Agenda item

Report of the Director of Adults, Health, and Communities. To be introduced by the Cabinet Member for Health, Social Care, and Wellbeing.

Agreement of a full extension to the twelve block contracts for the provision of adult social care home support and reablement services, as allowed for in the original Cabinet decisions.

The Cabinet Member for Health, Social Care, and Wellbeing introduced the report which sought approval for the execution of an 18-month extension to twelve (12) Call-Off contracts for the provision of bundled hours home support and reablement services (listed in Appendix 1 of the attached report), as provided for in the original tenders.

The Cabinet Member outlined the following:

-       The purchase of care for residents requiring home support and reablement services was judged a success due to not having significant waiting lists that was seen see in other parts of London and in in the country.

-       The Council were not seeing the level of care packages being handed back to them and had seen less complaints since the Council had embarked on this journey due to developing close working relationship with providers. This allowed the Council to have a better control and support providers better and in turn meet key themes such as improving adult social care and also improving the financial side of social care.

-       The current high cost of care was recognised and was not something that could necessarily be influenced, but the way forward was to work with providers to ensure better care.

In response to questions from Cllr Hakata and Cllr Emery, the following was noted:

-       Having a set number of providers that the Council were working closely with and had regular contact with, enabled effectively managing standards and ensuring that the Council were getting the best service possible for residents. The Assistant Director added that the theme of quality of service and value for money was replicated across health services commissioned by the Council and with the integrated teams as well. There was a quality assurance framework that was worked to across the North Central London Group.

-       In Haringey the objective of these contracts was to increase the sustainability and the quality of provision. This was done through pricing at a sustainable level for providers to ensure that they could recruit retain a workforce of carers.

-       Having 12 contracts meant that the Council could really hone that resource and build those relationships. Also having on site visits enabled a good understanding on what was happening on the ground level and helping support providers to continue to develop.

-       Client satisfaction surveys were done on a contract-by-contract basis. There were a sample of clients chosen and the Council would call the client or speak to their families. There would also be consideration of any complaints that were coming through to both to the providers and to the Council. The Council team would then assess any themes emerging across providers together with any specific issues with contractors to deal with at contractual level.

Further to considering the exempt information at item 28,

RESOLVED:

1. To approve, pursuant to Contract Standing Order 10.02.1 (b) , the extension of twelve (12) contracts for the provision of bundled hours home support and reablement service, for an 18-month period, from 1 March 2024 to 31 August 2025. The twelve contracts are listed in Appendix 1 (exempt) of this report.

2. The maximum cost of extending for 18 months, if all care hours are utilised, is £15,064,920, taking the combined total contract values to a maximum of £42,786,315. For the avoidance of doubt, payment will be made on services called-off and delivered only, and the estimated likely spend for the 18 month period, based on current utilisation, is £12.3m.

Reasons for decision

Haringey’s model of care for home care support was developed using a codesign process that engaged with front line care workers, provider agencies, service users, and social care staff, and reflected best practice in delivering home support and reablement services from across the country.

The contracts have been running for between two and three years, and a review of performance across the contract shows the contracts are performing well:

? between 70 and 80% of the contracts’ care hours are being utilised. The ambition is to increase to 90-100% within the contract extension period.

? 89% of packages are commissioned with a few hours of referral; and most packages are commissioned within 24-48 hours

? Package hand backs are low with just a handful of packages handed back since the start of these contracts where it was felt that the provider could not meet the needs of the client or at the client’s request. ? Client satisfaction is reported as top quartile, with the Council receiving fewer complaints from clients, family or social care staff.

? Around 90% of planned visits are made and continuity of care provider is good.

? Although workforce recruitment and retention issues persist, as they do regionally and nationally, providers have reported that the ability to offer greater pay, more care hours and in defined geographical areas that limit the need for travel, has perhaps shielded them from the worst effects of the prevailing climate, has allowed them to increase their employment of Haringey residents and has facilitated some overseas recruitment. All providers are reporting use of fixed hour contracts and payment of London Living Wage (LLW).

Although there have been issues with several providers being CQC rated Requires Improvement, leading to a suspension in new packages, one of the strengths of the new model, with a smaller number of providers, has meant we have been able to target our finite Provider Quality Assurance (QA) resource to work intensively with these providers to ensure their improvement plan is implemented in a timely manner. To date, five providers have been suspended, and three of the five providers have had their suspension lifted.

Areas for focus moving forward are reporting and achievement of reduction in care hours and delivery of outcomes-based care, and supporting clients to connect into their local community and networks.

As part of the implementation plan for the Adult Social Care Commissioning Peer Review undertaken in Autumn 2022, a Quality Assurance and Contract Monitoring Framework (QACMF) has been launched, and we will also be increasing the number of officers working in these areas. This will ensure that going forward regular contract monitoring and on-site provider visits will take place; these providers will also receive at least two Contract Monitoring meetings and two QA visits a year. This will enable a more proactive approach to addressing and resolving contractual performance and quality assurance issues.

The move towards adult social care service localities will further assist efficacy of service delivery for these contracts, as it will facilitate area knowledge and enable greater collaborative working with social care professionals. care workers to more easily reduce travel time for care workers and the move to localities-based working for adult social care services which is already underway with new work allocated on a locality basis and defined locality teams due to be in place by April 2024, and will enable greater collaborative working with the service providers.

Alternative options considered

Do nothing: the contract would end on 28 February 2024 and would undermine all the progress the Council has made with the successful providers to-date. It would also put at risk continuity of care for clients as providers may choose to hand back packages of care.

Go out to tender: It would be possible to go back out to tender but given the imminent expiration of the contract, will not allow for a full procurement process to be undertaken. It would also disrupt the good relationships and progress made with the providers to date. Given the challenges in the market and our duty to ensure sustainable fee rates, it would be unlikely to produce a reduction in cost.