London Borough of Havering Case
Study
As with many Local Authorities, the
London Borough of Havering has recently been faced with a number of
challenges in modernising and transforming its home care services.
The challenges faced by Havering included:
- How best to focus attention on issues of home care quality
- How best to provide for the accountability and ensure value for
money
- How to capture reliable and verifiable data
- How to best change the system to position home care within the
future transformed market of personalised budgets
At the time changes were first
contemplated the system was in need of serious attention. It was
paper driven, there was poor accountability, commissioners and
providers were not working on the same agenda, and the whole system
relied on paper timesheets. Corporate relationships within council
were strained due to an inability of such an antiquated process to
deliver accurate financial forecasts. Additionally there was a
requirement to move toward reablement. It became evident that that
the new system must accomplish the following outcomes:
- Position the authority for the transformation of adult social
services and provide a solid foundation for the personalisation
agenda.
- Provide for an end to end electronic solution that was
effective, efficient provided accurate data which must include
measures of quality and performance.
- Provide for a program shift toward reablement Under the
leadership of Project Sponsor, Chris Haynes, two project managers
Ken Ashong and Rachel Boston were assigned the tasks of both
developing the electronic solution and ensuring it was synchronised
with the planned program changes.
They found themselves in a fortunate position that earlier work
in 2004 had tested three different types of electronic monitoring
systems; CM2000s phone based system, Box 10, and a Swipe Card
system. Following the initial pilot CM2000 was judged the best
solution. Chris Haynes commented, CM2000 was the clear leader in
the field and were head and shoulders above the competition.
The key challenge was to introduce a system which would be
compatible with personalised budgets. Ken and Rachel recognised
that if service users received individual budgets providers would
require a mechanism to receive payment directly from service users,
while the council would still require an accountable audit trail to
track spending. Rachel and Ken identified a Transaction Data
Matching (TDM) system being used in Kent as a good fit. It provided
for the possibility of a pre-loaded visa card being utilised for
Direct Payments and Individual Budgets.
In practice this meant, improving and automating as far as
possible Haverings internal systems with an end-to-end solution
from care assessment to paying providers and charging Service User
for the care they had received. Rachel comments, at the start of
the project we had seven databases plus SWIFT when what we needed
was one central database in SWIFT to run the ledger. We then had to
tie CM2000 into the process which included using CMs Finance
Manager Module so that we could charge service users and pay
providers based on actual care delivered - at Havering we use a
banding system.
The Royal Bank of Scotland was Ken and Rachels preferred
supplier to handle automated payments and billing using their TDM
system. With an eye to the future they realised that RBS were also
a supplier for pre-paid visa cards.
Havering have adopted a centralised model for their home care
monitoring, meaning they have total access to the monitoring data
recorded across all non specialist home care provision. The Council
are therefore able to fully automate the payments / charging system
for service users and providers. They are also able to extract the
full range of management information for the efficient running and
quality assurance of the home care they provide. Rachael comments,
at that point in the project we knew where we were going
internally, but we didn't yet have a plan in place for our external
providers.
At this time we didn't have a forum for discussions with our
providers and this is where Chris Haynes was instrumental in
getting communications working effectively. There had to be a
change in how we worked with our external providers and this needed
to run alongside everything being done internally.
Form Havering's perspective the end-to-end process is best
described as follows: SWIFT contains details of each Care Package
and that information is put into CM2000. The providers then input
their rostering information so the Council gets a full picture of
what is commissioned against what is rostered. As Care Workers log
visits, variations between commissioned, rostered and actual care
are identified. Providers are paid based on the actuals after
making sure the information is reasonable. CM2000's Finance Manager
Module generates the invoice. The invoice is then uploaded to and
authorised in SWIFT. It is then automatically downloaded into the
banking system for payment to the provider. The file then comes
back into the Councils general ledger system.
In the course of introducing the new process, the relationship
with Havering's providers was transformed. The process for
triggering that change was full involvement in the implementation
process itself. Ken comments. We did several things:
- We held regular forums and separate working groups
- We held individual meetings with providers to take them through
the process to explain why we were making the changes and to
reassure them about there concerns.
- There was daily communication between the providers and
ourselves and we encouraged an open dialogue
To assist the roll-out process, four of Haverings providers
volunteered to test the CM2000 system, Rachael recalls, they said
they weren't ready but we had them work very closely with CM2000
and I have to say the project team at CM2000 were fantastic.
Chris Haynes says, "the one thing that made this project work,
strong leadership from the top in Councillor Steven Kelly who
oversees the whole of Adult Social Care and is Deputy Leader of the
Council. He really owned the modernisation project and championed
its various elements. Rachel adds, "once we started having provider
forums Councillor Kelly came to all the meetings and he really
helped to make it happen. Implementation took place within six
weeks. One of the providers said that in the first four weeks of
implementing the system she had never experienced so much pain, but
if you see them now they are so enthusiastic. They come into
meetings now and say "it's brilliant, do you know what the CM2000
system can do".
The ultimate beneficiary of the new process is the service user
as quality has improved, resources are extended to provide more
care and systems have been put in place to facilitate both choice
and independence. The major outcomes to Havering are:
- An accountable and transparent home care system that provides
accurate and up to date information.
- A system which provides the foundation for individual budgets
and direct payments as part of the transformation agenda.
- An ability to track, monitor and measure quality
improvements
- Improved relationships with the providers who now understand
the future direction of transformation and feel partners in the
journey.
- Improved corporate relationships within council as colleague
officers feel they have been involved in the process and reap the
benefits of reliable financial data
Havering's external providers have also benefitted. They now
have much more information to help them manage their business
efficiently. They know about potential problems before they happen
and potential dishonesty and fraud is easy to spot and removed from
the system. In terms of efficiency the new processes will allow
payment to providers and the billing of service users to be done
within seven days of service delivery.
Chris is now busy working on the next steps of developing
individual budget pilots and introducing the next stage of a
pre-loaded payment card. As part of transformation activities the
borough is also reviewing its day opportunities for vulnerable
adults and building day opportunities around service users wishes
as opposed to the bricks and mortar approaches of the past.
Chris comments "We realised that we can use CM2000 to monitor
and pay for our day opportunities delivered in a new community
context. CM2000 is proving to be our stable platform on which to
build the changes government requires for the future-a true tool
for transformation".