Agenda Item No
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health): 8th October
Report of the Director of Social Services
Commissioning Adult Social Care Services from the Independent Sector
Purpose of the Report
1. To update Scrutiny Committee regarding the commissioning arrangements in place for adult social care services in the Vale of Glamorgan.
1. That Scrutiny Committee notes the current arrangements for working with the independent sector in providing social care services.
Reason for the Recommendation
1. To ensure effective scrutiny of a key function undertaken by the Council.
2. Social care commissioning involves deciding what services are required to respond effectively to the needs of service users and carers - both now and in the future. This includes making decisions about the capacity, location, cost and quality of services, who will deliver them and how. The effect on people's lives can be profound. Ineffective commissioning may:
mean that the right services are not available;
produce unnecessary dependence; or
undermine strategies for managing risks to vulnerable groups.
3. Commissioning has become established as an important process in helping to drive improvements in social care and in securing better outcomes for service users but it is still a relatively new discipline. It is a complex area of work, partly because of the considerable prescription involved in procurement processes involving any public service.
4. Commissioning should be underpinned by the core values of social care - promoting independence and personal development and enabling service users to keep control of their lives. Additionally, commissioning social care must have regard for the wider local government context, one that requires councils to encourage social inclusion and sustainability while delivering best value. Many of the activities involved in commissioning social care are similar to the planning and development activities that all organisations need to perform. However, as well as managing their own services, local authorities also need to influence and shape services provided by other organisations. They are responsible for making sure that the mixed economy of care provision works effectively and that services provided on behalf of the local authority meet regulatory standards. There is a heavy reliance on services provided by the private and third sectors, which must complement the care and support provided by families and unpaid carers. Local authorities must ensure that social care services provided by the wide range of different agencies available to people in their area are well planned, designed and delivered.
5. The Welsh Government has provided statutory guidance on commissioning social services, setting out the responsibilities of local authorities in this area of work. “The Commissioning Framework Guidance and Good Practice” is issued under section 7(1) of the Local Authority Social Services Act 1970. The Framework has two parts. Part 1 contains 13 standards which provide the benchmark against which the effectiveness of local government commissioning activity is measured. Part 2 of the Framework describes good practice in commissioning and procurement.
6. Given the increasing importance of this work, commissioning is one of the key themes within the Vale of Glamorgan Social Services Change Plan 2011 – 2014. Good progress has been made in delivering the identified priorities and this is reported to Scrutiny Committee and Cabinet on a regular basis. In 2011, the Council produced its first Social Services Commissioning Framework to assist staff involved in this area of work and to help service provides understand the processes that must be followed. In addition, the service is now developing commissioning strategies for individual categories of services users, which outline the intentions of social services with regards to future provision. For example, the Commissioning Strategy for Older People’s Services 2011 – 2018 was approved by Cabinet in November 2011.
7. Increasingly, there are examples of very good planning and procurement practice within social services in the Vale of Glamorgan. Social Services now have in place a number of contractual arrangements for the provision of services. Once these are agreed, the Directorate takes on the role of helping to ensure that the services are delivered to the level required, within the budget allocated and in accordance with regulatory standards.
Relevant Issues and Options
8. On 16th July 2012, Scrutiny Committee considered the arrangements that the Directorate has in place to secure services from the Third Sector. This report outlines the contracting arrangements that currently operate in respect of the independent sector (i.e. organisations which seek to achieve a profit). It should be noted that the Council retains a statutory accountability for the way in which these services are provided.
9. During 2011/2012, Social Services spent £18.2m on services that were provided via contractual arrangements with the independent sector. Of this amount, £10.7m was spent on care home services (which includes nursing and residential care) and £7.5m on domiciliary care services (which includes home care and day care services). A list of the relevant organisations is shown in Appendix 1
10. In order to provide services on behalf of the Vale of Glamorgan, providers must be on the social services approved provider list. This involves
signing the Heads of Agreement documentation. This is a document that gives a generic service specification which alongside general terms and conditions and in conjunction with an individual care plan for each service user collectively form the contract;
complete a questionnaire in relation to the services they provide;
provide a breakdown of their costs;
give evidence of Public Liability Insurance to £5m;
give evidence of Employer ‘s Liability Insurance to £10m;
demonstrate that they are registered with the Care and Social Services Inspectorate Wales (CSSIW), where appropriate ;
provide references. If the provider is based in the Vale, two references are required. If the provider is out of county, we require the host authority to confirm that a) the provider is on their list, b) the provider is currently being used and c) they have no concerns including Protection of Vulnerable Adult issues.
11. Once a provider has been placed on the Approved Provider List, ongoing monitoring does take place to ensure that quality standards are maintained. This includes ;
ensuring that insurance cover is maintained on an annual basis;
requiring providers to undertake an annual questionnaire in relation to their business;
collating information gathered via complaints, service monitoring reports and POVA (Protection of Vulnerable Adults Arrangements) issues to identify any trends or problematic areas;
undertake spot visits, if required;
undertake arranged visits when time and resources permit;
share and discuss concerns with CSSIW;
scrutinise CSSIW inspection reports and seek satisfactory resolutions to recommendations for immediate action, if required.
12. CSSIW has a key role in the regulation of services in social care. Care home and domiciliary care providers must be registered with CSSIW in order to provide services. This ensures that they meet minimum standards. As a regulating body, CSSIW undertake inspections of all registered providers, announced and unannounced, and the resultant reports are all made pubic. Through the Directorate’s monitoring processes, any concerns identified in the CSSIW reports are followed up with the individual providers.
13. There is a sub group for the Area Adult Protection Committee that brings together individuals from a number of organisations who work in delivering Protection of Vulnerable Adults arrangements, complaints, advocacy and contracting. Through this group, information is shared and concerns addressed. This pioneering approach has proved to be a robust way of monitoring the quality of service provision and ensuring that service users are safeguarded.
14. If there are ongoing or serious issues regarding an individual social care provider, these are dealt with through an escalating concerns process. This process is applied throughout Wales and all appropriate agencies come together to share information and take the necessary action to ensure the safety of service users. The service provider is involved in these discussions and an action plan agreed to address the outstanding issues. Progress against the action plan is monitored and failure to agree to and complete the required actions can have serious consequences for the provider agency.
15. With regard to domiciliary care services, surveys are undertaken to ensure that staff are appropriately trained. In addition, service user questionnaires are used to gather information and feedback about the services provided to vulnerable people in the Vale.
16. It is essential that staff working with vulnerable people do not pose any form of threat to the service users and that they are suitably qualified to undertake their roles. All staff within provider organisations are required to have a current Criminal Record Bureau (CRB) check and this is inspected by CSSIW as part of their monitoring process. There is a qualification framework in place for social care services which identifies the appropriate qualifications for all staff within the service. Targets have been set by the Care Council for Wales with regard to the achievement of these qualifications and this is also validated by CSSIW and by the social services training team. Social Services help to provide staff from all sectors with access to appropriate courses and the qualification levels within the Vale have improved markedly in recent years.
17. The Care Council for Wales is making more rigorous the requirements with regard to the registration of individuals. For a number of years, social workers must be registered with the Care Council in order to practice. This is being extended into direct care. Care home managers now must be registered and domiciliary care managers are the next staff group to be included in the compulsory registration process. These measures should have a positive effect on quality of service. Levels of registration are being monitored by the social care workforce development group within the Vale.
18. There are two provider forums in the Vale of Glamorgan – one for care homes and one for domiciliary care. The forums enable providers from all sectors to share information and consider developments for the service. This has enabled all providers to share good practice and to keep up to date with the changes in social care, thereby maintaining service quality.
Resource Implications (Financial and Employment)
19. During 2011/2012, Social Services spent £18.2m on services that were provided via contractual arrangements with the independent sector.
20. The Approved Provider Lists in adult services include 149 care homes, 58 domiciliary providers and 24 day care providers. Of these, there are 21 care homes in the Vale and 20 of the domiciliary care providers are used on a regular basis.
21. Improved commissioning practices ensure that the right services are available, for the right people at the right time that best use is made of the resources available within Social Services.
Legal Implications (to Include Human Rights Implications)
22. Part 1 of the "Commissioning Framework and Good Practice guidance" is issued under Section 7(1) of the Local Authority Social Services Act 1970 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 with regards to commissioning and/or de-commissioning decisions.
Crime and Disorder Implications
23. There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
24. Commissioning of care services has to ensure that they are accessible to all those eligible to receive them and will require Equalities Impact Assessments to be carried out, where appropriate.
Sustainability and Climate Change Implications
25. Effective delivery of commissioning responsibilities helps to ensure that the Council's assets are managed efficiently and effectively and 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.
26. Commissioning documents will contribute to the corporate priority of "working with partners to meet the diverse needs of our residents in ways that will safeguard and support those who are most vulnerable and in greatest need; help people to keep fit and healthy; and increase social cohesion and equality of opportunity for all."’
Policy Framework and Budget
27. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
28. There are no implications for individual Wards as a direct result of this report.
Relevant Scrutiny Committee
29. Social Care and Health
Cabinet Meeting on 19th January, 2011 - Commissioning Guidance
Cabinet Meeting on 13th April, 2011 - Social Services Change Plan 2011-2014
Carys Lord, Head of Business Management and Innovation
Philip Evans, Director of Social Services