Older people and vulnerable adults are supported to lead fulfilled and independent lives

Are we achieving our targets?

Green – 4; Amber – 2; Red – 5; M – 6

Are we getting better?

6

Improved performance

6

Stayed the same

2

Requires improvement

3

Further information is needed or the latest measure is unavailable

Analysis and issues

The Older People and Vulnerable Adults Outcome Plan is reporting four measures as red, and two as amber overall. The picture in terms of direction of travel is mixed, with two measures improving, two declining, and two maintaining previous performance.

The Amber measures include performance regarding the proportion of adults with a learning disability who live in their own home or with their family, which is at 85.8% against the target of 88.3%. Secondly, the proportion of adults with a learning disability who live in their own home or with their family has maintained performance at 99.8% against the target of 100%.

Four key performance indicators have a Red status. Two of these indicators relate to delayed transfers of care (DToC), looking at both overall Cheshire West numbers and those in particular attributable to Adult Social Care. Two measures are included in recognition of this as a significant performance issue locally and nationally.

In 2017/18 the Council and its partners were set challenging targets as part of the Better Care Fund (BCF) submission by the Department of Health. These targets were agreed by the CWaC Health and Wellbeing Board.
(Total delays target – 11,302. Social care delays target – 5,014.)

New Targets for 2018/19 have only recently been released by the Department of Health and Social Care and subsequently approved by the Health and Wellbeing Board. The expectations are further challenging compared to last year’s target and emphasis for the reduction is weighted to social care delays.
(Total delays target – 8,667. Social care delays target – 2,554.)

Though August figures have now been released and have been included in the figures in the main tables above, the totals for August are broadly in line with July figures and have not met the monthly target set. At the time of writing this red template the latest published data was for July activity therefore narrative below is based on July 2018 delayed transfer data.

Ambitious targets representing significant reductions from 17-18 have been set to reflect the importance of this measure. The total figure of 4,509 overall represents a significant improvement in performance when compared to the same period in 17-18, when the number of delayed days was 6,846. However, the measure is projected as red against the full-year target of 8,667. The number of delays attributable to Adult Social Care has reduced significantly, which represents improved performance. There have been less than half as many delayed days attributable to social care in 18-19, at 1,252 compared to 3,244 delayed days at mid-year 17-18, however the measure is still Red contrasted to the full-year target. A significant amount of additional investment and programmes have been put in places to reduce delayed transfers, including;

  • Additional elderly mental infirm (EMI) nursing bed capacity;
  • Additional Social Worker resource to support seven day and bank holiday working;
  • Social Care assessor support for intermediate care facilities;
  • Mental health input into community assessment units and MH liaison support at home;
  • Enhanced transport services for timely discharges.

The third red key performance indicator looks at the total number of carers given advice, information or signposted is on course to miss the target set for the year of 965, having reached 152 by mid-year. This is also significantly below the overall figure achieved in 2017/18 of 469, which was itself under the 17-18 target of 931. A detailed set of actions has been agreed to improve performance on this measure, including:

  • Data cleansing. An extensive exercise has begun which is identifying and correcting errors in the recording and loading of over 4,000 individual records. This will be an ongoing exercise, with completion planned prior to March 2019.
  • It is anticipated that this exercise will highlight a larger number of carers who the Council has already supported and signposted to appropriate support. The Community Access Team has been briefed on what they are required to load in order to capture carer activity in reports.
  • Clear and updated user guides have been re-issued to all teams to address the inconsistent loading. These user guides have been issued and full briefings will take place with all teams throughout Quarter Two and Quarter Three.
  • Adult Social Care Performance Team and Carer liaison support have a programme through Quarter Two and Quarter Three 2018 of delivering team by team briefing and training on carer recording on Liquidlogic.
  • Identification of carers is included in the revised case file audit, which will identify correct data loading and capture. This will contribute to identifying any further training needs. Revised file audits are now in place and ongoing.
  • On 2 January 2018 the new integrated Carers service became operational. Since that date an additional 1300 carers have been identified within the borough by a variety of partner organisations on the recording system of Upshot.
    The fourth red key performance indicator measures the number of older people who have a permanent admission to a residential or nursing care home. Performance on this measure has declined, with 239 admissions to care in 18-19, contrasted to 218 admissions during the same period in 17-18. Furthermore, the target is red compared to the full-year target of 435 admissions.

An extensive review of the quality of the data that is used to calculate the permanent admissions indicator has been undertaken. Some of the issues identified included some temporary placements mistakenly being recorded as permanent, and some historic code removed from the report that compiles the base data that was dropping some of the placements. The net outcome of these issues being resolved was an increase in recorded placements. These issues have now been rectified and account for the increase from 31 to 80 placements from May to June 2018.

The number of permanent placements into residential and nursing care homes (65+) – customer care plan information

  • April 2018
    • Number of people: 13
    • Rate per 100,000 population: 18.2
  • May 2018
    • Number of people: 31
    • Rate per 100,000 population: 43.4
  • June 2018
    • Number of people: 80
    • Rate per 100,000 population: 112
  • July 2018
    • Number of people: 49
    • Rate per 100,000 population: 68.6
  • August 2018
    • Number of people: 42
    • Rate per 100,000 population: 58.8
  • September 2018
    • Number of people: 24
    • Rate per 100,000 population: 33.6
  • 2017/18 year end result
    • Number of people: 419
    • Rate per 100,000 population: 595.8
  • 2018/19 year to date total
    • Number of people: 239
    • Rate per 100,000 population: 334.5
  • 2018/19 year end projection
    • Number of people: 516
    • Rate per 100,000 population: 733.7
  • 2018/19 year end target
    • Number of people: 435
    • Rate per 100,000 population: 608.8
  • Projection against target
    • Number of people: +81
    • Rate per 100,000 population:+124.9
  • Change from last month
    • Number of people: -18
    • Rate per 100,000 population: –

Data quality is improving in the service and awareness of the correct categories means that fewer respite placements will be incorrectly loaded. This may account for some of the reduction seen, as the number of placements has dropped from 80 at June 2018, each month to a current figure of 24 for September 2018.

Service

The current population is forecast to increase by about 10% to 367,000 by 2035. Older age groups will see the biggest increase, with the number of residents aged 65 plus expected to increase by 28% and the numbers of people aged 85 and over forecast to more than double. The shift to a more elderly population with more complex need has contributed to increased admissions to residential and nursing care homes.

A significant programme of work is in progress to reduce the number of permanent admissions, such as:

  • Further data quality work being done with teams and to raise awareness of the importance of correct recording.
  • Service and commissioning teams are improving work with Extra Care Housing providers with the intention for them to accept more complex cases at the higher bands of need, thus not requiring permanent admissions to care homes.
  • Work is being undertaken with carers council-wide to improve support for long-term main carers of service users. Predictive analytic work is being reviewed with the intention in preventing temporary or permanent carer breakdown, to alert ahead of time where carers may be reaching the limits of their ability to cope. This should have the effect of removing some preventable admissions through carer support.
  • Further investment is being made in domiciliary care services to help providers and care workers support more vulnerable and complex people at home.

Wider Performance Indicators

Looking at the wider performance indicators in this Outcome Plan, six measures report as Green, compared to five which report as Red. Positive performance has been achieved on measures such as supporting residents in need of reablement, with 69.4% of residents requiring no ongoing support against a target of 70.5%.

Actions

Analysis and issues

Over 75% of actions have been delivered or are on-track for delivery. In terms of examples of actions which have been delivered or where progress is being made to deliver to timescale, key areas of progress to highlight include:

  • The complete re-design of Safeguarding and Domestic Abuse Team.
  • Asset based training continues to be rolled out across the organization. Initially all staff affected under phase 1 of the WCO underwent the training. This proved so successful that it was agreed to roll it out to all staff.
  • Implementation of the priorities of the Falls Strategy:
    • The multi-agency Falls Prevention Group is chaired by Public Health with representation from a wide range of partners including NHS West Cheshire and NHS Vale Royal Clinical Commissioning Groups, Countess of Chester Hospital NHS Foundation Trust, the Older People’s Network, Brio Leisure and Healthbox CIC. The Group has developed an Action Plan and rated current falls prevention performance against the Public Health England ‘Falls and fracture consensus statement: resource pack'(PHE, 2017).
    • As a result of this work, a Falls Operational Group, chaired by NHS West Cheshire Clinical Commissioning Group (CCG) has been developed in the West Cheshire CCG footprint. The group allows practitioners to share and reflect on current practice and learn from each other. It has resulted in a clearer understanding of the current falls pathway and service provision, both of which have been shared within Primary and Secondary Care. A similar approach is being taken in NHS Vale Royal and the advent of the Integrated Care Partnership will allow the opportunity to develop a single falls pathway for Cheshire West (i.e. the local authority footprint).
    • Work is also being undertaken to explore the possibility of creating a specific field for falls within the Cheshire Care Record, to allow practitioners to record falls.
    • Colleagues in the Countess of Chester and Leighton Hospitals have been working to raise awareness of falls prevention within secondary care, though the delivery of falls prevention training to staff.
    • Since 1 February 2017 the Cheshire and Merseyside Fire and Rescue Service have been undertaking falls risk assessments as part of their Safe and Well visits to householders over 65. Between 1 April and 30 June 2018, 65 referrals via this assessment process, were made to falls prevention services in Cheshire West and Chester.
    • Initial discussions have taken place with Clinical Commissioning Group and Local Authority colleagues across Cheshire to develop a Cheshire wide Joint Strategic Needs Assessment for Falls Prevention. Initial work has started to progress this work, which will enable a better understanding of why the Council continue to be a national outlier in relation to hospital admissions for falls in people aged 65 and over.
  • Procurement of a new Drug and Alcohol recovery service was completed, in advance of go-live in April 2019. The new provider is the Westminster Drug Project (WDP). A cross-party member working group is providing oversight of this process.

Regarding actions that have been re-phased, phase 1 of the West Cheshire Offer went live on 1st March. This saw new pathways for the Gateway team which has been rebranded as the Cheshire West Community Access Team. Furthermore, it included the introduction of a review team to ensure yearly reviews are completed and new pathways for the Patch Teams which will reduce the number of duplicated processes. Progress to report in September includes the approval of the Business case regarding phase 2. There are a series of briefings planned as well as a full staff consultation. The timeframe for implementation is now June 19.

Examples of actions that have not yet been initiated, and are scheduled for delivery further into the four-year plan, include:

  • The completion of a new Review of Mental Health provision;
  • The development of further links with voluntary and community sector organisations within the Community Access team.

Next Reporting Period: Examples of key milestones which are expected to be delivered in the second half of 2018-19 include:

  • Further implementation of Falls Strategy priorities.
  • Embedding the ‘Practice Point’ model of workforce planning, training and development across children’s and adult services.
  • Development of outcome-based care plans, and rolling these out across domiciliary care services.