Agenda item
Home Care Recommissioning
This report provides an overview of the homecare re-procurement, including an assessment of the different factors considered as part of this process. A version of this report has previously been taken to the Policy Co-ordination Group (PCG) for comment and direction, and the outcomes of that discussion are now reflected in this report.
The report further comments on how the proposed model will meet the objectives identified as part of the CWB Homecare Task Group report of February 2018 and will make the council fully compliant with the Unison Care Charter.
Minutes:
Councillor Farah (Lead Member for Adult Social Care) introduced the report which sought the Committee’s input into the recommissioning the Homecare Contract. Councillor Farah said it was hoped to incorporate the London Living Wage and reduce the number of zero hour contracts while improving the Homecare Provider Network.
Andrew Davies (Head of Commissioning, Contracting and Market Management) explained the reasons behind the recommissioning and the current position following the closure of the West London Alliance Homecare Framework. He highlighted the current issues which focussed around the high number of providers and the Council’s ability to monitor the quality of delivery and the employment terms of the employees. The Committee’s attention was drawn to the paragraphs in the report (5.1 onwards) describing the new Homecare model and the intention to move away from geographical commissioning to a patch based system aligned to the 13 primary care networks. In addition, there would be larger patches where specialist services that didn’t fit into the 13 patches would be commissioned. The overall provider numbers would reduce to between 13 and 25 enabling closer monitoring and greater consistency of care workers.
The Chair thanked Councillor Farah and Andrew Davies for the introduction and invited questions from the committee.
In the subsequent discussion, the Committee queried how the new model would fit in with the Borough Plan and how it would work robustly to improve performance from the existing commissioning and went on to ask questions around how the new model would enable closer monitoring of providers, how eliminating zero hour contracts would meet the increasing demand for services and would there be enough care workers with relevant skills. Additional questions were raised concerning the diverse range of needs in the Borough and how the smaller number of providers would meet these and what level of research had been carried out with service users in the light of frequent complaints and the needs of vulnerable people.
Further questions from the Committee covered the issue of workforce training, risk assessment, the idea of a holistic approach where carers linked their clients with other services, the option and benefits of bringing services in-house and the potential of partnerships and outsourcing.
Councillor Farah explained that the issues of the London Living Wage and zero hour contracts closely affected the residents of Brent, particularly women, and therefore a minimum of 16 hour contracts would be offered. He said the new system would be an improvement on the current model as the Council would have more control, ensuring contracts fell in line with Borough priorities. Andrew Davies responded to the Committee’s questions advising that growing demand for services and a greater complexity of user needs was envisaged year on year in the future and working with a smaller number of providers would enable better scrutiny of service quality and allow the monitoring staff to build closer relationships with the providers.
Andrew agreed that individual worker contract hours was a complicated issue and some workers liked the flexibility, but it was preferable to have as few zero hours as possible unless the worker genuinely requested it. Provider feedback showed that their own preference was for fixed hour contracts as they were better able to retain staff and plan the workforce effectively. On the question of the diverse range of skills required to meet the needs of service users, Andrew responded that staff retention was a factor here and this should improve under guaranteed hours contracts and the commitment to pay the London Living Wage. In terms of the skills needed to support the Borough’s diverse population, he explained that there was already a number of specialist care providers serving the smaller communities, and the tender process would test their suitability. Phil Porter (Strategic Director, Community Wellbeing) added that as well as the patch providers there would be an alternative choice of providers available.
Addressing the question about service user consultation, Andrew Davies said there was continuous feedback showing that the service was performing well. He acknowledged that with 1700 daily users there would always be issues and complaints but said the tender process would facilitate the opportunity to select the best quality providers and reject those falling below the desired standard. Andrew explained that training was a key challenge, particularly keeping workers up to date with constantly changing needs and the development of new equipment, and this issue would be covered in the tendering process with providers expected to present comprehensive training plans. There would also always be additional support from Council in-house training services. On the topic of linking up services, Andrew said he appreciated the sentiment but it was not within the scope of the current proposal. He would however take it on-board and look into how it might be incorporated. Phil Porter added that improved collaboration with GPs through the primary care networks aimed to link chosen providers up with GP practices looking at the Public Health Act and the ‘making every contact count’ initiative.
Andrew Ward (Head of Finance), responding to the Committee’s question concerning the costs and benefits of bringing services in-house, reported that this had been looked at but would be too costly when taking into account staffing on-costs and pensions. Phil Porter confirmed that the costings were estimated to be £34m against £27.9m based on staffing costs but the Council’s overheads and operating costs needed to be considered as well. He said there were no clear benefits to bringing the service in-house other than staff stability and terms & conditions but confirmed that the discrete small Re-enablement support planning team had been retained in house and this could be built on over time by bringing in house reablement care workers. Andrew Davies remarked that to bring a service of this scale in-house would bring significant risks and that Adult Social Care was a delivery service governed by statutory regulations. He suggested that any future move towards increasing in-house services could only safely be considered on a step by step basis and on the question of any possible external partnerships, confirmed that the new model would allow more potential collaboration with partners.
In response to the Committee’s question on how robust contract management would be applied, Councillor Farah reiterated that the smaller number of providers would enable closer monitoring. Phil Porter added that the Care Quality Commission (CQC) monitored providers and the rating currently showed that Brent outperformed most other boroughs in the quality of home care and residential nursing care. He advised that quality standards for London due to be released in April 2020 would provide a benchmark to compare providers across whole of London. Dealing with the Committee’s question about care criteria, Phil Porter responded that all care needs were assessed and full support to daily living activities was provided. Andrew Davies added that the care providers made care plans with the service users to ensure that all needs falling within the Care Act were met. If a service user was not happy they should report their concerns to the Council for action. Phil referred the Committee to Appendix 3 of the Report detailing the assessment criteria.
In response to a question from the Committee, Andrew Davies said that the procurement aimed to differentiate between some of the services requiring specialist skills - for example, mental health vs. older people with dementia. He acknowledged it would be a challenge for some providers in the market to meet expectations around those specialist services but the intention was to move toward a model that delivered identified specialist skills where needed. With reference to risk assessment, Andrew said that most users were elderly and disabled so the majority of providers worked within the West London Alliance framework but the aim was to move beyond this and reintroduce specialist services. Brian Grady offered an example from Children’s Services explaining children needed similar types of care but in very different circumstances and the management of risk was achieved by working with smaller group of providers to enable needs were met. Phil Porter said that previous drafts of this report had included a variety of options for analysing risks and he could provide the Committee with a summary of how risk would be identified and managed during the procurement process. The Committee emphasised that risks should be explicit for Scrutiny.
Councillor Farah confirmed that there would be rigorous assessment of potential new providers and issues raised at this meeting would be followed up. Andrew Davies highlighted changes in how providers would be required to deliver services and the use of e-brokerage and electronic tracking systems would enable more efficient monitoring and closer engagement with users to process feedback.
The Chair thanked everyone for their contributions and the Committee then RESOLVED to approve the recommendations set out in the report that:
1. Scrutiny note the financial implications to the council of delivering a London
Living Wage compliant homecare service
2. Scrutiny are asked to approve the proposed model and confirm that
implementation of the model as set out will deliver the outstanding
recommendations from the CWB Homecare Task Group report of
August 2018.
3. Scrutiny are further asked to confirm that the proposed model will deliver
the objective of making the council fully compliant with the Unison Care
Charter.
Supporting documents:
- 06. OSC Homecare Commissioning Report, item 8. PDF 145 KB
- 06a. Appendix 1, item 8. PDF 281 KB
- 06b. Appendix 2, item 8. PDF 189 KB
- 06c. Appendix 3, item 8. PDF 383 KB