Home Based Care Update Surrey Care Association 19 th September 2013

Home Based Care UpdateSurrey Care Association

19th September 2013Jean Boddy, Senior Commissioning

Manager Older PeopleKirsty Malak, Assistant Senior Manager

Emily Parker, Assistant Category Specialist.

1

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

2

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

3

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

4

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 5

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

6

Staff supply

• Pay is not attracting people with cars - petrol & insurance costs inhibit applications to posts

• Providers have to offer an increasing range of benefits to attract the right staff, e.g. vouchers, bonuses, awards.

• Recruitment costs, and an increased rate of staff turnover, means providers are spending significant amounts of time firefighting staff issues rather than planning for the long term

• Providers are setting up “training schools” in areas to reduce overheads

• Seasoned providers saying they don’t recall it being “this difficult”

• Public perception – Panorama and newspapers – affect motivation in the workforce

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

7

Needs and skills base

• Increasing health complexities• Accommodation of long term

conditions• Issues relating to end of life care

Broader skills base needed of staff

• Providers are telling us that the skills level needed is now commensurate with community health assistants

• The culture of planning support based on tasks is not consistent with the personalisation agenda

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

8

Viability

• Few providers on the framework are willing to offer contract hours – majority are zero based

• Many providers are embracing technology with an increased use of electronic monitoring, but at a cost.

• The geographical variation in Surrey means it is not economically viable for providers to operate in some areas

• The restrictions on taking ASC funded “customers” shopping or to external events (managing money, insurance etc) is reducing the opportunities for real person centred care

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

9

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 10

Demographic Data

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

12

Elmbri

dge

Epsom

/ Ewell

Guildfo

rd

Mole V

alley

Reigate

and B

anste

ad

Runny

mede

Spelth

orne

Surrey

Hea

th

Tandri

gde

Wav

erley

Wok

ing0

20000

40000

60000

80000

100000

120000

Borough and District Demographic Data 2013 and Predicted in 2018 (18 - 64 and 65+)

18-64 Population (2013)65+ Population (2013)18-64 Population Predicted (2018) 65+ Population Predicted (2018)

13

Budgeted spend on home based care

2012/2013 2013/14 2014/15 2015/16 2016/17 2017/180

10000

20000

30000

40000

50000

60000

Home based care spend for people aged 65+, according to SCC Medium Term Financial Plan

Spend (£000s)

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

14

Elmbrid

ge

Epsom / E

well

Guildfor

d

Mole V

alley

Reigate

and B

anste

ad

Runnym

ede

Speltho

rne

Surrey H

eath

Tandrid

ge

Wav

erley

Wok

ing0

20

40

60

80

100

120

Home based care in Surrey, 2013 and projected 2018 figures

(people aged 18-64)

20132018

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

15

Elmbrid

ge

Epsom / E

well

Guildfor

d

Mole Vall

ey

Reigate

and B

anste

ad

Runny

mede

Speltho

rne

Surrey H

eath

Tandr

idge

Wav

erley

Wok

ing0

100

200

300

400

500

600

700

Home based care in Surrey,2013 and projected 2018 figures

(people aged 65+)

20132018

Bariatric population 2008Borough/ District No. of obese adults

(16+) 2008% of obese adults 2006 - 2008

Elmbridge 18,824 18.17%

Epsom & Ewell 11,739 20.03%

Guildford 23,477 21%

Mole Valley 12,765 18.73%

Reigate & Banstead 23,079 21.06%

Runnymede 15,945 22.70%

Spelthorne 18,753 24.77%

Surrey Heath 14,998 22.46%

Tandridge 14,100 21.49%

Waverley 19,383 20.45%

Woking 15,931 21.55%16

Supply and Demand Data

Commissioning and Procurement

18

Where do people supported by home based care live?

SCC-funded HBC Hours

– North West

19

20

SCC-funded HBC Hours

– South West

21

SCC-funded HBC Hours

– Mid Surrey

22

SCC-funded HBC Hours

– East Surrey

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 visitsResponse 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 areas23

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. 24

Options Analysis Recommendation September 20131. 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.

2. 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

3. Review the potential options for structuring the contract which enables SCC and the CCG’s to support the development of domiciliary providers

25

26

27

Home Based Care Re-Tender – Potential Timescales

Undertake Options Analysis

Finalise Options &

ObtainApproval

ReviewProvider

Performance

Issue Extend/Exit

Notification toProviders

Stage One – Options Analysis (May –Nov 2013)

Stage Two – Extend & Exit Exercise (Dec 2013)

Stage Four – Full/Partial Re-Tender (April – Sep 2014)

Prepare for Re-tender

Conduct Tender

Exercise(April – June)

Go Live

(Aug - Oct)

Stage Three – Prepare for Tender (Jan – March 2014)

Award & Implement

Contract(July)

Market Shaping