Summary Statement
The ‘Reshaping Care for Older People: Engaging the Independent Sector’ project, initiated in April 2012, has been the catalyst for a significant shift by the sector in understanding and being involved in the RCOP agenda, and in engagement with the sector by local partnerships.
Despite a limited financial resource, the project has moved the sector from a position where there was limited capacity to engage at partnership level, to one where 23 out of
28 partnerships have a development officer representing the independent sector on relevant groups at partnership level. In addition, the high profile of the independent sector’s response to local joint commissioning strategies (JCS) in February 2013, raised the awareness at partnership level of the contribution to service delivery by the sector and of its potential to contribute to reshaping services for older people. In many areas, the communication around the Joint Commissioning Strategies has opened up meaningful dialogue with the sector as a partner, as the work on local commissioning strategies continues to develop.
The establishment of 23 development officers has also enabled increased communication with service providers at a local level, through providers meetings, news bulletins and direct contact with owners and managers. A growing number of service providers are now engaged in training and development of their staff in the knowledge and skills required to meet the changing needs of an increasing and ageing population. A small but increasing number of service providers are also engaged in RCOP related service redesign.
Funding
In addition to the rapid expansion of the team of development officers, all except one of whom are hosted by Scottish Care, the National Lead for the project has worked to attract a significant level of funding for the project. This has included funding for initiatives such as My Home Life and the modelling project in collaboration with IRISS.
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A small number of independent sector representatives took part in the pilot of the New
Commissioning Award and the outcome of a funding bid for research in relation to leadership and home care is awaited. An increasing number of change fund plans involve funding and projects for the independent sector, or for the sector in collaboration with other partners. Direct funding is estimated at around £4m up to March 2015 with indirect funding more difficult to quantify.
Infrastructure
Scottish Care, as the umbrella body for independent sector providers, has organised its members into local branches, for both care at home and care home providers. However, the membership, consistency of meetings and ability for either Branch chairs or other providers to represent the wider sector at partnership level on RCOP committees was proving difficult both in terms of capacity and also the knowledge and skills required. In turn partnerships, particularly public sector partners, were often suspicious of the intentions of individual business owners or managers attending meetings where budgets/disbursement of change funds was discussed.
In the past year, the project has significantly changed this landscape.
Development officers in many areas are creating advisory groups of service providers to test out, seek views and use as a conduit for information and consultation. This enables development officers to represent the sector’s views with some authority and credibility at partnership level, even though they are not part of the sector. The project has identified funding for development officers, recruited individuals through Scottish Care and laid out a framework for support and communication to this increasing team.
The substantial progress in the first year of the project has laid a sound and confident foundation for the independent sector’s important contribution to planning and developing future services for older people.
Main report
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Introduction and Background
1.
In April 2012, the Scottish Government via the Joint Improvement Team, agreed to provide funding to Scottish Care, the principal representative body for the independent sector, initially for a one-year project in order to ‘support the independent sector in engaging with the Reshaping Care and Change Fund agendas’.
2.
This came about as a result of a growing awareness within the independent care sector that there was little real engagement with and by the sector in the
Reshaping Care for Older People (RCOP) agenda, and difficulties in identifying sufficient representatives with the skills, knowledge or time to adequately represent the sector in this growing agenda. Two reports, the Christie Commission on the Future Delivery of Public Services (June 2011) and Audit Scotland’s report on Commissioning Social Care (March 2012), make many references to the need for the public, voluntary and private sectors to work more effectively together in order to avoid duplication, provide best value and improve outcomes for citizens.
The messages and recommendations contained in these documents reinforce again the need to ensure that there is effective engagement by and with the independent sector.
3.
The overarching aim of the 'Engaging the Independent Sector' project, is to
‘ensure that the sector is a full partner at both national strategic policy level and at a local level, engaged fully across the change fund plans, future joint commissioning strategies, health and social care integration and other key policy drivers such as self-directed support.’
4.
Following a busy and productive year, the Scottish Government has funded the project with £90,000 for a second year up to March 2014 and we are positive about continued funding to March 2015.
5.
This report outlines the activities and progress at the end of the first year of the project.
Resources
1.
The direct funding to the project of £60,000 has allowed Gloria McLoughlin,
Deputy Chief Executive of Scottish Care, to be seconded 4 days per week into the role of National Lead for the ‘Reshaping Care for Older People: Engaging the
Independent Sector Project.’ The work has been supported by Joan Mitchell, Joint
Improvement Team Action Group, for up to 2 days per week and together they
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make up the project team. Throughout the year, there has also been valuable input from David Rennie and Sam McLean, both consultants with Scottish Care.
2.
David’s role was to provide individual support to the development officers as they were recruited. This work included assisting development officers in the formation of their initial workplans, meeting with officers on an individual basis, contributing to improvement network days and liaising regularly with the core project team.
As Workforce Consultant with Scottish Care, David was also able to provide regular information to the project in relation to national workforce developments.
3.
Sam McLean’s remit was to provide consultancy advice to Scottish Care on
Commissioning and to produce Scottish Care’s report, ‘Positive Care – Making it
Happen: Developing a Strategic Commissioning Framework for Care Services – the Independent Sector perspective’. Sam McLean assisted the project to develop a template for use in preparing comments and feedback to partnerships on Joint
Commissioning Strategy (JCS) Plans, and provided direct feedback on a number of challenging JCS plans which benefited from an external opinion. Sam also facilitated two improvement network sessions around prioritising activities for
2013.
4.
In addition, the project has benefited from input by Dr Donald Macaskill with facilitation of two improvement network sessions on remodeling and project priorities. More recently Becca Gatherum, policy and communications officer with
Scottish Care, has attended sessions.
Ranald Mair, Chief Executive of Scottish Care and Stan Smith, JIT Associate have also provided regular advice and support to the project team.
Workplan
A national project work plan was developed and agreed by the Steering Group and updated quarterly. In the Reshaping Care for Older People programme, the five aims for the independent sector project are:
1.
The sector is represented as a full partner, effectively contributes to decision making and promotes the appropriate inclusion of independent services in national strategy and policy;
2.
is represented as a full partner, effectively contributes to shaping relevant policies and decisions, promotes the appropriate inclusion of independent services and has a joint ownership of the agenda at a local level;
3.
is better informed, grows provider capacity to manage change and has an increased number of organisations effectively contributing to the aims and the implementation of the programme at a local level;
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4.
has developed feasible options to effectively sustain participation in national and local programmes;
5.
has improved opportunities for and is engaged in the development of its workforce.
Governance
1.
This project is collaboration between Scottish Care and the Joint Improvement
Team, and is governed by a Steering Group consisting of Gloria McLoughlin, Joan
Mitchell, Ranald Mair and Stan Smith. Progress Reports are provided to Scottish
Care and JIT by Ranald Mair and Stan Smith as required.
2.
The Steering Group has met quarterly and standing items on the agenda have included a written progress report and updated workplan. Minutes are available for Steering Group meetings.
Activities
This section describes and summarises the main activities that have been undertaken in
2012-2013.
1. Baseline Survey
1.1
A survey was carried out at the beginning of the project to assist Scottish
Care and the Scottish Government's Joint Improvement Team to establish baseline information on the current level of understanding and engagement across the sector.
1.2
Three questionnaires were prepared using the survey monkey software- one for independent provider organisations, one for RCOP partnership leads and one for national leads. Three focus groups were held.
1.3
Seventy-three providers (9%), sixty-two partnership leads (42%) and 2 national leads responded to the questionnaire. The findings were analysed and a baseline survey report, along with an executive summary of findings and recommendations, was published. The report is available on the Scottish Care and JIT web sites and has been included in JIT Improvement Network and
Scottish Care bulletins. Two Web Exs on the findings of the survey were held with JIT leads. The findings, recommendations and actions were presented and discussed with a range of stakeholder groups including the Development
Officers, RCOP sub improvement group, the Alliance and at some partnership meetings.
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1.4
The findings and conclusions from the survey influenced the priorities set out in the workplan. Detailed analysis of the survey by partnership area was discussed with each of the development officers with a view to contributing to the priorities at a local level.
1.5
It was agreed to repeat the survey in one year.
2. Partnership Profiles
2.1
Following the findings from the survey, a detailed profile for each partnership area was developed and has been updated with new information throughout the project year. The profile includes hard information such as the size of the sector in relation to local authority and third sector providers; drilled down results from the survey; information on the culture/inclusiveness of the partnership and the robustness of governance structures (based on local intelligence); whether there are provider representatives (and their effectiveness); comments on the local infrastructure for providers; information on any case studies and the level of investment from the Change
Fund to the independent sector.
2.2
The profiles were updated to reflect the status of each partnership’s Joint
Commissioning Strategy as work on these strategies progressed. An action plan for each partnership area was developed and a Red, Amber, Green, status assigned to each. A suite of indicators was developed alongside the partnership profiles and these provide a guide as to how well the independent sector is involved and informed on the RCOP agenda at a local level.
2.3
The profiles, together with the key indicators, are an evolving and comprehensive database of a number of factors which contribute to the effective engagement by and with the sector at a partnership level.
3.
Development Officers
3.1
One of the main findings from the survey was that there was a need to establish a development officer or an effective provider representative in each partnership area, who would act as a conduit for information, represent the sector at partnership level and be available to help to engage providers in contributing to change plan implementation programmes. The previous model of identifying provider representatives in each partnership area was proving to be difficult to sustain within the context of increasing demands around the
RCOP agenda.
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3.2
The National Lead for the project has successfully negotiated funding from 23 out of a possible 28 partnership areas to support the establishment of a local development officer for the independent sector. At the time of writing, there are bids for funding for a development officer post with a further 3 partnerships. If these are successful, only 2 partnership areas will not have a development officer, namely Aberdeenshire and Moray.
3.3
As the number of development officers has increased, so has the need for systems of support for this new ‘team’.
3.4
The Improvement Network is a forum where the development officers come together on a 6-weekly basis. These development days are structured to include training/information sessions from external speakers together with sharing of learning and discussion of ideas. Throughout the year, each alternate Network event has included half a day together with provider representatives, although this format is currently being reviewed due to the low number of providers able to attend.
3.5
In addition to the Improvement Network, a support framework, which set out how development officers will be supported on an individual basis, was agreed. This framework linked each Development Officer with one of the
Project Team (including David Rennie). The increasing number of development officers and the reduction in resource (as David Rennie has reverted to his Scottish Care role) means that this model now needs to be further reviewed and resourced.
3.6
All development officers are funded by their local partnership and are on short term contracts linked to the Change Fund. Except for one partnership area, all funding has been to transferred to Scottish Care who ‘hosts’ these posts, providing HR and other related services. Some development officers have specific objectives set by the partnership, as well as working to the overarching aims of the project. Some development officers cover more than one partnership area whilst some are contracted to work full-time, although most are part-time. The daily rate paid to development officers is consistent across most partnership areas, although one partnership area has identified the need for a higher level of post than others.
4. Communication
4.1
The findings from the baseline survey indicated that providers generally had a poor level of knowledge about Reshaping Care for Older People. A major focus of the work this year has been to develop a range of ways in which
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providers and development officers can access and use the wide range of information that is available on RCOP.
4.2
A small amount of central funding was identified for 2 development staff to support the development of an internal Scottish Care RCOP knowledge hub over a period of 5 months. This has been useful to alert each other to new developments and to share information in a safe space.
4.3
Training sessions were delivered to a range to staff involved in the maintenance of a vibrant Scottish Care web and associated communication tools. The RCOP area has been enriched with word press, a direct web contact form, a RCOP email address linked to communications team and live Twitter feeds. The RCOP areas with development staff are now being created and updated on the web.
4.4
Despite all of the efforts on improving the content and accessibility of information and proactive communication using a range of methods, the feedback from development staff is that the sector remains difficult to engage with due to a high level of apathy. Feedback from providers confirms that current communications methods are ineffective. The project has no funding for further communication but a new post has been located within Scottish
Care.
5. Joint Strategic Commissioning Plans
5.1
The focus of the work of the project between November 2012 and April 2013 was on supporting development officers as they attended meetings, commented on and responded to draft Joint Commissioning Strategies.
Contact was also made with partnerships areas where there are no development officers, so that plans in all partnership areas were received, reviewed and comments made on a template. A flow chart and guidance was developed for Development Officers, to assist them and Scottish Care in the process around governance for ‘signing off’ on these important templates. All plans and templates were read by 2 members of the project team, with written comments from an independent sector perspective provided either to the development officer or directly to the partnership. A moderating process was developed and implemented in order to ensure a consistent approach to comments and feedback.
5.2
A report was then compiled on the main themes in relation to the implications for the independent sector, which arose from reading the JCS plans. This report was sent to the JIT to support both the thematic and round table reviews.
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6. IRISS: A Development Project in Partnership with the RCOP Independent
Sector project Reshaping Services for Personalised Care
6.1 A development project has been agreed with IRISS, to work with four different
partnership sites exploring potential models and opportunities for independent
providers as the RCOP programme progresses. This project will seek to
identify how providers can shape their delivery of care and support for the
future and the pathways to achieving success in creating new models. Funding
has been secured from four RCOP partnership sites: North Lanarkshire; West
Lothian, Falkirk and Argyll and Bute for a project officer, appointed and line
managed by IRISS to undertake the coordination and detailed work across the
sites. An event will be arranged to bring the partners and development officers
from the four areas together for a half day discussion at an early stage,
followed by more detailed discussion in each area. A more substantive
proposal for the design of the work can then be firmed up and a steering group
established.
7. My Home Life and Workforce Activity
7.1 Scottish Care has successfully secured RCOP (Reshaping Care for Older People)
funding and launched Scotland’s first ‘My Home Life’ (MHL) leadership and
community development program in North Lanarkshire. MHL is a UK charitable
initiative promoting quality of life for older people living and dying in care
homes, and for those visiting and working with them, through relationship-
centred and evidence-based practice. It is a collaborative scheme bringing
together organisations which reflect the interests of care home providers,
commissioners, regulators care home residents, and relatives and those
interested in education, research and practice development. The program in
Lanarkshire has been followed by funding approval for a further 8 cohorts
across 6 additional RCOP partnership areas, all commenced during 2013. We
are delighted to be working closely with MHL, City of London University, Age
Scotland and Professor Belinda Dewar from the University of the West of
Scotland in the delivery of the programme.
7.2 Together we hope to explore and develop a MHL advisory group and fund some
research around impact. As Scotland is reshaping care for older people, we
recognise Care Home managers need to have a strong voice, to be able to
influence decision making at every level and to play a vital role in influencing
and driving forward safe, quality, sustainable services for older people in
Scotland. MHL will support this agenda.
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7.3 As the Scotland MHL advisory group is being established, we are also in early
dialogue with a partnership about undertaking an academic literature review of
Care at Home services in order to develop the equivalent ‘My Life at Home’
programme.
7.4 The National Improvement Support Programme has been launched to receive
and discuss feedback on local Joint Commissioning Strategies, prepare
partnerships for statutory Health and Social Care Integration in 2015 and
promote cross sector learning about Joint Strategic Commissioning. A
commissioning award is being piloted by Institute of Public Care in the Lothians,
2 development staff are involved, along with 2 care at home providers.
8. Networks
The project team are involved with the following organisations and networks:
8.1 RCOP local partnerships - acting as pseudo Development Officers in areas where
there is no Development Officer or capacity for a provider representative
8.2 Scottish Government JIT RCOP Improvement and Sub Improvement Network
8.3 Scottish Government Active Ageing
8.4 Going for Gold
8.5 Scottish Government Living & Dying Well National Advisory Group
8.6 Anticipatory Care Group - QuEST
8.7
Scottish Partnership for Palliative Care
8.8 Good Life Good Death Good Grief
8.9 Scottish Government/ JIT Intermediate Care Group
8.10
Scottish Government Healthcare Associated Infection (HAI) TASK FORCE
8.11 Health Protection Scotland/NHS Education PICAH-Community ‘infection
prevention mini app’
8.12 CAUTI/UTI Short life working Group and the Infection Short Life Working Group
8.13 Diabetic Education & Foot care
8.14 My Home Life Scotland & My Life at Home
8.15 The HSC Alliance 12 propositions
8.16 Scotland Excel and Care at Home Commissioning
Achievements
The activities undertaken by the project in 2012-2013 described in the previous section have contributed to the following;
1.
23 (out of 28) partnership areas have a development officer who represents the independent sector at a partnership level and who actively communicates with and involves providers in RCOP agenda
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2.
an increasing number of change fund projects at partnership level which include the independent sector, either sector specific or in partnership with other sectors
3.
an increasing awareness by partnerships of the importance of including the independent sector as detailed commissioning plans are developed and implemented
4.
involvement by an increasing number of care homes, through My Home Life, in good practice which includes the RCOP principles
5.
increased infrastructure of support for and representation by independent sector providers
6.
improved flow of communication to and from providers
7.
action research project involving 4 sites to test out service redesign in the independent sector
Other areas of related activity
 Glasgow research in partnership with the Improvement Service
 Capturing activities at partnership level
 Learning and Development in North Lanarkshire
 Workforce Project Argyll and Bute
 Step up – Glasgow
 Palliative Care - East Renfrewshire,
 Respite Short breaks - West Dunbartonshire
 Dementia Beds - Edinburgh
 Early Discharge Pilot - Dumfries and Galloway
 Learn Pro – Pan Ayrshire
 Regulator flexibility for intermediate care pilot
 Care Home Liaison Nurse – Edinburgh
 Report/Sector Mapping – Glasgow with Improvement Service
 Dementia Mapping - Glasgow & Edinburgh
 Reablement/Enablement - Aberdeen
Priorities for 2013-2014
1.
As our understanding increases of what is required to engage the independent sector meaningfully in RCOP, so too do the implications for the work for the project.
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2.
The overall aims for the project for year 2 remain the same as year 1 but with a change in emphasis, specifically around the need to support the large team of development officers with their local work plans as well as developing activities and priorities for the coming year.
3.
The project also requires to provide the evidence and pathways for effective business modelling for the sector, to prepare the sector for the implications of
Self Directed Support, to follow through on the future plans set out in Joint
Commissioning Strategies, to improve direct engagement with providers plus the emerging Health and Social Care Integration agenda. As well as building on the work already undertaken, the project requires to develop options to sustain its immature but developing infrastructure, which will support and engage the sector beyond the life of the Change Fund and specifically into Health and Social Care
Integration.
4.
It has become clear as work in year 1 has progressed that the capacity and range of skills and experience within the core project team needs to expand in order to effectively address the ambitious but necessary priorities for next year and beyond. The additional resource of a further £30k for 2013-14 from Scottish
Government will assist, but it is important to acknowledge that the overall resource and input to the sector is limited in relation to the size of the task.
Investment is required to support a sustainable infrastructure which represents and communicates effectively with the independent sector as partnerships further develop and implement their joint commissioning plans and develop new models of governance around the Integration of Health and Social Care.
Challenges
1.
There is to date little published evidence of the independent sector’s contribution to good quality outcomes for older people. There is a need, as services change to meet the increasing demands posed by an ageing population and the changing age structure of the workforce to provide this evidence for partnerships, commissioners of services and service users.
2.
Many independent sector providers are unwilling to engage with the RCOP agenda, as they are unclear how they might change their service provision (e.g. care homes offering intermediate care or respite care and care at home services delivering reablement). There is a need to undertake some action research which will provide this modelling for the sector. The joint project with IRISS will contribute towards this learning, but the project should seek additional forms of action research in order to increase this body of knowledge.
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3.
Although most care home providers are committed to upskilling their workforce
(in areas such as dementia; complex care needs; person centred planning) and are working with partners on this shared agenda, at present there are mixed messages to care home providers about the need to engage with RCOP and to consider how they might change the way they provide services to meet changing demand.
4.
Many Joint Commissioning Plans outlined the need to disinvest in residential care over the next few years. Even in partnerships which have had some success in shifting the balance of care and helping more people to live independently in their own homes, the demand for residential and nursing care homes has not decreased. There is a need at national and local level to undertake detailed modelling about the likely profile of future provision, and to discuss the impact of this with providers. The difficulty in the negotiations around the National Care
Home Contract for 2013-14 also adds to the sector’s anxiety about the future of their services.
5.
There will be a shift in the way care at home services are commissioned as a result of the Social Care (Self Directed Support) (Scotland) Act 2013 and the details of these complex discussions at local level pose challenges (as well as opportunities) for the sector this year. This sector will also have to engage in robust options appraisal as 50% of all home care services are purchased with the other 50% provided by statutory partners, some of whom are creating arm’s length trading companies.
6.
There continues to be difficulties in engaging the sector in RCOP. The lack of clarity and pressures outlined in the sections above, together with perceived barriers to change from the Care Inspectorate and the difficulty in engaging with corporate providers all contribute to a challenging landscape for the sector.
7.
There will be changes in the project team, as the National Lead has resigned and will leave her post in September 2013. It is likely that this will lead to a review of how the project team is configured to ensure continuity, capacity and the right skill mix to progress this important agenda.
Recommendations
In 2013-14 the project will:
1.
Develop new business models for the sector to use to enable redesign of services, to more progressive models of care. The methodology will be through action research in collaboration with IRISS and others.
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2.
Continue to increase the number of development officers (or equivalent representatives) to ensure that each partnership area has an effective means of independent sector representation
3.
Improve involvement in change fund projects by the independent sector through support to development officers, direct contact with corporate independent providers and developing agreements with the Care Inspectorate
4.
Support development officers through regular flow of information, as well as individual and peer group network events to enable them to maximise their impact at local level
5.
Promote and raise awareness of the potential business opportunities for the sector (e.g. via JSC plans)
6.
Undertake a survey to monitor progress and identify barriers
7.
Identify and disseminate case studies of good practice by the sector
8.
Work with JIT and other bodies to identify options for sustaining effective engagement by and with the sector
9.
Increase capacity within the project team and ensure continuity amidst changes of personnel
10.
Ensure that the sector has improved opportunities for and is engaged in the development of its workforce
11.
Continue to explore models of effective provider engagement and representation
12.
Establish clearer governance and decision making arrangements for development officers and independent sector representatives.
This report was prepared by Joan Mitchell JIT Action Team Member and Gloria
McLoughlin RCOP National Lead for the Independent July 2013
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