Issue - items at meetings - Community Short Term Services

Report of Chief Operating Officer, Brighton and Hove Clinical Commissioning Group and the Executive Director of Adult Services (copy attached).

(1)    That the proposal to withdraw from providing Independence at Home services at New Larchwood is not agreed. 

(2)    That approval be given for the proposals for Independence at Home to concentrate on providing short-term reablement services, with the exception of those services provided at New Larchwood.

(3)    That the general update on Community Short Term Services be noted. 

51.1    The Committee considered a report of the Chief Operating Officer, Brighton and Hove Clinical Commissioning Group and the Executive Director of Adult Services which proposed changes to Independence at Home (the Council’s directly provided home care service) as a result of developments in the home care element of Community Short Term Services.  The report also provided a general update on Community Short Term Services including those areas highlighted in the June 2013 report.  The report was presented by The Clinical Commissioning Manager, Short Term Services. 

51.2         The Clinical Commissioning Manager explained that a multi-agency group had been established to look at the arrangements for commissioning home care within CSTS.  In order to offer service users a more streamlined service and to make the best of existing resources, the CSTS Project Board agreed that Independence at Home and the CSTS home based care team should become one team, integral within the CSTS model. The implications for this decision were set out in paragraph 4.6 of the report. 

51.3         As Independence at Home focused on CSTS work it was considered necessary to withdraw from providing care at New Larchwood.  To enable this to move forward, the care element at New Larchwood would need to be provided by an independent provider.  The implications for service users and staff at New Larchwood, should the service be tendered to a private provider, including the TUPE process, was set out in paragraph 5.5 of the report. 

51.4    Councillor Summers reported that New Larchwood was in her ward and she was aware of concern as to whether service users would receive the same level of care if the proposals were implemented.  Councillor Summers referred to the TUPE arrangements and asked what this meant in terms of protected conditions of employment.  Would it be to the detriment of current working arrangements? 

51.5    The Clinical Commissioning Manager, Short Term Services replied that there would always be an assurance that the care provided at New Larchwood would be the same or better than at present.   

51.6    The Executive Director of Adult Services reported that staff could transfer to a new provider on the same terms and conditions through TUPE arrangements.  However, it was possible that the new employer could change the terms and conditions. Staff had an opportunity to apply for vacancies within the council. 

51.7    Councillor Bowden commented that he thought the process of TUPE was to protect workers’ rights.  He was pleased that staff had the option of applying for jobs within the council and asked if there were jobs available.

51.8    The Committee Lawyer explained the TUPE arrangements.  At the point of transfer, current terms and conditions were protected.  However, terms and conditions could be changed at a later date.  

51.9    Geraldine Hoban stressed that although the implications for people working in the service were important, Commissioners had to consider how to make use of scarce resources.

51.10  The Head of Commissioning & Partnerships agreed that it was important to make the best use of available resources.  It made sense to combine teams to provide a joined up service.  The proposal was for Independence at Home to be part of Short Term Services.  This would make the best use of the staff concerned.

51.11  Councillor Meadows informed the Committee that she remembered New Larchwood opening in 2004.  It was considered to be gold star care for the elderly, with care being delivered in a holistic way.  Staff were skilled and highly regarded, and people praised the care and facilities.  Councillor Meadows asked if service users and community needs had changed.  She further asked if proposals were in place to make money or to provide a better service.    Councillor Meadows stated that she did not believe that service user’s needs had changed.   

51.12  Councillor Mears also remembered the opening of New Larchwood.  She stated that over the years there had never been any report of concern about the facility.  The clients at New Larchwood were content and happy and Councillor Mears was concerned that service users would have to face changes at their time of life.  She expressed the view that it would be interesting to make comparisons between the care at New Larchwood and Patching Lodge.  Councillor Mears had a number of concerns about Patching Lodge. 

51.13  Councillor Mears referred to paragraph 5.7.1 in the report.  This stated that the proposals for savings in the Adult Social Care budget for 14/15 included proposed savings of £150k in 2014/15 from New Larchwood.  Councillor Mears did not believe that that amount of savings equated to changing the service. 

51.14  The Head of Commissioning & Partnerships agreed that staff at New Larchwood had worked extremely well over the years..  However, when New Larchwood was established, it was always the intention to have an in-house care team for a temporary period.    It was necessary to make the best use of resources.   Meanwhile the quality of the work of the independent sector was regularly monitored.

51.15  The Executive Director of Adult Services stressed that the concept of the service was not being changed and it had been originally planned to transfer the service to Patching Lodge.  The main reason for the proposals was to change to Community Short Term Services so that service was free at the point of delivery. 

51.16  The Executive Director referred members to paragraph 5.2.2 which reported that 8 tenants at New Larchwood received support from independent providers. 

51.17  Councillor Summers considered that that £150k was a ‘drop in the ocean’.   Although she accepted that the service would be monitored, she expressed concern that staff performance might be affected if the same staff were transferred and later found themselves on less favourable terms and conditions.  Councillor Summers stated that she was inclined to say that officers would have to find the £150k elsewhere.  

51.18  Geraldine Hoban referred to the charging issue set out in paragraph 4.6 of the report and asked how this would be addressed.  This stated that ‘currently people are subjected to a financial assessment and might contribute to the cost of Independence at Home, but people who receive CSTS homecare do so free of charge which is inequitable.  This model will require the Independence at Home service to be free of charge for service users of CSTS for up to 6 weeks.’  

51.19  The Clinical Commissioning Manager, Short Term Services replied that the main reason for the proposals in the report was not to provide savings but to have a better model for Community Short Term Services.  The proposal would provide a more equitable service.  

51.20  Councillor Wakefield was pleased to see the work being carried out in relation to a discharge planning task and finish group and subsequent action plan (paragraph 6.5.3 in the report).  Councillor Wakefield said she knew New Larchwood and was concerned about the proposals for changes. It was a service that worked well.   She knew how difficult it was for staff to keep up moral when terms and conditions changed.  Councillor Wakefield wanted reassurance that these matters had been fully considered.

51.21  Councillor Bowden asked if staff at New Larchwood would be made redundant if they were unable to find jobs within the council.  

51.22  The Executive Director of Adult Services replied that there were a number of jobs available within Adult Social Care but not enough for everyone. 

51.23  The Head of Adult Social Care (Provider) explained that up until the TUPE transfer, staff could apply for other jobs within the council.  Jobs were available at the same grade and pay.  Any remaining staff working at New Larchwood would be transferred over through the TUPE arrangements.  

51.24    Janice Robinson asked what the consequences would be if the Committee did not agree to bring the two skilled teams together. 

51.25    The Executive Director replied that it would leave a smaller chargeable service at New Larchwood, plus the need to make £150k savings elsewhere.   

51.26  The Head of Commissioning & Partnerships informed members that she appreciated that clients at New Larchwood did not want change; however that issue would be carefully managed.  Some people were currently receiving a free service and some were charged.  This was not equitable.  

51.27  Councillor Meadows stressed that the service was only free for a 6 week period and she did not see why the current arrangements were inequitable.  She could not see why Independence at Home was withdrawing from New Larchwood.

51.28  The Head of Commissioning & Partnerships explained that Independence at Home was a reablement service and the majority of work was short term and generated from hospital discharge.  The Executive Director stressed that the proposals brought two teams together to have a more flexible service.  New Larchwood was a long term service which was provided in the main by the independent sector. 

51.29  The Committee Lawyer pointed out that paragraph 2.2 was a hybrid recommendation.  Independence at Home was for short term reablement and a matter for the whole committee.  The decision to withdraw from New Larchwood was a matter for the council members.  The Committee Lawyer proposed splitting the recommendation to (2.1) To agree to the proposal to withdraw from New Larchwood (council members only to vote on this recommendation).  (2.2) To agree the proposals for Independence at Home to concentrate on providing short-term reablement services (The whole committee to vote on this recommendation, if applicable).  Recommendation 2.2 would become 2.3.

51.30  At this point in the proceedings the council members of the committee voted on the new recommendation 2.1 – To agree the proposal to withdraw from providing Independence at Home services at New Larchwood.  There were no votes in favour of the recommendation.  Members were then asked to vote against the recommendation.  8 members voted against the recommendations and two members abstained from voting.   This was Part B – Council Business.

51.31  The Service Manager, Home Care was asked to explain how the Independence at Home Service could be split in two.  She explained that this was possible by having one team for the short term service and one at New Larchwood.  However, at the moment the two teams worked together and this course of action might cause problems. 

51.32  Councillor Mears commented that if agency staff were being used it could cost more than £150k.  The Service Manager, Home Care replied that there were currently vacancies in the service which would need to be filled if the council retained the service.  Councillor Mears commented that if there were vacancies, staff were doing an excellent job.

51.33  The Committee Lawyer asked if there was any reason on a practical level why the two teams could not merge and work together with Independence at Home staying as it was.  If the result was just a shift in working patterns it begged the question why the committee had to make a decision.  The Executive Director of Adult Services replied that there is a difference in the type of service provided and charging.  Officers wanted to move Independence at home so that it forms a part of the short term reablement service which is required to be free at the point of delivery. 

51.34  At this point in the proceedings the whole committee voted on the new recommendation 2.2 – that approval be given for the proposals for Independence at Home to concentrate on providing short-term reablement services, with the exception of those services provided at New Larchwood.  This was Part A Jointly Commissioned Section 75 business.   The recommendation was agreed.

51.35  RESOLVED – (1)     That the proposal to withdraw from providing Independence at Home services at New Larchwood is not agreed. 

(2)       That approval be given for the proposals for Independence at Home to concentrate on providing short-term reablement services, with the exception of those services provided at New Larchwood.

(3)       That the general update on Community Short Term Services be noted.