everyLIFE spoke with Jane Marshall and Donna Locke, Community Care Commissioners for Wirral Health and Care Commissioning. After trialling the PASSsystem for some months with one company, five more of their primary providers have since gone live, with secondary providers lined up in the near future.
With almost 3000 clients under their care, Wirral’s quest to go digital is an ambitious project which will eventually encompass Social Workers and District Nurses along with all of their social care, which has been outsourced. As part of an overarching project named The Healthy Wirral Programme, it brings together systems and business processes and is jointly commissioned with the CCG to include continuing healthcare through the integration of technology and innovative solutions. Jayne stressed, “As an intelligent commissioner, you’ve got to move towards a new digitalized world. Without significant change, you’ll just keep getting what you’ve always got and that’s no longer good enough. Our Director expects us to deliver in a way that’s modern and mature and we’re supported to think outside the box.”
This modern yet mature approach has seen Wirral’s Commissioners working collaboratively as facilitators to engender a strong sense of partnership. Most of their providers are locally run businesses, with a strong attachment to their communities, and Wirral spent valuable time assessing their pressures and responsibilities before selecting the right solution.
“We spent months gaining an understanding of market issues and deciding how to jointly move forward, together with our other Commissioners. We also had to ensure that our providers had a clear understanding of what we wanted from them. We were committed to going digital, so worked hard on embedding that and making sure people knew our ambitions, even before going out to tender.”
Jayne explained that they had identified a range of issues, some more serious than others, and needed solutions for ongoing problems around:
- inconsistencies in continuity of care
- medications errors across the whole sector
- delays in care delivery
- high levels of complaints
- business inefficiencies (e.g. changing care plans)
- lack of capacity and flow of care
- poor and inconsistent reporting with no measurable outcomes.
“Going through the lifetime of the contracts proved the importance of our providers commissioning towards outcomes and I think going digital supports that.” Donna told us, “We knew that a digital system would really help, and PASS appealed straight away.”
They both find the openness and transparency of PASS invaluable, proving evidential-based care and clearly tracked accountability. The responsiveness of its real-time reporting means that care is outcomes-based and can be individually tailored.
Since outsourcing all their services, Wirral has found openPASS, the view of PASS available to families, friends and other care professionals, has added a continuity of care level previously unimaginable. Now, District Nurses, Social Workers and other healthcare professionals, work in unison from a single source of truth and towards a common outcome. The interoperability of the PASSsystem makes it highly versatile and a lynchpin of their processes.
“openPASS was very interesting to us. We felt that, in terms of communication with families, friends, colleagues and those with permission, we’d be maximizing the use of people’s assets and communicating clearly. We knew that would help the contract with our social work providers,” Jayne added. In addition, Donna recalls a recent meeting with the Community Nursing Team where she explained openPASS: “Eyes lit up, so it’s something we’re really going to start seeing utilized.”
“In the past year, we’ve grown our domiciliary care market by 17% and that’s on top of 16% in the year before that. We aim to continue that upward trajectory, not only in the number of hours we commission but in having more efficient hours too. Now I think we have the means to do it.” The Commission currently spends £15 million a year on domiciliary care but Jayne says she’d like to be spending £20 million or more. “We want to increase the market, so I need my providers ready and working with us. Getting them fully digital will support them in being prepared for that.”
Key to the sustainable delivery of adult care services is shifting delivery from bed-based to community-based care settings. Jayne notes, “We’ve actually got very good transfer of care figures from acute hospital services now and we’re proud of that, but we want to get better at it too. What we’ve been able to do is release staff capacity so that their time is not spent recording paper notes which are often inaccurate. We needed a more efficient process that safely moves carers on to the next visitors, but which also creates increased capacity and flow.”
Jayne was focused on making the switch from residential nursing services to community-based service stating, “It’s very important and very high profile, so that’s our priority. We’ll help our providers in doing that and getting them fully digital supports them in being prepared for the switch.”
As well as being able to meet increasing demand, this has delivered cashable savings by reducing dependency on high-cost residential and hospital care. “Because of PASS, we’ve been able to roll out a tier of ‘trusted assessors’ through our domiciliary care providers. Part of that is about letting providers make recommendations on stepping levels of care up or down in a very responsive way. We’ve set the parameters, which they themselves can change quite quickly in their support plans because they’ve now got a digital system. It’s so much easier than it used to be before when carers were going out and redoing all the paper support plans. We really value the judgement of our trusted assessors. With PASS, we’ve stopped all that toing and froing between the care provider and the social work teams. We knew we could only do that with a real-time digital system in place.”
In the spirit of facilitators, they sought to remove barriers from their providers’ path and any mental blocks from their ability to progress. This was achieved by setting up a scheme to fully fund PASS for providers in their first year, with a grant from Wirral Council Capital, and then tapering thereafter. They believe that, if they want their carers to be responsive to the needs of others, then Wirral should be responsive to theirs in return. They’re keen to see local businesses prepared and ready for the future and are willing to provide significant help towards them achieving that goal. Looking ahead, providers applying for council contracts will need to demonstrate these high levels of excellence, which Jayne believes can only be achieved with a digital solution in place.
She knows that costs are tight for their domiciliary care market. “What we also know from a statutory perspective, is that we have a duty to shape, help, and support the market to deliver. Our market is a very good and responsive one and we wanted to work with them to ensure they had the best digital solution we could provide. We wanted to support them financially and morally in rolling it out which helps them and us.” Both Jayne and Donna have always felt that their cared-for adults, their businesses and their community deserve the best. Together with the PASSsystem, they can now deliver it.
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