Agenda item

Adult Social Care Transformation

To scrutinise outcomes from the implementation of the Adult Social Care Target Operating Model (TOM).


RESOLVED that: the People Overview and Scrutiny Committee:

a)    Recorded its thanks to staff involved in the successful implementation of the Adult Social Care Target Operating Model.

b)    Requested to be provided with aligned data for the outcomes produced by the Adult Social Care Target Operating Model in the periods before and after vesting day for the new Northamptonshire authorities.



The Assistant Director – Safeguarding and Wellbeing presented the report, which gave an overview of the aims, development and implementation of the Adult Social Care Target Operating Model (TOM).  The TOM had been introduced and funded by Northamptonshire County Council (NCC).  It had now been operating for 13 months and it was important to review that it was achieving its purpose.  The Assistant Director highlighted the following points:

·         The need to develop a new approach had been informed by feedback from service users that the previous service model was not clear to them, involved too many different contacts and not enough coordination between organisations providing services.

·         Diagnostic work had made clear the proportion of time that practitioners were spending outside of contacts with service users and their families, which added to the need for a different approach.

·         Newton Europe had provided expert support for the development of the new TOM.  The fact that they were also now supporting the Integrated Care across Northamptonshire (iCAN) programme gave continuity.

·         The design of the new TOM had been led by practitioners and had included work with Northamptonshire Healthwatch on service users’ views.

·         New care pathways had operated from 19 October 2020 using the footprint for the unitary authorities.  Services were linked in to local communities, used the ‘three conversations’ approach and supported a more flexible, outcome-focussed response to service users’ needs.

·         The TOM was delivering clear benefits in terms of outcomes for service users.  It was ahead of target on financial delivery in all areas, which was assisting WNC to manage current demand on services.  The iCAN programme would further build on this progress.

·         WNC would continue to develop its service offer using a place-based model to deliver positive outcomes for service users and staff and that left flexibility for partnership working.  The next phase of development would focus on linking in to wider issues around housing and communities and the Integrated Care System. 


The Committee considered the report and members raised the following points:

·         It appeared that one of the challenges in getting appropriate care in a timely manner was the need for occupational therapy (OT) assessment.  Could this be carried out in a different way?

·         Where did the voluntary and community sector (VCS) fit into the model for care provision?  Age UK had lost staff at Northampton General Hospital due to the termination of a previous NCC contract.  There seemed to be a better position at Kettering General Hospital.

·         How did WNC deal with the implications of people being discharged from hospitals in neighbouring areas into the authority?

·         How could WNC ensure that support was in place before people reached the point of being unable to cope, particularly if this resulted in them feeling unable to engage with reablement support?

·         The reported performance outcomes for the TOM pre- and post-vesting day did not align.  It would be helpful to have further information that would enable a better comparison to be made.

·         What risk to WNC would result if current service outcomes declined?

·         What measures were in place to ensure that telehealth devices were working properly and that risks to service users were not increasing?

·         How would the outcomes for an individual needing support now be different from a few years ago?


The Executive Director – Adults, Communities and Wellbeing and the Assistant Director – Safeguarding and Wellbeing responded as follows:

·         Occupational therapists were aligned to all community teams and the reablement team.  Other professionals could be used to carry out functions where appropriate.  There were challenges relating to capacity: OT was challenging area for recruitment although WNC did relatively well.  There were currently no OT-related delays in community teams, although there were issues with DFG that would be reported separately.

·         WNC had not been party to discussions about the previous contract with Age UK but a vibrant VCS was central to the approach that the authority was seeking to take.  VCS collaboration with the acute trusts had helped to change their thinking about ways of supporting hospital avoidance and safe discharge.  The VCS was also important for people who did not want formal support but help within the community, for example provision of allotments as part of social prescribing.

·         WNC had different arrangements in place to engage with the various acute trusts that served West Northamptonshire.  WNC tried to repatriate people to their local area to access reablement services but the relative scarcity of care provision in some areas such as rural south Northamptonshire could make this challenging.

·         Providing timely support was more of a challenge in relation to disabled children and young adults than for older people.  WNC sought to engage with service users and their families when they presented, whether they were new or returning.  In the current situation with busy hospitals and pressures on external care different risk-based conversations were taking place.  There was an emphasis on providing support in communities and working collaboratively with other groups that could contribute to this.  As a general principle the earlier that WNC could engage with people the better. 

·         The ways of working put in place as part of the TOM were intended to be sustainable.  There would be a risk if necessary community-based solutions were not available and bed-based solutions then had to be considered, which would have a greater impact on budgets.  WNC used a serious of processes to identify if any negative trends were developing.  A money management meeting was held each week to monitor the flow of people through services to understand how that translated to packages of care and to give early warning of any financial spikes.  Performance was also monitored against indicators for numbers in care placements and the average cost of placements.  It was important to identify any issues early to put mitigations in place.

·         Data on outcomes included in the report showed the full year effect across the whole county and was difficult to disaggregate.  The data could be looked at again and WNC performance would become clearer over time.

·         Assistive technology was used when agreed by the individual service user and it was assessed that it could be safely managed.  It was subject to appropriate safeguards.  It would be monitored by a WNC team of responders and as part of the annual review cycle.  Individuals could use assistive technology as well as having a care package and their case worker would be able to identify any concerns that might arise.  Exciting work around proactive monitoring was being implemented, which picked up early signs of risk.

·         In terms of improvements in outcomes compared with services before implementation of the TOM, the focus now was on meeting the needs of the person rather than on process.  Service users would now be on an annual review cycle.  If contact with them identified an issue they would be put through to speak to an adult social care duty worker, who would determine the next steps needed to support them.  If the individual was already receiving care this would trigger an early discussion at the third stage of the ‘three conversations’ approach about finding the most independent outcomes to resolve their issues.


The Cabinet Member for Adult Care, Wellbeing and Health Integration considered that the implementation of the TOM had been an excellent piece of work.  He was proud of what had been achieved.  Money had been saved and people’s outcomes improved.  The development of the TOM had put WNC in better position than counterparts who had not taken the same approach.


Committee members commented that the TOM did seem to put WNC ahead of the national direction and to be delivering better outcomes for service users whilst also using resources more effectively. This was commendable work.


RESOLVED that: the People Overview and Scrutiny Committee:

a)    Recorded its thanks to staff involved in the successful implementation of the Adult Social Care Target Operating Model.

b)    Requested to be provided with aligned data for the outcomes produced by the Adult Social Care Target Operating Model in the periods before and after vesting day for the new Northamptonshire authorities.


[The meeting was adjourned briefly at this point.]


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