Adult Care and Health Cabinet Panel - Wednesday 12 May 2010 at 10.00Am Item 5 - Meals-On-Wheels

HERTFORDSHIRE COUNTY COUNCIL

ADULT CARE AND HEALTH CABINET PANEL

WEDNESDAY 12 MAY 2010 AT 10.00AM

Meals on Wheels

Report of the Director of Adult Care Services

[Author: Peter Ruane, Commissioning Manager for Older People

Tel: 01438 843213]

Executive Member: Richard Smith (Adult Care and Health)

1. Purpose of report

1.1This report updates Members on the progress that has been made by Hertfordshire County Council over the last three years to establish a countywide meals on wheels service.

1. Summary

2.1Over the last two and a half years Hertfordshire County Council (HCC) has gradually taken on responsibility for the meals on wheels service in the county. The service was previously provided separately by the ten district councils, although legal responsibility rests with the County.

2.2As of April 2010, HCC provides the service in eight out of the 10 districts. One thousand seven hundred people receive the service, and approximately 360,000 meals are expected to be provided in 2010/11. In ThreeRivers and Welwyn Hatfield, the local councils are continuing to provide their own service.

2.3The service is delivered on behalf of HCC by Hertfordshire Community Meals (HCM), a social enterprise organisation, which was newly established by HCC in 2007 in order to deliver the countywide service.

3.Recommendations

3.1Members are invited to note and comment on the report.

4.BackgroundContext

4.1 Legal Duty

4.1.1The County Council has a statutory responsibility, under the 1970 Chronically Sick and Disabled Person’s Act, to make arrangements for the provision of meals, whether at home or elsewhere, to chronically sick and disabled people. The definition in the Act is ‘substantially and permanently handicapped people’. The County Council and district councils also have a power to provide meals to older people in their homes or elsewhere.

4.2 Background Information pre-2007/8

4.2.1Historically in Hertfordshire, the County Council’s statutory duty was largely fulfilled by district councils - each organised and subsidised their own meals on wheels services. The County Council commissioned some services to meet specific needs, or fill gaps in district provision during the week or at weekend. In terms of meals on wheels, Hertfordshire was an unusual, if not unique situation.

4.2.2Whilst some district councils were content to provide the service, others were less so. There were long standing tensions in that whilst the County had legal responsibility, it was the districts which were funding the service. On a number of occasions some districts indicated they were going to cease providing the service and hand responsibility back to HCC. This issue tended to be raised when budgets were under pressure.

4.2.3Operationally, the service was fragmented. Some districts ran it as an in-house service, others had contracted it out to a commercial provider or a voluntary organisation. There was wide variance in costs and charges, as well as the degree of subsidy provided by the district.

4.2.4Some districts relied on paid staff, others volunteers. As a result there were 11 different commissioners, with at least 11 different service providers with separate management, administrative and quality monitoring arrangements.

There were a number of areas of concern, including.

• Coverage was poor in some areas, and the minimum 5 day a week service was not being achieved;

• Access arrangements were not always clear, eligibility criteria for the service varied;

• Major capital equipment needed replacing;

• Some areas struggled to recruit and retain volunteers;

• Concerns about the quality of the meal and the length of time from oven to doorstep;

• Lack of choice of meal;

• Lack of special dietary meals;

• Lack of choice for black and minority ethnic residents.

4.3 Development of a Countywide Service

4.3.1Joint meetings between the districts and County were held to improve the standard of the service. However, thearrangements that were in place made it extremely difficult to propose or take forward changes. However, two external reports, produced at the time, helped support the strategy of establishing a countywide service.

4.3.2In 2004 a jointly commissioned report carried out by the consultants ‘Exemplas’ recommended that a social enterprise be established in Hertfordshire to prepare and deliver meals for the whole county. The suggestion in the report was that this could result in the production of meals at a lower unit cost which could allow full cost recovery from users of the service.

4.3.3In July 2005 the County Council’s Cabinet agreed ‘to further investigate options for the future provision of meals on wheels in Hertfordshire including the option of doing this through a social enterprise, subject to a full financial evaluation’. The reason for the decision was ‘to aim to identify an equitable, sustainable and cost effective meals service for vulnerable older people across the county.’

4.3.4In 2006 a further report,carried out by the consultancy ‘Mutual Advantage’, indicated that a meals production unit would not be able to improve on the current unit costs of the meals, but that considerable savings would be achieved if a social enterprise were established to take on organisation and delivery functions only, with the meals being purchased by contract from a meals provider.

4.3.5Financial projections for this option were positive, with an expected cost of a hot delivered meal in the region of £5. Given that some authorities were charging customers £3.50 at the time, the option of full cost recovery by achieving efficiencies and raising charges over time, became a possibility. The report recommended that ‘serious consideration be given to bringing the organisation and delivery elements of the service into a single county-wide social enterprise.’

4.3.6This latter recommendation was discussed and agreed as a way forward with districts. The development of a countywide service would be progressed as follows:

• Hertfordshire County Councilwould take on lead responsibility for commissioning the service;

• The decision to take part in the initiative would rest with each individual district, who by taking part would agree to formally transfer responsibility for the Meals on Wheels service back to Hertfordshire County Council;

• Hertfordshire County Council would contract for the food and vehicles, and set the charge customers pay;

• District agrees to financially subsidise Hertfordshire County Council for a limited period to cushion the costs of transfer; the subsidy amount is linked to the number of annual meals. After that districts have no financial responsibility for the service;

• District to meet TUPE (Transfer of Undertakings Protection of Employment regulations)transfer costs, and some one-off capital expenditure around setting up service;

• District has opportunity to subsidise price charged to customers;

• Hertfordshire County Council enters into an agency agreement with the social enterprise for service in transferring district.

5. Progress on Establishing a Countywide Meals on Wheels Service

5.1 Phase 1 North Herts - October 2007

5.1.1 A joint district and county officer group was set up in late 2006 to progress the recommendations. It was agreed that Phase 1 of the countywide service would begin in North Herts and Stevenage, with other districts coming on board at later dates.

5.1.2Also, at this time North Herts District Council (NHDC) gave notice to HCC that it was handing back responsibility for the service from October 2007, irrespective of the outcome of the joint discussions.

5.1.3 Hertfordshire Community Meals (HCM) the social enterprise was registered in July 2007, and initially existed as a ‘virtual’ organisation for a number of months. Premises for the new operation were found in Letchworth which were equipped and refurbished by HCC and North Herts District Council (NHDC) - the latter providing £70k capital monies.

5.1.4 In September 2007 staff from the existing NHDC service were transferred into HCM under Transfer of Undertakings Protection of Employment regulations (TUPE). The existing North Herts ‘volunteer delivery’ arrangements were maintained, in accordance with the district’s requirement.

5.1.5 HCM began delivering the meals service in North Herts from October 2007. The Stevenage transfer was postponed until April 2008, as negotiations took longer than anticipated.

5.1.6 As part of the transfer, and in keeping with the framework agreed by the county and the districts, NHDC agreed to pay Hertfordshire County Council a reducing subsidy over three years linked to the projected number of hot meals delivered.

5.2 Phase 2 - Watford Stevenage and Hertsmere - April 2008

5.2.1The meals services in Stevenage, Watford and Hertsmere all transferred back to Hertfordshire County Council in April 2008. As with the North Herts agreement this was seen as a TUPE transfer, and all three districts agreed to pay a three year reducing subsidy payment to Hertfordshire County Council. The three districts also paid the County Council one-off transfer costs, which contributed towards set up costs, but also covered any redundancy costs for staff who were TUPE’d across to HCM but then subsequently made redundant for economic, technical or organisational (ETO) reasons.

5.3 Phase 3 - Harpenden, Broxbourne, St Albans and East Herts - April - August 2009

5.3.1The meals services in Harpenden, Broxbourne, St Albans and East Herts were all transferred back to HCC between April and August 2009. All three districts agreed to pay a tapering meals subsidy (as per previous districts) and paid one off transfer and set up costs, including redundancy costs.

5.4 Phase 4 – Dacorum- March 2010

5.4.1The meals service in Dacorum transferred back to HCC on 27 March 2010.

5.4.2This was the largest of all the district services, and was also a TUPE transfer. Dacorum agreed to pay the redundancy costs of staff who were made redundant following transfer. Dacorum did not provide a general meals subsidy, but rather have focussed on a tapering subsidy for Dacorum Card holders.

5.5 Phase 5 ThreeRivers and Welwyn Hatfield

5.5.1During 2008/9, discussions were held with ThreeRivers and Welwyn Hatfield districts. Both councils indicated that for the time being that they wished to retain responsibility for their meals on wheels service.

5.5.2Three Rivers DC has a contract with the WRVS to provide a weekday service, and HCC are responsible for weekends.

5.5.3Welwyn Hatfield DC has a contract with a commercial provider.

5.5.4HCC will contact both councils again in 2010 to discuss the future of their meals on wheels service.

6 Hertfordshire Community Meals

6.1 Service Organisation

6.1.1 HCC established Hertfordshire Community Meals in July 2007, and entered into an Agency Agreement with HCM to deliver the meals on wheels service. This was a 3 year agreement which, subject to satisfactory performance, can be extended up to 2013, with scope for further extension.

6.1.2HCM has had three years of rapid growth and expansion, and now employs over a hundred mainly part time staff.

It operates from three main bases.

1Green Lanes, Letchworth (opened Sept 2007) - delivering the service to North Herts, Stevenage, East Herts, Potters Bar

2Jubilee Centre, St Albans (opened April 2008) – delivering the service to Watford, Hertsmere, Broxbourne, St Albans

3Hammer LaneHemel Hempstead (opened March 2010) – delivering the service to Dacorum

6.1.3HCM is a social enterprise, and was registered as an ‘industrial and provident Society’. It has clear social aims and values, is in social ownership, and earns the majority of its income by trading. As an independent organisation, it can operate without high overheads, and with greater flexibility.

6.2Meals Delivery

6.2.1HCM delivers meals produced by Apetito, which is one of the national leaders in the local authority sector. A wide range of traditional and special medical dietary meals, plus a wide range of black and minority ethnic food is available.

6.2.2In 7 out of the 8 Districts, meals are heated up in vans with specially designed multi-chambered ovens, either just before or on route to the delivery address. This method of operation ensures that the food arrives hot, well presented and nutrition is retained.The vans are also supplied by Apetito. Hertfordshire County Council hasa 5 year contract place with Apetito for food and vans from April 2009.

6.2.3In North Herts, where the volunteer service has been retained, meals are cooked in ovens prior to delivery. In Stevenage, St Albans and Dacorum, HCM is also providing meals to a small number of luncheon clubs and day centres. A weekend service is available in most areas, excluding North Herts and St Albans. As resources allow, the intention is to extend the weekend service to all areas.

6.2.4Approximately 240,000 meals were delivered in 2009/10, and in 2010/11 this will rise to a projected 360,000, given the Dacorum transfer, and the full year effects of other districts.

6.2.5The table below gives more information on the numbers of meals in each district. Take-up varies considerably across districts, and this largely reflects the situation of the former district run service.

6.3 Frozen Delivery

6.3.1HCM can also provide a frozen meals service. Up to a fortnight’s supply of meals can be delivered. The service has not been widely publicised and promoted, and only 31 clients receive their meals this way. HCM will be researching demand for the service later this year.

6.4 Referral and Access Arrangements

6.4.1There is an eligibility criteria which must be met in order to qualify for the service. Clients or their family can access the service by contacting the Customer Services Centre, or as part of an assessment carried out by ACS or HPFT care workers.

7. Price of Meal to Customers

7.1 Price of Meal in Hertfordshire

7.1.1As part of the transfer of service, HCC is now responsible for setting the customer price of a meal and pudding. From April 2010, this is £3.30. The table below shows the price that people actually pay for their meal in the districts that HCM deliver to. The variation is because some districts have chosen to continue to subsidise the price of a meal to customers living in their area. In Dacorum, there are two prices, as the district has decided to focus their subsidy on existing meals on wheels customers who hold a Dacorum Card.

7.2 Price of Meal in Other Councils

7.2.1For comparison, the 2010/11 charges in 10 nearby authorities are shown on the next page. In terms of the most expensive, Hertfordshire ranks 7th out of 11.

8. Quality Monitoring

8.1 Interviews with Service Users

8.1.1In November and December 2009, Quality Monitoring Officers (QMO) from Adult Care Services carried out face to face interviews with a random sample of 51 meals clients.

8.1.2The interview covered all aspects of the service, including portion size, temperature, presentation, menu choice, delivery, pricing, politeness of the driver and contacting the meals on wheels office.

8.1.3The findings were extremely positive.Some selected highlights are shown below:

86% were satisfied with the quality and taste of the meal. Only 1 person was dissatisfied. (the most frequent concern was about hard carrots)

90% were satisfied with the portion size of the meal. Only 3 people were dissatisfied.

91% were satisfied with the temperature of the meal. Only 1 person was dissatisfied.

90% were satisfied with how the meal looked on the plate. Only 3 people were dissatisfied.

82% were satisfied are you with the menu choices.

85% said their meal always or usually comes at times that suits. 15% said it sometimes did.

88% were able to open the meal container?

100% were satisfied that the driver was polite and listens.

Nice people.”

“They are all very nice.”

“…….. is very good, he'll ring up the office and speak to them if I've got a problem.”

“he’s alright, I get on well with him.”

“Can be different people - some use the key safe - some don't.”

“Got a nice gentleman.”

“Give cheque to driver.”

“In & out quite quickly - don't chat.”

“I think he's very good.”

“Never had bad one.”

33% received help from the driver with other tasks.

Of the 33 people that had to contact the office, only 1 was dissatisfied with the response they received.

16 people had a concern or complaint about their meal in the past year? Examples were as follows:

“They are little niggles not really complaints. I don't like to complain.”

“Often doesn’t turn up - my case worker gets me fish & chips.”(H)

“Burnt meal.”

“Couple of times no pudding”

“Carrots”

“I have recently filled out a form to let them know about the problem with the vegetables being too tough for my husband. I'll have to wait & see if it does change.”

“Every bank holiday or Christmas they charge, we never have a meal on these days.”(W)

“Billed twice for some period. Delays on Weds - so cancelled usually 12-12.30 but on Weds 1.30pm. Delivered meals when on holiday & had to pay.”

“Not improved - I appreciate they have a hard time getting drivers - it is so important the way you see someone at your door. I find it very sad as I used to have a lovely service. A month ago we did not get a meal at all – it was a 'stand by' driver - the office were unaware that no one turned up to do the driving - after I had rung it was found out that the driver had not turned up - there was no one else to do it - happened at least 3 times this year.”

“Veg is still hard.”

80% felt the amount charged (£3.25 in 2009/10) was reasonable. 8% felt it was not, and 12% said their bill was paid by someone else.

Extract from ‘ Meals on Wheels Quality Monitoring Report – Outcomes for Service Users in the three audit areas – November / December 2009’

9. Financial Implications

9.1 Background - subsidies provided by district councils

9.1.1As mentioned earlier, legal responsibility for the meals on wheels service rests with HCC, even thoughpreviously the districts were providing and paying for the service.However, districts were increasingly signalling that they were likely to hand back financial and operational responsibility to HCC.