Collaborating to deliver Adult Social Care support
Posted: 03 July 2023
Image
Find out about OneBexley, a consortium made up of eight charities including Greenwich and Bexley Community Hospice.
Since September 2020, the London Borough of Bexley has commissioned OneBexley to undertake reviews and assessments for non-complex referrals to Adult Social Care.
In 2019, Greenwich & Bexley Community Hospice (GBCH) joined the OneBexley consortium with seven other local voluntary organisations in Bexley:
Age UK Bexley
Bexley Mencap
Bexley Voluntary Service Council
Carers' Support Bexley
Crossroads Care South East London
Inspire Community Trust
Mind in Bexley and East Kent.
Since September 2020, the London Borough of Bexley has commissioned OneBexley to undertake reviews and assessments for non-complex referrals to Adult Social Care. GBCH is the prime contractor for this contract, which currently runs until September 2024 and will see the consortium support around 2,500 people each year.
Outcomes
OneBexley now delivers Care Act Assessments, Carers' Assessments and reviews of Care Act Assessments for the London Borough of Bexley. This might involve supporting people who need help with personal care; help with maintaining their homes; help with meals; help with seeing friends and family; or help with caring for others.
Some central staff are employed by GCBH, but most are employed by the partners. As well as a team of assessors, the consortium employs two social workers, who have access to the council’s recording systems and are able to fulfil the statutory requirements of the Care Act. This means they can approve assessments without having to refer people on to another team. Using their knowledge of the local landscape, they implement creative, holistic care packages that are tailored to each individual’s needs.
The GCBH team have been able to carry out Care Act assessments during or following routine hospice visits.
By working with Adult Social Care and developing more routes to support, GBCH has been able to identify people who need hospice support earlier. The hospice has also been able to reach patients who would not otherwise have been referred for hospice support.
How do Adult Social Care Assessments work?
Text
One patient was referred to GCBH for community support. During the initial assessment, the clinical nurse specialist (CNS) identified that he needed social support and referred him to the Compassionate Neighbours team at the hospice.
The Compassionate Neighbours co-ordinator identified that the patient had recently been rehomed and did not have access to certain things that would have made his life more comfortable (and enable him to manage his symptoms). He also had a son, who lived a distance away, who he could not visit.
Through OneBexley, the hospice completed a Care Act assessment. Instead of having to refer the patient on to a separate social work team, the assessment was carried out quickly, and by somebody the patient already knew and trusted. Following the assessment, the patient received direct payments, which he used to pay for a taxi so that his son could visit him at weekends. The team sourced a television from a hospice charity shop, and the direct payments also covered the TV licence fee.
By carrying out a Care Act assessment, the OneBexley team were able to put more support in place than the hospice alone would have been able to provide. The patient was able to get the support he needed, when he needed it.
Facilitators, challenges and advice
Text
Key facilitators
Undertaking social care assessments is not necessarily part of a hospice’s core activities – however, this work has been fully funded by the London Borough of Bexley and has clear benefits to patients and organisations. It is relatively low cost for the council, because it enables people to access more support from the voluntary and community sector.
Through the consortium, GCBH has been able to share knowledge and skills with other organisations. The hospice has provided ad hoc training about palliative and end of life care, whilst learning from partners who have expertise in areas such as mental health and care for older people. The hospice has also been able to coach some of the other smaller organisations in areas such as governance.
Having a Local Authority contract has enabled GCBH to build stronger links with key colleagues in Bexley council. The hospice represents OneBexley at all contract management meetings, but brings a partner to most meetings on a rotational basis. This raises the profile of the hospice and will hopefully contribute to long-term sustainability.
Challenges
Local Authority contracts are different to NHS contracts and other types of funding. They come with a high level of scrutiny, because local authority commissioners are reporting to elected councillors. Voluntary and community sector organisations may not be used to this way of working and OneBexley has adapted to meet the Local Authority’s requirements.
OneBexley is made up of eight charities, all of which are different. It can be challenging negotiating these differences. For example, some of the organisations in the consortium had never had to work within statutory requirements before taking on the Care Act contract. As hospices are used to following statutory requirements, GBCH was able to offer support and advice.
It has been challenging to recruit assessors, and the consortium has looked at a broad range of skills to make sure they are attracting suitable candidates. Assessors do not need to have a Health and Social Care background, but may have worked in a related area such as hospital transport. OneBexley is exploring how best to develop routes into social care.
The consortium also had to navigate different employment models and pay scales, so there is consistency for people working in assessor roles across different organisations.
Tips and advice
Text
Be front-footed. Explore what you can offer and present commissioners with solutions to problems. Remember that hospices bring extra money into the system, by accessing voluntary funding to provide services. Hospices are also great value for money – we are very good at making a big impact with relatively little resource!
Use your strengths – you might be in a stronger position than you think. Are you ahead of other local organisations in terms of diversity and inclusion, governance, or relationships? If so, take the lead and share your skills.
Think about who is best to represent the hospice when negotiating with commissioners. It can sometimes be difficult for a CEO to have challenging conversations about funding whilst also maintaining good relationships with key stakeholders. Is it more appropriate for someone else to take the lead in certain discussions?
Future development
Text
Most of OneBexley’s referrals currently come from the Adult Social Work triage team, but the consortium would like to develop more routes to referral. They will work to identify gaps in referrals, so they can better engage with communities who are being missed.
Although an increase in referrals will cost the council money in the short term, it will lead to prevention of emergency care in the long term.
