To consider an account of the quality of the care market in Herefordshire for adults and children.

The assistant director operations and support introduced the adult care market element of the report, noting that the quality assurance framework offered some reassurance and there was good practice highlighted by the Local Government Association reflected in the Care Quality Commission’s report that the county had some of the best care homes in the country.

The senior commissioning officer highlighted that for the adult care market:

·         the report focused on the quality of the care market and domiciliary care market but that consideration was needed of other areas of contracting monitoring arrangements including the delivery of care by external providers as there was a significant self-funding market which created challenges.

·         There were just over 2000 beds in the care home sector and joint commissioning of around 500 of the bed capacity was an advantage.

·         Commissioners monitor planning applications in order to comment on the needs for nursing beds

·         With regard to the home care market, there are around 800 users and a significant number of small organisations as local

·         domiciliary care workers provided around 3000 hours per week of care

·         quality framework information gathered from service users and their families, and from providers, was used for reporting to the quality review panel. Ways of gathering more information from providers in care sector was being explored, to understand more about self-funding and to support providers to grow

·         Care Quality Commission ratings were good but there was work to be done around developing understanding of reablement and the home care market to encourage care homes to consider short-stays as a viable option. 

In answer to a question about delivering the reablement model in care homes, this was aspired to in the longer term and there was therapy in place at one home so there could be a step-up facility as well as a step-down facility, and more options could be considered to care for people at home. It was also noted that care homes were not carrying out assessments although this was a contractual requirement which needed following up.   Some of the homes were small with limited staffing resource to do this and to meet on-call and weekend cover requirements.

Responding to a question about encouraging collaboration between homes, the assistant director identified that was limited appetite for this despite the advantages and there was greater encouragement needed alongside greater focus on domiciliary care and help to live at home.  

There were also workforce planning implications and an observation was made regarding a poor perception of nursing home careers amongst the nursing profession despite competitive salaries, leading to recruitment difficulties.  This had led, in one case, to a provider withdrawing nursing care for challenging behaviour despite this being a growth area.

There were other factors affecting the overall condition of the nursing workforce, including vacancy levels, age profiles and salary levels falling in real terms. There could be a further impact from Brexit and potential loss of workforce from the EU.

The assistant director education and commissioning presented the children’s care market element of the report, which referred to the looked after children and complex needs commissioning and sufficiency strategy (appendix 1).  Summarising the report, he made the following points:

·         Increasing the number of Herefordshire foster cares was going well and on course to deliver on the strategy’s objective there was currently a comparatively high number of looked after children and although needs were met effectively, the service was considering what were the causes and how they could be appropriately  addressed

·         with regard to increased complex needs, the range of provision had expanded with the Herefordshire intensive placement support service (HIPSS) and the therapeutic intervention support service (TISS)  in place to support practitioners and foster carers, particularly with regard to potential placement breakdown, and with  managing challenging behaviours

·         short breaks for children with complex needs had expanded through recommissioning coming into effect from April 2017

·         there was joint working with adults’ services on developing housing for young adults, which is expected to bear fruit and is part of the strategy

·         for young people in tier 4 mental health services, work was underway to explore how to enhance planning for discharge

It was identified that there was some good practice to be shared between adults’ and children’s services, noting the successful work to recruit foster carers.

It was noted that an update on housing was planned for the next meeting. 

RESOLVED:

That

a)    the report be noted; and

b)    the following project areas be proposed through the Joint Commissioning Board to be taken forward to address market forces and sustainability:

o   workforce planning

o   domiciliary care

o   the care home market; and

c)    that adults’ and children’s services work together to develop recruitment and retention approaches that would benefit  adults’  services in conjunction with the communications team