Angus Council Social Work and Health Best Value Review Of Services for Older People. EXECUTIVE SUMMARY and SUMMARY OF RECOMMENDATIONS

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1 Angus Council Social Work and Health Best Value Review Of Services for Older People EXECUTIVE SUMMARY and SUMMARY OF RECOMMENDATIONS February 2009

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3 CONTENTS PAGE Introduction 2 The scale of older people s services 3 Key challenges 4 Evaluation of current services 5 Quality and performance 5 Budget and resources 5 Equity of access 6 Value for money 6 Meeting the future needs of older people 7 Fostering independence and choice - enablement 7 Telecare 7 Supported housing 8 Service infrastructure 8 Demographic change and sustainability 9 Summary of s 10 Enablement 10 Telecare and the Community Alarm Service 10 Supported Housing 11 Assessment and Care Management 11 Homecare Services 12 Day-care Services 12 Residential Care and High Dependency Residential 13 Care Respite and other Support for Carers 14 Eligibility and Access to Services 15 Service Charging 15 Strategic Planning and Commissioning 16 Monitoring and Review Arrangements 19 Information Systems and IT 19 Staffing 18 Corporate 18 1

4 INTRODUCTION The best value review of older people s services provided by Angus Council Social Work and Health commenced in This is the largest best value review ever undertaken by Angus Council, and has been carried out in the context of major reorganisation within the council and significant developments in Scottish Government policy. The main aim of the review was to assess the range, quality, and value for money of existing directly provided and commissioned services. However, the review also considered how the service will need to be re-designed in order to meet the needs of older people in the future in a way which is sustainable financially and in terms of human resources. 2

5 THE SCALE OF OLDER PEOPLE S SERVICES The budget for older people s services in was 26m, or around 12.4% of the council s budgeted expenditure. Around 5,250 people benefit from the services provided by older people s services, 92% of whom are aged 65 or over. Of these around 4,500 are cared for in community, and approximately 750 are cared for in residential care homes or nursing homes. Almost all homecare services funded by Angus Council are directly provided by the older people s services. By contrast, Angus Council directly provides only 10% of care home places in Angus and nursing home care is commissioned exclusively from the private and voluntary sector. The largest homecare service, in terms of service users, is the community alarm service which provides a preventative and rapid response service for around 4,150 service users. For around 38% of these service users the service provides sufficient peace of mind and safety monitoring to enable them to continue living independently without requiring any other services. 790 service users receive the personal care service which delivers 190,000 hours of care each year. The community meals service delivers around 6,000 hot meals each week to approximately 830 service users. Around 200 service users depend on the specialist community laundry service which processes an average of 12,000 items of clothing and bed linen each month. Older people s services also deliver intermediate care for people at risk of admission to hospital and to assist people return home from a period of hospitalisation as early as possible. The prevention of admissions and early supported discharge schemes supported 777 service users in , saving an estimated 8,205 emergency hospital bed days. Older people s services also provide a variety of respite care to support carers in continuing their caring role. Around 5,000 nights of respite are provided or commissioned within a residential home or nursing home setting. Respite is also provided in people s own homes for short periods of time, amounting to 9,200 hours in As well as providing personal care and social interaction for service users, day-care offers respite to carers during the daytime. At present there are 800 places provided each week, with some provision at weekends. The services provided by older people s services are delivered in discharge of the council s statutory duties. Service provision is on the basis of assessed need and unless services are refocused on enabling people to regain their independence, there is little scope for reducing the level of services delivered. 3

6 KEY CHALLENGES The proportion of the population of Angus aged 65 or over is set to rise from just under 20% to more than 29% over the next 20 years. In the same period the number of those aged 85 or over, the age group who are the main users of older people s services, will increase by 120% to around 5,600 people. Over the same period the working age population of Angus is projected to fall by around 9%. Recruiting the suitably trained workforce required to deliver the care required by older people is already challenging, but will become much more difficult as the number of older people requiring care continues to rise. People s expectations of later life are also changing and services will need to adapt to support older people to maintain the level of independence they want and to provide greater choice in their care. 4

7 EVALUATION OF CURRENT SERVICES Quality and Performance Older people s services were inspected in 2007 as part of the Multi-agency Inspection of Services for Older People in Tayside (MAISOP). The service was rated as very good on five of the six assessment criteria, and good in respect of achieving outcomes for service users. This high assessment of the quality of directly provided services has also been reflected in Care Commission inspections of registered services, and in feedback from service users and carers. Older people s service has also performed well in delivering the council s key community care priorities as set out in the Care Group Strategy for Older People, notably in the provision of: intermediate care including the prevention of admissions and early supported discharge schemes community alarm and emergency response services specialist dementia day-care community meals high dependency residential care While the current configuration of services has been successful in enabling people to remain in their homes, the proportion of people with high care needs placed in care homes remains high. This is generally not the best outcome for service users. There is evidence that the current configuration of services does not enable older people to regain or maintain the level of independence they desire, and that some services do not currently provide sufficient flexibility and choice. This is particularly true in relation to the timing of provision of personal care and access to respite services for carers. The review makes a number of specific recommendations to improve the flexibility of services to service users and carers. Budget and Resources Angus Council s expenditure per head of population aged 65 or over has declined over recent years and has now fallen below the Scottish average. At the same time demand for services has increased steeply and will continue to grow as the older population increases. Homecare services, especially personal care and the community alarm and rapid response services are seriously under-resourced and are struggling to meet the council s statutory duties. The review recommends that the council approve an uplift in the budget for these services as a matter of urgency to ensure that the council can continue to meet its statutory duties. The scope for increasing income through charges is limited. Services which fall within the statutory definition of personal care must be provided free to people aged 65 or over. Most private and voluntary sector care home provision is subject to a national fee 5

8 agreement. Between them, these services account for over 75% of the budget for older people s services. Where charges are made they do not reflect the actual unit cost of the service and there charging structure is further complicated by the number of transitional protection schemes currently in operation. The review recommends that a the current charging regime is revised to more accurately reflect the cost of services and that transitional protection schemes are brought to an end. Equity of Access Not all services are available locally with the result that some people are disadvantaged by having to travel to access services. Supported housing and high dependency residential care are currently only available in a few burghs across Angus which means that people from other areas who require this type of accommodation are uprooted from their home communities. The review recommends that specialist day-care, high dependency residential care, and residential respite provision is extended to all community planning areas in Angus where there is an identified need. Expansion of these services should be phased and integrated with the proposed expansion of supported housing across the county. Value for Money Most directly provided services appear to deliver best value when compared with other providers, and where costs appear to be significantly higher in personal care and residential care there are sound policy reasons for retaining at least some direct provision. Commissioned services also appear to represent good value, although the review has highlighted the need for more rigorous monitoring of quality and performance, particularly in relation to care home provision. Investment in services for older people has not kept pace with population change, and the level of expenditure per head of population aged 65 or over in Angus is now lower than the Scottish average. Homecare services are seriously under-resourced and require additional funding to ensure Angus Council is able to continue to meet its statutory duties. Camus House, Carnoustie, St Drostan s House, Brechin, and the Community Laundry facility are no longer fit for purpose and substantial capital investment is required to upgrade or provide suitable accommodation for these services. The cost of most homecare services directly provided by older people s services appears to be in line with other local authorities and with equivalent services in the private and voluntary sectors. However, the unit cost of directly provided personal care service appears higher than services offered by external providers. The review recommends a phased increase in the proportion of personal care services commissioned from the private and voluntary sectors, and that direct provision by the council should focus on re-ablement and on people with complex care needs. 6

9 MEETING THE FUTURE NEEDS OF OLDER PEOPLE Fostering Independence and Choice - Enablement Increasingly people expect to maintain their independence into old age and wish to retain as much control over their lives as possible, preferably receiving care in their own homes. The review identifies that services need to be refocused to ensure that they help people regain and retain independence and provide the flexibility and choice expected by service users. The approach adopted by Angus Council in assisting people to remain in their own homes has been a traditional model of providing a range of services which do tasks for people rather than enabling people to do more for themselves. This approach is taken by many local authorities across Scotland, and reflects the common assumption that decline in older age is inevitable and that the purpose of community care services is to undertake tasks which older people can no longer carry out for themselves. There is now growing evidence that this approach can actually contribute to increased dependency and loss of independence. An enablement approach has been developed in a number of English local authorities to assist older people to regain skills and confidence to manage independently rather than providing services to undertake those tasks for them. This approach has now been mainstreamed in a number of local authorities in England and the City of Edinburgh Council has recently adopted this approach for homecare services. The evidence from England suggests that this approach offers much better outcomes for service users, reducing their need for services and improving their capacity to remain independent over a sustained period. The approach has been piloted in Angus for a number of services and the benefits for service users have been very positive. The review recommends that the enablement approach is adopted across all services for older people and sets out a number of specific proposals to enable a phased rollout. Once introduced, eligibility for services should be on the basis of any residual need following an enablement focused assessment. Telecare Angus Council has to balance the desire of older people to remain as independent as possible with its statutory duty to ensure their welfare. The challenge is to ensure that risks can be managed in a way which interferes with people s independence as little as possible, while providing an emergency response when difficulties occur. The community alarm service currently assists in enabling over 4,000 people to remain independent in their own homes with safety and confidence. Angus Council has received around 280,000 over the last two years through the Scottish Government s Telecare Development Programme to further develop the service and exploit the capacity of Telecare equipment to enhance people s safety and capacity for self-care. The review concludes that Telecare has a critical role in supporting enablement and in securing the safety of people who do not currently require care services. However, the service is currently under-resourced and needs to be expanded to provide an effective emergency response service in all areas of the county. 7

10 The review recommends expansion of the current community alarm and response service, and makes specific recommendations to ensure the sustainability of the service and its capacity to respond promptly to emergencies. Supported Housing The principles of the enablement approach apply equally for people who are currently placed in residential care. Moving to a care home is rarely a positive choice and most people would prefer to be cared for in their own home. While residential care can be of a very high standard, both in terms of the environment and the quality of care, there is an inevitable loss of independence and choice. The review concludes that supported housing is an effective alternative to residential care for all but those with the most complex care needs, and offers better outcomes for services users. Tenants in supported housing retain the independence of having a home of their own, and are able to maintain their own lifestyle, while receiving the level of care they require as their needs change. Delivered flexibly, supported housing can also be a less expensive option than residential care from the point of view of the council, while offering significant benefits for service users. There are currently only three small schemes of supported housing in Angus which means that very few people are able to benefit from this alternative to residential care at the present time. The review recommends that the council support an expansion of supported housing provision to ensure sufficient local provision within each community planning area of Angus is delivered over the next 20 years. It is recommended that the care centres at St Drostan s and Camus House should be based around a supported housing model. It is recommended that the council reduce its use of residential care as supported housing becomes available. Service Infrastructure Older people s services currently employ just under 890 staff. Maintaining records of activity and the changing needs of service user and carer s is administratively very intensive. At present few front line staff and team leaders have access to basic IT, which impacts on the efficiency of service delivery and resource management and the effectiveness of communication between staff. Demographic change will have a major impact on the capacity of care providers, including the council, to recruit and retain sufficient suitably skilled staff to delivery the care people require. The review identifies a number of ways in which the efficient use of staff resources could be improved to meet emerging demand, including greater flexibility in staff contracts and ways of working. Investment in IT and mobile communications will be an important element in achieving this. The review identified the need to improve IT systems to support service planning and front line delivery. In particular, the review recommends that an options appraisal be undertaken to establish the cost benefits of extending the use of mobile IT systems for care staff to improve communications, reduce administration overheads, and enable staff to be more efficiently deployed. 8

11 Demographic Change and Sustainability Most of the services covered by the review are delivered in discharge of a statutory duty and the council requires to maintain them at a level which is sufficient to meet assessed need. Taking this into account, continuing with the current approach to meeting the care needs of older people would lead require an increase in the budget of between 1m and 1.2m in real terms each year in order to discharge the council s statutory duties to the growing number of older people requiring community care. Adopting an enablement approach, expanding provision of supported housing as an alternative to residential care, and continuing to expand the use of telecare, will result in a considerable reduction in the projected growth in the budget required to deliver these statutory services. The three key policy measures recommended in this section offer the best means for achieving these outcomes for older people, in a way that is sustainable over the longer term, namely: adoption of an enablement approach across all service areas expanding the use of Telecare to support people maintaining their independence at home shifting away from residential care through the expansion of supported housing provision A review of current access to and use of IT by operational staff should be undertaken to identify gaps which are impacting on service delivery. In particular, an assessment should be undertaken of the options for, and cost benefits of, deployment of mobile IT systems for frontline staff to streamline service delivery and improve the consistent recording of assessment and management data. 9

12 Summary of s Enablement 7 It is recommended that the enablement model is integrated into all services delivered or commissioned by Older Peoples Services. 8 It is recommended that the enablement model is monitored to assess its contribution to achieving better outcomes for service users and the impact on future service delivery. 29 A service development proposal should be drawn up for the roll-out of the enablement model, including a full assessment of the resources required Telecare and the Community Alarm Service 9 The Council is well placed to capitalise on the benefits which Telecare offers to service users and carers, and should continue to invest in developing the Community Alarm Service to make best use of technology to support enablement and independent living. 32 An option appraisal should be undertaken to establish how the response service should be reconfigured and developed to meet the current and projected needs of service users, and to ensure equity in delivery of the service to all areas of Angus. In particular consideration should be given to the creation of an additional team to cover the South of Angus and to expanding the existing teams to ensure two person cover is available at all times. 33 In the light of the preventative benefits of the Community Alarm and Response Service, the Council should consider whether the service should continue to be restricted to those who meet specified eligibility criteria, or whether the service should be universally available. Prior to this review access to Community Alarm will remain on the basis of a needs led assessment with direct access arrangements for partner agencies. In reaching a decision the Council should consider whether it is financially sustainable for the service to continue to be free in the light of other demands on budgets. 34 A capacity plan for the Community Alarm Service should be developed and budgets identified to ensure the service can be expanded to meet emerging need and to enable planned testing, upgrading, and replacement of equipment. 35 The current charging arrangements with Perth & Kinross Council and housing associations should be reviewed to establish if the current level of charge covers Angus Council s costs

13 Supported Housing 10 The Council should adopt a policy of expanding the provision of Supported Housing with the aim of securing an adequate supply within every community planning area to meet the future needs of the older people of Angus. The Council should set a policy objective of reducing its use of residential care as Supported Housing becomes available. 49 Opportunities for developing additional Supported Housing provision should be identified including the potential upgrading of existing sheltered housing stock. Consideration should be given to commissioning any new services, and/or operating in partnerships. 66 Consideration should be given to expanding provision of Supported Housing within or adjacent to existing Care Centres where appropriate. The Council should also encourage the development of Supported Housing by social housing partners, private developers, and care home providers. 67 The Council should ensure that the policy of expanding the provision of Supported Housing is reflected in the statutory regional and local development plans, including those relating to the Council s responsibilities as the strategic housing authority for Angus. Assessment and Care Management 20 The role of Occupational Therapists as an integral part of the Augmented Care Service should be further developed, specifically in the delivery of the enablement approach and in the development of therapeutic re-ablement programmes for individual service users. The role of para-professionals should be developed to enable the service to be more flexible and responsive. 23 The process of selection and implementation of a computerised assessment system for Social Work should be concluded as a matter of urgency. Social Work should ensure that the system selected is fully compliant with the national information standards and has the capacity to be further developed to meet the information needs of the national outcomes framework and the implementation of enablement. 24 The Community Care Partnership should agree a common model of care co-ordination across all care groups, underpinned by the development of an appropriate competency framework. 25 The ethos of holistic assessment, personalisation, self-management, and enablement should be embedded in practice and reinforced through training. Care Managers, Homecare Assessors, and other professionals and para-professionals involved in assessment and in care / case management or care co-ordination, should be trained together to ensure consistency in standards and practice

14 Homecare Services Personal Care 36 Specific financial modelling should be undertaken to confirm whether alternative providers could provide a broadly equivalent level of personal care service at lower cost to the Council. It is suggested that this modelling be based on actual levels of service provided in an area of Angus over a specified time, comparing the Council s actual costs with the costs which would have been incurred by commissioning the same services from alternative providers (taking into account the various elements of their charging regime). 37 The Council should undertake a phased expansion of the proportion of personal care services it commissions from external providers, where this is demonstrated to be more cost effective than direct provision. The Council should continue to be a direct provider of personal care services for people with complex or varying needs in order to deliver an efficient and effective enablement service. Community Meals Service 39 The opportunity for collaborative procurement of this service with other Councils should be investigated well in advance of the current community meals contract expiring in Community Laundry Service 40 A development plan for the Community Laundry Service should be drawn up on the basis of an assessment of the future level of need. The plan should include consideration of the procurement of alternative premises for the community laundry as part of the redevelopment of St Drostan s, and an assessment of the capital investment required. Intermediate Care Services 42 More detailed financial modelling should be undertaken to confirm the level of savings made (or costs avoided) as a result of the schemes and in particular the benefits of POA, ESD and IIC schemes as separate components. This modelling should look at the full costs for both the Council and the Health Service Day-care Services 55 Provision of mainstream day-care should be increased, where there is a demonstrated need following rollout of enablement, by extending existing services to include weekend provision and evening provision. 56 The need for additional specialist dementia day-care should be closely monitored and existing services expanded, where possible, to meet emerging demand. An option appraisal should be carried out to establish the most appropriate model for delivery of this service in North East Angus

15 57 An analysis of need in South West Angus should be undertaken to determine how suitable mainstream and specialist day-care services can best be provided or commissioned, including consideration of how services might be integrated with the development of supported housing in the area. 58 The service agreement with day-care providers should be reviewed to include specific catchment areas for each day-centre, and an agreed transport allowance based on attendance records Residential Care and High Dependency Residential Care 50 Options for expanding the provision of High Dependency Residential Care should be developed in line with projected need. In particular, the current mainstream residential units should be re-provisioned as High Dependency Units and the staffing and budget increased accordingly. Consideration should be given to expanding provision by external providers where this is of appropriate quality and offers value for money. 61 The Council should continue to be a direct provider of care home services on a limited basis in order to provide an element of choice, to demonstrate and promote best practice, and to ensure that the Council is always able to meet its statutory obligations. The Council should focus on providing specialist high dependency residential care and developing supported housing as an alternative to mainstream residential care. 62 The Council should commission a new Care Centre for the Carnoustie area to replace Camus House which is no longer fit for purpose or sustainable in its current form. The replacement should primarily provide supported accommodation with an integrated high dependency residential facility, dedicated residential respite service, and facilities for the delivery of day-care services. Camus House should be maintained and continue in operation until the new Care Centre is operational. 63 The Council should undertake a redevelopment of the St Drostan s Care Centre as the residential facility at St Drostan s House is no longer fit for purpose or sustainable in its present form. Provision of supported housing on the site should be expanded and St Drostan s House redeveloped to provide an integrated high dependency facility, dedicated residential respite service, and the capacity to deliver specialist dementia day-care services in response to emerging demand

16 Respite and other Support for Carers 21 Carer s needs should be consistently recognised and addressed through assessment and discrete carer support plans. Entitlement to carer support, such as respite care, should be explicitly set out in support plans and be on the basis of the carer s assessed needs. Details of carers and household composition should be recorded on the CareFirst system to inform service planning. 22 Consideration should be given to establishing a single budget for services for carers, incorporating the budget for respite and other carer support services. 43 Further work should be undertaken to establish whether the Short Breaks Service could be delivered via an external provider and if so whether this could be done at lower cost taking into account cancellations. This should also look at the possible operational benefits of being able to redeploy social care officers to other duties. 51 The respite service bookings system should be improved to enable unmet need and demand pressures during periods of peak demand to be systematically recorded. 52 Further work should be carried out to quantify the demand for residential respite and the requirement for additional specialist respite going forward. The Council should develop a capacity plan for residential respite within the context of the Angus Carer s Strategy and Older People s Care Group Strategy to ensure equity of access across the county. 53 Entitlement to planned respite care should be on the basis of an assessment of the carer s needs and an appropriate allocation of annual respite days should be incorporated into the carer s support plan. Access to respite in emergencies should continue to be available to all carers subject to agreed criteria. 59 The Council should formally recognise the respite function of day-care within the carer assessment and support planning process, and develop the day-care service to provide more flexible respite opportunities for carers. 64 In view of the benefits of this service in supporting carers, and the benefits to the Council in the potential care costs thereby avoided, the Council should continue to expand provision of residential respite care. In expanding the service consideration should be given to ensuring that local access to the service is as equitably distributed across Angus as practicable. 65 The Council should carry out further work to identify whether additional respite services can be commissioned from the private and voluntary sectors at a lower cost than direct provision by the Council

17 Eligibility and Access to Services 11 It is recommended that eligibility for access to all services (with the exception of the Community Alarm and the Occupational Therapy Equipment Service) should be on the basis of an assessed need following completion of an enablement focused assessment programme. 18 Consideration should be given to setting a limit to expenditure to support people in their own homes where a placement in a care home setting is more cost effective. 47 The system for allocation of supported housing should be further reviewed in order to ensure that tenancies are allocated to those most likely to benefit from this type of accommodation and care as opposed to those with the highest priority in terms of risk or urgency, to ensure that the service is not compromised by an inappropriate mix of care needs. Service Charging The current transitional protection schemes on non-residential charges should be phased out as soon as possible to minimise the bureaucracy associated with applying multiple charging regimes. 13 The CareFirst system should be used as a basis for establishing a more accurate picture of the non-residential charges income received for individual services so that a more accurate picture of the net cost of these individual services can be established. This information can then inform future policy choices about service and charge levels based on full information. 14 The current practice of the Council paying private and voluntary care homes and then invoicing service users should be reviewed as part of a wider review of debt management arrangements in Older People s Services. The pattern of bad debts should be reviewed to see where particular problems arise. 15 All charges should be reviewed with a view to bringing them in line with the unit cost of the service. In calculating the level of charge an allowance for admin / overhead costs should be included where these are significant, in order to provide greater transparency over the real cost of service provision. 38 The precise level of subsidy for community meals should be identified 166 based on current year costs. The sustainability of this level of subsidy should be considered in light of other budget pressures and service demands. 41 The Shopping and Pension Collection Service should be reviewed 169 following an evaluation of the enablement pilot, with a view to developing a more cost effective service model which is consistent with the principles of enablement. Consideration should be given to whether the current level of subsidy is appropriate or sustainable. 54 The charging regime for residential respite should be reviewed with a

18 view to removing any financial disincentive to carers benefiting from this service. Consideration should be given to introducing subsidised rates for emergency respite and for planned respite which forms part of a carer s support plan. 60 Mechanisms should be put in place to ensure that the actual costs of individual services delivered by Angus Council Care Centres can be identified. Charging levels for these services should be aligned with the actual costs identified. Strategic Planning and Commissioning 2 The commissioner and provider functions within Older People s Services should be reviewed to ensure greater transparency. Commissioning and provider functions in other divisions of Social Work and Health should also be reviewed in so far as they relate to services provided to older people who are users of Older People s Services or to services provided to other care groups by Older People s Services. 3 Building on the Best Value Review, the Council should develop an outcomes focused strategic commissioning strategy for all social work services for older people. The strategy should set out a clear rationale for the proposed balance between direct and commissioned services, and establish a single framework for the monitoring and review of performance in the delivery of outcomes for both direct and contracted services. 4 A review should be undertaken of the strategic development capacity within social work to progress development of services for older people over the long term in partnership with health service development, in order to improve management information and longer-term, strategic planning for older people services. 19 The Angus Community Care Partnership should review and revise the Angus Mental Health Strategy in the light of developments in policy and in professional practice, and the emerging needs of older people in Angus. Current operational management structures and service priorities should be reviewed to ensure they are aligned to the revised joint strategy and supporting financial framework. 27 Evidence collected by Augmented Care as part of the review process on the effectiveness of services in delivering quality outcomes for service users and carers should be routinely analysed and used to inform service commissioning and development. 28 Existing arrangements for the calculation and monitoring of resource transfer should be reviewed and if necessary new arrangements put in place to ensure calculations are robust, transparent and agreed by both the Council and Health colleagues. The balance of funding between the Council and Health resource transfer should be reviewed to confirm that this remains appropriate given each body s respective legislative responsibilities

19 30 The benefits of Enablement and the potential of Telecare and Homecare services to support older people in their own homes (or alternative housing) should be widely promoted, with the aim of raising awareness among the public and professionals. 44 The responsibility of Health services in the continuing care of individuals receiving high-dependency and nursing-care needs to be clarified and specific financial and service arrangements agreed. Monitoring and Review Arrangements 16 The roles of the Review Team and Contracting Team in ensuring the standard of care commissioned by the Council should be reviewed. Consideration should be given to enhancing the Council s monitoring and compliance arrangements and for the Review Team to be given a more proactive role in supporting quality improvement across all sectors. 17 A monitoring framework should be developed to ensure that the results of care plan reviews are formally recorded and collated so that they can be used to inform commissioning decisions. 26 The quality of assessments, care plans and reviews (including assessments and support plans for carers) should be monitored on a regular basis Information Systems and IT 5 As a matter of urgency, further work should be undertaken to ensure the CareFirst System is configured to enable the systematic recording of all necessary management information and the production of reliable analytical performance reports, including statutory returns and performance indicators. The system should also be developed to enable the impact of services on the wellbeing of service users to be recorded and the delivery of outcomes measured and reported, including the recording of unmet need. 6 A review of current access to, and use of, IT by operational staff should be undertaken to identify gaps which are impacting on service delivery. In particular, an assessment should be undertaken of the options for, and cost benefits of, deployment of mobile IT systems for frontline staff to streamline service delivery and improve the consistent recording of assessment and management data

20 Staffing 31 Staffing arrangements should be reviewed to provide increased flexibility in service delivery, and to minimise the levels of unproductive hours arising from cancellations of services. In particular, it is recommended that consideration is given to the possibility of re-introducing split shift contracts and extending the system of banked hours to all homecare staff. 46 The use of a dependency measure should be integrated into service planning and staffing deployment. 48 The staffing arrangements for supported housing should be reviewed in order to incorporate greater flexibility and responsiveness to changing needs Corporate Numbe r 1 A corporate group focused on delivering services for older people should be established to ensure that all relevant departments develop appropriate services for older people and contribute to a coordinated corporate strategy, with funding of initiatives which contribute to healthy and active ageing being aligned to departmental priorities within the context of the Angus Single Outcome Agreement. 45 Slippage targets are inappropriate for direct care services, and should no longer be applied

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