Reportfor:
A C TIO N
Item N u m ber: 8 vi
C ontains C onfid ential
orE xem ptInform ation
Title
Responsible O ffic er(s)
C ontac toffic er, job title
and phone nu m ber
M em berreporting
ForC onsid eration B y
D ate to be C onsid ered
Im plem entation D ate if
N otC alled In
A ffec ted W ard s
Keyword s/Ind ex
N o -P art1
Transform ing A d u ltS oc ialC are S ervic es P rogress Report-Q u arter2 2 01 4/1 5
C hristabelS hawc ros s , S trategic D irec torofA d u ltand
C om m u nity S ervices
N ickD avies , H ead ofS trategic C om m iss ioning A d u lts
and H ou s ing. 0 1 62 8 68 361 4
C llrD avid C oppinger, L ead M em berforA d u ltS ervices ,
H ealth and S u s tainability.
C abinet
30 O c tober2 0 1 4
30 O c tober2 0 1 4
A ll
O u tc om es , Ind epend enc e, H om ec are, P ers onalC are,
Res id entialc are, S u pported A c c om m od ation, L earning
D isability, V u lnerable P eople, P ortal.
ReportS u m m ary
1.
This reportprovid es an u pd ate on the Trans form ing A d u ltS oc ialC are
program m e 2 0 1 4/1 5 thatwas agreed by C abinetin A pril2 0 1 4.
2.
Itc onfirm s thatthe program m e has d elivered betterou tc om es forres id ents
and is on targetto d eliveran es tim ated £ 8 0 8 kofefficienc ies by A pril2 0 1 5.
3.
Trans form ation projec ts , s u c h as Telec are E xpans ion, N u rs ing C are
P revention and H igh C os tP lac em entwork, are m aking s ignificantprogres s
toward s m eeting and in s om e c as es overac hieving theirfinanc ialtargets .
4.
The reportd etails the progres s ofind ivid u alTrans form ation projec ts and
explains how thes e willc ontinu e to c ontribu te toward s the ac hievem entofthe
2 0 1 4/1 5 program m e.
If rec om m end ations are ad opted , how willresid ents benefit?
B enefits to res id ents and reas ons why they willbenefit
D ates by which
115
1 . Res id ents willc ontinu e to benefitfrom a range ofhigh
q u ality s pec ialistc are and s u pports ervices .
2 . Res id ents who are m aking c hoices abou ttheirc are will
be able to m ake inform ed c hoices thatbes tm eettheir
s oc ialc are need s .
3. Res id ents willgetbetterou tc om es ata lowerc os t.
4. Res id ents willbe atlowerriskofreq u iring long term
s oc ialorhealthc are s u pport.
res id ents c an expec t
to notice a d ifferenc e
1 Janu ary 2 0 1 5
1 Janu ary 2 0 1 5
1 Janu ary 2 0 1 5
1 Janu ary 2 0 1 5
1 . D etails of Rec om m end ations
RE C O M M E N D A TIO N : ThatC abinetnotes the progress of the Transform ing
A d u ltS oc ialC are program m e forQ u arter2 of 2 0 14/15.
2.
Reason forRec om m end ation(s)and O ptions C onsid ered
2 . 1 C abinetreq u es ted a q u arterly u pd ate on the A d u ltS oc ialC are Trans form ation
program m e. This reportprovid es an u pd ate to c onfirm the progres s ofthe
projec ts within the program m e in the s ec ond q u arterof2 0 1 4/1 5.
2 . 2 The efficienc y program m e is forec as tto d eliveran ou ttu rn of£ 8 0 8 kofs avings
in 2 0 1 4/1 5 from s pec ific Trans form ation P rojec ts agains ta targetof£ 8 0 5k. The
reportd etails the progres s ofthe ind ivid u alprojec ts within the Trans form ation
P rogram m e.
2 . 3. The Trans form ation P rogram m e c ontinu es to s u pportthe preparatory work
req u ired to d eliverthe req u irem ents ofthe C are B ill2 0 1 4 and the Governm ent
W hite P aper: ‘ C aring forou rFu tu re Reform ing C are and S u pport’ 2 0 1 2 . Italso
u nd erpins the worktoward s s haping s ervices forthe B etterC are Fu nd (B C F).
The Trans form ation program m e willc ontinu e to ad aptand evolve to ens u re that
itd elivers the req u ired c hanges .
2 . 4 E fficienc y P rogram m e -P rogres s
The program m e c ontinu es to d elivers ignificantefficienc ies . Thes e have been
ac hieved by progres s being m ad e to d eliverthe s pec ific projec ts . The projec ts
are c ons id ered in the D as hboard in A ppend ix 1 . The es tim ated ou ttu rn foreac h
projec tfor2 0 1 4/1 5 are s u m m arised in the table in paragraph 2 . 6.
2 . 5 The A d u ltS oc ialC are s ervice has targets avings of£ 7 8 5kbu iltinto its bas e
bu d getforthe year2 0 1 4/1 5, and a fu rther£ 2 0 kac c elerated efficienc y s avings
brou ghtforward from 2 0 1 5/1 6. The Trans form ation program m e when c om bined
with ac c elerated efficienc ies has a targetoftotalefficienc ies in 2 0 1 4/1 5 of
£ 8 0 5k.
116
2 . 6 P rojec ts u m m ary:
3 yearP rojec ts (see 2 . 6
above)
Inc reas e in the u s e of
Telec are
P lac em ents into “S hared
L ives ”c are
Review ofH igh C os t
P lac em ents
Im proved planning forthos e in
Trans ition
Im proved operation of
H om ec are. D irec tP aym ents
& M eals c ontrac ts
S avings
Target
1 4-1 5
£ '0 00
S avings
P rojec ted
ac hieved
S avings
atQ 2 14-1 5 O u ttu rn
1 4-1 5
£ ’ 0 00
110
80
120
75
21
51
32 0
210
331
50
0
50
100
30
50
N u rs ing C are P revention
1 50
80
206
E ffic ienc y Total
8 05
42 1
8 08
2 . 7 The d etailand reas ons forany c hanges are c overed in the d as hboard s u m m ary
ofthe projec tprogres s in A ppend ix 1 ofthe report. Graphs illu s trating the s avings
ac hieved and the es tim ated fu llyeareffec tofthe ac tivity from Q 2 2 0 1 4/1 5 is
inc lu d ed in A ppend ix 2 .
2 . 8 The key projec tarea thatis notc u rrently d elivering is the S hared L ives s ervice.
The provid erhas notd elivered agains ttheirtargets . C ons eq u ently we have not
d elivered the levelofs aving in 1 4-1 5 thatwe have expec ted . W hile this
u nd erperform anc e has been offs etby the s u c c es s ofthe otherprojec ts this is not
s atisfac tory.
2 . 9 A nu m berofac tions have been taken in Q 2 to rec tify the s itu ation. A financ ial
review ofthe c ontrac tis u nd erway to rec overpaym ents for u nd erperform anc e in
year1 . The c ru c ialreas on forthe u nd erperform anc e is thatthe c ontrac torhas not
been able to d eliverrec ru itm entofappropriate c arers . RB W M have s u pported the
provid erwith a m arketing c am paign forc arers thathas res u lted in 5 new c arers
being rec ru ited in Q 2 . RB W M have also worked with the provid erto re engage with
the referring s oc ialworkteam s to review the pipeline ofs hared lives referrals to
m atc h them . The Q 4 perform anc e is expec tto s ee a s ignificantim provem entas a
res u ltofthes e ac tions .
2 . 1 0 The im proved operation ofH om ec are has notm etits targetd u e to a lac kof
c apac ity in the provid erm arket. P rovid ers are having d ifficu lty rec ru iting s taffand
therefore hou rly rates forhom ec are are inc reas ing. This m eans thatthe s trategy of
plac ing with innerc irc le provid ers is notd elivering the expec ted s aving. The tend er
foran O u tc om e B as ed H om ec are s ervice is expec ted to res olve the iss u e ofthe lac k
ofc apac ity by giving gu aranteed work, zoning and paying forou tc om es .
117
O ption
To note the progres s ofthe A d u lt
S oc ialC are Trans form ation
P rogram m e in Q 2 of2 0 1 4/1 5. This
has been atthe s am e tim e as noting
the foc u s on the q u ality ofs ervice
d elivered .
C om m ents
The am bitiou s program m e is on targetto
d eliverthe 2 0 1 4/1 5 targets .
Rec om m end ed
3. Key Im plic ations
D efined
O u tc om es
Unm et
M et
E fficienc ies Und er£ 8 0 5k £ 8 0 5k
d elivered
throu gh
im plem enting
the 2 0 1 4/1 5
program m e
4.
E xc eed ed
S ignific antly D ate they
E xc eed ed
shou ld be
d elivered by
£ 8 0 6k-£ 8 2 5k O ver£ 8 2 5k 31 M arc h
20 15
Financ ialD etails
a) Financ ialim pac ton the B u d get
Forec as tefficienc y s avings for2 0 1 4/1 5 of£ 8 0 5khave been bu iltinto the
2 0 1 4/1 5 bu d get.
The table inc lu d ed in paragraph 2 . 6 above ind icates the ind ivid u al2 0 1 4/1 5
projec ttargets . The totalaggregate am ou ntofs aving rem ains u nc hanged at
£ 8 0 5k.
Year1 (2014/15)
* Revenu e
£ 000
A d d ition
Red u c tion
Year2 (2015/16)
Revenu e
£ 000
Year3 (2016/17)
Revenu e
£ 000
8 05
N ote in the O c tober2 0 1 3 C abinetreport1 4/1 5 s avings targetwas £ 7 1 5. S inc e
then £ 90 kofad d itionals avings have been ad d ed s eeing the targetrise to £ 8 0 5k.
b) Financ ialB ac kgrou nd
The Financ iald etails have been fu lly ou tlined in d etailin S ec tion 2 . The c ontext
is thatthis a c hallenging program m e forthe D irec torate to ac hieve with rising
d em and and res triction on res ou rc es . D es pite this, the trans form ation projec ts
are forec as tto d eliver£ 8 0 5ks aving for2 0 1 4/1 5 financ ialyear.
118
5.
L egalIm plic ations
5. 1 The Trans form ation agend a is c ons istentwith the C are A c t2 0 1 4 in its aim s for
d eveloping s ervices thatim prove W ellbeing. The A c tintrod u c es a s tatu tory
req u irem entofloc alau thorities to have a d u ty ofW ellbeing.
6.
V alu e forM oney
A llprojec ts are d es igned to ac hieve V alu e forM oney.
7.
S u stainability Im pac tA ppraisal
N one
8.
Risk M anagem ent
Risks
Unc ontrolled Risk
C ontrols
E fficienc ies are not
d elivered d u e to an
es c alation in the
d em and fors ervices .
H igh
The C are B illand
Trans form ation
P rogram m e B oard
m onitors on a m onthly
bas is, progres s ,
toward s the ac tivity,
financ e and
perform anc e targets
req u ired to d eliverthe
program m e. In the
eventthatd em and
es c alates , other
efficienc ies willbe
id entified .
9.
C ontrolled
Risk
M ed iu m
L inks to S trategic O bjec tives
This program m e is s u pporting the d elivery ofthe priorities id entified in the
H ealth and W ellbeing S trategy. Its u pports Res id ents Firs tby enc ou raging
healthy, prod u c tive and fu lfilling lifes tyles forad u lts living in the borou gh.
Italso c ontribu tes to S aferand S trongerC om m u nities by provid ing a s afe living
environm entforvu lnerable people, and enabling them to participate in
c om m u nity ac tivities . Itis a program m e foc u s ed on d elivering m ore ec onom ic
s ervices as d etailed in the efficienc y plan, by u nd ers tand ing the em erging
need s and planning forthem . Fu rtherm ore, the P ortalwillm ean thatwe
im prove ou ru s e oftec hnology. The M arketP os ition S tatem entwills trengthen
ou rP artners hips to d elivereffec tive s ervices . Itwillalso eq u ipthe workforc e for
exam ple, by provid ing a fram eworkofRes id entialhom es as a toolto ens u re
thatthe O perationalC om m iss ioning team have the ability to pu rc has e the m os t
c os teffec tive c are fors om eone.
119
10.
E qu alities, H u m an Rights and C om m u nity C ohesion
A n E Q IA P art1 has been c om pleted forthis program m e. Itwillbe regu larly
reviewed . There were no negative im plications id entified fortargetgrou ps .
11.
S taffing/W orkforc e and A c c om m od ation im plic ations:
A tthis s tage there is no d irec ts taffing orworkforc e im plications , however, there
willbe worklaterin the yearto c ons id erthe A S C workforc e and this workwill
s u pportthat.
12.
P roperty and A ssets
N o d irec tim plications on property oras s ets
1 3.
A ny otherim plic ations:
N /A
1 4.
C onsu ltation
O verview & S c ru tiny P anelviews to follow.
1 5.
Tim etable forIm plem entation
A c tivity
D eliver£ 8 0 5kofTrans form ation bas ed
efficienc y from the A S C bu d getby
ens u ring thatthe P rogram m e ofs ervice
c hanges is d elivered .
1 6.
D ate
M arc h 2 0 1 5
A ppend ic es
A ppend ix 1 –Trans form ation D as hboard
A ppend ix 2 - P rojec tS avings Graphs .
17 .
B ac kgrou nd Inform ation
Trans form ing A d u ltS oc ialC are C abinetreports –M arc h 2 0 1 2 , M ay 2 0 1 2 , Janu ary
2 0 1 3, A pril2 0 1 3, Ju ly 2 0 1 3, O c tober2 0 1 3, Janu ary 2 0 1 4, A pril2 0 1 4, Ju ly 2 0 1 4.
18 .
C onsu ltation
N am e of
c onsu ltee
P ostheld and
D epartm ent
D ate
sent
D ate
Rec eived
Internal
C llrB u rbage
L ead erofthe
C ou nc il
C llrC oppinger L ead M em ber
forA d u lt
S ervices &
H ealth (also
S u s tainability)
S ee
c om m ents
in
paragraph:
1 3/1 0 /1 4
2 6/9/1 4
2 9/9/1 4
120
M aria L u c as
C hristabel
S hawc ros s
A lan
A braham s on
H ead ofL egal
S trategic
2 4/9/1 4
D irec torof
A d u ltand
C om m u nity
S ervices
Financ e
2 2 /9/1 4
partner
1 6/1 0 /1 4
2 9/9/1 4
2 4/9/1 4
ReportH istory
D ec ision type:
Key d ec ision
Urgenc y item ?
No
Fu llnam e ofm ain report
au thor
/N ickD avies /
Job title
Fu llc ontac tno:
H ead ofS trategic
C om m iss ioning A d u lts
and H ou s ing
0 1 62 8 68 361 4
121
ASC Transformation (Efficiency Projects) - Dashboard
Telecare
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£120k
Savings Target
14-15
£110k
Excellent progress continues to be made on expansion of the
telecare programme. At the end of August 160 installations had
been achieved against a year end target of 240. This represents an
increase of 92 installations when compared to this time last year.
High Cost Placements
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£331k
Savings Target
14-15
£320k
Good progress made in year, as well as completing negotiations on
outstanding Learning Disabilities high cost placements (HCP), new
focus has been given to Physical Disabilities & Mental Health HCPs,
and Learning Disabilities ‘medium cost’ placements. As well as this,
there has been significant work to embed Commercial Awareness
across the Operation Commissioning Team (OCT) and Care
Management. The online Care Funding Calculator (CFC) has been
purchased for RBWM as a 'fairer pricing' tool, work with the OCT and
Care Managements teams has been undertaken to design how to
best use this tool to support with getting best Value For Money for
the Council.
Improved Operation of Homecare & Meals Contracts
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£50k
Savings Target
14-15
£100k
There is a continued focus on delivery savings from existing
contracts, however the impact of reducing and diverting residents
from more costly residential and nursing care placements has meant
an increase in demand for home care services which enables
residents to be more independent and remain in their own home for
longer. Recruitment of care staff remains difficult and which
remains a risk as providers are increasingly having to supplement
their core staff base with agency staff at an increased cost.
Nursing Care Prevention
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£206k
Savings Target
14-15
£150k
An appointment to the Nursing prevention post has now been made
to ensure continued focus on this area. The number of placements
made continues to decrease. There remains an ongoing risk from
wealth depleters who are at this stage unknown to council services,
however this will change with the implementation of the Care Act as
more self funder approach RBWM to register for their Care Account
from 2016.
2. Shared Lives & Homeshare
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£51k
Savings Target
14-15
£75k
Ategi (the provider) are working to an agreed action plan which
addresses their underperformance. the increased Publicity &
Marketing activities have yielded good results, recruiting several
Shared Lives carers. Underperformance has been formally addressed
with the provider, and we are seeking a variation to contract to
rework the placement targets and cost based on the revised
expectations of the local area. There continues to be good
engagement across the service areas to generate referrals, however,
continued focus is required to ensure the new momentum is not
lost.
Improved Transition
£
RAG
Resident
Outcome
Performance
Financial
Performance
Project
Performance
Risk
Rating
Projected
Savings Outturn
£50k
Savings Target
14-15
£50k
A pathway review of the transition from children services into ASC
took place in August, with colleagues coming together to understand
and clarify each others role and responsibilities. A draft 'Towards
Adulthood Protocol' has also been produced as a result. There
continues to be good collaborative care/case management focus on
costs (savings) efficiencies across the top highest cost young people
through the Transition Panel meetings and separate focus meetings.
Further work is required to review transition data, and how this is
used to generated the most meaningful and useful 'information' to
support with planning, commissioning, and financial forecasting.
*RED text = Risk for noting or escalation
Date: 24122Sept 2014
Owner: Mark Methven v2.1
Start Of Year 2014/15
Cumulative High Cost Placement Savings Quarter 2,
Actual against Target
Cumulative Telecare Savings Quarter 2,
Actual against Target
Telecare
Efficiencies
Target
25
140
120
High Costs
Placements
Efficiencies
Target
350
Telecare
Efficiencies
Actual
100
300
High Costs
Placements
Efficiencies
Actual
250
£'000s
Telecare
Efficiencies
Forecast
80
£'000s
25
60
40
200
High Costs
Placements
Forecast
150
100
20
50
0
Start Of Year
2014/15
Q1
Q2
Q3
0
Q4
Start Of Year
2014/15
Q2
Q3
Q4
Cumulative Transitions Savings Quarter 2,
Actual against Target
Cumulative Shared Lives Savings Quarter 2,
Actual against Target
60
80
Shared
Lives
Efficiencies
Target
Shared
Lives
Efficiencies
Actual
Shared
Lives
Efficiencies
Forecast
60
50
40
30
Transitions
Efficiencies
Target
50
Transitions
Efficiencies
Actual
40
£'000s
70
£'000s
Q1
30
Transitions
Efficiencies
Forecast
20
20
10
10
0
Start Of Year
2014/15
0
Start Of Year
2014/15
Q1
Q2
Q3
Q4
88888
123
Q1
Q2
Q3
Q4
Cumulative Homecare & Meals Contract Savings Quarter 2,
Actual against Target
Cumulative Nursing Care Prevention Savings Quarter 2,
Actual against Target
120
250
Homecare &
Meals
Efficiencies
Target
Homecare &
Meals
Efficiencies
Actual
Homecare &
Meals
Efficiencies
Forecast
£'000s
80
60
40
Nursing Care
Prevention
Efficiencies
Target
Nursing Care
Prevention
Efficiencies
Actual
Nursing Care
Prevention
Efficiencies
200
150
£'000s
100
100
50
20
0
Start Of Year
2014/15
Q1
Q2
Q3
0
Q4
Start Of Year
2014/15
124
Q1
Q2
Q3
Q4
Savings
Savings
Target 14-15 Outturn 14-15
£’000
£'000
Increase in the
use of
Telecare
Placements
into “Shared
Lives” care
Review of
High Cost
Placements
Improved
planning for
those in
Transition
Improved
operation of
Homecare &
Meals
contracts
Nursing Care
Prevention
Acceleration
of efficiency
savings
planned for
2015/16.
SUB TOTAL
805
110
120
75
51
320
331
50
50
100
50
150
206
808
125