Agenda item

This report provides an update to the Community and Wellbeing Scrutiny Committee on the recommissioning of home care contracts.

The Chair invited Councillor Farah (Lead Member for Adult Social Care, Brent Council) to introduce the item for discussion. In introducing the report, Councillor Farah advised that the paper was presented to the Committee to note and see progress so far. He added that the 3 recommendations of the home care scrutiny task group from 2018 had been taken into consideration.

Gill Vickers (Operational Director Adult Social Care, Brent Council) highlighted that the recommissioning was good news as services would be place, or patch-based to support local people within their local communities. The report detailed that the Council had already achieved the providers uplift to provide the London Living Wage (LLW), had incorporated the Unison Care Charter, and there was a regular forum for providers. The challenge faced going forward would be linking home care patches with Primary Care Networks (PCNs).

Andrew Davies (Head of Commissioning, Contracting and Market Management; Adult Social Care, Brent Council) advised that, prior to the award of the new contract for homecare, Brent had been spot purchasing homecare provision from an old West London Alliance homecare framework. The benefits of the old framework, such as providing good control of hours and costs of homecare, were set out in the report, but the Committee were advised it was a generic open framework which meant the Council were working with in the region of 70 homecare providers which was felt to be too many to get a sense of the quality of providers and develop a working relationship with providers. The aim through the new tender was to move to a place based approach for homecare and implement the recommendations from the scrutiny task group, which they had been able to do. The Committee were advised that the new homecare contracts were Unison Care Charter Compliant, paid LLW, and had less zero hours contracts for staff. The Council had appointed 14 lead providers for homecare services in Brent; 7 for older people and physical disability services; 3 for children and young people services; 2 for learning disability services; and 2 for mental health services. The new contract went live on 1 February 2021 so any new homecare package a person in Brent had needed since February 2021 had been awarded through these new contracted lead providers. Andrew Davies added that only 2 providers in the new contract were not already delivering services in Brent prior to the award so the vast majority were all known to Brent. He advised that since the contracts went live in February 2021, officers had been meeting with providers every 4 weeks to update them on implementation and make clear expectations of service delivery. Feedback from service users and providers had been very positive so far.

Continuing to introduce the report, Andrew Davies advised that from the 4 April 2021 the transfer of existing care packages had begun, which had been done a patch at a time as outlined in the report. He advised that it was very much a service user led decision to move to a new homecare provider and no care package would be transferred without the consent of the service user. The team had written to all service users explaining the reasons for the award of new contracts and the benefits of them but also giving a very clear choice of whether to transfer. Any service users who decided not to transfer would be given a direct payment to enable them to commission any care provider they wished, including their existing provider. The aim was for transfers to be completed by mid-October 2021.

The Committee were reminded that the final lot of homecare awards had not been tendered and awarded yet, which was the award to the homecare framework. This was because the impact of the COVID-19 pandemic had shown a need for greater flexibility to place more providers on that framework through lessons learnt where the capacity to keep working through the pandemic was helped by the fact there were more providers to work with. Because of this officers wanted the flexibility to increase the number of providers appointed to the framework, and work with Brent based providers where possible, offering capacity building for bidding. Four sessions would be ran with businesses through April and May 2021 with a plan to tender through August and September and appoint to the framework with a go live date of November 2021.

The Chair thanked adult social care colleagues for their introductions and invited the Committee to raise comments and questions, with the following issues raised:

The Committee queried what oversight the Cabinet Lead had over the transition into the new patch based model and how it was managed effectively. Councillor Farah advised that he was regularly informed on this. He advised that service providers ensured they worked closely with health partners and accommodated local providers who knew the local workers and wanted to sustain them and give them the right training. He reassured Committee that he regularly engaged and made sure the scrutiny task group recommendations were taken fully into account and while the recommissioning was in the early stages he was confident moving forward.

Members of the Committee highlighted that, partly due to the pandemic, mental health issues were prevailing and asked what was being done in Brent and what work was being done with the NHS to achieve better outcomes for the residents of Brent. Councillor Farah highlighted the SMART programme that was geared towards support for people with mental health issues within adult social care. Andrew Davies reassured the Committee that mental health had played an important part of the homecare tender and the approach working with mental health service users was exactly the same as those with physical and learning difficulties and children and young people, which was very much a service user led approach. He advised that the mental health team worked with service users to determine if it was appropriate to transfer care or not, and it was recognised that the past year had been incredibly difficult for people of all ages with respect to mental health.

From a children and young people’s perspective, Brian Grady (Operational Director for Safeguarding Performance and Strategy, Brent Council) advised that homecare services for families with children with disabilities had been very important, as had ensuring the emotional wellbeing of children and young people was being supported during the pandemic. For some children classed as vulnerable they may not have been able to go to school due to their vulnerability during the pandemic and therefore homecare services had been very important. Brian Grady referred the Committee’s attention to some of the previous reports to the scrutiny committee that summarised in comprehensive detail how the Council had tried to ensure support to vulnerable children in particular with mental health needs. Now that the Council were in the recovery phase of the pandemic officers had been working very closely with NWL CCG on wellbeing recovery and focusing on interventions and themes that had been previously presented to Committee. Educational wellbeing was also a focus in schools. There was also Child and Adolescent Mental Health Services (CAMHS) for those with very severe clinical needs and the Council were looking to work with the voluntary sector to ensure it had good emotional wellbeing support. He expressed to the Committee that he believed the Council had the appropriate focus on that range of issues, and assured the Committee that a benefit of the commissioning process had been to promote positive care, support and wellbeing for children and families.

Robyn Doran also responded to questions surrounding mental health from her role as both ICP director for Brent and her role as Chief Operating Officer for CNWL NHS Trust, which was the provider delivering adult and children’s mental health services in the Borough. She advised that from an ICP perspective, post-covid they had recognised that inequalities was a real issue. As part of the inequalities work there was a drive for extra resources in the Borough and the ICP were working very closely with the Council and third sector and other partners targeting in particular Church End and Alperton in the first instance to reach out to those not being served well by mental health services and did not know how to access services. There was also work being done with the community which was particularly important due to the loss the community had suffered. She added that of the 4 priorities of the ICP mental health was one of them. From a CNWL NHS Trust perspective, Robyn Doran advised there was a major transformation for community mental health teams. New money had come into CAMHS and primary care where 7 new primary care posts working with GPs and PCNs would be appointed to build bridges with primary care practitioners and there was a lot going on regarding transformation locally. She offered to come to the Committee at a later date with an update on mental health.

In response to Committee members queries regarding how many carers were now paid the LLW and whether they were entitled to maternity benefits, Andrew Davies reassured the Committee that every contracted provider under this contract was required to pay workers the LLW as of 1 April 2021, and that the reference in Appendix 2 to paying employees was regarding the Unison Care Charter which dated back to 2013-14 therefore was out of date. In relation to maternity benefits, this would depend on the terms and conditions of employment with their employer and was not part of the specification or contract terms and conditions.

Discussion was held regarding specialism due to confusion over the report as to whether the Council had lost or gained specialisms. Andrew Davies confirmed that paragraph 3.4 of the report referred to the old West London Alliance homecare framework and was not the position now, with the position through the new contract being that the Council had contracted providers who had specialisms in the fields they had been appointed to. Under that old framework which was a generic open framework there were no different categorisations of care and any provider could join that framework and potentially be awarded packages whether for older people, people with disabilities or other. With the new contract officers had specifically commissioned four different elements of care and appointed providers who could demonstrate their capabilities to deliver services for each of those four specialisms and there was no overlaps. He hoped that gave the Committee assurance that those providers were firstly appointed on their ability to provide for that client group and secondly to work with the commissioning team and other teams in the Council such as the learning disability team for training opportunities to enhance the services that those needing specialist care were receiving. He added that this was not about saving money but about the Council investing into these contracts.

The Committee highlighted that out of the contracts only 2 were new to Brent with the remainder already having provided a service in Brent and queried what had changed with the new contract. They wanted to know whether under the new contract these providers were only providing to Brent and whether care workers were limited to serving only one patch. Andrew Davies advised that under the previous system a care provider could have, for example, 10 care packages in Brent with some in Kenton, some in Kilburn, and so on, with a small number of care workers expected to travel right across the Borough to deliver services. The new patch based model concentrated those providers into much smaller confined geographical areas of the Borough, enabling providers to plan routes and rotas to keep care workers within those areas, and gave care workers more guarantee of care hours or indication of the hours they were likely to be delivering each week, which had been less possible to do when spot purchasing on the previous framework. He added that the new model helped keep care workers employed locally meaning they were more likely to be sustained in Brent. Andrew Davies did acknowledge that there was no guarantee care workers did not have 2 jobs. In relation to areas the providers serviced, he confirmed that they did provide services in other boroughs with registered officers in other boroughs and a different set of workers to deliver that care.

Regarding the final contract yet to be appointed to the homecare framework, Andrew Davies informed the Committee that officers were yet to determine the exact number of providers that would be appointed. The view was that more than 8-10 as originally envisaged would need to be appointed due to capacity needed in the market after lessons from the pandemic to keep a viable homecare market. The way the Council appointed to that framework was still to be determined, and he would be happy to update the Committee as officers came forward with proposals for the tender of the backup framework as they were finalised.

In relation to the financial viability, Andrew Davies confirmed it was a fully costed model and not a pilot, with the Council making the investment into the contracts. The model would be the approach for the next 4-5 years.

The Committee raised the importance of culturally competent care from providers, and asked how the Council would deal with the quality assurance of independent providers. The Committee asked for the answer to also focus on those living in their own homes with Dementia and Parkinson’s disease. In relation to the consistency of care workers for service users with Dementia and Parkinson’s disease, Andrew Davies advised that this could be improved with the new contracts through the better guarantee of hours, enabling care agencies to plan rotas, routes and care workers. He added that while dementia was a specialism it was also a part of the day to day of care work as the majority of those older people receiving homecare services did have some form of dementia. In relation to cultural competency he advised that the vast majority of homecare workers in Brent lived in and around the Borough and were reflective of Brent’s diverse communities which helped to meet the cultural needs of the individuals they worked with. It was rare that the Council had received feedback that a provider had been unable to do that, although they were aware of areas that could be improved upon such as recruitment of more male carers. Quality assurance he felt was crucial to this and within the commissioning service there were 2 supplier relationship managers and 4 provider relationship officers who looked at quality assurance including the payments of the LLW, minimum use of zero hours contracts, ensuring consistency of care workers and other aspects that were worked into the service specification. He advised that a really important part of quality monitoring was ensuring the services were client led, and officers did reviews with service users to get direct feedback from them, looking at complaints and quality concerns that came through that process to build up a picture of the quality of care being delivered. Ensuring there was a tangible link between a care plan and the outcomes being expressed when setting up care plans and what was being delivered by care agencies was important. Finally he added that homecare providers had been appointed because of their specialisms and officers were looking at training opportunities for the providers and seeing how they could best ensure care workers were using best practice and the latest techniques working with those people.

Councillor Farah summed up the oversight and assurance he sought in relation to service users and carers, advising that the contract was in its early stages and issue monitoring was important when dealing with external providers with their own arrangements. It was important to the Council that there were clear outcomes moving forward.

The Chair drew the item to a close and invited the Committee to make recommendations, with the following RESOLVED:

i)              To note the report.

ii)             To request that the Committee was provided evidence that the London Living Wage was being paid to all care workers under the new contract.

iii)           To request that information was provided to the Committee in the future regarding additional efforts made to meet the cultural needs of those receiving homecare services.

iv)           To ensure that in future reports to the Committee the mental health needs of children and young people are being addressed as part of the report.