Witnesses:
KirstyMalak, Senior Commissioning Manager
Ian Lyall, Senior Category
Specialist
Erica Lockheart, Chief Executive,
Surrey Care Association
Richard Williams, Director, Carers at Home Ltd.
Mel Few, Cabinet Member for Adult Social
Care, Wellbeing and Independence
Clare Curran, Cabinet Member for
Children and Families Wellbeing
Nick Markwick, Surrey Coalition of
Disabled People
Declarations of interests:
None
Key
points of discussion:
-
Officers provided a short update to the Board on the
state of the market conditions and the planned commissioning of
service.
-
It was explained by officers that the Home Based
Care (HBC) market was facing significant local and national
pressures. A key challenge was highlighted with regard to capacity
to meet increasing demands, particularly in rural areas, and the
recruitment and retention of care staff.
-
Officers noted that there was a planned shift in
strategy with regard to contract procurement, noting that
strategic, large care providers had not adapted to the changing
conditions in the market as well as was anticipated. It was
explained that the new system of procurement was aimed to be more
flexible in its approach to adapt to market changes. It was
explained that an e-brokerage system was being introduced to
improve care outcomes and provide value for money.
-
Witnesses noted that there were difficulties in
staff recruitment for HBC workers on a local and national level. It
was suggested that a possible cause for this were the low rates of
unemployment within Surrey. The Board was informed that, as a
result of the provision of the Care Act 2014, new skills were
required in the role, making recruitment more challenging.
Witnesses noted that, in an effort to alleviate this issue, the
Surrey Care Association had employed a Partnership Workforce
Project Manager.
-
It was noted by the Director of Carers at Home Ltd.
that there was a significant challenge with regard to HBC staff
turnover, noting an average rate of 20% - 25%.
-
The Cabinet Member for Adult Social Care, Wellbeing
and Independence noted that there was a requirement for funding
high needs groups and that there was a funding shortfall as a
result. It was noted that strategies that encouraged best practice
and value for money were a key element to reducing this, in
conjunction with other strategies, but that there was still a
challenge posed by this shortfall.
-
The Board questioned whether HBC workers had the
capacity to be flexible and provide care across a community
effectively. The Director of Carers at Home Ltd. noted that there
was a need to deploy HBC workers in close proximity to the
community they serve to effectively deliver urgent care in a timely
manner. It was noted that this was a challenge in rural communities
where there was less commercial profitability for a private
enterprise to operate. Officers noted that they work with providers
to provide care in these areas.
-
It was highlighted by the Director of Carers at Home
Ltd. that there was a challenge involved with the provision of the
National Living Wage, particularly in smaller HBC
companies.
-
Members queried whether there were any safeguarding
risks linked to lower levels of staff. Officers stressed that
no-one would be left without provision and that there were several
other options of delivering care; including, reablement teams, provision from external providers
or, in some circumstances, respite care. It was also noted that the
e-brokerage system was in place to better provide provisions for a
person in care and avoid potential safeguarding issues.
-
The Board questioned the number of failed HBC
providers over the last financial year, but stressed that these
providers had not been terminated, but had received assistance to
improve their service. It was noted that the service maintained a
provider log to keep track of issues and had taken a pro-active
approach to improvement
-
Officers informed the Board that there had been some
instances of closures as a result of financial pressure, noting
that nine providers had gone through this process.
-
Members questioned whether there was paid provision
for HBC workers during their travel times and whether this pay was
monitored. The Director of Carers at Home Ltd. stressed that it was
a requirement that providers pay their workers inclusive of travel
time. Officers also noted that this provision was part of the
procurement contracts and that quality assurance teams monitored
adherence.
-
Members questioned whether there was any available
support and training for HBC workers. Officers highlighted that the
training and support of HBC staff was part of the Terms and
Conditions of the contracts offered. The Surrey Care Association
also helped provide training to HBC workers. It was also noted that
the service was encouraging the implementation of a peer support
network to support HBC workers. Members suggested that there were
further opportunities for improving training for staff,
highlighting the need to provide support for to meet the
requirements of the Mental Capacity Act.
-
Members questioned the concept of strategic
providers for HBC, asking whether there were benefits maintaining
such a system in comparison to opening the provision of HBC to
small and medium enterprises (SMEs). The representative of the
Surrey Coalition of Disabled People noted that SMEs had proven
mostly effective at providing local care, particularly in rural
areas. Officers also highlighted the key disadvantage in
procurement, noting that large strategic providers slowed down the
procurement process and were not always best value for
money.
Recommendations:
The Board notes the
considerable pressures facing the home based care market, and
commends partners and ASC officers for working collaboratively to
find solutions to these.
It notes and supports the
directorate’s plans to re-commission the HBC service in
2017.
It recommends:
-
That a further report is brought on the outcome of
the re-commissioning of the HBC in the autumn, with evidence
included of the impact of the e-brokerage system in developing
flexibility in the market; and
-
That officers explore what additional opportunities
exist to support providers with the delivery of Mental Capacity Act
training