To agree the redesign and procurement of a home care service to be known as Help to Live at Home.

The cabinet member for health and wellbeing introduced the report. She highlighted that this was an area of significant expenditure for the council and that it was important to provide good services to allow residents to remain independent.

The joint commissioning better care fund manager gave a presentation to the meeting. Copies of the slides used were circulated as an appendix prior to the meeting.

In the discussion following the presentation the following points were made:

·         that providers had indicated in their feedback to the consultation a need for between 700 and 2,000 hours of care per week to sustain a viable business, depending on the size and type of provider

·         that the proposed hourly rate had been derived using a number of factors such as the national living wage, travel costs and reasonable on costs for providers; the proposed rate is consistent with those used by other authorities

·         that providers had expressed a preference for a single hourly rate rather than separate urban and rural rates so long as each provider had a mix of urban and rural care packages to deliver

·         that the proposed new framework would reduce the number of providers working with the council, this would give them greater certainty over the quantity of work available and allow the council to develop closer relationships with providers

·         that there would be flexibility to adjust the zones in future, to take account of demographic changes for example

The cabinet member for contracts and assets argued that the council should not set an hourly rate but should allow the market to dictate the cost of the care packages. It was suggested that this approach could reduce the costs to the council.

In response it was noted that while some packages did achieve a lower hourly rate under the present system than that now proposed, other packages, particularly in more rural areas, had to be funded at a much higher rate and some were extremely difficult to allocate. Where providers did not pick up packages or withdrew from packages because they were felt to be unsustainable the council had to step in with expensive emergency measures. It was also noted that tendering individual packages required a significant amount of officer time.

In response to a question from a group leader the assistant director operations and support stated that the service redesign was part of a programme of work associated with the whole systems approach to transformation within adults and wellbeing and that it was focussed on achieving outcomes for individuals.

A group leader noted that 17% of respondents to the service user questionnaire issued as part of the consultation on the new model felt they were treated differently because of who they were. He queried whether this was a recent development or whether there had been a trend over time.

The commissioning officer adults and wellbeing responded that the figure was reflective of the cohort in general and that there had been no recent increase. He stated that this was an issue the council needed to be mindful of when introducing the new model but that there was no evidence of any serious issue that had required moving a care package to another provider.

A group leader noted that adult social care was an area under considerable strain and that increases in the hourly rate would put pressure on the budget but could make providers more viable.

In response to queries from a group leader it was stated that use of a zoned approach was not unusual for county councils and that in house provision was unlikely to deliver lower costs due to high council overheads and complex TUPE requirements.

A group leader noted that there was an assumption of community involvement, including parish councils, in supporting more vulnerable residents. He asked whether the risks associated with this had been considered and zones organised to allow parish councils to interact with a small group of providers. The assistant director operations and support explained that community involvement was not specifically linked to the proposed service model and that care and support elements were clearly defined.

In response to a question from a group leader the better care fund and integration manager explained that providers would have to pick up all packages in their zone and could not cherry pick the urban work at the expense of the rural packages.

A group leader queried if the 7.5 minutes time allowance between clients was sufficient to allow carers to deliver a good standard of care. In response it was stated that this was an average figure derived from analysis of current provision and that moving to zonal working should allow for shorter routes between visits.

The leader stated that all members of the council were conscious of the tight budget and that the council was spending tax payers’ money. Best value had to take precedence but the council had to be mindful of its responsibilities to vulnerable residents.

The cabinet member for contracts and assets asked that the use of a set hourly rate be reviewed at the next opportunity with a view to reducing costs.

Resolved that:

a)    a redesigned model of home care as set out within the Vision and Delivery Document in appendix one is adopted;

b)    procurement of approved providers be undertaken with a recommended hourly rate as set out within the legal and financial implications sections;

c)    approval of the detailed service specification for the redesigned service and the final decision to approve acceptance of providers meeting the qualification criteria onto the framework in each zone, be delegated to the director for adults and wellbeing for the total contract period of five years;

d)    the director for adults and wellbeing be authorised to extend the existing contractual arrangements, if required and within existing budgetary provision for up to a 9 month period, until 31 March 2018.