Agenda item

Cabinet Portfolios: Adult Social Care and Health

                             Housing

Strategic Directorate: Adult Care, Housing and Public Health

A short presentation introduced the Adult Care, Housing & Public Health Market Position Statement 2020/21, setting the context and outlining duties under the Care Act 2014.  The Rotherham Market Position Statement (MPS) would cover all aspects of commissioning requirements for Adult Care, Public Health and Housing from 2020/21 onwards, setting out the Council’s intentions and expectations.  Increasingly the role of housing was viewed as fundamental to delivering desired outcomes, not just in terms of permanent accommodation but also buildings to support general needs, hence inclusion of elements of housing in the MPS. 

Provider feedback had informed the development of the MPS, with commissioning intentions and timeframes named as the most important thing from a business perspective - what was wanted and when, how much money was available and how to bid in.  A move away from traditional provider/commissioner relationships towards one of greater partnership and co-design/co-production, with a strong values base, was envisaged.  Regular communication, engagement and relationship building with providers would be essential,  and less segregation of providers, especially where cross-cutting issues emerged.

Although a non-digital document would be published in April 2020, Members were informed that it would primarily be an on-line MPS to allow for regular editing and refreshes to keep the content current and relevant. The core content to populate it initially would be drawn from the paper included in the agenda pack.  Information would be set out under key themes in five broad areas to facilitate people being able to go straight to pertinent issues without having to go through a lengthy paper document:-

1 Understanding Demand – Introduction, Demographic Change and Service Take-up

2 Understanding the Market - Market Overview, Self-funders, Quality, Workforce, Sustainability and Resources

3 The Vision - Models of Housing, Care and Support and Commissioning Intentions

4 Commissioners Approach to the Market - Managing the relationship, Future Support and Key Dates and Timelines

5 Useful Links and Key Contacts

More detail was provided for each of the three specific commissioning intentions, as set out below.

“Act to help yourself”

•        Further test digital solutions e.g. Alexa technology

•        Support community capacity building and neighbourhood working

•        Implement “Active Solutions” Pre front door with Age UK – voluntary and community sector (VCS) mobile information and advice hubs

•        Support and jointly develop town centre unpaid Carers Hub with Crossroads

•        Continue to promote “5 Ways to Wellbeing” – using key tools to keep people safe

“Act when you need it”

•        Mobilisation of new model for Home Care April 2020 - 1300 people in customer base  and a successful tender process with social value aspects that resulted from that tender with the providers all agreeing to pay their staff the real living wage

•        Explore Dynamic Purchasing System for a range of Learning Disability and Autism services including accommodation/support - mechanism to bring in new providers or to develop more coherent pricing, learning from the use of the dynamic purchasing system for home care

•        Increase the number of flexible Core & Cluster Supported Living units for Learning Disability/Autism – Transforming Care Partnership/Preparing for Adulthood etc. - more choice and preparation for the next group of people who are going to come into services as people who transition with complex needs will require different solutions to older people with learning disabilities in service a long time

•        Recognised Provider List for housing options –  housing partners to work with the Council – call  off when needed

•        Review Mental Health social care pathway and develop a new offer including accommodation/support – limited choice at present

•        Develop Domestic Abuse Pathway and test new ways of working – interface with other services not only around the Care Act, new legislation likely with new requirements

•        Review Housing Related Support pathway for Adults – those who do not meet assessment criteria

•        Further develop the Housing First model and homelessness prevention interventions - maximising grant funding opportunities – already increased from 20 to 30

“Act to live your life”

•        Mobilise the new Healthwatch service following tender process – Citizens Advice Bureau

•        Mobilise the new Advocacy service following tender process - built in social value drivers so Cloverleaf will need to sub contract some of the non-statutory to the local voluntary sector

•        Implement a Quality strategy – based on LGA/ADASS Quality Matters v.2 incorporating TLAP/NICE/CQC measures - improved standards in Rotherham but no complacency and it is hoped new national standards result, although Rotherham was looking to adopt some of the principles of early drafts

•        Develop services for people in receipt of direct payments e.g. Personal Assistants

•        Support for unpaid carers – golden thread

•        Further development of Micro Enterprises

An example of a digital MPS in another local authority was shown to indicate how Rotherham’s MPS might look and how to navigate around it once in place.  It was also expected to link in data from the Joint Strategic Needs Assessment.

Cllr Roche highlighted that looking to the future, although some adult commissioning work already took place with the Clinical Commissioning Group (CCG) and partners in the integrated Rotherham Place Plan, discussion regarding commissioning levels and whether some might move up to regional level had been held.  Council commissioning would also be looked at and whether more links could be made.

Members questioned whether it would be advantageous to have numerous small providers, operating a range of models, in order to meet the Care Act duties and whether the market could be governed to keep money in the local economy to ensure an understanding of and focus on specific Rotherham needs. This would be the desired direction although inevitably some contracts would be awarded to large national organisations. In the Home Care offer, two tiers of providers had been established with the second for growing smaller, local businesses.  In the past, frameworks had been quite restrictive but the move to a dynamic purchasing system allowed new providers to be added. The second tier was also designed for smaller volumes of work which could be advantageous for smaller providers.  Micro enterprises and third sector organisations helped to create the mix.  The Social Value policy was important and providers, especially Rotherham providers, were increasingly on board.

Clarification was sought on what support would go into the carers’ hub. This was a question of not looking at adult care in isolation but linking in other services, optimising the use of the building, for example with meeting rooms, and also being able to provide support for others if resources could be channelled. Alignment with neighbourhood working and joint work with health partners would also be important.  The CCG was a big investor into services for carers so there should be alignment and even scope potentially to pool monies and look at joint commissions and joint investments. It was acknowledged that some groups and carers groups would need support and focus.

Within the new operating model, a lead officer had been appointed for carers and one of their first tasks would be to develop a new carers strategy.  This would need to reflect the points made about the diversity within carers in terms of environment, age and the people for whom they provided care.

Members asked about quality assurance and control regarding residential homes and ensuring quality in services delivered in people’s own home.  Control in residential homes was difficult because ultimately people chose where they wanted to live and the Council also had no powers to enter people’s own homes with regards to inspection.  The long standing contracts and compliance function was looking at rebranding on quality but with no change to the standards. That service regularly went into care homes and liaised closely with the CQC.  Any issues identified were raised with the establishment in the first instance and if improvement was not forthcoming through informal means then formal processes would be initiated with action plans, often shared with the CQC.  Community services were equally important and all services were monitored.  Services provided in people’s own home were more challenging as there were a large number of people each with their own requirements and views but feedback was elicited through follow up calls when care packages had been brokered, which helped to address any issues.  Electronic monitoring also gave assurance that care workers had been to the person’s home.  Quality was a golden thread running through the new adult care pathway as being everyone’s responsibility and the intention was to identify concerns through collaborative work.

Members queried whether the action plan for a person living in their own home with dementia would include a named carer in the case of any issues to discuss.  The CCG were remodelling the dementia pathway from a health perspective and a key aspect would also be how the adult care pathway fitted in.  Training and awareness raising would follow.

Concerns were raised about the paucity of mental health data and what measures would be taken to address this as it should be informing all the relevant issues, such as housing.  Data was crucial to effective commissioning and one reason for gaps was due to health information being on SYSTM1 and the Council having Liquid Logic as its core system.  Present information to inform the MPS had been limited, but the Rotherham Health Record allows for portal access to open up possibilities.  Better data was needed and it was a priority for the mental health pathway this year.  A further concern was the lack of data regarding transitions from children’s services, especially the mental health cohort, as it was essential for commissioning housing, supported living etc.  Information came across from CYPS to adults because both used Liquid Logic, meaning a good overview of younger people.  The MPS focused primarily on people aged 18 plus and it was more a question of data around the existing cohort.

Questions in relation to prioritisation of older people’s accommodation in certain wards with limited land availability for development and subsequent allocation of older people’s housing were taken back for a response from Housing.

The officer was thanked for his informative presentation.

Resolved:

1)    That the information presented be noted.

2)    That Improving Places Select Commission scrutinise any issues in relation to the Market Position Statement and Housing.

3)    That Health Select Commission scrutinise issues regarding mental health data and the development of the mental health pathway.