To consider the draft Market Position Statement 2020-2025 for Adults and Communities and to determine any recommendations that the committee wishes to make.

The head of care commissioning presented the Market Position Statement 2020-2025, the principal points included: the statement was not a statutory duty of the council but was considered good practice; the statement was aimed at providers to indicate the strategic direction for the council and to enable providers to align their business plans to meet needs and demand now and in the future; this statement was more diverse than the previous iteration, with greater emphasis on the strengths based approach, technology enabled living, and prevention; attention was drawn to the implications of the ageing population and increasing demand on services, with the consequential need to explore alternative models of support and locality based commissioning responses; providers needed to engage with people on their health and care needs as individuals, rather than centring on particular conditions or disabilities; the commissioning intentions section was an important part of the document and reflected the council’s move to an all ages commissioning approach; further analysis and information for providers would be available through the Understanding Herefordshire website in due course (https://understanding.herefordshire.gov.uk); feedback had been received from other consultees and the statement would be updated accordingly.

 

The chairperson welcomed the report and invited questions and comments from attendees, the principal points included:

 

i.           A committee member commented that falls had been an enduring issue and questioned the progress that had been made.  The head of care commissioning provided an overview of the work that had been undertaken and reported that a project was underway, led by the director for adults and communities, to establish an effective system wide falls prevention approach.

 

ii.         A committee member said that an overriding theme was the council’s reliance on its partners and sought assurances about the resilience of the care home sector and of Primary Care Networks (PCN).

 

In terms of care homes, the head of care commissioning advised that the council was working continuously with the provider sector on business continuity planning and, whilst noting the significant impact on the sector nationally and locally, said that the implications of Covid-19 on long term goals and aspirations were uncertain at this stage.  The assistant director adult social care operations said that the document set out some of the different models and approaches that would be needed in order to sustain the increase in demand, and the development of the council’s own services and accommodation offer would be key to managing this. 

 

The assistant director all ages commissioning advised than an unforeseen outcome of Covid-19 was that system working, out of necessity, had improved vastly to ensure that citizens and providers were supported and protected.  The relationship with the PCNs was described as now being much stronger and the PCNs were more forthcoming in their approach; references were made to the provider forum and the Enhanced Health in Care Homes programme.

 

The assistant director all ages commissioning contrasted the local pattern of care home ownership with the national position, confirmed that care home sustainability was monitored carefully, and provided an overview of the support provided to care homes.  In recognition of the support provided during the pandemic, Herefordshire now hosted and chaired the West Midlands provider forum.  However, capacity remained an issue, especially given the high proportion of self-funders, and the county could not be wholly reliant on the independent sector.  Therefore, the development of a care home facility remained a priority.

 

The committee member suggested that, in view of the fragmentary nature of the health sector, the committee may wish to explore partnership relationships and resilience further as part of its work programme.  The assistant director adult social care operations provided further examples of the improved working relationships and interdependence between different departments and agencies, reflecting the changing paradigm in the approach to community-based care.

 

iii.        The vice-chairperson:

 

·                noted that this was a huge piece of work and congratulated the officers involved;

·                recommended that stronger links be made in the document with the social value areas that the council was moving into;

·                with attention drawn to agenda page 51 which referred to ‘in April 2020 NHS mental health and learning disability services will transfer’ and to agenda page 55 which referred to the ‘recently agreed and will implement a new Herefordshire and Worcestershire Living Well with Dementia Strategy’, it was recommended that these paragraphs be updated to reflect the current positions;

·                with attention drawn to agenda page 57 ‘How well the council is doing’, noting references to the Adult Social Care Survey and the comment that ‘The voice of residents and the wider workforce will be key to capture for future design principles and delivery’, it was recommended that the committee receive an update on progress in twelve months’ time, in the form of a written briefing note; and

·                with attention drawn to agenda page 59 ‘Commissioning intentions’ which referred to ‘Increase and improve services that support complex and challenging behaviours such as autism or dementia’, it was recommended that this should also include learning disabilities.

 

The assistant director all ages commissioning: recognised that it was essential for commissioners who design services to listen to their customers; provided an overview of the customer and service user engagement work being undertaken through the ‘Making it Real Board’; and advised that Healthwatch Herefordshire had recently been awarded a new contract for the continued provision of the Healthwatch service.  He added that, whilst the statement was a provider focussed document, the views of customers and services users in the design of services was just as important; as a further example, it was noted that the Making it Real Board would be involved in the design of an assessment centre at the Hillside Care Centre.

 

iv.        A committee member noted that Council had set aside £13.1 million for its own ‘care home and extra care development’ but he could not identify any obvious reference to this in the statement and had expected some expression of intention to be made.

 

The head of care commissioning said that the general intention to deliver in-house care and support provision had been included but acknowledged that reference to the actual development should be made explicit in the document.

 

v.         A committee member: supported the all ages approach; considered the glossary helpful; felt that some phrases, such as ‘home and family can be best’, could be perceived as glib assertions by some; drew attention to the rate of first time entrants to the criminal justice system which had reduced but was still higher than the national average, and to the higher rate of looked after children compared to statistical neighbours; noted the commissioning of new accommodation based services for care leavers with complex needs; questioned whether it was appropriate to reference ‘Locally the political leadership has changed with a renewed focus on People and Communities’ in the ‘Local Context’ section; and commented on the merger of GP surgeries in Ledbury and that, despite the launch of a new website, outdated information on other websites and on social media was causing confusion for local residents.

 

The head of community commissioning and resources advised that, since the publication of the agenda, amendments and additions to the commissioning intentions and other text had been proposed, including matters relating to care leavers and other vulnerable young people.  He also provided an overview of service developments in terms of the all ages approach.

 

vi.        A committee member expressed relief that transition in care was being addressed positively and, noting difficulties with local authority care homes in the past, commented on the need for ongoing vigilance in terms of in-house developments.

 

vii.       The chairperson made observations, including:

 

·                the statement was a dense document but was well laid out and user friendly;

·                on the issue of ‘develop new locality based model(s) by PCN’ (agenda page 46), there was a need to address the cohort of Herefordshire residents who were not served by PCN footprints;

·                the ambition to have a diversified offer which was almost bespoke was supported;

·                it was noted that there was enormous potential in terms of the shared lives offer but it was also felt that there were potential synergies and aggregated benefits in the concept of home share, particularly for older people living alone currently; whereby people could be supported to remain in their own homes by sharing their living space with someone in need of accommodation or perhaps someone wanting to gain experience in the care industry;

·                with attention drawn to agenda page 41, it was suggested the statistics on predicted increases in dementia should be clarified, particularly in terms of the period covered; and

·                with attention drawn to agenda page 40, the chairperson said that she was curious about the reasons behind the increasing costs which could not be accounted for by inflation.

 

The assistant director adult social care operations: said that it was difficult to understand some of the cost increases but it was felt that there may be a degree of lag locally, resulting in sudden increases in order to realign with the costs of delivering care; work was being carried out in terms of the learning disabilities pathway; with the acceleration in progress made in response to Covid-19, it was a good time to reflect on relationships with the PCNs and also on technological innovation; and it was recognised that further work was needed on the supported living accommodation offer, potentially including the concept of home share.  The chairperson added that home share could be particularly relevant to self-funders and could contribute to achieving better balance in the market.

 

The director for adults and communities said that there was a need to revisit the historic trends and the reasons why additional costs had come into the system; for example, a shift in learning disabilities towards direct payments had increased the cost of some packages without necessarily improving quality in terms of the care that was being delivered.  He said that there was also a need to reflect the issue of higher acuity in the statement.  The assistant director adult social care operations commented on the increased levels of data captured in recent months which was being interrogated, particularly in terms of the discharge to assess process.

 

viii.      The vice-chairperson questioned workforce implications in terms of the care home and extra care development, ageing population demographics, and rural sparsity.

 

The assistant director all ages commissioning said that it was likely that the care home and extra care development would be staffed by people employed by Hoople, with the council as the registered provider of the service, in a similar arrangement to that used for the majority of Home First care staff.  He commented on the need to attract, recruit and retain younger people, and act strategically to lower the statistical average age of the population in Herefordshire.  References were made to work with Skills for Care and to marketing of the care sector to people working in retail currently.

 

A committee member commented on the need to ensure that salaries were competitive, that there were opportunities for career progression, and there were incentives for young people to return to the county once they had gained qualifications and experience elsewhere.

 

The chairperson noted that recruitment and retention was crucial across a number of activities, and recommended that a written briefing note be provided on this.

 

ix.        The vice-chairperson, drawing attention to agenda page 45, considered the proportion of NHS Continuing Healthcare (CHC) commissioned care (2%) to be surprisingly low compared to council commissioned care (59%), and questioned what was being done to manage this situation.

 

The assistant director adult social care operations said that an assessment was being undertaken for the period between March and September 2020 in order to map outcomes, to compare these to NHS predictions, and to inform further discussions.  She also said that consideration was being given to a project, including the development of an algorithm, to establish an external process in terms of funding arrangements.  She added that the position for self-funders had been particularly difficult to establish in the past.

 

The chairperson recommended that a written briefing note be provided to update committee members on these developments in due course.

 

x.         Ian Stead, chair of Healthwatch Herefordshire, made a number of comments, including: Healthwatch Herefordshire was pleased that a new contract had been awarded for the continued provision of the service and looked forward to continuing the good relationship with the council ; Healthwatch Herefordshire had been very impressed by the work undertaken during Covid-19, particularly in terms of the discharge arrangements and care homes, and contrasted this with the position elsewhere nationally; Healthwatch Herefordshire had submitted its own comments on the Market Position Statement, commending the wider approach to commissioning and suggesting some matters for further consideration, such as young carers and accessibility to the internet; and the PCNs were in their early stages of development and had the potential to work well with the Talk Community agenda.

 

The assistant director all ages commissioning noted that the relationship with Healthwatch Herefordshire provided a balance of challenge and pragmatic support.

 

xi.        The cabinet member – health and adult wellbeing: thanked the officers involved for producing an in depth Market Position Statement and for responding to questions from the committee; although not a statutory requirement, it was considered important to produce the document to acknowledge the changing needs of Herefordshire residents, both adults and children; the challenges of austerity were recognised and resources needed to be managed appropriately; learning from the past enabled the council to plan for the future; and members were thanked for the debate and the recommendations of the committee would be welcomed.

 

xii.       The assistant director all ages commissioning also thanked the committee for its scrutiny of the statement, noting that members were well sighted on the key issues in health and social care in Herefordshire, and praised the officers involved for producing such a well-received document.  He added that the statement was important to how the authority would operate going forward, it would be an organic resource that would be updated to reflect the changing local position, and he looked forward to updating the committee on progress with the delivery of the commissioning intentions in due course.

 

The chair said that the level of engagement with providers and the commitment of the team was exemplary, and endorsed the movement towards diversity and a broad base of offer to meet need.

 

The committee discussed draft recommendations.  During the discussion: the director of adults and communities provided additional information on the falls prevention project and the intention to move from a react and respond model to a predict and prevent model; the director also commented on the work undertaken by the adults social care workforce development team on the recruitment of social workers but noted that there were now significant pressures in terms of occupational therapists; and the chairperson proposed that, as well providing a written briefing note, the executive be asked to give consideration to an all-member workshop on recruitment and retention across council services.  The committee then discussed amended recommendations and agreed the following resolution.

 

Resolved:

 

1.       That the committee welcomes the development of the Market Position Statement and recommends:

 

a.       That a written briefing note be provided to the committee on progress in twelve months’ time, including how service users have been engaged in the development and design of specific care and support services.

 

b.      That the importance of the social value elements be made more prominent in the document.

 

c.       The document be refreshed to reflect the current positions in terms of the new arrangements for mental health services and the adopted dementia strategy.

 

d.      Learning disability services be included under commissioning intention 3.

 

e.       Explicit reference be made to the Council’s intentions for care home and extra care development, and any associated workforce implications.

 

f.       That consideration be given to clarifying the situation for Herefordshire residents that are not served by the footprints of Primary Care Networks.

 

g.      That consideration be given to synergies and diversified offers (such as home share) to meet the needs of people needing care (both those funded by the council and those funding themselves) and people prepared to provide support in exchange for accommodation and / or to gain experience in the care industry.

 

h.      That the statistics included on page 15 (agenda page 41) on predicted increases in dementia be clarified.

 

i.        That identified trends in page 14 of the statement (agenda page 40) be reviewed and be supported by additional narrative, as appropriate.

 

j.        That a written briefing note be provided on NHS Continuing Healthcare, including the development of a related algorithm and the progress made on retrospective cases.

 

k.       That a written briefing note be provided on recruitment and retention issues, and the executive consider the usefulness of an all-member workshop, so that all members can be apprised of the challenges.

 

l.        That a written briefing note be provided on the falls prevention service.

 

2.       That issues of resilience and business continuity in the care home sector and the Primary Care Networks be included in the committee’s work programme, potentially in the suggested task and finish group on the Covid-19 system response.