Pioneering acute and community trust hails 'successful' first year of home care

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An acute and community trust that was the first in the NHS to enter the home care market says the first year of its new service has exceeded its expectations.

Last year, Northern Devon Healthcare Trust launched Devon Cares, through which it manages providers of domiciliary care services in three areas of the county. The trust does not directly deliver services.

Andy Ibbs, the trust’s director of operations and strategy, told HSJ the first year has been “successful” and “gone better than we hoped”.

Northern Devon was awarded the five year contract, worth between £70m and £80m, in April 2016 and then embarked on three months of preparation, which Mr Ibbs described as “hectic”.

“We had to procure an IT system; we had to get all the providers onto our books; and we had a week of practice before the contract went live,” he said.

The number of “unfilled” packages of care was brought down from 28 to zero on occasions during its first week. Unfilled care packages relate to patients who have not yet had a caseworker assigned to them.

Mr Ibbs said there were on average 20-25 unfilled packages of care at any given time in the year before the trust won the contract.

Devon Cares now reports that the number of unfilled care packages at any one time is usually less than five. Seventy per cent of packages are filled within 1.5 hours of referral, and 97 per cent within four hours.

It receives around 30 new packages to fill from Devon county council every week.

The trust initially worked with 23 providers, ranging from national companies to small village organisations, but this expanded to 31 providers over the past year.

Mr Ibbs said the care providers have reported better staff retention rates, which he attributed to improved career opportunities and more flexible working due to closer links with the trust.

NHS England figures show a small reduction in delayed transfers of care from the trust from 2016-17 to 2015-16. Mr Ibbs said the number of DTOCs caused by patients awaiting a care package has “fallen sharply”.

The number of avoided admissions has risen but Mr Ibbs said this could also be because of other work the trust is doing to keep people out of hospital.

Through Devon Cares the trust has made a “small profit”, but Mr Ibbs declined to say how much. He said the primary benefit relates to “non-cash releasing savings through beds saved”.

The biggest financial challenge of managing the contract was in cashflow rather than level of income, Mr Ibbs said.

He cited an example shortly after the service launched where it took the trust longer than expected to process all the invoices, which meant it came close to breaching the 28 day deadline to pay providers.

Mr Ibbs said the next priorities for Devon Cares include fully integrating a shared managing system and developing a system where domiciliary care workers can look after patients in their homes while their care plan is designed – rather than the patient waiting in hospital for a discharge plan.

The trust is also in early stages of discussions with the council over a potential shift to an outcome based contract to encourage providers to increase their focus on supporting patients to become independent and not rely on care.