Care and Support at Home Redesign Project

A 'Task and Finish' group was established by Falkirk's Head of Integration in 2019 to review Care at Home Services.

The group brought together staff representatives, trade union colleagues, service managers, human resources, and key stakeholders to review current and future challenges. The group was tasked with identifying ways to improve and develop a sustainable service.

Identified challenges and findings

• The current model does not represent best value in either financial modelling or service delivery. This has been identified following a review of contracted hours compared to delivered hours of care, and the financial costs of delivering support via Falkirk Council and external providers.
• Within the current model, it is unclear what unique added value the local authority-delivered service brings. A clear role should be established for the Falkirk Council-delivered service, and how this will support sustainable services across the local social care system and commissioned care providers.
• Staffing and recruitment continues to be a significant challenge to all providers, locally and nationally.
• The Falkirk Council-delivered service currently manages smaller packages of care (i.e 15-30 minutes per visit) in comparison to commissioned care providers. The service has limited capacity to take on new referrals.

Recommendations

The Task and Finish group identified three ways the new Care and Support at Home Service should be developed:

• Dedicated reablement teams should be established: Reablement teams will support the flow of people being discharged from hospital and prevent unnecessary admission to hospital or residential care settings, and reduce demand for ongoing care at home packages. Reablement support should be offered to individuals to ensure they build skills and techniques to achieve and/or maintain a maximum level of independence. By helping people to live independently, building skills and adapting to life following an injury or illness, reablement support can help reduce the need for ongoing care. There is an opportunity to train reablement home care staff in all aspects of reablement, offering qualifications and career development opportunities to the workforce.
• Urgent home care should be enhanced: To reduce demand on emergency care home placements, prevent hospital admissions, and help people stay within their own homes, there is a need to establish an urgent response care at home service. This service should respond to requests at short notice to support hospital discharge; offer short term support at home during times of crisis; and provide interim care for people awaiting allocation of an ongoing care package.
• Maintenance (ongoing) care should be reviewed: Home care support is delivered by Falkirk Council and almost 30 other local care providers commissioned by Falkirk Health and Social Care Partnership. Falkirk Council is required to provide a level of maintenance (ongoing) home care provision which ensures care packages which are challenging to deliver due to geography, complexity of care, or availability of resources are fulfilled. To provide capacity to introduce the new reablement and urgent care support, Falkirk Council's maintenance care provision will be responsible for a small number of the most complex or 'challenging to provide' care packages. A review should establish new criteria for allocating care packages between Falkirk Council and commissioned care providers.

Board approval

During its meeting on 21 March 2021, Falkirk's Integration Joint Board, the body responsible for planning local community health and social care services, reviewed and approved a new proposed model for care at home services.

During the meeting, the Board:

1. noted the progress made by the service over the last 3 years in terms of service development and delivery;
2. agreed the model for the in-house care at home service, and
3. instructed the Chief Officer to progress with implementation of the agreed model

Board papers: