Agenda item

Purpose of the report:

At its meeting on 20 January 2017, Surrey County Council’s Social Care Services Board received a report on Surrey’s Home Based Care market and agreed to receive further update from officer following re-commissioning of the Service in October 2017. This report provides an update on the Home Based Care market in Surrey to the Adults & Health Select Committee as the successor to the Social Care Services Board while also detailing the impact of the e-brokerage system in more efficiently engaging with and developing the market.

Declarations of interest:

None

Witnesses:

Akbar Dhala, Alpenbest Care

Mel Few, Cabinet Member for Adults, Surrey County Council

Ian Lyall, Strategic Procurement Manager, Surrey County Council

Caroline Lapwood, Project Officer, Surrey County Council

Nick Markwick, Surrey Coalition of Disabled People

Matt Parris, Deputy CEO, Healthwatch Surrey

Liz Uliasz, Deputy Director of Adult Social Care, Surrey County Council

Key points raised during the discussion:

1.     Members asked if Key Performance Indicators (KPI) were the only mechanism through which the Council could assess providers’ usage of the e-brokerage system given that data relating to these KPIs was input by providers themselves. The Committee was advised that SCC also maintained an Action Log for each provider which allowed information on their performance to be completed by Council officers and stakeholders which provided an accurate picture of individual provider’s performance.

2.     Discussions turned to whether the e-brokerage system was supporting Surrey’s Home Based Care provider market. Members heard that the introduction of the e-brokerage system had improved efficiency and productivity among Home Based Care providers allowing all organisations to compete for packages of care on a level playing field. The system also enabled providers to work with their staff in order to understand flexibility and capacity within the market.

3.     Members highlighted that people living in rural areas found it challenging to secure a home based care package and asked whether it was difficult to recruit care workers to operate in rural areas. Witnesses confirmed that it was harder to recruit care workers for rural areas given the additional costs associated with travelling but suggested that these challenges could be mitigated by awarding a travel allowance to these staff to offset these additional costs.

4.     The Committee asked why not all registered home-based care providers in Surrey used the e-brokerage system. Officers highlighted that the system had significantly increased choice for residents wishing to access a package of care since it was first introduced but indicated that some providers deal exclusively with self-funders meaning that it wasn’t necessary for them to use the e-brokerage system.

5.     Members sought clarity on how SCC ensure that the e-brokerage system is fair and doesn’t heap added pressure onto the already stretched home based care provider market. The Committee was advised that officers had done a great deal of engagement with providers through the Surrey Care Association Provider Network to ensure that the implementation of the new system helped rather than hindered providers. It was stated that all providers registered on the system had a contract with Surrey with agreed rates for delivering packages of care. Furthermore, data generated by the system enabled the Council to monitor the market and take mitigating steps if the market came under significant pressure.

6.     The Director of Surrey Coalition of Disabled People informed the Committee that the e-brokerage system had improved the market in some parts of Surrey although it remained difficult to get a package of care in many areas. He indicated that it was hard to pinpoint a significant change in home based care provision in Surrey for users since the new system’s introduction and highlighted that that there frequently wasn’t a great deal of choice with users often having to take the package of care that was offered. Members also heard that the quality of care among home based care providers was variable, a cause for concern among those seeking a package of care. Officers acknowledged that the e-brokerage system hadn’t solved all of the problems within the home based care market highlighting that it was much easier to manage quality within the nursing and residential care sectors. The Select Committee was asked to nominate a Member to attend a meeting of the home based care Quarterly Reference Group to provide an understanding of SCC’s quality assurances processes within the home based care market.

7.     Members asked whether there was a provision for those who received home based care to provide feedback on the service they received. Officers confirmed that this service users had the ability to comment on their provider through development coordinators who also ensured that any specific issues raised through this feedback were resolved swiftly. The Committee was further advised that providers will undertake their own quality assurance processes which includes seeking feedback directly from service users. Field supervisors were often dispatched to service users to review their specific requirements and ensure that the correct package of care was in place. Some home based care providers also undertook spot checks on their carers as a means of quality assurance which included seeking feedback on performance directly from users.

8.     The Committee was informed that Healthwatch heard little about quality and provision within the home based care market as those in receipt of home based care were a hard to reach group. The Deputy CEO of Healthwatch did, however, enquire as to whether National Institute for Health and Care Excellence (NICE) guidance had been implemented in respect of home based care. Officers confirmed that these guidelines had been incorporated into SCC’s commissioning standards which were then checked through user feedback surveys.

9.     Attention turned to the workforce challenges facing the social care sector and Members asked what steps were being made to make being a care worker a more attractive profession. Witnesses stressed that staff retention was a significant challenge for social care providers but that steps were being taken to try and address the issue. The representative from Alpenbest Care highlighted that pay was a particular issue for carers. The introduction of the national living wage had, however, placed a significant additional burden on providers and so work was underway with the Council in an effort to mitigate this challenge. The Committee further heard that the UK’s decision to leave the EU had also made it more difficult to recruit to care workers to offset the high rate of attrition within the profession. Members were advised that the workforce stream within the Surrey Heartlands STP plan was making funds available to grow the health and social care workforce within the footprint.

Recommendations:

the Adults and Health Select Committee:

i.       noted the status of the re-commissioned Home Based Care Service in Surrey, specifically the part of the market commissioned by Adult Social Care; and

ii.      noted Surrey County Council’s plans to:

a.     continue gathering efficiencies through the usage of e-brokerage;

b.     exercise regular contract management and performance monitoring; and

c.      work with the provider market to stimulate and support sufficient quality delivery capacity.