Agenda Item No. 7
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health): 3rd November, 2014
Report of the Director of Social Services
Increasing the Range of Service Providers in Social Care
Purpose of the Report
1. To inform Scrutiny Committee of the need to increase the range of service providers in social care within the Vale of Glamorgan.
1. That Scrutiny Committee notes the content of this report and the commitment to securing, an appropriate range of service providers in social care.
Reason for the Recommendation
1. To ensure effective oversight of key potential developments in the delivery of frontline social care services.
2. The Council faces formidable challenges in continuing to deliver high quality social care services. This is the result of demographic trends, increased citizen expectations, changing family structures and increasing numbers of children with long standing and complex disabilities. In addition, the Council must find ways to bridge the gap between the reducing resources available and the year-on-year growth in our costs and in demand for care and support.
3. To balance the competing priorities of managing service demand, improving quality, meeting higher expectations and reducing expenditure is especially problematic in situations where safeguarding people from harm and promoting their well-being are the key factors in decision-making.
4. Because of the difficult financial context and increasing demands for services, the only sustainable answer is for the Council and its partners to change the pattern of social care services. This work must be based upon an understanding that we need to reduce levels of dependence wherever possible and focus services on prevention, using the strengths within families and communities as key resources.
5. This requires:
· reshaping services in line with new models of care and the Council's social care commissioning strategies, to make sure that people get the right support at the right time within the funding available;
· finding new types of service providers while helping current providers to become more efficient to reduce costs where possible and to improve the quality of care they offer;
· integrating services;
· regionalising services;
· even better resource management; and
· some retrenchment.
6. Significant work has been undertaken to improve arrangements in three key and interconnected areas: resource management; commissioning and contracting; and planning and partnerships. We now have in place many of the arrangements needed for further progress. This includes a well-managed budget programme and the collaborative arrangements needed for integration and regionalisation - the Health, Social Care and Wellbeing Partnership and the Children and Young People’s Partnership, the Integrating Health and Social Care Services Programme Board (with Cardiff Council, the Cardiff and Vale University Health Board and the third sector umbrella organisation for each local authority area), and the South-East Wales Improvement Collaborative (with nine other local authority social services departments).
7. Effective service planning requires that partners across social care (including users and carers, other Directorates within the Council, the NHS, the third sector, the independent sector and other potential service providers) cooperate in developing a shared model of service. As reported in detail to this Committee on 6th October, the work has been augmented through use of the Regional Collaboration Fund and Intermediate Care Fund grants
8. The Directorate’s work on developing these new service models is producing dividends. It is:
· providing opportunities for creative thinking about how services are delivered, encouraging dialogue and getting consensus about overall direction;
· helping to embed concepts which our service users and others believe are necessary to underpin wellbeing – choice and control, a citizen-centred and rights-based approach, social inclusion opportunities;
· providing a way of establishing priorities and clarity for staff, partners and service users/carers;
· acting as a precursor for decisions about investment of resources and commissioning;
· encouraging investment in preventative services to divert families from inappropriate and higher cost provision or managing demand at lower levels of intensity/ intrusiveness; and
· generating debate about tiers of services, thresholds and access.
9. Following the design of appropriate service models, the next step has been the production of effective commissioning strategies. Commissioning involves making decisions about the type, range and quality of services that will be made available, where and in what settings, on what scale and with what capacity, at what cost and by which provider. Effective commissioning helps to ensure that:
· there is a consistent focus on people's needs and achieving the best possible levels of support;
· the independent and voluntary sectors and other potential service providers have a clear understanding of the intentions of the Local Authority and so range, quality and cost effectiveness of services can be adjusted to meet the needs specified;
· constructive dialogue with all stakeholders is encouraged;
· a framework for best use of resources is developed, to achieve objectives through making appropriate use of all provider sectors;
· social care providers have more certainty, which gives them the opportunity to plan ahead; and
· bridges are built between service and financial planning.
10. Elected Members have contributed to the development of the commissioning strategies produced by the Directorate in respect of older people services and children's services. A consistent theme emerging from the strategies has been the need to increase diversity in service provision by promoting and assisting the development of new models of delivery through organisations such as social enterprises, co-operatives and user-led collaboratives. The Social Services and Wellbeing (Wales) Act will make this a statutory duty for local authorities.
11. In the longer-term, the goal is to increase the amount of social care that can be described as "citizen directed support", to provide viable alternatives to either in-house provision or traditional outsourcing and to reduce the risks of service failure or mitigate the impact upon vulnerable people.
Relevant Issues and Options
12. There are a number of ways in which services can be provided to individuals that reduce the need for the Council itself to be the direct provider of care and support. This includes provision by the third and commercial sectors and the Council has a strong track record in making effective use of their contribution.
13. In recent years, the potential role for other types of service providers has begun to receive considerable attention, especially organisations such as social enterprises. The Department of Trade defines social enterprises as "businesses with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community rather than being driven by the need to make profit for shareholders or owners". The Social Enterprise Action Plan for Wales 2009 has three core themes:
· to inspire people and organisations with the unique attributes of social enterprise such as a strong values driven agenda, flexibility and responsiveness to people's needs;
· to champion the role that social enterprises play in the Welsh economy by extending the range of job opportunities;
· to liberate developing social enterprises from the barriers and burdens that stifle their development.
14. Social enterprises take many legal and organisational forms, with their origins in different traditions and contexts. What unites them is the commitment to the public interest and their ability to work in diverse ways and adopt distinctive business, operating and financial models. Social enterprises will typically concentrate on their core business of delivering services to the community and build business models that allow them to be sustainable while contributing to social and economic inclusion as well as to equality of opportunity.
15. Social enterprises can be structured as a for-profit or non-profit organisation, and may take the form of a co-operative, a mutual organisation, a community interest company or a charity.
16. A co-operative is a group of people acting together to meet the common needs of its members, sharing ownership and making decisions. A co-operative is not a charity but it is a non-profit organisation. All profits are given back to the co-operative's members. The three principles of a co-operative are: the subordination of capital; one person equals one vote regardless of that person's percentage of ownership; and dividing profits or margins among the members according to the percentage of business done with the co-operative.
17. A mutual organisation is based on concepts of mutuality and reciprocity. Unlike a co-operative, members usually do not contribute to the capital of the company by direct investment but derive their right to profits and votes through their customer relationship. A mutual exists with the purpose of raising funds from its membership or customers which can then be used to provide common services to all members of the organisation or society. Profits made will usually be reinvested in the mutual for the benefit of the members, although some profit may be required to sustain the organisation and ensure it remains safe and secure.
18. A Community Interest Company (CIC) is a business with primarily social objectives whose surpluses are principally reinvested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners. CICs tackle a wide range of social and environmental issues and operate in all parts of the economy. By using business solutions to achieve public good, it is believed that social enterprises have a distinct and valuable role to play in helping create a strong, sustainable and socially inclusive economy. CICs are diverse. They include community enterprises, social firms, mutual organisations such as co-operatives, and large-scale organisations operating locally, regionally, nationally or internationally.
19. There are a number of perceived benefits from using social enterprise as a model for delivering a greater proportion of public services.
· Social enterprises can reach and engage local people in ways that neither the public nor private sector can, which helps the targeting and take-up of services as well as offering different ways of involving users and citizens in the development and delivery of public services.
· They can offer novel combinations of skills and capabilities that meet the needs of particular groups by seeing and responding to different areas of need and the linkages between them.
· Social enterprises offer flexibility for new approaches without the profit motive distorting implementation and by acting as a trusted partner to trial and deliver new activities.
· They can bring innovative capacity and momentum usually, finding new ways of responding to an issue and levering in different forms of finance; and
· Social enterprises plan a key role in regeneration by acting as role models for community enterprise and ensuring that the money spent on public services circulates in the local economy.
20. As part of their individual care plan, adults and parents of children with a disability can choose to be provided with Direct Payments, which enables them to exercise greater control over the support they need by providing an alternative to social care services provided by a local authority. A Direct Payment gives the person flexibility to determine how best to meet their social care needs, often by the employment of a Personal Assistant or by directly paying for services. This often helps to increase opportunities for independence, social inclusion and enhanced self-esteem. The Council is increasing the use made of Direct Payments, where appropriate and there is a clear potential for linking provision through social enterprises with the further development of Direct Payments. This is being supported via the tendering process which is now starting with regards to the Direct Payment service.
21. The Welsh Government ten-year strategy for social care, "Sustainable Social Services for Wales: A Framework for Action", says "we expect a much greater range of services to be run by citizens themselves....... Social care is ripe for the development of social enterprises. We will work with stakeholders to look at how the barriers to their development can be overcome. It will be necessary to consider how new sources of funding can help to create new models of service and we will explore how social impact bonds could play an important role in this."
22. There are growing numbers of social enterprises in Wales offering social care and support. This Council has expressed a commitment to increasing the range of service providers in social care but there are issues that need to be addressed when doing so. Any changes to the way in which the Council commissions social care services will require detailed consideration and legal advice in respect of governance arrangements, any potential employment law implications, the implications of any relevant legislation governing the area of activity involved, procurement rules and legislation. Service users need to be assured that any providers can deliver continuity and security of service over a fixed term and can manage risk appropriately. These would need to be included in the assessment criteria used as part of any tendering process. Staff directly employed by the Council need to be engaged at an early stage, to contribute their ideas about the types of organisational arrangements that most effectively meet and the possible implications for them. Consequently, the Council needs to adopt a managed approach to the work. Additionally, it would be helpful to engage in this task with the other key commissioners of social and health care in the region, including neighbouring local authorities and Local Health Boards.
23. Further consideration of different service delivery models is being undertaken currently through the Council's reshaping services agenda. Also, Welsh Government has made funding available to support a maximum of five projects that will pilot new models of care and support delivery. The Vale of Glamorgan Council has been successful in their bid to be part of this initiative and expertise is being made available to Social Services by the Wales Co-operative Centre to take this work forward.
Resource Implications (Financial and Employment)
24. Currently, the Social Services Directorate is both a commissioner and a provider of social care services. In terms of in-house services, the Council spent over £5m on the direct provision of residential care, reablement care and day care during 2013/2014. In the same year, it commissioned more than £25m of care and support for individuals.
Sustainability and Climate Change Implications
25. Part of the overall purpose of changes to service delivery models is to ensure that current and future demand can be met and delivered in settings which are fit for purpose, sustainable and financially viable.
Legal Implications (to Include Human Rights Implications)
26. One of the most distinctive provisions in the Social Care and Wellbeing (Wales) Act concerns the requirement in section 16 that local authorities must promote both:
· the development of social enterprises / co-operatives / third sector organisations to provide care and support and preventative services;
· care and support and preventative services that involve service users in the design and running of services.
27. Any changes to the way in which the Council commissions social care services will require detailed consideration and legal advice in respect of governance arrangements, potential employment law and HR implications, the implications of any relevant legislation governing the area of activity involved, procurement rules and legislation.
28. The Council's responsibilities in respect of direct payments are governed by legislation namely the Health and Social Care Act 2001 and the Children Act 1989, various regulations and the Community Care, Services for Carers and Children's Services (Direct Payments) (Wales) Guidance 2011, such guidance having been issued under Section 7(1) of the Local Authority Social Services Act 1970.
Crime and Disorder Implications
29. There are no crime and disorder implications as a direct result of this report.
Equal Opportunities Implications (to include Welsh Language issues)
30. In developing proposals in respect of service delivery models, the overall objective is to improve access to high quality and appropriate services for vulnerable people across the Vale of Glamorgan.
31. The development of new service delivery models will support the following corporate objectives:
· To make the Vale a safe, healthy and enjoyable place in which individuals can live their lives to the full; and
· To manage the Council's workforce, money and assets efficiently and effectively in order to maximise its ability to achieve its service aims.
Policy Framework and Budget
32. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
33. Any changes to service delivery models will be subject to consultation with service users, their carers, service providers and the Care and Social Services Inspectorate Wales.
Relevant Scrutiny Committee
34. Social Care and Health
Scrutiny Committee Report - Social Services Commissioning Framework 2011 and the Social Services Commissioning Strategy For Older People's Services 2011 to 2018 (28th November 2011)
Scrutiny Committee Report - Contracts with Third Sector Organisations for Providing Social Care Services (16th July 2012)
Scrutiny Committee Report - Commissioning adult care from the independent sector (8th October 2012)
Scrutiny Committee Report - Commissioning Strategy for Children Services (11th February 2013)
Scrutiny Committee Report: Update on the Regional Collaboration Fund and Intermediate Care Fund Programmes (6th October, 2014)
Carys Lord, Head of Business Management and Innovation
Corporate Management Team
Philip Evans, Director of Social Services