is having to carefully monitor her diabetes medication. She has a new shower fitted but wants some support with getting in and out of the bath once or twice a week, where she enjoys a good soak. Mabel also needs support to put on her medical stockings. What is important to Mabel: • Keeping well - staying out of hospital or a care home • Keeping in touch with her neighbourhood and village • Keeping a relationship with her son and her hairdresser • Enjoying a Sunday ‘pamper’ - a soak in the bath and having her hair done. What is important for Mabel: • A regular healthy diet • Taking her medication at prescribed times • Wearing her stockings every day and keeping mobile • A welfare rights assessment.

NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

References Wales Government: Well-being & National Outcomes Framework for Social Services “To define what well-being means to the individual, and understand whether this is being achieved, we have published a wellbeing statement. The statement will help service providers to plan, it will monitor the contribution and performance of agencies throughout Wales, track progress made and inform actions for improvement. The definition of ‘well-being’, in this context, builds on broad powers currently placed on local authorities & the local health boards to promote the improvement of the economic, social and environmental well-being of their area” www.bit.ly/WelshGovMeasure New Economics Foundation: Commissioning for Outcomes and Coproduction “This handbook and practical guide is the result of eight years of collaboration between the New Economics Foundation (NEF) and local authorities. It sets out a model for designing, commissioning and delivering services so that they focus on commissioning for ‘outcomes’, promote co-production & promote social value by placing social, environmental and economic outcomes at the heart of commissioning.” www.bit.ly/CommissioningOutcomes

The following are particularly recommended: Briefing paper 11: Redesigning Homecare Services & Briefing paper 13: Outcome based contracting. Think Local Act Personal: Stronger Partnerships for Better Outcomes. “A set of principles and good behaviours that is intended to enhance effective ways of working between people and family carers, service providers and local authority commissioners” www.bit.ly/StrongerPartnerships Institute of Public Care (Oxford Brookes University) ‘Emerging practice in outcome-based commissioning for social care’ “A progress report prepared by IPC Associate Professor John Bolton; the paper explores the lessons learnt from a variety of approaches taken by councils to “outcomebased commissioning” in adult social care (sometimes called ‘payment by results’). It considers some of the opportunities and risks that arise from taking this approach.” www.bit.ly/EmergingPractice

Impact Change Solutions: Smarter commissioning case studies and briefing papers “An evidence base for action and a suite of practical resources to allow councils and their partners to make progress with their market shaping activities” www.bit.ly/SmarterCommissioning

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NORTH WALES DOMICILIARY CARE: DEVELOPMENT WORKSHOPS

Appendix 2 Consultation draft: North Wales Domiciliary Care and Support Service Specification: Delivering Well-being Outcomes