Front Door, Gateway and Flow

Overview

Adult Social Care in Torbay has demand on its services from different front doors, including residents of Torbay and their family and friends, local and community-based services, primary care and acute services.

The programme of work will redesign the front door working in partnership with the local networks to address continuity of access, seamless referrals; future needs analysis and person-centredinformation, advice and guidance to ensure Care Act 2014 prevention and delay principles are the key drivers.

An improved front door will increase diversion from formal care and enable and support an agreed approach to sharing information to provide well informed local networks with effective referral mechanisms that deliver good outcomes. The programme will develop a measurement strategy that enables impacts to be measured and business intelligence gathered which can be used for strategic commissioning.

Improves Gateways and Flow is key to how a person moves through our system. Improved gateway and flow mechanisms will result in high quality information flowing from one operational team to another leading to greater efficiencies and effectiveness within ASC teams.

Arranging Support and Brokerage

The contract with Mears for the provision of home and domiciliary care ended on 31 March 2020. The brokerage service was transferred into the Arranging Support Team to ensure business continuity.

In order to manage flow of patients, Torbay and South Devon NHS Foundation Trust (TSDFT) needs to ensure they have sight of the availability of specific types of service, which will include nursing support at home, standard personal care as well as re-ablement based domiciliary care; physiotherapy, occupational therapists, intermediate care bed facilities.

A single point of brokering support packages will enable effective market management and support building relationships with providers that enable adult social care to communicate effectively with the market in relation to the needs of the organization.

The project offers opportunities to gather data in relation to current market position and opportunities to improve the way we contract with providers.

Professional Practice and Performance Management

We need to adopt a fully, strength-based approach and a cultural of performance management, learning and continuous improvement.

The Professional Practice and Performance Management project seeks to understand social work behaviours and will look to assure stakeholders that staff are compassionate and legally literate.

It is recognised that there is variation across adult social care approaches to embedding strengths based working as well as a limited assurance process that staff are working in a strengths-based way due to limitations in systems and process.

The project will look to develop processes that provide assurance to senior leaders that staff are continuing to work in accordance with legislation. The project will also build in mechanisms that will support staff in terms of the timeliness and quality of work being carried out.

The project has strong interdependencies with Training and Development Project and Front door, to ensure staff are supported to develop their capabilities in line with the needs of the organisation.

Quality Assurance and Improvement Team

Adult social care in Torbay is transitioning to an ongoing improvement-driven model of working across all areas of operation. Supporting this approach will require a different kind of quality assurance model that has a wider capability to look at both internally delivered and externally contracted assessment, care and support services.

TSDFT’s current QAIT provision is predominantly used as an assurance function and needs to increase its capability and capacity to provide a continuous improvement function.

There is a need to implement learning, integrating and improving the quality assurance / improvement functions, routine ASC contract reviews and provider-focused elements of adult safeguarding which continues to reduce risk and further create a more forward looking improvement system.

Review and Insights

The Review and Insights Project will focus on Care Act (2014) principles of promoting wellbeing through engaging the person in genuine conversations about “what is important to them”.These conversations will be supported by using a strengths-based approach, utilising community assets, Technology Enabled Care (TEC) and completed with a commitment to personalisation and co-production of support plans, recognising that a focus on the strengths of the individual creates empowerment and can aid recovery in a positive way. Community led support (CLS) is a key part in the approach to improving packages of care.

The project also presents an opportunity to identify alternative provisions of support and communicate this information to ASCiP projects as well as providing insight to the Professional Practice and Performance Project regarding the workforce activity to ensure all staff continue to be compassionate and legally literate.

Systems and processes must be reviewed to ensure a consistent and equitable approach across ASC in Torbay. The Review Project provides an opportunity to develop best practice processes and test their efficacy before roll out to wider teams.

Contract Management

The Contract Management project provides a welcome opportunity to work collaboratively with Torbay Council colleagues to ensure contracts and the contracting process supports positive life outcomes for the person in receipt of care in a cost effective and sustainable way.

Current contracts should be legally robust, clear in their communication with providers and clients, outline expectations and monitored.

The project will create a mechanism, through good contract management, for QAIT to use as a tool to hold providers accountable for providing a high quality service for our clients.

Market Shaping

The Market Shaping Project has been established in part from the ‘Shape of Adult Social Care in Torbay 2019 to 2029’ report which sets out a ten-year blueprint for how Torbay Council and partners expect to work with providers of adult social care. It is aimed at current and potential providers of support services, engaging them in understanding and meeting future demand.

The project provides an opportunity to be fully integrated in the approach to commissioning and managing services by supporting partners to engage with providers differently and communicate the changes in approach required to meet future demand. The project will support conversation with providers, inviting providers to shape their business to meet the needs of the market and make way for new models of care offering cost effectiveness and importantly better life outcomes.

Voluntary Sector Development

Effective strengths-based approaches can help reduce demand for high cost services over time, but only after developing effective and equal partnerships with the community and voluntary sector. Torbay has a rich and sizeable community and voluntary sector which offers and provides support to a wide range of Torbay’sresidents.

The TSDFT and Torbay Council have positively engaged with the voluntary sector in Torbay and invested £200k in voluntary sector development. As part of this work there is an increased emphasis on understanding, supporting and developing the voluntary sector to provide person centered information, advice and guidance; understanding and building of community resilience, which will help support a thriving community.

The programme of work will begin with a review of current voluntary assets, their resilience and opportunities for all partners. The outcome of the work is to have a deep understanding of each others priorities and an ongoing positive relationship to the benefit of the Torbay community.

Training and Development

Adult social care in Torbay needs to continue to more towards an approach where the interdependence between community, family and the individuals own strengths are fundamental and where an approach to developing a support package supports person-centredoutcomes. The social worker is key to providing a role a supportive service in helping individuals find solutions for themselves. It is vitally important to provide a variety of support to social work staffthrough continuous development and training.

The project will improve the effectiveness of staff working in a strengths-based way and continue to assure compliance with the Care Act 2014 in including alignment with framework principle from Integrated Service Units Delivering Integrated Care: Personalised Care and Support -Conversations with people based on what matters most to them. Support is built up around a persons strengths, their own networks of support, and resources (assets) which can be mobilised from the local community.

The project will also seek to increase efficiencies within and between business processes in Adult Social Care in Torbay which are measurable in terms of outcomes and process through staff training based which is in part based on insights from other ASCiP projects.

Data Culture

Torbay adult social care presents a number of challenges, there is a need to provide a culture of continuous improvement which is supported by good quality data. Torbay adult social care does not currently have a data culture that promotes the use of data in a consistent way across the system.

The project will also look to create a consistent approach, implement standardised operational definitions which are agreed and implemented as well as appropriate training in how to record accurately to provide accurate data.

A good data culture is critical to the effectiveness of any organisation and Torbay adult social care seeks to make even more effective decisions which support both operational and professional practice needs.

Innovation Hub

The Innovation Hub will focus on what matters to TSDFT ASC, the provider market and the recipient of adult social care services through insight. It will define and operate a common understanding, structure and way of working that aligns to the strategic vision and business goals of TSDFT ASC and at the outset, the ASC Improvement Plan.

It will define the customer for each innovation and ensure the customer is the focal point and use a data-driven approach to innovation, develop financial modelling to support tangible value proposition and use TSDFT Benefits Realisationto support assurance.

It will create visible access to the hub and the undertake a transparent approach which will ensure business goals and prospective innovations are aligned, resource is allocated and decision-making sought in the appropriate areas of TSDFT with involvement from wider stakeholders as appropriate.

It will support an innovation mindset and capabilities for all staff, at grassroots, and importantly work with intrapreneurs from within TSDFT ASC and therefore increase volume and quality of ideas entering the innovation hub and being received by the ASCiP and Transformation Group.

TEC and Aids/Adaptions Projects

Currently in Torbay there are separate service/contract arrangements for the aids, adaptations and technology enabled care (TEC) offer. These include: the Joint Community Equipment Service (JCES), Disabled Facilities Grants (DFGs) and Technology Enabled Care Services (TECS).

The use of TEC when assessing new packages of care and re-assessing existing packages is improving but still not fully embedded and in line with the strengths based approach. A project manager has been recruited for Technology Enabled Care which will support progress moving forward.

Aids and Adaptations no longer sits within Adult Social Care Improvement Plan as a project as this is a procurement exercise being carried out as part of the operational activity within commissioning.

Project Timeline