Delivering Differently in Neighbourhoods
OVERARCHING LOGIC MODEL
Support individuals’, carers’ and communities’ resilience within Adult Social Care – Supporting people to support themselves and others
GOAL
Transformational change is urgently needed to secure a sustainable model of social care which will continue to meet the needs of
the most vulnerable people in our communities. Delivering Differently in Neighbourhoods aims to work with local residents to codesign and develop community owned enterprise to deliver alternative models of care and support which are more community
focussed and accountable - thereby reducing health and social care costs.
CONTEXT
The biggest demand pressure facing local government is from Adult Social Care because of ageing populations, increased longevity
and rising expectations combined with the required dramatic budget reductions. The two communities which are the focus of
Delivering Differently in Neighbourhoods in KCC are Wye and Hinxhill, and Newington.
Wye and Hinxhill has 2282 residents of which 35% are over 65 and 54 people are 90 or over. There are 28 people who receive an
ongoing support package. The total annualised average spend is over £358,000 - in addition to this will be many people who fund
their own care.
Newington has 5210 residents of which 14.5% are over 65 and 20 people are 90 or over. There are 51 people receiving an ongoing
support package. The total annualised average spend is over £168,000 - with less people funding their own care.
INPUTS
Kent County Council will work with the two communities, including engaging parish and town councils and users and their
families. Each neighbourhood has different local schemes which will be involved, namely: Our Place in Wye and Hinxhill, Big Local
and Ageless Thanet in Newington and Village SOS in both areas.
Individuals employing private sector care and local service providers will also be consulted and engaged throughout the process.
External advisors include Department for Communities and Local Government and co-operative development bodies e.g. Cooperatives UK, Principle Six or Mutual Advantage.
ACTIVITIES
Activities are split into 2 areas: The community co-production process being conducted differently and the new community owned
enterprise’s impact.
Analyse, develop, plan, implement and review a social co-operative in Wye and Hinxhill and Newington.
IMPACTS
OUTCOMES
OUTPUTS
Develop a business plan for the roll out of a social co-operative scheme to more neighbourhoods in Kent, based upon the
evidence and lessons identified.
USER
COMMUNITY
FINANCIAL
SOCIAL CARE SERVICES
EMPLOYMENT
No. users entering
care system
Community
involvement in the
development of care
Cost of care
Choice in care
# users managing their
own care
# community
involvement in the
delivery of care
# business income
# appropriateness of
care
$ tradition provision
# user’s wellbeing and
situation
# community
responsibility of care
# community
outcomes
$ demand
$ cost of care
# effectiveness of care
# volunteers networks
# staff retained
Investment in staff
No. of people trained
No. of people
recruited
Delivering Differently in Neighbourhoods
COMMISSIONING PROCESS THEORY OF CHANGE
Support individuals’, carers’ and communities’ resilience within Adult Social Care – Supporting people to support themselves and others
‘As Is’
Develop commissioning strategy to identify
commissioning priorities for the portfolio
Develop project plan
ANALYSE
Review effectiveness of current service including
seeking service user feedback
‘As Is’ Assumptions
Pick Location
Location chosen is based upon need
/ gap in provision
Familiarisation with location &
history
Data is available
Identify KCC support, resources &
timeframe
KCC support will not change during
the process
KCC support is adequate
KCC timeframes are realistic
Engage community activists, other
statutory community and
voluntary sector bodies
Agreement to be involved
Capacity to be involved
Remain engaged
Make formalised contact with the
community
Contact is adequate and
appropriate
Formal co-design group created
Remain engaged
Communications strategy
developed and implemented
Communication is adequate and
appropriate
Viable models
identified
Data is available
Best practice exists and is identified
Model options appraisal
Robust method implemented
Correct stakeholders are involved
Preferred model identified
Community has capability and
capacity to implement
Preferred model is the most
appropriate & will make the most
impact
Model accepted by the community
Outputs, outcomes and impacts
identified
Outputs, outcomes and impact are
the most appropriate and SMART
There is a counterfactual needed
PLAN
Baseline data
collection
Engage service users to seek their views their needs,
how best to them and how to manage demand
Agree success criteria and expected outcomes
Confirm resources available
Consider EqIA of proposed service
Develop commissioning plan including assessing
options for how to meet the identified needs
Lead the development of effective outcome-based
specifications
Co-produced business plan
developed
Legal responsibilities understood
and fulfilled
There is support to write a
comprehensive business plan
Training within co-design group
identified to implement model
DO
Baseline cost of current service
‘To Be’
Develop strong relationships with prospective and
selected providers
Prepare for contract mobilisation including how the
contract will be managed
Carry out initial contract review
Lead on getting necessary approvals for contract award
Model implemented
Funding is available
Funding is secured
Consider current and future legislation
Complete diagnostic report (including needs analysis)
Develop clear summary of outcomes to be achieved
through the commissioning exercise
PROCESS EVALUATION QUESTIONS
What is the current social care provision like now? Why do you want it to be delivered differently?
2) How was the new model delivered? How did it vary from previous social care commissioning?
3) Was the model implemented in the way it had been planned?
4) What did participants and staff feel worked well / less well in delivering the model, why and how?
What, therefore, might act as facilitators and barriers to desired impacts? How can barriers be overcome and facilitators harnessed?
6) How might the model be refined or improved?
1)
5)
Delivering Differently in Neighbourhoods
Support individuals’, carers’ and communities’ resilience within Adult Social Care –
Supporting people to support themselves and others
If possible all measures to be collected quarterly (starting 3 years prior to project)
USER
OUTPUTS
No. users entering care system
No. users provided with care and support
No. users entering care system
Due to unavailable population figures at this level %
of users has not been included as a measure
Data from Swift – does it include private social care?
OUTCOMES
# users managing their own care
No. users managing their own care – Self Funders
No. users managing their own care – Direct Payments
Data from Swift
% of users managing their own care – Self Funders
% of users managing their own care – Direct Payments
IMPACTS
# user’s wellbeing and situation
Warwick-Edinburgh Mental Wellbeing Scale
(7 Item Scale):
Users wellbeing
http://www2.warwick.ac.uk/fac/med/research/platfo
rm/wemwbs/swemwbs_7_item.pdf
http://www2.warwick.ac.uk/fac/med/research/platfo
rm/wemwbs/
Delivering Differently in Neighbourhoods
Support individuals’, carers’ and communities’ resilience within Adult Social Care –
Supporting people to support themselves and others
If possible all measures to be collected quarterly (starting 3 years prior to project)
COMMUNITY
OUTPUTS
Community involvement in the development of care
1. I can make a positive difference to the social care
provision within the community around me
2. I consider myself involved in the community
Start and finish of co-design and development:
(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)
3. I have been able to shape the provision of social
care within the community around me
OUTCOMES
# community involvement in the delivery of care
1. I can make a positive difference (to the social care
provision) within the community around me
Start (question 3 only) and finish of delivery:
2. I consider myself involved in the community
(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)
3. I am involved in the delivery* of social care within
the community around me
* Insert specific initiative activity
# community responsibility of care & # community outcomes
IMPACTS
1. I can make a positive difference (to the social care
provision) within the community around me
2. I consider myself involved in the community
Start (question 3 only) and finish of delivery:
(1 Strongly agree, 2 Agree, 3 Neutral, 4 Disagree, 5 Strongly Disagree)
*Insert specific initiative activity
3. I feel that the social care provision* is accountable
to community around me
No. of community outcomes* met
Community outcomes need to be defined once what
is being delivered is finalised
Delivering Differently in Neighbourhoods
Support individuals’, carers’ and communities’ resilience within Adult Social Care –
Supporting people to support themselves and others
If possible all measures to be collected quarterly (starting 3 years prior to project)
FINANCIAL
OUTPUTS
Cost of care
Cost of social care – Self funders
Cost of social care – Direct Payments
Cost of social care – Other
Data from Swift
Cost of social care – No. of users
OUTCOMES
# business income
Income generated*
*Dependent on specific initiative
$ Demand & $ cost of care
IMPACTS
No. users provided with care and support
No. users entering care system
No. of hospital admissions
No. of Emergency Admissions - primary reasons for
admission to hospital
Using the counterfactual area as a comparison the
number of prevented / delayed / avoidable can be
calculated
Using the New Economy Manchester Unit Cost
database costs prevented can be calculated
No. of hospital admissions from Public Health (in a
given age range?)
Delivering Differently in Neighbourhoods
Support individuals’, carers’ and communities’ resilience within Adult Social Care –
Supporting people to support themselves and others
If possible all measures to be collected quarterly (starting 3 years prior to project)
SOCIAL CARE SERVICES
OUTPUTS
Choice in care
No. of users of the initiative
Collected by the initiative
OUTCOMES
# appropriateness of care
1. Overall how satisfied or dissatisfied are you with
the care and support services you receive?*
(Extremely satisfied, very satisfied, quite satisfied,
nether satisfied or dissatisfied, quite dissatisfied, very
dissatisfied, extremely dissatisfied)
*Ask the users at an appropriate time frame
dependent to specific initiative
User satisfaction in this instance is being used as a
proxy to appropriateness
Question taken from ‘Personal Social Services Adult
Social Care Survey’ (Question 1)
http://www.hscic.gov.uk/catalogue/PUB16162/pss-ascseng-1314-fin-rpt.pdf
Inappropriate A&E referrals (attendances at A&E for
injuries/illnesses that could have been handled
elsewhere)
Compare this score with Kent ASCOF scoring
http://www.hscic.gov.uk/catalogue/PUB16162/pss-ascseng-1314-fin-annx.xlsx
# effectiveness of care
IMPACTS
No. users provided with care and support
Using the counterfactual area as a comparison the
number of prevented / delayed / avoidable can be
calculated
No. users entering care system
No. of hospital admissions
Emergency Admissions - primary reasons for
admission to hospital
Re-attendances at A&E
Using the New Economy Manchester Unit Cost
database costs prevented can be calculated
No. of hospital admissions from Public Health (in a
given age range?)
Emergency admissions - elective data would be useful
here as a comparative
Delivering Differently in Neighbourhoods
Support individuals’, carers’ and communities’ resilience within Adult Social Care –
Supporting people to support themselves and others
If possible all measures to be collected quarterly (starting 3 years prior to project)
EMPLOYMENT
OUTPUTS
Investment in staff & No. of people trained & No. of people recruited
No. local people / volunteers active within the
initiative
No. local people / volunteers trained as a result of
the initiative*
This output does not need to be measured for the
counterfactual
* The type of training depends on the specific
initiative
OUTCOMES
$ traditional provision
No. users provided with care and support
No. of users of the initiative
This outcome does not need to be measured for the
counterfactual
Calculate proportion of users of the initiative over
users provided with care and support
IMPACTS
# volunteers networks & # staff retained
No. of local people retained
No. of volunteers retained
This impact does not need to be measured for the
counterfactual