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Theme two - how we support people

In this section

  1. 1
    Our self assessment - introduction
  2. 2
    Strengths and areas for improvement
  3. 3
    Context
  4. 4
    Our performance
  5. 5
    Our approach to equalities, diversity and inclusion
  6. 6
    Our integrated commissioning approach
  7. 7
    Our assessment services and our social care model - 'make the difference'
  8. 8
    How we keep people safe
  1. 9
    Our approach to supporting unpaid carers
  2. 10
    Our approach to co-production
  3. 11
    Our approach to managing risk
  4. 12
    Theme one - working with people
  5. 13
    Theme two - how we support people
  6. 14
    Theme three - how we keep people safe
  7. 15
    Theme four - our leadership
  8. 16
    Acknowledgements

Our ambition is…

 

  • To build a world class ‘model’ of short-term care (the ‘Enhanced Independence Offer’) together with NHS and other partners; improving the impact of short-term help to make sure people regain their confidence and independence whenever possible
  • To work with independent care providers to address capacity gaps and over provision, and to make progress in creating the conditions for financial and market sustainability;
  • To develop a culture of continuous improvement and quality assurance of commissioning, care and practice; having improved capacity and skills across our internal and external workforce;
  • To be an effective partner within the ICS’s urgent and emergency care response “Working as One” Programme.

Our strengths

  • We have willing and engaged Partnership Boards which are chaired by independent chairs and people with lived experience.
  • We have a strong history of using Health Act flexibilities to deliver joined up services which is governed by our Joint Commissioning Partnership. Our Operational teams that are co-located with NHS and other colleagues tell us that really increases mutual understanding and generally quicker and easier communication and problem solving.
  • Our Carers Hub have a pool of willing and engaged volunteers who support unpaid carers in their communities.
  • A strong Strategic Housing Partnership and the work of our Specialist Housing Occupational Therapist has seen some positive outcomes.

Priorities for improvement

  • Support the Partnership Boards to define their position and influence within the GCC Governance structure. Clarify the lines of communication, decision making and accountability for and to our partnership boards; including setting out the remuneration and recognition of people who contribute to co-production activities.
  • Set out our strategic approach to improving co-production, ensuring corporate support and clear policy for reward and recognition of people with lived experience for the work they contribute to.
  • Coordinated approach to inequality, multiple engagements and feedback loop across the whole of the ICS.
  • There is a need for better transport options, especially in rural areas, to support people's participation in meaningful activities and occupations.

Key statistics

Activity

Working Well

Improvement

4508 calls to Carers Hub Welcome Team (April 23 – Dec 23). Resulting in 848 people supported by peer support groups, 2916 people accessing short break respite, 748 referred for counselling and 458 full care act compliant assessments carried out (see IR 33.5)

People supported into employment with a disability[1] (Q1 772, Q2 809, Q3 892).

We want to co-design our Insights structure to close the loop of feedback e.g. from Partnership Boards, Surveys, Healthwatch etc. This will then provide us with key qualitative data to support our transformation and improvement journey.

Our Home First organisations provide a discharge service supporting discharge of on average 100 people per month. They also provider a welfare call service to on average 750 people per month.

The latest Warm and Well report shows that over 2021-22, for every £1 of Warm and Well funding, £11.43 more in capital investment is brought into the region.

 

 

We conduct impact reports for example related to Thriving Communities, Know Your Patch (KYP). The biggest impact areas for the grants awarded over the last few years are in relation to reducing social isolation, supporting children and families and meaningful occupation (having things to do).

 

[1] This is a corporate measure and relates to voluntary work as well as paid employment.

Our Partnership Boards

Our Partnership Boards have active representation from statutory partners, VCSE and people with lived experience across five Partnership Boards with enthusiastic and committed co-chairs. Co-chairs are people with lived experience and bring that knowledge and understanding into discussions and focus of the work of each Board.

Examples of how we work with VCSE

For people with disabilities we have a long-standing relationship with Inclusion Gloucestershire, who support us with our quality assurance of care provision and with Kingfisher Treasure Seekers Association who we commission to deliver low level mental health support[i] and Building Circles who we commission to deliver Sexual Abuse Prevention training to people with a learning disability across the county, one of the many unique aspects about the training is that it is peer led. We also commission the Gloucestershire Deaf Association to deliver the Deaf and Hard of Hearing Equipment Assessment Service and Q-Care to provide a floating support 1:1 support and a drop-in service for people with a sensory impairment.

The VCS Alliance[ii] are key members of a number of our integrated transformation programmes of work and a Joint Memorandum of Understanding has been established to support working with people and communities across the integrated care system. How we capture insights from these organisations to inform our improvement work in Adult Social Care will form part of our improvement plan[iii] on how we can work in co-production consistently across the system.

Commissioning includes a range of opportunities to invest in local community infrastructure not limited only to formal procurement. Grants and investment in infrastructure agencies, user led organisations and specialist services such as Citizens Advice demonstrates commitment to local agencies who are more likely to understand local community needs and deliver social impact.

Strategic Housing Partnership

Gloucestershire has an established structure for bringing together housing, health and care services. Senior officers from the six District Councils, Public Health, NHS Gloucestershire, Gloucestershire Health & Care NHS Foundation Trust (GHC), Adult Social Care Integrated Commissioning, and social housing providers are all represented on the Gloucestershire Strategic Housing Partnership (see IR23.1 for more information).

Employment and skills hub

GCC and GFirst LEP have worked together to develop a central resource around skills and employment with access to specialist coaches, tailored packages of support. This is called the Employment and skills hub.

Community transport

The main Community Transport providers are Community Connexions, Lydney Dial-a-ride and Newent Dial-a-ride, and Cotswold Friends. Between them they cover the county of Gloucestershire. GCC invest £500k annually in community transport. The services are ‘door to door’ and provide transport to older, disabled or otherwise vulnerable people (this might be because they are rurally, socially, or financially isolated). However, stakeholders have reported access to accessible transport, especially in more rural areas to get to activities and fulfil daily living activities as well as social care workforce to be able to get to work is a real challenge. GCC has introduced a mini bus[iv] on demand service in Cotswolds and Forest of Dean as a pilot. However, this bus is not a wheelchair accessible one, further needs analysis is being undertaken by our Transport colleagues within GCC.

Our strengths

  • We have willing and engaged Partnership Boards which are chaired by independent chairs and people with lived experience.
  • We have a strong history of using Health Act flexibilities to deliver joined up services which is governed by our Joint Commissioning Partnership. Our Operational teams that are co-located with NHS and other colleagues tell us that really increases mutual understanding and generally quicker and easier communication and problem solving.
  • Our Carers Hub have a pool of willing and engaged volunteers who support unpaid carers in their communities.
  • A strong Strategic Housing Partnership and the work of our Specialist Housing Occupational Therapist has seen some positive outcomes.

Priorities for improvement

  • Support the Partnership Boards to define their position and influence within the GCC Governance structure. Clarify the lines of communication, decision making and accountability for and to our partnership boards; including setting out the remuneration and recognition of people who contribute to co-production activities.
  • Set out our strategic approach to improving co-production, ensuring corporate support and clear policy for reward and recognition of people with lived experience for the work they contribute to.
  • Coordinated approach to inequality, multiple engagements and feedback loop across the whole of the ICS.
  • There is a need for better transport options, especially in rural areas, to support people's participation in meaningful activities and occupations.

Key statistics

Activity

Working Well

Improvement

4508 calls to Carers Hub Welcome Team (April 23 – Dec 23). Resulting in 848 people supported by peer support groups, 2916 people accessing short break respite, 748 referred for counselling and 458 full care act compliant assessments carried out (see IR 33.5)

People supported into employment with a disability[1] (Q1 772, Q2 809, Q3 892).

We want to co-design our Insights structure to close the loop of feedback e.g. from Partnership Boards, Surveys, Healthwatch etc. This will then provide us with key qualitative data to support our transformation and improvement journey.

Our Home First organisations provide a discharge service supporting discharge of on average 100 people per month. They also provider a welfare call service to on average 750 people per month.

The latest Warm and Well report shows that over 2021-22, for every £1 of Warm and Well funding, £11.43 more in capital investment is brought into the region.

 

 

We conduct impact reports for example related to Thriving Communities, Know Your Patch (KYP). The biggest impact areas for the grants awarded over the last few years are in relation to reducing social isolation, supporting children and families and meaningful occupation (having things to do).

 

[1] This is a corporate measure and relates to voluntary work as well as paid employment.

Our Partnership Boards

Our Partnership Boards have active representation from statutory partners, VCSE and people with lived experience across five Partnership Boards with enthusiastic and committed co-chairs. Co-chairs are people with lived experience and bring that knowledge and understanding into discussions and focus of the work of each Board.

Examples of how we work with VCSE

For people with disabilities we have a long-standing relationship with Inclusion Gloucestershire, who support us with our quality assurance of care provision and with Kingfisher Treasure Seekers Association who we commission to deliver low level mental health support[i] and Building Circles who we commission to deliver Sexual Abuse Prevention training to people with a learning disability across the county, one of the many unique aspects about the training is that it is peer led. We also commission the Gloucestershire Deaf Association to deliver the Deaf and Hard of Hearing Equipment Assessment Service and Q-Care to provide a floating support 1:1 support and a drop-in service for people with a sensory impairment.

The VCS Alliance[ii] are key members of a number of our integrated transformation programmes of work and a Joint Memorandum of Understanding has been established to support working with people and communities across the integrated care system. How we capture insights from these organisations to inform our improvement work in Adult Social Care will form part of our improvement plan[iii] on how we can work in co-production consistently across the system.

Commissioning includes a range of opportunities to invest in local community infrastructure not limited only to formal procurement. Grants and investment in infrastructure agencies, user led organisations and specialist services such as Citizens Advice demonstrates commitment to local agencies who are more likely to understand local community needs and deliver social impact.

Strategic Housing Partnership

Gloucestershire has an established structure for bringing together housing, health and care services. Senior officers from the six District Councils, Public Health, NHS Gloucestershire, Gloucestershire Health & Care NHS Foundation Trust (GHC), Adult Social Care Integrated Commissioning, and social housing providers are all represented on the Gloucestershire Strategic Housing Partnership (see IR23.1 for more information).

Employment and skills hub

GCC and GFirst LEP have worked together to develop a central resource around skills and employment with access to specialist coaches, tailored packages of support. This is called the Employment and skills hub.

Community transport

The main Community Transport providers are Community Connexions, Lydney Dial-a-ride and Newent Dial-a-ride, and Cotswold Friends. Between them they cover the county of Gloucestershire. GCC invest £500k annually in community transport. The services are ‘door to door’ and provide transport to older, disabled or otherwise vulnerable people (this might be because they are rurally, socially, or financially isolated). However, stakeholders have reported access to accessible transport, especially in more rural areas to get to activities and fulfil daily living activities as well as social care workforce to be able to get to work is a real challenge. GCC has introduced a mini bus[iv] on demand service in Cotswolds and Forest of Dean as a pilot. However, this bus is not a wheelchair accessible one, further needs analysis is being undertaken by our Transport colleagues within GCC.

Our strengths

  • We have an in-house respite offer for people with complex needs and a learning disability, and an integrated reablement and community equipment services which contribute to our wider prevention agenda
  • We have a strong quality assurance offer for those with disabilities and working age. The adults care provider market are utilising PAMMS IT system to help us manage risk.
  • System wide digital transformation programme to deliver shared care record “Joining up your information”[i] (JUYI), work around digital literacy, supporting the digital offering of care providers and keeping digital records.
  • Our provider portal supports improved communications with the market; it enables providers to see purchased care, documentation and contracts we have published. It also supports 2-way communication with us.
  • We have a strong, engaged and willing systemwide transformation programme (Working as One) to improve system flow across multiple organisations.

[i] One Gloucestershire, Joining up your information “JUYI”, https://www.onegloucestershire.net/programmes/joining-up-your-information/

Priorities for improvement

  • Ability to monitor and evaluate outcomes and impact of commissioned services.
  • Developing an improved approach to assuring quality of the older person’s care market
  • Our In-house services need modernisation, including the procurement of a digital case recording system, the requirements for this are currently being scoped.
  • Consistency, clarity and delivery of joined up services delivered by GHC to create the conditions for people to receive optimal experiences – in particular Mental Health Social Work teams and Occupational Therapy Teams.  A review of these teams has commenced.
  • We recognise that while there are a lot of support offers to the Care Provider Market, this can sometimes be confusing for providers, and we are working as a system to develop ways to improve access to support.

 

Key Statistics

Activity

Working Well

Improvement

Between April 23 to Feb 24, the Care Navigators received 252 new referrals of which only 10% (n=24) required onward referral to Adult Social Care locality teams for more intensive social care input.

Our permanent admissions to care homes in the rolling year remain lower than the comparator group average (2022/2023).

25% of calls to 999 from care homes in relation to Falls with 21% conveyance to ED.

Fair Cost of Care exercise showed that the median cost per hour identified for domiciliary care in Gloucestershire is above our standard contract prices and is also more than the mean actual payment per hour made across the county.

Low numbers of people placed out of area on average 10 placements a month.

Our data tells us that 53% of people who waited over two weeks for a service lived in the four rural areas of Gloucestershire which points to the increased difficulty of recruiting in those areas.

 

We have a good relationship with our care providers and utilise Gloucestershire Care Providers Association (GCPA), Provider Forum, monthly Provider Bulletin as well as our Provider Portal.  In addition to this we have strong relationships with our community organisations through our Know Your Patch Networks[i] (KYPN) which bring together cross-sector partners to form a network for the needs of our communities and individuals.

Our Integrated Brokerage teams will work with individuals, family, care providers, safeguarding, social workers and CQC to ensure care provided meets the assessed needs and is delivered in line with contractual requirements and meeting regulatory requirements. We commission packages of care and contract on behalf of the ICB for Continuing Health Care through our Section 75 and Section 256 arrangements (see Appendix 6 for further information about our commissioning approach).

Our market position statement is out of date; the refreshed version is due to go to Cabinet Q2 2024-2025.

The opportunities have not yet been realised around our new bed-based contract (due to go to Cabinet for approval Spring 2024) which will build in greater assurance and escalation protocols, clarification of roles and responsibilities and the interdependencies across contract management, quality assurance concerns and safeguarding.

Hyper-localised and carbon footprint commissioning

Gloucestershire have identified via electronic call monitoring the ability to re-commission care packages to providers who have a significant footprint in an area.  By focussing providers in a specific locality, they have the ability to deliver care more efficiently, effectively and sustainably. This process enables providers to work more flexibly with their commissioned hours to provide a personalised approach based on individual’s needs.

Proud to Care

Our Proud to Care[ii] team supports the external care market with the safe recruitment of care, works in collaboration with care providers around staffing resource requirements and works with Community Catalysts to support workforce. Our Proud to Learn platform  supports the training, development, and retention of the external workforce.

Care and Support Directory

We publish annually a Care and Support Guide directory[iii] which is available on Your Circle and provides written guidance (online or printed) on how to live well for longer, independently and in your own home as well as choices for when people choose to self-fund their care. The Guide explains how to access a wide range of services across Gloucestershire.  Free copies of the guide are available from a range of venues inc Cares Hub, Hospitals, Libraries, GP surgeries, Age UK etc.

Systemwide falls prevention and response programme

We have co-produced a comprehensive Falls Prevention and Response Programme[iv] with our independent care providers and this will be implemented with care homes for older people in the forthcoming year. We have plans to further develop the programme for domiciliary care providers and care homes for people with Learning Disability and/or Physical Disability during 2024.

Care navigators

Care navigators, employed by GCC, work as key members of the multidisciplinary teams of Complex Care at Home and the South Cotswolds Frailty Service to provide timely response to an appearance of social care need. Their role is to work with individuals and families to resolve and provide solutions to a range of social issues that help maintain people in their circumstances and prevent deterioration in their situation.

Home First Model and support for system flow

Gloucestershire has significantly invested in the Home First model; this has provided additional resources of front-line workers and by utilising a blended model we have made available additional community domiciliary care capacity to meet demand. This is via a partnership between GHC and private providers and facilitated by our Integrated Brokerage system.  Our system control centre (SCC), Transfer of Care Bureau (TOCB) and System Flow dashboard provide us with the information and tools to systematically work together as partners to offer patients the most suitable care pathway for their needs.

Part of this approach has also been to develop further working with the VCSE to support people going home via Pathway 0 or simple Pathway 1 to alleviate pressure.  We have also increased resource into our Age UK / British Red Cross partnership to support both discharge and admission avoidance with health and social care and wider community engagement.  

The Out of Hospital service offers short term practical solutions to facilitate a return home from hospital. As well as supporting the individual to adjust and regain confidence as they recover, the service will also offer longer term support through relevant community networks and resources of the provider or by contact with VCS groups and networks. 

We have eight hospital step down flats in general needs accommodation and extra care housing.  The Lead Housing Officer supports Adult Social Care colleagues to make best use of eight flats secured and funded to support hospital discharge across Gloucestershire for people unable to return home due to housing related issues access to funds, for example, to resolve deep cleaning or basic furniture.

 Working as One Programme

Newton Europe[i] has completed a diagnostic of our system as it supports urgent and emergency care. This has shown that our rapid response, frailty, falls, discharge to assess and reablement offers could improve efficiency and effectiveness in the way they work together to focus on prevention, independence, admission avoidance and system flow.  A programme of improvements are planned until 2025 and this is outlined in Figure 4.

The LGA Peer Challenge Report noted that in relation to system flow:

“GCC has consistently shown its dedication to working creatively with voluntary and community groups in order to offer services designed to enable individuals to stay at home or return home safely”.

Figure 4 - Working as One Programme on a Page October 2023
Infographic of the improved journey through out of hospital services that help people stay and return home when their needs escalate.

[i] Newton Europe, Review into our Urgent and Emergency Care Pathway, https://glostext.gloucestershire.gov.uk/documents/s86603/Improving Urgent and Emergency Care Services in Gloucestershire Report.pdf   

Our strengths

  • We have an in-house respite offer for people with complex needs and a learning disability, and an integrated reablement and community equipment services which contribute to our wider prevention agenda
  • We have a strong quality assurance offer for those with disabilities and working age. The adults care provider market are utilising PAMMS IT system to help us manage risk.
  • System wide digital transformation programme to deliver shared care record “Joining up your information”[i] (JUYI), work around digital literacy, supporting the digital offering of care providers and keeping digital records.
  • Our provider portal supports improved communications with the market; it enables providers to see purchased care, documentation and contracts we have published. It also supports 2-way communication with us.
  • We have a strong, engaged and willing systemwide transformation programme (Working as One) to improve system flow across multiple organisations.

[i] One Gloucestershire, Joining up your information “JUYI”, https://www.onegloucestershire.net/programmes/joining-up-your-information/

Priorities for improvement

  • Ability to monitor and evaluate outcomes and impact of commissioned services.
  • Developing an improved approach to assuring quality of the older person’s care market
  • Our In-house services need modernisation, including the procurement of a digital case recording system, the requirements for this are currently being scoped.
  • Consistency, clarity and delivery of joined up services delivered by GHC to create the conditions for people to receive optimal experiences – in particular Mental Health Social Work teams and Occupational Therapy Teams.  A review of these teams has commenced.
  • We recognise that while there are a lot of support offers to the Care Provider Market, this can sometimes be confusing for providers, and we are working as a system to develop ways to improve access to support.

 

Key Statistics

Activity

Working Well

Improvement

Between April 23 to Feb 24, the Care Navigators received 252 new referrals of which only 10% (n=24) required onward referral to Adult Social Care locality teams for more intensive social care input.

Our permanent admissions to care homes in the rolling year remain lower than the comparator group average (2022/2023).

25% of calls to 999 from care homes in relation to Falls with 21% conveyance to ED.

Fair Cost of Care exercise showed that the median cost per hour identified for domiciliary care in Gloucestershire is above our standard contract prices and is also more than the mean actual payment per hour made across the county.

Low numbers of people placed out of area on average 10 placements a month.

Our data tells us that 53% of people who waited over two weeks for a service lived in the four rural areas of Gloucestershire which points to the increased difficulty of recruiting in those areas.

 

We have a good relationship with our care providers and utilise Gloucestershire Care Providers Association (GCPA), Provider Forum, monthly Provider Bulletin as well as our Provider Portal.  In addition to this we have strong relationships with our community organisations through our Know Your Patch Networks[i] (KYPN) which bring together cross-sector partners to form a network for the needs of our communities and individuals.

Our Integrated Brokerage teams will work with individuals, family, care providers, safeguarding, social workers and CQC to ensure care provided meets the assessed needs and is delivered in line with contractual requirements and meeting regulatory requirements. We commission packages of care and contract on behalf of the ICB for Continuing Health Care through our Section 75 and Section 256 arrangements (see Appendix 6 for further information about our commissioning approach).

Our market position statement is out of date; the refreshed version is due to go to Cabinet Q2 2024-2025.

The opportunities have not yet been realised around our new bed-based contract (due to go to Cabinet for approval Spring 2024) which will build in greater assurance and escalation protocols, clarification of roles and responsibilities and the interdependencies across contract management, quality assurance concerns and safeguarding.

Hyper-localised and carbon footprint commissioning

Gloucestershire have identified via electronic call monitoring the ability to re-commission care packages to providers who have a significant footprint in an area.  By focussing providers in a specific locality, they have the ability to deliver care more efficiently, effectively and sustainably. This process enables providers to work more flexibly with their commissioned hours to provide a personalised approach based on individual’s needs.

Proud to Care

Our Proud to Care[ii] team supports the external care market with the safe recruitment of care, works in collaboration with care providers around staffing resource requirements and works with Community Catalysts to support workforce. Our Proud to Learn platform  supports the training, development, and retention of the external workforce.

Care and Support Directory

We publish annually a Care and Support Guide directory[iii] which is available on Your Circle and provides written guidance (online or printed) on how to live well for longer, independently and in your own home as well as choices for when people choose to self-fund their care. The Guide explains how to access a wide range of services across Gloucestershire.  Free copies of the guide are available from a range of venues inc Cares Hub, Hospitals, Libraries, GP surgeries, Age UK etc.

Systemwide falls prevention and response programme

We have co-produced a comprehensive Falls Prevention and Response Programme[iv] with our independent care providers and this will be implemented with care homes for older people in the forthcoming year. We have plans to further develop the programme for domiciliary care providers and care homes for people with Learning Disability and/or Physical Disability during 2024.

Care navigators

Care navigators, employed by GCC, work as key members of the multidisciplinary teams of Complex Care at Home and the South Cotswolds Frailty Service to provide timely response to an appearance of social care need. Their role is to work with individuals and families to resolve and provide solutions to a range of social issues that help maintain people in their circumstances and prevent deterioration in their situation.

Home First Model and support for system flow

Gloucestershire has significantly invested in the Home First model; this has provided additional resources of front-line workers and by utilising a blended model we have made available additional community domiciliary care capacity to meet demand. This is via a partnership between GHC and private providers and facilitated by our Integrated Brokerage system.  Our system control centre (SCC), Transfer of Care Bureau (TOCB) and System Flow dashboard provide us with the information and tools to systematically work together as partners to offer patients the most suitable care pathway for their needs.

Part of this approach has also been to develop further working with the VCSE to support people going home via Pathway 0 or simple Pathway 1 to alleviate pressure.  We have also increased resource into our Age UK / British Red Cross partnership to support both discharge and admission avoidance with health and social care and wider community engagement.  

The Out of Hospital service offers short term practical solutions to facilitate a return home from hospital. As well as supporting the individual to adjust and regain confidence as they recover, the service will also offer longer term support through relevant community networks and resources of the provider or by contact with VCS groups and networks. 

We have eight hospital step down flats in general needs accommodation and extra care housing.  The Lead Housing Officer supports Adult Social Care colleagues to make best use of eight flats secured and funded to support hospital discharge across Gloucestershire for people unable to return home due to housing related issues access to funds, for example, to resolve deep cleaning or basic furniture.

 Working as One Programme

Newton Europe[i] has completed a diagnostic of our system as it supports urgent and emergency care. This has shown that our rapid response, frailty, falls, discharge to assess and reablement offers could improve efficiency and effectiveness in the way they work together to focus on prevention, independence, admission avoidance and system flow.  A programme of improvements are planned until 2025 and this is outlined in Figure 4.

The LGA Peer Challenge Report noted that in relation to system flow:

“GCC has consistently shown its dedication to working creatively with voluntary and community groups in order to offer services designed to enable individuals to stay at home or return home safely”.

Figure 4 - Working as One Programme on a Page October 2023
Infographic of the improved journey through out of hospital services that help people stay and return home when their needs escalate.

[i] Newton Europe, Review into our Urgent and Emergency Care Pathway, https://glostext.gloucestershire.gov.uk/documents/s86603/Improving Urgent and Emergency Care Services in Gloucestershire Report.pdf   

Last reviewed:
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