Practice example: Isle of Wight raising standards and Personal Assistant Hospital Discharge Initiatives

Who?

Isle of Wight Council

Newport

Isle of Wight

What

Developing the quality and increasing the number of personal assistants (PAs) across the Isle of Wight, establishing a ‘route to market,’ support functions and a defined framework. In addition, providing support to people in hospital – giving individuals a genuine

alternative to traditional domiciliary care agencies.

Why?

No oversight of PA market numbers, services or hours.
No safe and established route to market – social workers and individuals – adverts in papers, no approved lists, etc.

No interaction with local authority or support mechanisms for individual PAs.
Poor coverage – no PAs in some geographical locations.
Limited number of PA packages not being filled, with anecdotal reports of poor quality.
No training offer for PAs.
Complete lack of confidence in PA provision by social workers.
Lack of opportunity to make savings. Commissioned home care is £17.60 per hour; PA hourly rate is £12.50.
Limited traditional market provision resulting in extended length of stays in hospital for individuals wishing to return home.
Required a more responsive service – we were often waiting days for agency assessments in hospital and limited weekend coverage to support discharges during this time.

When?

Ongoing from January 2018.

How?

Establish a PA market development team
establish a clear framework to proactively develop and grow the PA market
ensure quality is improved and provide a clear route to market.

This was achieved by:

identifying and creating a dedicated group of PAs to support hospital discharges – responsive and person centred
creating clear pathways – and explaining options to the person/their advocate
developing advice and guidance for individuals and families – creating support structures to facilitate informed decisions
introducing a direct payment brokerage and direct payments (DPs) support service
implementing accreditation scheme/DBS/insurance/Unique Taxpayer Reference (UTR) and skills profile through the PA development team and PA hub/jobs notice board
improving PA recruitment through events, Isle of Wight College, summer shows and a partnership arrangement with Isle of Wight job centre
PA training offer, network events and support groups – joint working arrangements.

Challenges

The Isle of Wight reduced adult social care DTOCs by over 55% in the year ending September 2018 – however, the 2018/2019 target of 2.6 per 100k meant that we needed to dig deeper still

ongoing challenges with traditional agency engagement
delays in assessments or ability to support discharges at weekends
locality and coverage issues.

Impact

Two hundred hours of PA support was provided to facilitate hospital discharge in February 2019.
Average weekly support provided to PAs = 20 hours per week.

Cost of care (August 2018–January 2019) provided by PAs = £340k compared to equivalent provided by domiciliary agency (would have cost £1.2m).
Between August 2018 and January 2019, total PA support hours provided across the Isle of Wight totalled almost 70,000.

Case study

Mrs JB, 82, was admitted to hospital in November 2018 following a stroke. She was assessed to find out what care and support she would need to enable her to return home once she was considered medically fit.

It was decided that a large package of support would be required. Mrs JB lived in a rural locality which was covered by only one contracted provider so it was quite possible that finding the right package would be challenging. Within 24 hours of contact, a dedicated PA met with Mrs JB, her family and the personal assistant team. It was agreed that a PA was the right solution for Mrs JB’s care needs and she was discharged home the next day.

Isle of Wight raising standards and Personal Assistant Hospital Discharge Initiatives

Scheme