Agenda item - Home Care Services

Brian Doughty – Head of Adults Assessment – 10.15-10.45am

Debbie Greening – Contracts Manager

83.1         Brian Doughty – Head of Adults Assessment presented information which included:

1.                  The service was assisting individuals through rehabilitation and re-enablement back to independence. The process began after hospital discharge and took around 6 weeks. Research had shown that there was a greater chance of success if introduced within the first few weeks of recovery.

2.                  Care packages were individually designed according to the person’s needs.

83.2         Questions and answers included:

1.                  How did it work when patients were discharged and needed Occupational Therapist equipment installed at their home? Members were told how the hospital team would assess the patient’s needs before they were discharged and would have the appropriate equipment installed before the patient was discharged from hospital. Further clarification was that there was a statutory obligation to undertake a Community Care Assessment when requested. The Social Work and Care Management team, (who are based at the County Hospital) carry this out before the patient is handed over to the provider ie. the community.

2.                  What happens if a person is assessed and isn’t entitled to have any services? All individuals have a statutory right to have an assessment. After having an assessment, if the individual is identified as not requiring any services, the individual can request a reassessment if desired.

3.                  All services are chargeable and national guidance sets out the criteria for this.

4.                  What happens if a patient refuses care? Members were advised that there was nothing that could be done as it was the person’s choice.

5.                  All individuals were means tested, which included a financial assessment. These were national requirements. If individuals receiving care had monies that were above £23k threshold, they would be required to need fund their residential care package. It was noted that the vast majority do not have to pay, or pay a minimum for their care.

6.                  It was confirmed that there were reductions in the budget over a number of years. However the success of the re-enablement packages would assist the service in dealing with these budget shortfalls.

83.3         The Chair thanked the Head of Adult Assessment for the information and answering questions.

83.4         Debbie Greening – Contract Manager presented information on the provision of Home Care on Brighton and Hove, which included:

1.      Background - Most home care is provided by 14 Independent Providers on the council’s contract (re-tendered in June 2012)

2.      Facts and figures- An average of 1500 service users were seen per week, approximately 20,000 separate visits per week, delivering 12,000 hours per week, and there were around 700 home care workers.

3.      service specification – care and support plans should detail personal care, medication, goals or outcomes desired by the individual

4.      Issues and challenges- staff recruitment and retention, financial constraints and higher demands and more complex care.

83.5         Questions raised and answered:

1.      Was there a financial limit on care packages, otherwise would individuals be requesting expensive desires? Home care is a chargeable service, of which the spend from the community care budget is £11 million. The skill of the social worker is to determine whether a request is either a “want” or a “need”. The provision of home care services is a statutory requirement.

2.      Were there examples of services that were not accessible in the community but were offered in residential care? It was advised that this was not something that was happening at the moment.

3.      What skills would home care staff need in meeting individual’s needs? Members noted that more complex healthcare in the terms of peg feeding would be needed and that care staff would be expected to trained to deliver these specifics. Most people wanted their end of life care at home (not in hospital); which meant that a type of hospice care would need to be delivered in the future. The service needed to meet the needs of individuals and gave individuals the choice to take control of their home care provision.

4.      How confident were vulnerable older people to make decisions about their care? Most people wanted control and were assisted through the decision making process.  Personal budgets were monitored annually. Some individuals asked the council to manage their budgets, or asked for assistance when they had a problem. They would contact their social worker or Access point (the council’s telephone contact point into adult services). Members were told that home care services were moving towards  a  more outcome based approach.

5.      It was clarified that the provider would need to skill up their teams to meet the increasing needs of individuals. Staff would need to be aware of the individual’s deterioration and provide additional support whether it’s through equipment, technology or knowledge, right through to end of life care.

6.      How would the provider ensure that there was consistency of staff when visiting individuals? The contract had performance indicators build into it, such as consistency of staff, though it needed to be reasonable in its demands. This was dependent on the frequency of visits and how many carers were needed per individual.

7.      The Electronic Care Monitoring System (ECMS) was bought in by the council to monitor all the contractors. Reports were used to respond to queries, analyse and monitor data on continuity of staff, timings, other care provision to performance targets.

8.      Jo Tulloch- Home Care Assessor from Impetus confirmed that in general the continuity of staff had improved.

9.      Whether the individual was answerable to the GP? It was noted that the main link with the individual was with the home care assistant and that the District Nurses were more of a point of contact rather than the GP. Though in cases when the individual did not have a family member then the care agency would contact the GP if they became unwell.

10. The Lay Assessors would also identify issues and include these in their report to the contract officers.  All cases of abuse were followed up as it was a statutory duty to protect vulnerable adults. 

11. It was confirmed that the provider would have contact with the family if the service user had made a request to do so.

12. How would people choose their provider? The council will have a quality portal where they would publish performance data for providers proving more information to assist people when making choices about providers.

13. Were providers’ staff paid less than the £7.16 living wage? During the recent procurement process the council had awarded a higher score to those providers who paid more then the living wage. Most providers said they would do so on an average basis and would meet the national minimum wage. It was noted that the providers are paid £14.50 or £16.50 by the Council for an hour of care, but the Council has no control over what rate an independent provider chooses to pay their staff.

14. What language skills did provider staff have? The contract stipulated that the provider needed to meet the diversity of the service users and had to have basic English. This was included in the evaluation process for the tender.

15. Members were informed that 14% of the provision was provided in house by the Independent at Home team. The maximum charge to service users of this service was £21.50 per hour.

83.6         The Chair thanked the Contract Manager for an extremely informative presentation.