Agenda item

Purpose of the report: To provide an update on the current status of the Home Based Care (HBC) market in Surrey; and provide an update on the proposed re-commissioning of the Adult Social Care HBC Service in 2017.

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:

1. Officers provided a short update to the Board on the state of the market conditions and the planned commissioning of service.
   
   
2. 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.
   
   
3. 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.
   
   
4. 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.
   
   
5. 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%.
   
   
6. 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.
   
   
7. 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.
   
   
8. 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.
   
   
9. 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.
   
   
10. 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
    
    
11. 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.
    
    
12. 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.
    
    
13. 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.
    
    
14. 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:

1. 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
   
   
2. That officers explore what additional opportunities exist to support providers with the delivery of Mental Capacity Act training