Agenda item

The Strategic Director for Adult Social Care and Health submits a report to provide the Commission with an overview of the process to jointly commission/procure a new domiciliary support service across health and social care, and on how the new services have been operating since October 2017.

The Commission is recommended to note the report.

The Strategic Director for Adult Social Care and Health submitted a report to provide the Commission with an overview of the process to jointly commission/procure a new domiciliary support service across health and social care, and on how the new services had been operating since October 2017.

Sally Vallance, Joint Integrated Commissioning Board Lead, delivered a presentation (attached to the minutes), and attention was drawn to the following points, and questions from Members answered:

·         Commissioning had been a four-stage process of information gathering, planning, making it happen, and review;

·         Over 600 people had responded to say what proprieties for a domiciliary support service were. Providers of care were also part of discussion on how the system could be improved and were pleased to be engaged at an early stage;

·         Key messages from engagement were the importance of continuity of care, carers arriving on time and carers being strong communicators, friendly and naturally caring;

·         It made sense to commission with health as sometimes there was competition between agencies which could increase prices;

·         The chosen model was that the Council would lead on procurement, arranging brokerage of placements in care organisations on behalf of both health and the authority, contract management, and quality assurance;

·         The second stage of planning ensured a smooth transition to the new providers. Legal documents (such as contracts and agreements) were written by both organisations and included things most important for service users;

·         A lot of work was undertaken on the selecting of the right care providers;

·         A written agreement between the Council and CCG mapped out arrangements between them;

·         500 service users facing a change were supported;

·         When making the change all service users had been transferred safely. Numbers of people that had been a struggle to place were very low compared to previous years, which showed the strength of the model;

·         There was a good working relationship between providers and health, and continued to work collectively to address issues;

·         All with a stake in the service had helped with the success of the change, which had taken approximately two years;

·         The average time for people awaiting care was 9.6 days. in terms of those where it was a struggle to make a placement, individual assessments were undertaken and their needs met by other services, for example, the community re-ablement service would be involved;

·         As part of work undertaken, the department included costs around training and the National Minimum Wage, and established a baseline. When considering the increase for 2018/19, the National Living Wage would be taken into account as part of the budget. Members asked for clarity detail on whether it was an uplift of the Living Wage or Minimum Wage to ensure those working were recognised for their work. It was clarified that National Living Wage and National Minimum Wage were covered by the uplift;

·         The Local Authority led on buying services, and that cost was charged back to Health. Costs around contract management and quality assurance were recharged to the CCG;

·         A service user would not see a change if they needed to transition from one funding stream to another as it was easier to move and they would rarely face a change in provider;

·         There were currently five domiciliary support providers contracted to work with the Council rated by the CQC as ‘Requires Improvement’. Whilst the CQC inspection rating couldn’t be amended by the Council, the providers were receiving regular visits from the department and one of the services was not able to accept new cases. Regular discussions were held with the CQC and the department to coordinate a response. Also to note was that the department undertook its own quality assurance checks;

·         With regards to safeguarding, all organisations with a contract with the Council had been through a CQC inspection. The safeguarding process would be instigated if any issues arose;

·         When determining fees the National and Minimum Living Wage was taken into consideration. Over-25s received the National Living Wage;

·         If a direct payment was made to purchase own support, money would be clawed back if not used on care;

·         All carers had general first aid training and a long list of training requirements were covered in the contract. For the more complex health needs, nurse oversight was required.

The Chair requested that more information on the providers the council worked with, and for the mean age of workers to be brought to a future Commission meeting.

The Chair noted that during the two bad cold spells every carer in the city and county managed to get to the people who needed care services, which she considered outstanding. She asked that her gratitude be passed on to all of those carers, who she said undertook a very difficult role, and asked that a letter be sent to all providers to thank their staff. The Director for Adult Social Care and Commissioning was asked to produce and distribute the letter on behalf of the Chair.

AGREED:

1.    That the report be noted;

2.    Members asked that when considering the budget for 2018/19 that clarity be provided on whether the National Minimum Wage or Living Wage was taken into consideration;

3.    That more information on the providers the council worked with, and mean age of workers be brought to a future Commission meeting.

4.    The Director for Adult Social Care and Commissioning to produce and distribute the letter on behalf of the Chair to thank providers and their staff for outstanding work during the cold weather periods.

Information Update from the Director for Adult Social Care and Commissioning after the meeting - Information around the uplift for domiciliary care rates:

The current domiciliary care contract allows for the Council to apply at its discretion an inflationary increase (or decrease) to the price applicable for the following year. Such inflationary increases will have regard to changes in the National Minimum Wage (for those aged 21 to 24 – and accounts for 12.8% of the workforce), National Living Wage (for those aged 25 and over – and accounts for 87.2% of the workforce), and the minimum employer pension contribution rate on the existing hourly fee rates for Day, Waking Night, and Sleep-in Payments.