Practical Approaches to Human Rights in Health and Social Care

- The Wiltshire StoryOctober 15th

V1

• Rural county, 470k population• Unitary authority• 101k people over 65 (2011 census)• Eligibility criteria• Budget £85m net• 4000 older people being supported at home• 40% of budget spent on care homes

Context

Voice of the Customer

Top 15 Statements from EVOC

3.45 3.50 3.55 3.60 3.65 3.70 3.75 3.80 3.85 3.90 3.95

I want to speak to someone at the right time for me

I want to keep as active as I can

I want to go outside my home

I want the right to choose how I live my life

I want a simple way to access information and advice

I want to know how much it will cost me

I want to see and talk to people

I want to be able go to the toilet independently

I want good quality information that is easy to access

I want to speak to someone face to face

I want to feel safe

I want to stay at home as long as possible

I want you to be honest with me

I want to be free from abuse

I want help when I am in a crisis

Voice of the customerRanked ‘top six’ themes

• Difficult to know where to get help when it is needed

• Too many organisations – too much choice

• Lots of money wasted from duplication

• Concern about crises at night• Importance of “that little bit of help”• Loneliness and isolation• Same issues for everyone

What people told us

What are the Council doing about it?

• Commission a new service for people at home based on what people want

• Develop telecare and Response service to help people feel safe

• Commission a new equipment and practical help service focused on people remaining at home

• Improve access to information, advice and support

Telecare and Crisis Response

Support when you most need it

• Call monitoring service• Emergency response 24/7• Fall detectors and movement sensors• Prevention

Equipment

Better access to equipment for everyone

Value for money on equipment

Community Equipment Service

• Traditional model• Lots of providers doing different things for the

same people• Hours based care• Assessments based on services rather than

outcomes• Poorly paid and de-valued workforce• Reablement only at the beginning• Providers paid by the hour – no incentive to

promote independence• Assessments and support plans by WC staff• Only available to WC eligible customers

Help to Live at Home Service

HTL@H

Domiciliary Care

Reablement

Neighbourhood Team

rehabilitation

Housing Support

• 4 providers• Outcomes rather than hours• Assessments based on outcomes• Salaried and professional staff• Reablement built in – each support plan is time limited• Providers paid for delivering outcomes that are agreed• Support plans completed by providers and customers• Free initial support available to everyone

Help to Live at Home Service

• Don’t bamboozle customers with choice

• Choice about what service they receive – outcomes not hours

• Person centred planning – important to and important for

• Choice about direct payment or service

Choice, Control and Personalisation

• Payable and non payable

• Payable have to be demonstrable

• Outcomes written in a way described by the customer

• Capture what’s important to the customer not the member of staff

• Only pay for outcomes meeting that meet eligible needs

OUTCOMES – WHAT ARE THEY?

• I can manage my personal care• I can wash • I can dress/undress • I can manage my hair • I can use toilet/commode • I can get on/off toilet/commode • I can clean myself after using toilet • I can manage my foot care • I can shave • I can manage dental care • I can manage continence

Personal Care Outcomes - payable

• I can make decisions and organise my life• I can communicate with people independently • I can communicate with people with the use of aids and

equipment• I can participate in my local community• I can use public transport or have access to travel  • I can access local amenities (shops, faith groups, pub etc) • I can visit/receive visits from family and friends when I want

More Payable Outcomes

• Non Funded Outcome statement ‘ Meeting personal care needs’ . Customer had said that “It is important to me that I visit the hairdressers once a week and also have a manicure whilst I’m there”. This is important to the customer but does not meet FACS criteria (non funded) however the provider might support the person with advice and information but the outcome is not an eligible need so therefore is non payable.

• An important point here is how a provider designs a support plan. There may be an eligible need around personal care that on occasions can be met by supporting this in-eligible outcome.

Non Payable Outcome

• Talking to people

• Customer Reference Group

• Care quality helpline

Customer Engagement