SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE – 18
MARCH 2004
REPORT
OF THE HOME CARE TASK GROUP AND UPDATE ON HOMECARE SERVICES
REPORT OF THE CHAIRMAN OF THE HOMECARE TASK GROUP AND THE PORTFOLIO HOLDER FOR SOCIAL SERVICES AND HOUSING
This report was requested by the Select Committee and follows the work of the committee appointed home care task group, which was formed as a result of concerns relating to viability of the home care market place.
ACTION REQUIRED BY THE SELECT COMMITTEE
To debate and make recommendations
BACKGROUND
Members
will be aware that continuity of service provision in some areas of the island
has become increasingly difficult over the recent past and more acutely so in
the preceding 12 months. As a result of
this a home care task group was instigated, comprising Members and Officers to
consider possible actions required in order to both stabilise and develop homecare
provision, their report is attached at Appendix A.
The
joint commissioning unit and adult services management team have also been
working to improve provision across all types of provision and in all adult
client groups. As a result of the work
to manage the wider market place for care provision, there has been some
overlap with the task group and it was agreed that this report be put to Select
Committee combining the outcome of both strands of work.
KEY ISSUES
WORKFORCE
Along
with many other parts of the country, we have had difficulty both attracting
and retaining staff within this area, however, there are a number of issues
which have compounded the problem for the island:
Lack
of guaranteed hours
Lack
of permanent contracts
Increasing
competition from retail sector and other employers
Lack
of clear career pathways
Difficulty
in extending localised recruitment – “island factor”
Whilst
we have little control over what employers outside of this sector do and offer,
so that the retail and leisure sectors will always be our competitors for a
limited workforce, the revised arrangements will make the home care sector more
attractive as block contracting via the tender process will allow employers to
offer staff guaranteed hours and long term or permanent contracts. An element for awarding contracts will be
based on the plans for workforce recruitment development and retention.
We
are working with our colleagues in the “Housing and Community Service” Division
to find mechanisms for arranging affordable housing and available year round
housing to enable us to recruit staff from off-island and therefore increase
the size of the staff pool.
CAPACITY DEVELOPMENT
Historically
we have had a reactive and ad hoc approach to developing capacity within the
home care sector, the revised process as detailed below allows for a much more
proactive and planned process to be undertaken using a building block approach
to creating capacity which will enable us to commission providers to go ahead
and recruit staff before fully required, supported in the interim by the in
house intake team.
As
part of the capacity development consideration, we have looked for areas where
there are efficiencies to be made in the way that we use home care staff. One such area has been identified around
provision of meals. Through a tendering
process, the Portfolio Holder will shortly be awarding a contract to the WRVS
which will provide a marked improvement to the current “meals on wheels”
arrangements leading eventually (over the course of the next year) to a 7 day
hot meal service. This means we will be
able to re-use carers currently preparing and cooking meals in areas where
deliveries are not possible or only available 2 days per week, to provide
capacity within the home care sector.
The
revised meals on wheels service also provides additional quality benefits in
that the meals are cooked on route and therefore arrive in a better state. In other parts of the country the service
has been extended to allow sales of snacks and basic grocery items and in some
areas has been extended to incorporate a home shopping service. All of these initiatives encourage more
efficient use of staff and allow workforce capacity to be added back to home
care.
MANAGING EXPECTATION
Whilst
we wish to continue to offer as much choice as possible to islanders requiring
services, we need to balance this with the massive demand for services first
thing in the morning and at other peak times during the day.
We
need to work with service users to balance their assessed need for a service
with their wish to receive services at specific times and increase
understanding that receiving a consistently adequate and appropriate service is
paramount. In future we will be looking
to providers to fill call slots within existing block contracts first. We expect that providers will run an
internal “waiting list” for the most popular call times to allow users to
exercise choice over a period of time.
VIABILITY OF A FRAGMENTED
PROVIDER SECTOR
The
revised process will almost certainly mean a reduction in the overall number of
providers – some will merge and become larger and others will not survive due
to a lack of sufficient hours to remain viable and meet the cost of achieving
registration standards. However, we
need to balance the market reaction to the reduction in the number of providers
with the critical mass necessary for organisations to meet their obligations
for training, quality and sickness and absence cover all of which will be an
element in the tender matrix and will be key performance indicators within the
new contract system.
INABILITY TO PROVIDE COVER
FOR RURAL AREAS
This
is one of the greatest areas of difficulty experienced over the recent past and
indeed at the present time we are having to pay in some cases double the normal
fee in
order
to arrange cover to more rural areas.
As part of the revised contracting process, these rural areas become
part of the overall contract for the individual locality areas and providers
will need within their costing to ensure that they are able to meet contractual
performance indicators for their whole locality or risk breech of contract and
forfeiture.
We have a very fragmented provider sector in the home care market place on the island which means that sickness and absence can occasionally leave service users without support at times and also means that providers pick and choose the areas where staff are easier to obtain, leaving large areas of the island virtually impossible to organise home care. The result of the revised commissioning arrangements will result in a realignment of the market, leaving us with fewer providers. However, they will be larger and more robust and better able to manage absence cover and growth requirements, as well as having sufficient capacity to meet staff training, development and registration standards.
The term home carer has a low status. This needs to be more appealing and to be given a higher status and we will be working with the organisations who tender to consider job titles such as enabler or independence support worker to change perceptions.
Clearly the above system will require an open tendering process and contracts will be awarded on a combination of cost and quality outcomes which may mean variance between the 4 localities based upon the level of rural work anticipated within each locality. We have allowed a 12 month period for the tender process because we wish to have a significant period of time after tenders are awarded and before they begin, to allow workforce development and restructuring to take place.
We have identified a system of 4 locality areas as providing the best combination of sufficient hours for viability whilst maintaining competitive forces within the market place. Although we will have a preferred provider for each locality, other providers may continue to operate within the private direct purchase sector.
We anticipate our in house service, ‘Wightcare’, becoming a specialist provider, not involved in the locality tendering process but rather providing an overarching island-wide service that will provide a range of specialist services such as challenging behaviour, rapid response/intake team, out of hours etc. This will allow our Wightcare to become the flagship provider, which it needs to be in order to retain credibility.
The block purchase cannot include the packages which combine Supporting People funding with general community care funding at this point, as the providers may be different and there are different statutory and monitoring arrangement for the 2 different provider groups. Further work is required to ensure an cogent and coherent approach in the future.
We have also taken the decision
to exclude specialist physical disability and learning disability support at
this point, although we will be working over the coming months with these
specialist providers to ensure that we have an appropriate block purchase
system for this provision.
We have a consultation process and working party, which involves the provider sector, and have identified a range of measures to ensure that we are able to communicate with all service users. This will focus on reassuring users that the changes will not mean a loss of service and that although it may involve a change in the organisation employing their carers in many cases their actual carer will remain the same, as a result of the careful and extended workforce planning which has been built into the project plan.
There have been a number of meetings with various stakeholders, including a public meeting, all of which have informed us that the public want significant changes to the way we purchase services to ensure that they are robust and able to provide for all areas of the island not just urban areas. Most of the feedback received also confirmed that people want staff to be better valued through permanent contracts and guaranteed hours.
The homecare sector affects a number of our key performance indicators including:
PAF B11 Intensive homecare as a %age of intensive home care & residential care
D41 Delayed Discharges
D43 Waiting time for care
packages
C28 Number of households receiving intensive
home care
C27-28 Supported admissions to residential care
C29–32 Adults supported to live at home
Having adequate and robust services is also key to implementing areas such as the National Service Framework for older people and influences our ability to develop services to meet our obligations under ‘Valuing People’ (the White Paper for People with a Learning Disability.)
Others areas would be:
There are no crime and disorder implications. Financial consequences of not having a robust homecare sector are that we will continue to place people in residential care at a higher cost than could be expected within homecare packages.
The legal implications relate to areas such as our statutory duty to provide services & elements of the choice directive. Clearly there are legal implications to the tendering process itself, and a project plan is being prepared in conjunction with advice from our colleagues in our legal and HR departments to assist us to mange areas such as TUPE of staff where appropriate.
There were no background papers used in this report not already mentioned
Contact Point: Sandy Weller, Head of Adult Services – Social Services & Housing Directorate F 2247, e-mail: [email protected]
GORDON KENDALL