Agenda Item No. 7
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 18th July 2016
Report of the Director of Social Services
Update Report on Domiciliary Care within the Vale of Glamorgan
Purpose of the Report
To update Scrutiny Committee members on issues faced by Domiciliary Care providers within the Vale of Glamorgan.
- That the Scrutiny Committee notes the contents of the report.
- That Scrutiny Committee notes the Vale of Glamorgan Council's response to provider performance concerns, including actions being taken to improve the monitoring of providers performance and the support offered to provider organisations.
- That Scrutiny Committee notes the action plan relating to Operation Jasmine and the proposed joint work with Cardiff Council.
Reasons for the Recommendations
1,2&3 To ensure that Members continue to exercise effective oversight of the important
functions undertaken by the Social Services Directorate.
- The Vale of Glamorgan has a diverse domiciliary care provider sector. There are 39 domiciliary care providers registered with our approved provider list; 36 of them currently support citizens on a regular basis.
- The independent sector provides 97% of the care hours commissioned to support the assessed care and support needs of our citizens. The Vale spent £11,376,567 million on domiciliary care in the last financial year, with an anticipated further £2 million increase in spending on domiciliary care in this current financial year as demographic factors are causing rising levels of need and demand.
- Based on data for a reference week in June 2016, 14,296 hours of domiciliary care are provided per week across 957 packages of care. The average size of care package is 15 hours per week. 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 proposed aim is to seek to maximise an individual's independence 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. Investment is designed to improve response times and extend the hours of service. Based on data for the same reference week in June, the VCRS currently provides in the region of 405 hours of care per week to 41 individuals.
Relevant Issues and Options
- Scrutiny Committee received a report regarding the Council's position in respect of 1st Grade Care at the meeting held 4th January, 2016. Following the meeting, Members requested a six month update on domiciliary providers. There have been no further incidents in relation to 1st Grade Care. As planned, 1st Grade Care completed all the steps outlined in the Action Plan to the satisfaction of our Contract Monitoring Officers. There have been no further actions taken in regard to this agency.
- Committee members will be aware that the Vale of Glamorgan Council recently terminated its contract with Gabriel's Care Limited. This followed a period where the agency was under embargo and an action plan was developed to support the agency meet required standards. However, although some improvements were noted, these were modest and unsustainable, leading to the Authority's decision to terminate the contract.
- The Directorate received a positive response from domiciliary care providers who supported service users who were affected by termination of Gabriel's contract. All service users were transferred to alternative providers in a timely manner, with support from Council staff. All service users who transferred agencies because of this issue will be offered a care review, to ensure that they are appropriately supported and that their assessed needs are being met by the new providers.
- Officers within the Division are currently reviewing the Provider Performance Monitoring Protocol to examine where we can further improve on the execution of this policy to further protect vulnerable citizens. Within the Regional Action Plan prepared in response to the Flynn report - In Search of Accountability (also referred to as "Operation Jasmine"), we have engaged in discussions with Cardiff Council about the merits of using common operational policies. This includes working on a joint policy for the Provider Performance Monitoring Protocol to ensure uniformity in respect of processes and terminology. This will assist providers and professionals whose work spans both the Vale and Cardiff.
- There is also work being done to consider developing a national contract for commissioning care and support services and we will be keen to participate in this task.
- Local Authorities in England and Wales are obliged to undertake an annual review of fees paid to providers of care and support services. There is no statutory duty to offer an increase in fees following review or at any specific time during the financial year or to follow any particular process in calculating appropriate fees. There are some additional factors that need to be considered for the 2016/17 financial year; changes to legislation and case law have generated financial pressures for providers of services, including domiciliary care.
- The following key issues have caused anxiety for providers in domiciliary care on a national and local basis:
- Introduction of the National Living Wage for Over 25s;
- Minimum wage for under 25s;
- Payment for all work related time, including the requirement to pay staff for travelling time; and
- Auto-enrolment in pension schemes.
- In recognition of financial pressures experienced by agencies providing domiciliary care, the Council awarded a 3.5% increase on hourly rates from 6th April, despite the Directorate's own budget and financial pressures.. In the allocated budget for social services, provision had been made for a 1% increase in the rates paid to domiciliary care agencies. All providers within the Vale of Glamorgan were informed of this situation and were also given the option of meeting with the Authority's officers if they felt that the increased level of fees would have an adverse and unsustainable impact upon the financial viability of their business.
- Nine provider domiciliary care organisations have met with officers of the Council to discuss the implications of the 3.5% fee increase. The majority of agencies proposed that, if they are to meet the contractual requirements of the Council and remain financially viable, any increase in fees this year would need to be in the region of 7-8%.
- Other concerns raised during the meetings that the providers want the Council to consider included:
- advice from the United Kingdom Home Care Association (UKHCA) about the fee levels which organisations need if they are to comply with all new legislative requirements and deal with the resulting cost pressures.
- shortfalls in the training offered to staff as a consequence of cuts in the Social Care Workforce Development Grant from Welsh Government, which now operates on a regional basis;
- reduced ability to allow time for staff to attend training events because their work is becoming more complex (as the older people for whom they provide a service are becoming older and more frail);
- difficulties in recruiting and retaining staff because they are unable to pay competitive rates vis-à-vis other sectors such as retail.
- The rates which provider organisations quote when engaged in discussions with the Council about contracts for individual packages of care vary significantly. It is important that some degree of competition operates alongside our responsibilities to ensure that providers comply with regulations and our expectations about quality of care. Therefore, we will continue to work with the sector to address their concerns within the resources available.
Resource Implications (Financial and Employment)
- There are significant resource implications as a consequence of the current pressures on domiciliary care providers. A 3.5% increase on last year's rates has been offered. Some organisations have challenged this figure and they are waiting for the outcome of their meetings with officers which we anticipate will be resolved within the next few weeks.
- An increase demand for domiciliary care in 2016/17 is predicted. The rise is generated not only by demographic factors but also by plans agreed with the University Health Board to take forward a 'Home First' approach to prevent hospital admissions and ensure rapid discharge. An increased spend against this budget in the region of £2 million is already anticipated due to demographics. This does not take account of any increase in fees.
- Furthermore, the financial impact of the Social Services and Wellbeing (Wales) Act 2014 is not yet fully known. There will be constrained opportunities to seek income with the changes required by legislation. For example, Residential Respite care (for a period of 8 weeks) will now be subject to domiciliary charges (i.e. a maximum charge of £60.00 per week as per Welsh Government Policy) and not treated as residential care. However, there are other changes which will increase the income available to the Authority (eg charging from the date care is first provided) and the Welsh Government intended the Act to be cost neutral.
Sustainability and Climate Change Implications
- 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.
- There are no climate change implications as a direct result of this Report.
Legal Implications (to Include Human Rights Implications)
- 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.
- 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 in respect of commissioning and/or de-commissioning decisions.
Crime and Disorder Implications
- There are no direct crime and disorder implications as the result of this report. However, should there be issues identified during monitoring or reporting of incidents in relation to domiciliary care agencies, both within Council's reablement service (VCRS) and the independent sector, the necessary actions to consider any potential criminal offences would be considered in conjunction with South Wales Police, in line with the Protection of Vulnerable Adults procedures.
Equal Opportunities Implications (to include Welsh Language issues)
- Commissioning of care services has to ensure that they are accessible to all those eligible to receive them and this will require Equalities Impact Assessments to be carried out, where appropriate.
- Under Section 7 of Social Services and Well-being (Wales) Act 2014, a person exercising functions under this Act in relation to an adult falling within section 6(1)(a) or (b) must have due regard to the United Nations Principles for Older Persons adopted by the General Assembly of the United Nations on 16 December 1991.
- 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
- This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
- The issue relates to all areas supported by the Vale of Glamorgan Council and so there has been no individual ward consultation in relation to this matter.
Relevant Scrutiny Committee
- Healthy Living and Social Care.
Suzanne Clifton, Interim Head of Business Management and Innovation
Corporate Management Team
Operational Manager, Accountancy
Head of Finance/Section 151 Officer
Philip Evans, Director of Social Services