Home Based Care Update Surrey Care Association 19 th September 2013

1. Home Based Care UpdateSurrey Care Association19th September 2013 Jean Boddy, Senior Commissioning Manager Older People KirstyMalak, Assistant Senior Manager Emily Parker, Assistant Category Specialist.

2. Purpose of this document • Provide an update on the HBC Framework • Make SCA aware of the decisions that are proposed for the HBC framework over the next 6 months to a year

3. Current position • The existing HBC framework was awarded in April 2012 as a 2 year plus 2 year contract • The first two years of the contract expire in April 2014 • A decision is required as to how to proceed with HBC Framework

4. The national context • Workforce Strategy – tools for ‘Value based employment ‘ • Norman Lamb June 2013 ‘crisis talks’ - HBC is the next big scandal • Equality & Human Rights Commission – Close to Home report • Unison Ethical Care Charter – proposals for the living wage and changes to work practices • UKHCA – Care is not a Commodity report • Direct payments and the use of personal assistants (PAs) • Long Term Conditions strategy - increased complex needs living in the community • Technological improvements - monitoring, Telecare and Telehealth

5. Local context • For a variety of reasons there has been a lack of capacity in some areas e.g. difficulty recruiting and retaining staff, some locations (particularly rural areas) are less viable than others • The Sourcing Teams experience a lack of responsiveness from some providers • Quality standards not consistent – resulting in a higher number of safeguarding and quality assurance concerns • Quality of assessment and information from social care not consistent. • Concern as to whether the existing contract can meet the anticipated demographic changes

6. Market analysis - Summary of one-to-one discussions with framework providers

7. Market analysis - Summary of one-to-one discussions with framework providers

8. Market analysis - Summary of one-to-one discussions with framework providers

9. Quality assurance feedback • Capacity – in some areas there have been significant issues with capacity this is exacerbated in holiday periods • Language/ cultural barriers – staff unable to communicate with people and not considerate of cultural norms • Missed calls – also staff not staying the allocated time, or arriving on time • People not receiving rotas therefore unaware who is coming to provide care • Some providers are increasing their packages of care but are not increasing the number of supervisory staff • Medication audits are not being conducted

10. Summary of customer feedback Summary of half yearly results from HBC customer survey • 234 people responded (37% response rate) • 86% aged 65+ Key themes identified: • Inconsistent visit times • Lack of continuity in care staff, and inconsistent levels of care • Lack of rotas • Language/ communication issues • Service not tailored for dementia users • A reduction in respondents who: • Were ‘very’ or ‘quite’ satisfied with their HBC service • Felt their care worker listened to them on their support • Were supported with taking medication at the right time

11. Demographic Data

12. Borough and District demographic data 2013 and predicted in 2018 (18 – 64 and 65+)

13. Budgeted spend on home based care

14. HBC open cases 2013 and projected open cases 2018 (people aged 18-64)

15. HBC open cases 2013 and projected open cases 2018 (people aged 65+)

16. Bariatric population 2008

17. Supply and Demand Data Commissioning and Procurement

18. Where do people supported by home based care live?

19. SCC-funded HBC Hours– North West

20. SCC-funded HBC Hours– South West

21. SCC-funded HBC Hours– Mid Surrey

22. SCC-funded HBC Hours– East Surrey

23. Potential new requirements within a HBC contract Electronic Monitoring • ASC is considering stipulating that providers should have an electronic monitoring system in place • Electronic monitoring can provide assurances and alerts around missed calls • Electronic monitoring can guarantee length of stay of visits Response to emergencies/ crises • ASC wants to ensure that there are a number of guaranteed providers that can respond in a timely and appropriate manner to hospital discharges • ASC wants to ensure that there are a number of guaranteed providers to respond to emergency/ crisis placement requests Guaranteed capacity in specific geographical areas • Introduce factors that will mitigate the capacity issues that arise within in certain rural areas

24. Conclusions and recommendation for new specification Conclusions • The increased population will have an impact on the demand for HBC and the contract will need to ensure that it can meet this new demand • The existing framework already has difficulty meeting the current demand for HBC • Need to mitigate risk of missed calls – Electronic Monitoring • Need to guarantee supply in some areas • Crisis / rapid response is not commissioned • Reablement to be core to delivery of home based care. • Transport – explore how we widen the offer.

25. Options Analysis Recommendation September 2013 • The recommendation from the Home Based Care Reference Group is to offer a 6 month extension to the framework rather than 2 years in order to reshape the current model. • Review the potential contract models e.g. Spot, block, cost/volume to find a model which is fit for purpose and locality and will best meet the needs of Surrey’s residents • Review the potential options for structuring the contract which enables SCC and the CCG’s to support the development of domiciliary providers

27. Home Based Care Re-Tender – Potential Timescales Stage One – Options Analysis (May –Nov 2013) Stage Two – Extend & Exit Exercise (Dec 2013) Review Provider Performance Issue Extend/Exit Notification to Providers Finalise Options & Obtain Approval Undertake Options Analysis Market Shaping Prepare for Re-tender Go Live (Aug - Oct) Award & Implement Contract (July) Conduct Tender Exercise (April – June) Stage Three – Prepare for Tender (Jan – March 2014) Stage Four – Full/Partial Re-Tender (April – Sep 2014)