Les Amis: Some Facts from 2017

We have a social worker making the assessment and then saying it is going to cost X amount of pounds. Then a High Cost Care Panel will sit and will let them know if they can spend that amount of money. That is a bit of a conflict of interest, I would say. That is the stuff that we constantly challenge, because the people we support deserve to have their needs met and it should not have a pound sign attached to it. (Managing Director, Les Amis)

The “Health and Social Security Scrutiny Panel” looking at Les Amis on 24th July 2017 seems to be one of the few public documents in which we can see the pressures Leslie Norman faced.

Issues with Long Term Care - Square Pegs do not fit into Round Holes

The Managing Director of Les Amis noted at the start that there were issues with the Long term care model because it was not a good fit for adults who were disabled and accessing the Les Amis services.

First of all, we started discussions with the States departments back in September 2013, to get ready for the introduction of long-term care. So, we have been at this for a while. Throughout we have advised that the process was not fit for purpose in regards to the people we support. It is ideal for the elderly general population, but for people with learning disabilities and associated conditions it does not really fit. This threw a few spanners in the works, where we find ourselves today still with outstanding assessments. We still have ongoing discussions with the Health Department, mainly, in regard to rectifying the situation. Yes, it has been an interesting process from beginning to end.

This is noted in an example of letters from October 2015, which detailed some of the negotiations that were going on between Les Amis and Social Security. By 14th April 2017, despite a push by Les Amis, almost 70 per cent of residents who had not yet had a full assessment and subsidiary assessment, so did not have a personal care plan in place.

States of Jersey IT Failures in Design and Implementation

Part of the issues was IT problems. As the MD explained:

The system that they use is Care Partner. What had happened in 2015, we were now in the LongTerm Care Law by this point, but we had not finished our complete assessment process. We had carried out a considerable piece of work with Care Partner Version 6. Then they moved to Care Partner Version 6.4. It sounds like a Microsoft joke, but it is not. We were told that the work could not be transitioned from one system to the other, so it had to start again. We had to re-input the work. That is why we have gone beyond the end date of completion at the end of 2015.

This in incredible incompetence on behalf of whoever was in charge of the project in the government, but perhaps not quite surprising, given the Auditor-General’s various reports exposing the many failings in implementing States IT systems.

How the transitions have worked

The Funding at Les Amis has gone through three stages here.

It has gone through 3 stages. The first one we had the Parish. The Parish used to pay for the individuals that lived with us. We had deficit funding. Then you made Social Security Department receive all the money in, so we worked on a group rate where we were paid a group amount and we had to make that work. Then the long-term care came in. So, we have had to transition from the old system to the new system over a period of 5 years, with no real clear direction on how to get there, apart from long-term care will pay for it.

The long term care was assessed on an individual basis, despite the fact that Les Amis provides group support, so the individual care packages were brought in and that equated to £500,000 less income, some more, some less, but overall a reduction .

So Les Amis had to think long and hard and budget for that reduction:

We were using Lean processes. We were looking at how many staff were on the ground and what they were doing. We were looking at our back office operations. We stripped a lot of that out. To be fair, we recognised that you have to change, you cannot stand still. It was more about evolution than revolution, in a sense. We took the period of time from 2013 to 2016 to do all that work. So, credit to everybody who works for Les Amis they took it on the chin. It was hard. It was very hard. It was not easy. But it paid dividends when we got to the point of receiving less income, but we made what we had work for us.

This means that for each individual supported, a considerable amount of input was required, and was not helped by having the re-input a lot of data for the States to use in their assessments. Clearly the Social Security Department was running on “guestimates” in this time period because they were awaiting assessments to complete care packages. 

It is clear that no transitional provision was made until the backlog was fully cleared, instead the government made estimates on what they had, of varying reliability.

What they did is they looked at what we were receiving, they worked on each individual case and said: “That looks right for that individual. That looks right for that individual.” That is how they have gone. At the point of the review they said that we will get all the paperwork in, because Care Partner Version 6 was not in existence, so Care Partner 6.4 needs all that inputting. So, we will use this time now to re-input all the information and then you will have the 2 pieces of paper. You get your assessment, then you get your care package, which is Care Partner element of it, which then gives the indicative budget for the individual. Then that enables them to either broker their care package with any other care provided or it enables the family to broker on their behalf, to say: “We have X amount of pounds. This is the care package, can you do it?”

The Usual Government Lies

The Health Department at this time was saying that as far as assessments and paperwork was concerned, there were no longer any issues. They said: “We are now fully staffed. The backlog has been cleared.”

This was in fact a falsehood. By October 2017, around 70% of the backlog had still not been assessed properly.

The delays were at the Health Department: “We are waiting for a piece of work to be given to us to give us a timeline for completion of this work. We have been waiting for that since the beginning of this year”

So there were 84 residents in group homes, and about 70 per cent of them were still outstanding with both pieces of paperwork needed to complete the loop, and a delay in assessments from Health and Social Services.

Assessments, Backlogs, and Conflicts of Interest

The Assessment process itself has inbuilt conflicts of interest.

We have a social worker making the assessment and then saying it is going to cost X amount of pounds. Then a High Cost Care Panel will sit and will let them know if they can spend that amount of money. That is a bit of a conflict of interest, I would say. That is the stuff that we constantly challenge, because the people we support deserve to have their needs met and it should not have a pound sign attached to it.

And the delays in the assessment process also causes issues:

We have other families that are contacting us, phoning us, dropping us emails: “I really want to get respite but I have not got this done yet, I have not got my assessment.” We will refer them back to Health and say: “You really need to chase your social worker because you cannot do anything until you get your assessment done, your care package is attached that will get you your budget.” Then that paperwork gets sent to Social Security who will release the cash to approved providers, whoever that may be.

Enough is Enough

It is understandable - and with endless meetings which got nowhere - why Leslie Norman finally felt enough was enough and resigned as Chairman of Les Amis. There is, in the Scrutiny hearing, detailed how the Health and Social Services department failed to try and understand how bad a fit Long term Care was - because it wasn't devised thinking about those exceptional cases, and a general inability to comprehend, listen and sort out the problems.

Lack of a Transparent Record

Unfortunately there is very little else available as a matter of public record. Evidently from the recent news story - no doubt in an attempt to cut Les Amis budgets further - some report was mentioned commissioned from BDO. Where is this report, commissioned using tax payers money? Can we have sight of it? And what is of concern - is it an attempt to get a cheaper service?

The Push for Second Rate Care

In 2017, it was noted that lower cost was a priority over care:

What happens is when you get the paperwork it will run down all the areas of individual’s needs, so they will have access to community whatever it is and it will tell you what the needs are. It does not say how many hours or whatever and then that care assessment is given to the care provider and the care providers say: “Our hourly rate and to meet all of these needs, that is how much that care package would cost.” You can imagine we get quite a lot going to the High Cost Panel and more often than not and probably about 98 per cent of those sort of cases, we are asked to see if we can do it a bit cheaper. Then we question the fact that if you need all these needs met, we need to have the staff available and we will review it as things go. But if you pay cheap, you get cheap and we are not willing to give a second-rate care package just because it is a bit cheaper.

That is something which may still be the case.