Agenda item

Attending for this Item from the Adult Services Directorate were:

Elaine Carolan, Strategic Commissioner for Adult Services

Steve Medley, Senior Project Manager

Adrian Hardman, Cabinet Member with Responsibility for Adult Social Care

By way of presentation, Outcome Based Commissioning in Domiciliary Care was explored and the following main points were highlighted:

·         Since its introduction in April 2017, a dynamic purchasing system had enabled a thriving domiciliary care market to be built up in Worcestershire

·         This had resulted in the opportunity for the Council to build up a stronger and more responsive relationship with Providers

·         Providers work in a locality and are then responsible for covering the social care needs of that population

·         Challenges around the rurality of Worcestershire remain and cross border working was accepted.  Examples were given whereby Providers based in Birmingham may work in north Worcestershire

·         The financial risk and reward is managed with the Provider to deliver an agreed set of outcomes that promote and maintain independence

·         There was a lot of contract monitoring and assurance was given that no resident in Worcestershire had a 15 minute call (for care) with 30 minutes being the minimum.  However, other visits, for example checking if medicine had been taken could involve a 15 minute visit

·         Of the 3 Pilot Projects in Worcestershire (Pershore and Upton, Central Bromsgrove, Malvern), initiated in October 2017 and being run until September 2018, savings had already been made and national examples cited, suggesting Council savings could achieve 20% savings over 2 or 3 years

·         Providers would be much more involved in delivering the care on outcomes, therefore if a provider felt that there was an alternative delivery model, discussions would be had with the client and Council.  There would no longer be any Social Worker prescribed 'task and time'

·         This new of working aligned well with the Three Conversation Model of Social Care

·         The Pilot Projects would only be working with Older People who were new to social care, with Officers reporting that routines for existing clients would not be disrupted

·         In return for securing a block contract, Providers had agreed to reduce from a Tier 4 to a Tier 3 banding rate, enabling a saving of around £300 per week reduction per person

·         Other savings had already been achieved by Providers proactively getting in touch to suggest alternative care packages

·         Challenges included the capacity of Providers, especially given the perception of the care profession and the reliance on Eastern European workforce

·         There was a need to manage expectations going forward and investigate whether housing is able to meet future caring needs

·         Additional Pilot Project Areas were being developed in Wyre Forest, Redditch and Worcester City with a view that a Tender process would be enable projects to start in April 2018 and run for 12 months

·         It was hoped that evidence would continue to be collected to prove the effectiveness of the Outcome Based Commissioning approach and develop further to ensure the approach was sustainable

·         A risk/reward payment model with existing Providers would be developed, with the intention of moving towards a place based payments approach

·         The use of assistive technology was seen as crucial to managing social care demands in the future.

In the ensuing discussion, the following key points were raised:

·         All Members were encouraged with the work done to date and welcomed the phased approach which would evolve into a County wide model

·         In response to a query about a 'Place based approach', it was clarified that this would enable a Provider to work in a locality and manage their workforce and clients as appropriate.  There was ongoing discussion around how to reward Providers if they identified a reduction in a care package and free up more carer time in the local area

·         One Member asked how much spare capacity there was in the whole system.  It was explained that capacity had increased, but the demand would only continue to rise due to the demographic profile of the County

·         Private funders, or independent packages, were getting bigger, resulting in a large percentage of the market being made up of private funders

·         Assurance was given that patients being discharged out of hospital without support from family would not be affected and packages of care would still be available, depending on which Pathway they were discharged on.  In addition, Social Workers would continue to provide a full assessment as was currently the case

·         Ordinarily, Social Workers would set up a care package, which was reviewed after four to six weeks, whereas the new model enables the Provider to review the package and refer to a Social Worker when appropriate and could well be before the scheduled six week review

·         The benefits would hopefully promote independence earlier and by building trust and joint working with Providers have a stronger care market

·         It was clarified that at no point does the Provider determine the domiciliary care package alone

·         When asked about the extent of the client involvement in decision making, it was made clear that the client is at the heart of the decision making process and as Staff and Clients build up a working relationship the package of care can be modified

·         Quality Assurance was still active and feedback from the client and their family was considered by Officers.  Plans were developed with them rather than to them and Members were assured that the Council has a person based approach

·         Until recently, care providers had to have an office in the County in order to obtain contracts, whereas now, this stipulation has been removed and the market has become more competitive, especially in Redditch and Bromsgrove for example, where Providers come down from Birmingham

·         When asked whether the Council check what Providers are paying Staff, it was reported that it was one of the questions that was asked and checked.  In addition, other questions included hours worked, ensuring that travel time is paid and also the rate of staff turnover.  If turnover is reported as over 20% questions are asked of the organisation

·         There are around 200 Providers on the system in Worcestershire, with 107 based in the County and 150 Organisations providing domiciliary care

·         It was noted that the Council still also has domiciliary care in house, mainly side by side care and dementia domiciliary care

·         One Member asked about assistive technology and the recent Cabinet decision to further invest in this area of work.  It was reported that there were numerous ways that technology could aid future demand, for example an alert to remind someone that they hadn't had a drink in a specific time.  An alert like this could prevent cases of dehydration, which could reduce the number of hospital admissions.  Another example was given whereby people with epilepsy may be able to have a monitor which could result in not requiring an overnight sitter.  Both examples maintain independence for longer, although it was noted that everyone is different and needs are different

·         When asked, it was clarified that care packages are updated if levels of need change

·         The Cabinet Member commented that one of the purposes of this work was to get people on their feet quicker, using the example that if a 3 week review was more appropriate than a 6 week review it would promote independence and although it would also provide a saving, it was not about the money

·         When looking at the sustainability of a service, it was stated that the clients would be tracked for 12 months

·         One Councillor asked about the process of Older People moving in and out of the County to be informed that individuals have the right to live anywhere

·         The subject of Aids and Adaptations (such as grab rails) was discussed.  District Councils were responsible for these works and the working relationship with them was good.  Members learned that there were hardly any delays in transfer of care due to this area of work.

The Chairman thanked everyone for a useful discussion and stated that she had booked in a visit with a Social Worker to advance her knowledge base.  In addition, the Cabinet Member commented that he was pleased to hear the positive feedback from Officers.

Members requested further information on the following:

·         the Quality Assurance process and Independent Advisers role

·         Key Performance Indicators

·         a progress update at an appropriate time in the future.

In addition, Members requested that Scrutiny Officers arrange a Member visit to see assistive technology in action.