To provide the Health, Care and Wellbeing Scrutiny Committee with an overview of home care services in Herefordshire, both services commissioned by the council and the wider market. The report also outlines plans to support hospital discharge arrangements over the winter and provides information on the council’s Shared Lives services.

The committee considered a report on home care services, discharge arrangements during the winter, and Shared Lives services.  A presentation was given and the slide pack was published to the webpage for the committee following the meeting (link to the presentation).

 

The slides presented by officers from the Community Wellbeing Directorate are identified below, along with a summary of the principal points of discussion.

 

Home Care

 

A            The Interim Head of Care Commissioning presented the Home Care slides:- Legislative Framework; Key Facts; Commissioning History / Arrangements (1); Home Care Framework Providers – Areas; Commissioning History / Arrangements (2); Current Provider Landscape; Overview of Quality of Provision; Legacy Provision; Apr 2021 Estimated Demand to Sep 2023 Delivery; Commissioned Home Care Customers and Weekly Hours; Weekly Cost of Commissioned Home Care; Community Waiting List for Home Care; Challenges; Response to Challenges; Future Plans and Next Steps.

 

a.1.          It was noted that, unlike the Primary Framework, the Secondary Framework was not based on specific geographical areas.

 

a.2.          It was reported that demand had been lower than anticipated (the estimate for April 2021 was 710 people but the actual numbers were 559 in April 2021 and 593 in September 2023) but the total hours were similar (the estimate was 9000 hours but the actual hours were 8282 and 8882, respectively), reflecting the appropriate management of pathways but also increasing levels of acuity.

 

a.3.          The Chairperson noted the improvements that had been made in recent years and thanked the officers for their hard work.

 

a.4.          An overview was provided of the work of the Commissioning Support Unit (including brokerage, quality and review, and contract support) and the activities undertaken as part of the quality assurance process.

 

a.5.          It was noted that the Care Quality Commission (CQC) undertook inspections of providers periodically and there could be changes in the intervening period.  In terms of the one provider commissioned by the council currently rated as ‘requires improvement’, it was reported that the council was working closely with the provider to monitor and support improvements, and intelligence was shared with the CQC to inform the risk profile. 

 

a.6.          The committee was advised about the due diligence process undertaken for potential new providers prior to appointment to a framework.

 

a.7.          It was reported that care providers had to apply for a licence to recruit social care workers from overseas, intelligence on practices was shared via regional networks, and sanctions could be taken against providers if they were in breach of licence conditions.

 

a.8.          The committee was advised that, at the point of commissioning, an equality impact assessment was undertaken to ensure that diverse characteristics and emerging needs were considered in formulating the specification for the service.

 

a.9.          It was reported that there were regular fora with providers, there was a complaints process for individual clients, and an external process for obtaining feedback was being introduced.  The Vice-Chairperson commented on value of previous scrutiny activity involving providers.

 

a.10.      The council was working with providers to identify clients that would be prepared to participate in pilots for the use of technology equipment and adaptations.  The Chairperson suggested that technology enabled living could be added to the scrutiny work programme.  In response to a question about internet connectivity in rural areas, it was reported that the plans included both fixed-line wireless and mobile data solutions.

 

a.11.      Attention was drawn to the sentence ‘One example of [coproduction] already coming into effect has been the expansion of one provider to operate and open an office in an area where there was limited availability of care and significant waiting lists, resulting in no longer having waiting lists in this area’ (paragraph 4.29, agenda page 31).  It was noted that the challenges were different in each area, particularly given the issues associated with population sparsity.

 

a.12.      The Corporate Director Community Wellbeing confirmed that work was ongoing to prepare a business case for a potential care facility which could be operated by the council.  It was noted that the original proposal was for a facility for older people but it was now considered that some form of facility for people with complex learning disabilities, challenging behaviours, and autism could represent a better use of council resources; there was limited provision within Herefordshire currently, resulting in out of county placements.  It was also noted that this initiative could support local workforce development.

 

Discharge to Assess

 

B            The Interim Head of Care Commissioning presented the Discharge to Assess slides:- Background; Pathways; Services; Demand; Capacity; Winter Readiness / Preparation.

 

b.1.          Although no significant shift was expected in demand in the short term, actual demand would be tracked and modelled over the next twelve months.

 

b.2.          It was reported that there was a multidisciplinary team approach to discharge planning, involving patients and carers, and this work was supported by a discharge fund through the Better Care Fund framework.  It was noted that patients that met reablement criteria could receive free, short-term care for a maximum of six weeks.

 

b.3.          An overview was provided of the mechanisms for Continuing Health Care, including the use of a fast-track tool for individuals who may be entering a terminal phase, and other health and social care pathways. 

 

b.4.          It was reported that council and health partner representatives met regularly to ensure that discharge practices were effective and minimised delayed transfers of care or ‘bed-blocking’.

 

b.5.          It was confirmed that the Health and Care Act 2022 revoked previous procedural requirements for local authorities to carry out long-term health and care needs assessments before a patient was discharged from hospital, with further details provided about the discharge planning process.

 

b.6.          The Corporate Director Community Wellbeing commented on the distribution of adult social care discharge funding to local authorities and that longer term funding was a significant issue nationally, especially in view of increasing demand, acuity and costs.  It was noted that alternative models were being explored to secure value for money but also to ensure equity of access and provision across the county.

 

b.7.          The Chairperson suggested that discharge to assess could be added to the scrutiny work programme, with input from Hoople Cares and Wye Valley NHS Trust. 

 

b.8.          It was reported that processes were being reviewed, in conjunction with health partners including Primary Care Networks, to ensure safe and effective discharge.

 

Shared Lives

 

C            The Registered Manager Shared Lives Shared Lives presented the Shared Lives slides: Background; Key Facts (1); Key Facts (2); Challenges and Response; Future Plans – Shared Lives Plus Review; Future Plans – Homeshare Feasibility Study.

 

c.1.          In terms of safeguarding, it was reported that Shared Lives providers underwent a period of detailed assessment, were subject to DBS (Disclosure and Barring Service) checks, employment and character references were obtained, and the service was monitored under CQC regulation.  It was noted that a panel, including external participants, considered the approval of providers.

 

c.2.          It was reported that the Homeshare Feasibility Study would explore potential issues for stakeholders, including the position with Council Tax.  The Chairperson suggested that Homeshare could be added to the scrutiny work programme.

 

c.3.          An overview was provided of the process to match an adult who had care and support needs with a Shared Lives provider, and examples were provided of a range of situations where people were enabled to live safely and independently.

 

c.4.          It was reported that part of the work with Shared Lives Plus would include a communications plan to attract different types of providers, including short and long term arrangements.

 

c.5.          It was noted that there was no age barrier to Shared Lives and some of the models of care and support were outlined.

 

At the conclusion of the debate, the Chairperson identified potential future scrutiny activity.  With attention drawn to the sentence ‘Council officers are in the process of establishing a project within the Community Wellbeing Transformation Programme to review and further develop home care solutions…’ (paragraph 4.33, agenda page 32), a committee member suggested that this could be examined through a task and finish group.  The Statutory Scrutiny Officer suggested that draft Terms of Reference be prepared for this purpose.

 

Resolved:  That

 

a.           The progress outlined in the report be noted;

 

b.           Potential items be added to the work programme long list on:

 

·              Technology Enabled Living;

 

·              Discharge to Assess, with input from Hoople Cares and Wye Valley NHS Trust; and

 

·              The development of a Homeshare model in Herefordshire.

 

c.           Consideration be given to an informal discussion with care providers to discuss challenges and opportunities.

 

d.           The Statutory Scrutiny Officer be requested to prepare draft Terms of Reference for a potential task and finish group on the project to review and further develop home care solutions.