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Agenda Item No 12

The Vale of Glamorgan Council

 

Healthy Living and Social Care Scrutiny Committee: 13th March, 2017

 

Report of the Director of Social Services

 

Update Report on Domiciliary Care within the Vale of Glamorgan

 

Purpose of the Report

  1. To update Scrutiny Committee members on issues faced by independent sector Domiciliary Care providers within the Vale of Glamorgan.

Recommendations

  1. That the Scrutiny Committee notes the contents of the report.
  2. That Scrutiny Committee notes the work of the Directorate to ensure that domiciliary care providers and workforce are able to deliver a high quality, sustainable domiciliary care service to the residents of the Vale of Glamorgan.

Reasons for the Recommendations

1&2 To ensure that Members continue to exercise effective oversight of important

        functions undertaken by the Social Services Directorate.

Background

  1. The Vale of Glamorgan has a diverse domiciliary care provider sector. There are 38 domiciliary care providers registered with our approved provider list; currently, all of them support citizens on a regular basis. The independent sector provides 96% of the care hours commissioned to support the assessed care and support needs of our citizens. We have 20 providers who offer domiciliary care packages to ten people or fewer, with two providers providing support to over 100 clients per week.
  2. According to data for a reference week in June 2016, 14,296 hours of domiciliary care were provided per week across 957 packages of care and the average size of a care package was 15 hours per week. In comparison, for a week in February 2017, we were commissioning 15,907 hours per week, across 969 packages of care citizens with the average size of a care package being 16.5 hours per week.
  3. The Vale Community Resource Service (VCRS), based at Barry Hospital, continues to provide reablement care for citizens requiring short term support following a period of illness or injury. The aim is to maximise an individual's independence, usually within six weeks and to prevent the need for ongoing support. In recognition of the positive impact which the service achieves in improving the lives of older people, VCRS has been awarded several grants to take forward the work. The additional investment is designed to improve response times and extend the hours of service. Based on data for the same reference week in February 2017, the VCRS currently provided 640 hours of reablement care per week to 58 individuals.

Relevant Issues and Options

  1. Scrutiny Committee has previously received several reports about domiciliary care, particularly with reference to the operation of the provider performance process. Scrutiny members will recall that a contract with a domiciliary care provider was terminated last year, following the provider performance process. There have been no further instances where the Council has needed to consider this course of action and, at present, no domiciliary care agency is involved in the provider performance process.
  2. The Directorate surveyed all service users who were moved to alternative agencies as a result of the termination of the contract with the domiciliary care provider. This was undertaken as a 'lessons learnt' exercise so that, in similar circumstances, we would know what had been done well and where improvements could be made. The survey generally showed a good level of understanding about restrictions on informing people at an early stage. Many people reported greater levels of satisfaction after their package of care was moved to an alternative provider.
  3. As part of the Regional Action Plan prepared in response to the Flynn report In Search of Accountability (also referred to as "Operation Jasmine"), we have continued to engage in discussions with Cardiff Council about the merits of using common operational policies. This includes working on a joint approach to the Provider Performance Monitoring Protocol, to ensure consistency of processes and terminology. It is anticipated that this valuable piece of work will be completed by the end of the financial year and made operational from April 2017.
  4. The domiciliary care provider forum has not met as regularly in recent times; we are planning how to engage more actively with providers as a group. This has involved sharing information with Cardiff County Council about what engagement approaches are most productive, and what could be conducted on a regional basis. Given the number of providers who support residents of both local authority areas, it is important that, wherever possible, we consider joint models of service and of practice.
  5. Officers continue to engage frequently with the Inspectorate (CSSIW). There are regular meetings with Heads of Service and an engagement meeting with the Director where information is exchanged regarding the care sector. CSSIW published the National Review of Domiciliary Care in Wales: Above and Beyond in October 2016. The Executive Summary is attached at Appendix 1. It is fair to say that he national picture reflects the context within the Vale of Glamorgan, especially in respect of workforce issues. The regional workforce and training partnership has identified domiciliary care as a priority area and its work programme is designed to address the challenges.
  6. Furthermore, the National Commissioning Board and our Regional Joint Commissioning Board have also identified domiciliary care as a priority workstream. The Vale of Glamorgan is greatly involved in both groups.
  7. Members will be aware of the financial challenges facing the domiciliary care sector. At the beginning of the current financial year (2016/17), the Council increased in domiciliary care fees by 3.5%. A number of providers made representations, to advise that this rise was not sufficient to enable them to respond properly to the demands of the National Living Wage, pension auto-enrolment and travel time directives. Following several meetings with officers, the Council introduced a minimum hourly rate that would be used when commissioning domiciliary care, which was implemented from 3 October 2016. All providers were required to confirm compliance with the National Living Wage, Minimum Wage and HMRC guidance on work time payments, including travel time.
  8. Fee levels remain a concern for providers. In discussions with officers, they report that this issue has the potential to make some domiciliary care businesses unsustainable in the short to medium term. Several of the providers have advised us of their intention to request increased rates for the 2017/18 financial year, citing the UK Homecare Association's toolkit for calculating the cost of domiciliary care. We are examining the budget recently set for the Directorate to ascertain the scope for any uplift in fees, acknowledging our responsibility for helping to ensure a sustainable and good quality service for the citizens of the Vale of Glamorgan. We are working with a group of providers to roll-out a toolkit that can be used to inform the Council about the local costs incurred in delivering domiciliary care.
  9. Overall, coverage of domiciliary care provision across the local authority area is satisfactory, with all areas serviced by one or more providers. Some of the more isolated areas of the Western Vale (e.g. Southerndown) would benefit from increased availability and we are exploring options for encouraging an approach which can respond better to the needs of specific localities and communities.
  10. It is important that the Council seeks to introduce an outcomes model of domiciliary care as its default commissioning position. A pilot is currently underway with one commercial provider. The aim will be to shift away from a 'time and task' model to an 'activity' model, where the service provider focuses on its relationship with the service user and responds more flexibly to need. This will require providers to demonstrate that they can generate greater trust and confidence in their ability to make positive changes to the way in which they deliver the care and support plan, without always referring back to care managers. Local authority staff will need to make this change possible by devising more flexible care and support plans to meet a person's eligible needs. Initial assessment will identify the outcomes required to meet the social care needs and wellbeing of the individual. The outcomes will be shared with a chosen provider, who will then liaise with the person and agree how the care will be delivered; this may be very different to traditional ways of meeting need. This demonstrates clearly our commitment to increased personalisation, putting the individual and their families at the centre of all discussions and planning, while improving the quality of support and customer satisfaction.
  11. This model is not likely to generate wholesale financial savings. However, it should facilitate increased productivity and effectiveness, achieving more from each individual package of care at no additional cost. It will also increase service provider capacity for taking on more work, increasing choice and availability for the public. It will also save social worker time, allowing them to focus on new cases and assessments. The changes will be underpinned by new requirements contained within the Regulation and Inspection of Social Care (Wales) Act 2016.
  12. The Intermediate Care Fund has enabled us to start an outcomes based commissioning pilot in October 2016, operating on a small scale with a willing and innovative provider. We hope to extend this approach following initial analysis of the information obtained from the pilot. This approach is intended to support the sector, provide better outcomes for the service user and to be more cost effective.

Resource Implications (Financial and Employment)

  1. There are significant resource implications as a consequence of the current pressures on domiciliary care providers. A 3.5% increase in fees for 2016/17 and introduction of a base rate have been implemented in recognition of the challenges faced by the sector.
  2. Demand for domiciliary care is predicted to continue rising in 2017/18 and beyond. This is generated not only by demographic factors but also by the University Health Board's efforts to take forward with partners a 'Home First' approach, to prevent hospital admissions and to ensure rapid discharge from hospital. An increased spend against this budget was identified as a cost pressure for the Directorate, estimated as being at least £1million per year. This does not take into account any increase in fees.

Sustainability and Climate Change Implications

  1. Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively. It also helps to ensure that best use is made of the resources available for social care services, establishing sustainable models of assistance and support as well as contributing to the most appropriate ways of meeting the needs of vulnerable people.
  2. There are no climate change implications as a direct result of this Report.

Legal Implications (to Include Human Rights Implications)

  1. The Regulation and Inspection of Social Care (Wales) Act 2016 received Royal Assent in January 2016. Implementation will have a considerable impact upon the provision and commissioning of care services, especially when new areas of the social care workforce such as residential and domiciliary care staff become regulated.
  2. Part 1 of the "Commissioning Framework and Good Practice guidance" is issued and it provides standards with which local authorities are expected to comply. Commissioning practice should not place constraints on people's statutory rights to have their need for social care met by the services which the Council makes available under the relevant legislation. Legal Services are consulted in respect of issues in respect of commissioning and/or de-commissioning decisions.

Crime and Disorder Implications

  1. There are no direct crime and disorder implications as the result of this report.

Equal Opportunities Implications (to include Welsh Language issues)

  1. Commissioning for care services has to ensure that they are accessible to all those eligible to receive them; this may require Equalities Impact Assessments to be carried out, as appropriate.
  1. Under Section 7(1) of Social Services and Well-being (Wales) Act 2014 (SSWWAA 2014), a person exercising functions under this Act in relation to an adult (with a need for care and support) must have due regard to the United Nations Principles for Older Persons (1991). The Authority must, when exercising its social services functions in relation to disabled people who need care and support, have due regard to the United Nations Convention on the Rights of Persons with Disabilities (2007) (see para 67 of the Code of Practice Part 2 (General Functions) issued under the SSWWA 2014).

Corporate/Service Objectives

  1. The work outlined in this report addresses the following corporate objectives outlined in the Corporate Plan 2016-2020:
  • Wellbeing Outcome 4: An Active and Healthy Vale - Objective 8 Safeguarding those who are vulnerable and promote independent living.

Policy Framework and Budget

  1. This is a matter for Executive decision.

Consultation (including Ward Member Consultation)

  1. The issue relates to all areas supported by the Vale of Glamorgan Council and so there has been no individual ward consultation.

Relevant Scrutiny Committee

  1. Healthy Living and Social Care.

Background Papers

  1. None

Contact Officer

Suzanne Clifton, Interim Head of Business Management and Innovation

Officers Consulted

Legal Services

Operational Manager, Accountancy

Head of Finance/Section 151 Officer

Responsible Officer

Philip Evans, Director of Social Services