HERTFORDSHIRE COUNTY COUNCIL
ADULT CARE AND HEALTH CABINET PANEL
THURSDAY 11 SEPTEMBER 2008 AT 10.00AM
Update on the Home Care Contracts AND DEMENTIA HOME CARE SERVICES
Report of the Director of Adult care Services
Author: Guy Pettengell, Acting Head of Contracts (ACS)
Tel: 01438 844269
Executive Member: Sally Newton (Adult Care and Health)
- Purpose of report
1.1To provide a general update on the implementation of the recently re-tendered home care contracts.
1.2To provide a further update on the implementation of specialist dementia services in both the countywide home care contract (effective 1 April 2007) and the recently re-tendered local home care block contracts (effective 1 April 2008).
2.1The Countywide Block Contract
2.1.1In February 2007 the contract between HCC and Leonard Cheshire for the provision of the countywide home care service transferred to Goldsborough Home Care Services (GHC).
2.1.2Although the transfer was carried out successfully, Goldsborough Home Care Services began to experience service quality issues five months into the contract. The contract with GHC was suspended in August and an action plan implemented to resolve issues.
2.1.3Ongoing work with this provider has stabilised the service and they continue to work with the Authority to introduce the initiatives in line with the contract.
2.2GHC and their Specialist Dementia Services
2.2.1As outlined in the previous report, the new contracts included a clear requirement for the new contractor to provide a robust countywide home care service for users with a medical diagnosis of dementia. Since the introduction of the contracts ACS has agreed targets with GHC which are to be monitored on a quarterly basis.
2.2.2As stated in the previous report, on transfer LC were providing a total of 920 hours of specialist service per month in support of users with a medical diagnosis of dementia. This equates to an average of 11,040 hours per annum, or just over 2% of total provision. Within the first year GHC had increased this by a further 17% to 1156 hours per month with an actual provision (by the end of January) of 12,969 hours of service provided. This equates to around 3% of their total guaranteed volume, against the 10% target.
2.2.3Between January and the end of April 2008, GHC increased their provision further to 1133 hours per month. This equates to an average annual volume of 13,596 hours per year. However it has not been possible to establish the correct figures from GHC between April and the end of July. This highlights an issue with the monitoring arrangements as, currently, IRIS is not able to record services provided for specialist dementia. ACS therefore intends to consider the incorporation of these referrals within the RR1 form (which should be completed by the Area teams on a monthly basis).
2.2.4It has been noted that GHC have also increased the area of provision and are now able to offer services across the whole of Hertfordshire although there remains some small pockets where provision is difficult. This includes the villages around St.Albans and some of the smaller locations in East Herts.
Figure 1 includes an outline of the hours provided by GHC from Feb 07 to April 08
Other Block Contractors
2.3Following the re-tender of Home Care services in April 2008 there were a number of changes in providers operating in Hertfordshire. Below is a brief overview of each block provider.
Hours (per week): 3257St. Albans/Three Rivers
Service Users: 571
Concerns: Low risk
2.4.1Following transfer there were a range of issues with Supporta Care. These have been well documented and have formed part of the recent scrutiny process. However Supporta Care has responded well, showingsignificant improvements in their service during the past two months. There has been a significant drop in the levels of concerns and complaints received. The suspension of work previously put in place was lifted at the Serious Concerns Meeting on the 5 August 2008;however Supporta Care will not be in a position to reinstate the Rapid Response hours until the end of August. This shortfall is currently being met by short-term contracts with Goldsborugh and Sage.
2.4.2The catalyst for the main issues and problems experienced was the poor transfer in the Three Rivers area and the subsequent shortfall in the number of careworkers that transferred from Ainsworth Care. This was compounded when Supporta Care tried to provide cover for this shortfall from the St Albans area. ACS Contracts Unit has continued to receive daily updates from Supporta Care indicating levels of missed visits (if any) and unallocated hours for each weekend. Recruitment remains the main focus for Supporta Care, an effective Recruitment Pipeline has been in place and Supporta Care will be fully staffed by the end of August. Supporta Care remain receptive to change and partnership working and have shown a pro-active attitude towards service improvement.
2.5Community Careline Services
Hours (per week): 3603Dacorum
Service Users: 596
2.5.1This agency is currently subject to a 'Serious Concerns about an Establishment' process. A relatively high number of complaints continue to come in. During the weekend of 14/15 June 08 a high number of calls were known to be missed, and although it appeared to settle down, during the weekend of 30/31 August there was again a high level of missed calls. CCS maintains that the transfer of the Platinum staff was the major cause of these problems.
2.5.2Employment conditions for one agency were very different for CCS and several of the transferred staff did not adapt well. Also, the agency has stated that many careworkers have taken large amounts of annual leave which the Manager did not take responsibility for ensuring the safe rostering of weekend work. This matter was investigated by the agency under their procedures. The agency has in fact suggested this lack of management was a deliberate undermining of the service from the transferred management staff.
2.5.3The office has subsequently transferred to the Berkhamstead premises following CSCI identifying that the Hemel Hempstead Office was not formally registered. Additional management support has been drafted into the Berkhamstead office and the managers are responsible for carrying out the necessary actions to secure improvements. The organisation’s action plan (still to be received by ACS) needs to urgently address the recruitment of care workers and management structure and also needs to include approaches to improve the retention of existing staff. Also, CCS needs to improve capacity and efficiency by the ‘re-zoning’ of care within certain areas.
2.5.4Although the response to complaints is beginning to improve (as reported by the Local Team), there is very virtually no capacity in the Dacorum area. Contract staff continue to discuss concerns directly with the Directors of CCS and are meeting with them shortly.
Hours (per week): 2853Hertsmere/Watford
Service Users: 433
2.6.1Westminster Care had (in the end) a relatively smooth TUPE transfer with minimal concerns and complaints. However, it should be noted that prior to 1 April 2008 there were some significant issues with Hertsmere Crossroads and the potential transfer. The solution was for ACS to support Crossroads in retaining an identified volume of work; however this did cause Westminster some difficulty as it reduced the number of careworkers eligible to transfer under TUPE.The main two issues facing this agency are lack of capacity at times, and sometimes a difficulty in our ability to contact the office directly as the phones are often transferred to voicemail.
2.6.2The Contracts Teammet with Westminster Care’s Senior Management Team on Friday 15 August to discuss capacity issues, where it was agreed that Westminster would now provide Contracts with an overview of how many staff they need to fulfil the current hours, along with how they are going to meet the Rapid Responseand Enablement requirements moving forward.
Hours (per week):North Herts - 158,591
Broxbourne - 153,083
Service Users - 816
Concerns: Low risk
2.7.1At the start of the contract the transfer was considered high risk due to difficulties with the outgoing provider; however following much hard work the transfers actually went well. Recruitment remains slow and this has continued to be an issue. However Careforce has worked hard with the Authority to continue to pick up work where possible, notwithstanding the difficulty in certain areas. The OT's have now been recruited for the new model of care and Careforce are keen to get careworkers onto the ACS dementia training once organised. Below is an area update:
2.7.2Royston - Initially there were concerns that the handover would be difficult due to difficult relationships with the outgoing provider; however following a high level of input from the ACS Contracts Unit the actual transfer went relatively smoothly. Capacity remains tight, but there are no service users waiting for care.
2.7.3Cheshunt–The handover went well, again ACS continues to experience reduced capacity at times. The contracts unit has raised concerns around the lack of office staffing and feels that Careforce does not currently have sufficient staff to manage this expanding area. Careforce have responded by looking to recruit additional management staff to address this perceived shortfall.
2.7.4North Herts –This area was originally provided by Careforce and therefore has no particular problems although capacity remains tight.
Hours (per week): 162,476East Herts
Service Users – 467
Concerns – High Risk
2.8.1This contractor was subject to the recent scrutiny of the home care contract procurement process. There have been significant problems with the ongoing management of the service and capacity: although progress is being made it is at a very slow rate.
2.8.2From the award of contract to the start everything was on track, with most staff from all three outgoing agencies transferring over to Care UK. The transfer was considered to be low risk. The first two weeks of the contract went well before the problems started. These problems included missed visits and late calls, the on-call service not responding, which was due to the fact Care UK lost most of their office staff shortly after transfer (they now have no remaining transferred office staff left).
2.8.3Care UK changed their rostering system on day one and it has become clear that transferred staff didn't understand the computer systems. It was further clear that Care UK did not provide sufficient training to support staff in this change of system. Care UK did not appear to understand what care they should be providing and this was further exasperated by the fact that they did not conduct service user visits as agreed.
2.8.4There was an early shortage of careworkers so Care UK brought additional staff in to support the service. These staff were either supplied by an agency, or came from other Care UK branches. However it soon became apparent that this increased the problems as these staff did not know the area which led to very late calls and missed visits.
2.8.5The Contracts Unit hascontinued to meet withand visit Care UKon a regular basis. Care UKnow has a new whole management structure in place and the level of complaints havereduced; however there remain ongoing concerns. Care UK are still subject to an ongoing ‘serious concerns’ process and ACS are still not placing any new work with them.
Hours (per week): 225,486Welwyn Hatfield
Service Users: 577
2.9.1At transfer a number of missed calls were experienced but Plan Personnel worked hard to resolve these problems quickly. By the end of April they had been the subject of six strategy meetings regarding missed and late calls,and it was noted that the level of complaints was increasing. A two week cessation of new work was implemented and this allowed Plan Personnel to remedy these initial problems. Capacity remains tight but the local team reports that they are able to pick up the work in the main.
2.9.2Plan Personnel have made a change in their back office system (to Carefree) and the office staff have confirmed that they find this an easier system to work with. The main ongoing issues are concerned with their invoicing and this is still to be addressed. On a positive note they have already sent staff on the new model of care training and have staff teams identified to go on the specialist dementia care training. Recently,concerns have been highlighted in relation to their ‘actual versus commissioned’ times where there is a significant difference. The contracts unit in liaison with the area team are investigating these issues.
Hours (per week): 97,358Stevenage
Service Users: 251
2.10.1Caring Hands retained their old contract area and there have been no issues since the start of the new contract. The Enablement Service will be starting as soon as the OT's are in place.Capacity remains good.
3Specialist Dementia Rollout – General update
3.1In relation to all new block providers the dementia targets will be in place by the end of September. The delay in establishing specific targets has been caused by the lack of available resources in the Contracts Unit. This is due to the workload caused by the difficult transfer of contracts as well as reduced staffing with the additional impact of long term sickness.
3.2Further delays in implementing the specialist dementia services have also been due to the delay in securing additional training. Although the actual dates are still to be confirmed, the indication is that this should be in place by the end of September.
3.3Once providers are delivering services to their overall targets of 10% there will be access to a minimum volume of dementia care services (including the C/wide service) of around 350Khours per annum.
4.1In late 2003 ACS decided that it needed to develop its provision of specialist services for users with a medical diagnosis of dementia. Initially it was decided to pilot this service with Leonard Cheshire (LC) who managed the countywide contract. In February 2007 the LC contract transferred to Goldsborough Home Care Services (GHC) together with the small but effective group of specialist care workers who were delivering these specialist services.
4.2In order to further embed the requirements of this service, the contract with GHC included a clear requirement for the ongoing provision of a robust home care service for users with a medical diagnosis of dementia and a requirement that this should be developed to deliver across the county. Following a ‘needs analysis’ conducted with the Older People Mental Health Team (SMHTOP), the new contract specified that tenderers should submit prices based on an initial need for around 10% of the total volume of provision. This would therefore provide a capacity of around 45,000 hours of specialist dementia services.
4.3The ACS contracts team also worked with SMHOTP and the Hertfordshire Partnership Foundation Trust (HPfT) to develop a specialist service specification which formed part of the new home care contracts.
4.4Other Block Contractors
In addition to the countywide service a similar requirement, for specialist dementia services, was incorporated in all new block contracts (effective 1 April 2008). Although these contracts are relatively new, all providers are committed to developing and providing these services.
4.5These targets, together with those agreed with the remaining block providers will be monitored on a monthly basis and reported via the quarterly ACS, Commissioning Data Group (CDG) to ensure that the implementation remains on target.
4.6In order to maximise efficiency and provide a robust service, ACS provides free access to a rigorous and specialist training programme that adopts a ‘Train the Trainer’ approach in order that the providers’ senior care workers and staff who will be expected to provide this service can do so appropriately and effectively.
The Panel is invited to note the report.
080911 AC&H Cabinet Panel
Item 5 – Update on the Home Care Contracts and Dementia Home Care Services