Agenda item

 

To receive an update in relation to Adult Social Care, Domiciliary Care. 

 

Members are encouraged to review the input that was delivered to the Health Select Comission in January 2024 should further background information be required.  This can be accessed via the following link:

 

Agenda Pack for Health Select Commission, 25/01/2024

 

The relevant information is detailed on Pages 11-38 of that agenda pack.

 

 

The Chair invited Councillor Baker-Rogers, Cabinet Member for Adult Social Care and Health to introduce the presentation.

 

Councillor Baker-Rogers advised that the update relating to Adult Social Care Commissioning was requested following its last presentation to the Health Select Commission in January 2024.

 

The presentation focussed on the following commissioning themes:

 

·       Domiciliary Care.

·       Mental Health.

·       Learning Disabilities and Autism.

 

It set out progress against a number of dynamic purchasing systems, which were at varying stages of maturity, and the ways in which these had positively impacted the lives of Rotherham residents.

 

The Cabinet Member for Adult Social Care and Health advised that Scott Matthewman Assistant Director of Strategic Commissioning, Jacqueline Clark, Service Manager, Adult Care, Housing and Public Health and Garry Parvin, Joint Head of Learning Disability and Autism Commissioning were assisting with delivery of the presentation.

 

The Assistant Director of Strategic Commissioning provided background and context to the frameworks that were in place to support the wider commissioning process and the important outcomes that were seen from commissioning activity over the past 12 months.

 

Commissioning adult social care services involved planning, identifying and monitoring services required by Rotherham’s residents. It was essential to ensuring that the appropriate support was in place to meet the needs of local communities, and enabled residents to live fulfilling lives as independently as possible.

 

The following were cited as key considerations when services were commissioned:

 

·       Assessment of need.

·       Priority setting.

·       Service planning.

·       Service procurement.

·       Service monitoring.

 

Co-production was highlighted as an essential part of the process, as was ensuring sufficiency within the market and ensuring that the quality of services delivered was at the highest possible standard.

 

The legal framework that covered services delivered was outlined:

 

·       Duties under the Care Act 2014:

¾   Prevent, reduce and delay needs.

¾   Market shaping.

¾   Managing provider failure.

 

The purpose of Dynamic Purchasing Systems was explained.  This was a vehicle to support providers to achieve the highest possible service standards in order to bring them to the local market, which enabled the Council to draw on those services as and when required.

 

This resulted in providers being brought onto the framework but at that stage there were no purchasing commitments from the Council’s perspective.  It afforded flexibility and responsiveness of service delivery in line with the needs of service users and ensured value for money.

 

The Service Manager, Adult Care, Housing and Public Health described the dynamic purchasing system that was in place for home care and support services.

 

There were a total of 21 providers appointed, which remained the same as when last reported in January 2024.  Tier 1 providers were obliged to take requests for service under contract arrangements, and 9 of these were appointed with three in the North, Central and South areas of the borough respectively, which ensured capacity.

 

There were a further 8 Tier 2 providers, who were called upon in the event of capacity issues from Tier 1 providers.

 

Whilst one small provider had exited the market from Tier 2, as dynamic purchasing systems were open frameworks, it was quite simple to appoint a new provider.

 

There were 4 specialist care providers in place.  These were subject to additional training to address learning disabilities and mental health issues.

 

Since last reported, there was an upward trend in the number of hours increasing by approximately 1000 hours to 19,600 hours of activity per week, however capacity was consistently meeting demand.

 

By quarter 2 of 2024/25, 15 of the 21 appointed providers had completed the quality assurance process. Quality was constantly monitored and systems and processes were in place via which concerns were reported and investigated.

 

The position at the time of reporting was as follows:

 

·       2 providers were rated excellent.

·       8 providers were rated good.

·       6 providers were completing the quality assurance process.

·       4 providers were rated as requiring improvement.

·       1 provider was rated poor.

 

For those that were rated as poor or requiring improvement, there was a process in place to ensure that the issues identified were resolved, however the last grading remained in place until those providers had undergone a further full assessment process.  All affected providers had achieved the improvement plans that they were issued and had satisfied the Council that safe service was maintained.

 

The Service Manager, Adult Care, Housing and Public Health explained the position regarding key performance indicators. KPI 1, which related to utilising assistive technology was at 58% against a 75% target, which was lower than was previously reported in January 2024. KPI 2 which related to strengths based approaches training had increased to 92% against the 100% target.  KPI 3 relating to level 2 professional qualifications was at 55%. It was noted that nationally, level 2 achievements rates were 22%, so whilst 55% was pleasing it was the intention to push for further improvement.  For KPI 4, 90% of care staff had completed the care certificate and the remaining 10% were undertaking the certificate.

 

Results from a telephone survey conducted with services users was shared with members, which indicated positive experiences which had enabled service users and delivered quality services. In the event that concerns were shared through the survey, they were addressed via the contract compliance team.

 

The Service Manager, Adult Care, Housing and Public Health summarised the Mental Health Recovery Focussed Community Services framework. Lot 1 was a supported living service which supported individuals with mental ill health to live in the community. There were 3 distinct elements to the service:

 

·       Tenancy.

·       A registered housing provider responsible for managing the property.

·       The care and support provider.

 

The 3 care and support providers were CQC registered as some service users needed personal care and medication management.  There were 8 residential units of supported living accommodation occupied, 3 units were in the process of having tenancies finalised and a further 18 units were in development.

 

In relation to the 8 supported tenants, 5 had moved into the units from a hospital setting, 4 had reduced support needs through supported living and 2 were ready to move on to fully independent living.

 

The methods via which supported living was funded was explained, drawing links to the Care Act 2014, Section 117 of the Mental Health Act and

 

The Joint Head of Learning Disability and Autism Commissioning described the Learning Disability and Autism (LD&A) Supported Living framework. They explained that as was reported to Cabinet in September 2022, LD&A Supported Living was very well established in Rotherham, with an established base of national providers alongside a strong micro-enterprise presence which the Council were keen to develop further. However, it was noted that there was no dedicated support living specifically for people with Autism. It was further determined that market shaping was required.

 

Since that time, a Dynamic Purchasing System was implemented with 19 providers appointed, 14 of whom were new to Rotherham and all of whom were paying real living wage accredited or paying above national minimum wage in accordance with the Council’s social value agenda.  The framework allowed the Council to respond to need flexibly and responsibly.

 

With regards to next steps, it was explained that new dynamic purchasing system was due to be published at the end of January 2025.  This was intended to enhance community opportunities and offer greater choice for service users.

 

The Chaired thanked officers for the presentation and invited questions and comments from members.

 

Councillor Clarke wanted to understand how many Rotherham households were supported by the 5 home care and support service providers who were rated as poor or requiring improvement, and queried whether that was a CQC rating or one determined by the Council.  They also sought clarity on what processes were in place to improve their quality of service.

 

It was explained that the ratings applied were the Council’s own.  Whilst exact figures were not known, it was believed that approximately 500 hours of services were delivered by providers rated as poor or requiring improvement.  The process in place to address identified issues involved the Council working with the Registered Manager for the service to implement an action plan which targeted the required improvements over a period of 6 weeks. Progress towards the achievement of action plans was closely monitored by the Council’s Contract Compliance Officers. It was acknowledged that the decision to continue to apply the poor and requires improvement ratings after successful completion of an action plan potentially gave an unfair reflection of the actual quality of service that was being delivered, but the intention of this was for the Council to maintain vigilance until that improvement was sustained over a period of time. It was agreed that figures regarding the exact number of households served by providers rated poor or requiring improvement would be provided to Health Select Commission at a later date.  It was confirmed that all 5 affected were Tier 2 providers.

 

Councillor Clarke wanted to understand how scrutiny and oversight of the quality of services was undertaken, and how complaints were monitored.

 

It was explained that contact was predominantly via telephone, but where issues were raised there was direct contact.  Contract Compliance Officers were responsible for monitoring complaints in conjunction with the registered provider.  Individual services were expected to have a process in place and manage their own complaints, however, where these were not satisfied they did come into the Council.  Internal controls were extremely robust and were applied in addition to the requirements of the CQC.

 

Councillor Duncan wanted to understand the contracting arrangements in place with regards to the home care services contract that had commenced in 2019 and appeared to be due to come to an end in 2025.  They sought clarity around what the key considerations for procurement were.

 

It was explained that the service was due to end in March 2026. Service planning and co-production was taking place and the development of a different model would be considered if this was needed. This was expected to go to Cabinet in September 2025.

 

Councillor Duncan acknowledged that whilst the national achievement rate was 22%, they felt that a 55% achievement rate locally against a 100% target stood out as a potential cause for concern. They queried whether the contracts awarded incentivised improvement of qualification rates or sanctioned failure to achieve the target.

 

It was explained that any contract default notices were imposed based on a global review of providers, and would not consider qualification achievement rates in isolation.  It was felt that incentivisation was more successful method.

 

Councillor Duncan queried whether rates or pay and other issues driving staff turnover in the sector were contributing to low levels of qualified staff, and whether future contracts awarded would seek to address that.

 

It was acknowledged that there was the need to review the terms and conditions of care workers, particularly around the secured hours, however there was the need to balance that with the cost of service delivery. It was certainly the ambition to improve that position and mature conversations were had with providers through forums, alongside significant investment from the Council to continue to improve that moving forward.

 

Councillor Garnett wanted to understand how the Council was contributing to market shaping required for Learning Disability and Autism Supported Living, and how it was advocating for Rotherham residents as part of that process.

 

There was active engagement with providers through forums and robust conversations, the housing needs assessment was completed on a South Yorkshire basis which the council fed into, which considered demography, transitions and need.  There was also collaborative working with professional from Children and Young People’s Services (CYPS) to further understand need and support market shaping activities.

 

Councillor Thorp wanted to understand the differences between Tier 1 and Tier 2 services, and which of those Tiers the 33% of providers that it was noted had failed the targeted standards of care fell into.

 

It was clarified that Tier 1 providers were obliged to take on care work when asked to do so, with 3 providers in each geographical area to ensure service capacity. Tier 2 providers could be offered work where there was no capacity within the Tier 1 providers.  All of the providers that were rated poor or requiring improvement were Tier 2 providers.  It was emphasised that whilst there were concerns at some stage, they were not considered to be failing.

 

Councillor Thorp queried whether there was transition planning between CYPS and Adult Care services and whether Housing were involved that planning to ensure that those needs were considered.

 

It was confirmed that transition planning was vitally important and there was close liaison with colleagues in CYPS.  Where there were particular complexities of care, other services and professionals such as social workers were also involved in ensuring smooth transition. It was acknowledged that there was scope to improve further, and be more mindful of future need, and there was the aspiration to develop that level of sensitivity within service delivery and planning.

 

Councillor Clarke commented that Councillors were aware of the acute pressures on adult services and requested that Officers contact Councillors if there were any ways in which they could offer support.

 

Resolved:-

 

That the Health Select Commission:

 

1.    Noted the Adult Social Care Commissioning Update.

2.    Extended an offer of support to Officers in relation to involvement in co-production conversations and recruitment activities where it was felt that would be beneficial.