Improvement in Occupational Therapy Performance and Disabled Facilities Grant Activity
- Meeting of Cabinet Committee on Performance Improvement, Thursday, 12th September, 2019 2.00 pm (Item 4.)
A report was presented by Sue Lott, Head of Service – Adult Social Care Health on the development of the Occupational Therapy service within Adult Social Care at Lancashire County Council. The report demonstrated the improvements seen in the timeliness of assessments and the increase in Disabled Facilities Grants recommendations over recent years. The report also demonstrated the positive benefits of Occupational Therapy in adult social care and innovation possibilities for the future.
It was reported that prior to 2008, the NHS in Lancashire delivered all moving and handling, and equipment and adaptations assessments on behalf of the county council. The decision had then been taken to trial bringing the service back in-house. This had been completed in 2013 with both the Central Lancashire and North Lancashire Occupational Therapy services being delivered by Lancashire County Council and a Section 75 partnership arrangement remaining in East Lancashire whereby the NHS complete up to 100 Occupational Therapy assessments per month on behalf of Adult Social Care.
The Committee were informed that, within the Passport to Independence transformation programme in Adult Social Care, dedicated Occupational Therapist leadership had been created in the form of an Occupational Therapy County Manager post. In addition, the new Improved Better Care Fund monies offered the opportunity to enhance the overall Occupational Therapy establishment to better match demand and the number of Occupational Therapist posts within Adult Social Care was increased from 20 to 40 full time posts. All Social Care Support Officers had also been trained to assess for and commission lower level, less complex community equipment items.
An action plan had been produced in 2018 to reduce the waiting lists which set out new screening processes to be followed, data cleansing of the waiting lists, recruitment to new posts and initially some overtime hours for defined numbers of assessments.
A graph showed Cabinet Committee Members the significant improvement in the timeliness of assessments, with the number of people awaiting assessment across the county reducing from 1363 in March 2018 to 497 in August 2019. It was noted that these figures were for people who had been waiting 1 day or longer for an assessment. The Cabinet Committee noted that work was continuing on this, with the aim of the service reaching their 'business as usual' target to see everyone within 28 days of referral to an Occupational Therapist.
Details of community equipment activity and spend were provided to the Cabinet Committee, together with the three categories of provision:
· simple items of equipment - available for general purchase and not provided by Health or Social Care as an outcome of an assessment;
· 'Retail Model' equipment - provided via a prescription (and available for general purchase) to receive standard equipment funded by Lancashire County Council or NHS, or service users could pay a 'top up' amount for a more suitable model;
· complex community equipment – larger items e.g hoists, specialists chairs/beds loaned to service users for as long as they need them.
The process for accessing a Disabled Facilities Grant was via an Occupational Therapist assessment, who then made a recommendation to the District Council for a Disabled Facilities Grant adaptation to take place. Due to the staffing capacity within the Occupational Therapy service some years ago, lower numbers of recommendations were being made for these grants and some District Councils had reported that they were struggling to spend their allocation across the year. As the Occupational Therapy service worked through the waiting list and was now in a much better performing position, the numbers of Disabled Facilities Grants recommendations sent to the Districts each year had improved significantly, moving from just 812 in 2014/15 to 2814 in 2018/19.
Details of the new initiatives in place, both within adult social care and in collaboration with the District Councils, to broaden access to Disabled Facilities Grants within the regulations, reduce hand-offs between services, avoid delays and increase people's independence and choice, were provided to the Cabinet Committee.
The significant improvements in the performance of the Occupational Therapy service, in terms of more timely assessments, improved waiting times and in people getting more timely access to community equipment and Disabled Facilities Grant adaptations, were as a result of a combination of the following factors:
· Significant investment to increase the number of qualified Occupational Therapists employed by the county council;
· Increased leadership capacity within the Occupational Therapy service;
· Improvements in productivity and business processes;
· Improvements in partnership working with District Councils, private sector equipment providers and the NHS.
A query was raised in relation to bed blocking. Sue Lott assured Committee Members that nobody would be expected stay in hospital any longer than they should but, if they were not able to be discharged due to a major adaptation needing to be carried out at their home, a short term residential care placement would be sought.
A discussion took place around when adaptations were no longer required and the cost of removing these from a particular property. CC Crompton asked whether there was a system in place whereby anybody due for hospital discharge could be matched up with the right adapted property for their needs. Sue Lott confirmed she would take this matter up with the districts as they had the most contact with the registered social landlords, and that the outcome would be reported back to the Cabinet Committee.
Committee Members were very pleased with the progress made and the Chair wished to place on record his thanks and congratulations to the team and the relevant Cabinet Members.
Resolved: That the Cabinet Committee on Performance Improvement note the report and the improvements seen in the performance of the Occupational Therapy Service.