Agenda item

Report of the Bi Borough Director of Integrated Commissioning

7.1       Following concerns raised at the last committee meeting regarding an internal audit of Tri-Borough Homecare members received a report that outlined the current commissioning approach to the provision of home care services within the City of Westminster.  Whilst the service had received a satisfactory assurance review the audit had identified a number of areas for improvement which the committee wished to raise with senior officers of the directorate.

7.2     Home care is a key service to enable people who need care and support to remain living as independently as possible in their own homes. In Westminster around 1000 people per week are receiving this service. Approximately 60% of the service is delivered through 5 main ‘block’ contracts.  Residents have the right to choose who provides their care and the remaining 40% of the service is delivered through a number of spot contracts.

7.3     The report explained the role of the Care Quality Commission (CQC), the national regulator for these services, and provides the Committee with information on CQC’s rating of the performance of local home care providers.  The report also provided information on any Safeguarding alerts or complaints that have been received on local home care providers.

7.4     Mr Boyle, Bi-Borough Director of Integrated Commissioning, Adult Services, reported that further to the information set out in the report the CQC had not been able to re-inspect Vincentian Care Plus in mid-April as intended. However, they had undertaken an inspection of spot home care provider Bluebird Care which it had rated outstanding. Mr Boyle provided some context around the CQC ratings. He explained that only 2% of all health and social care services in England have received an outstanding rating with 60 to 70% receiving a good rating and the remaining requires improvement. The CQC had in 2016 raised the rating threshold making it hard to achieve the highest rating.

7.5     The Committee asked questions about a range of issues including how vulnerable residents choose who they may receive care from, who does the initial assessment and whether all carers have received a DBS check.

7.6     Mr Boyle explained that the initial inspection as to whether a resident is in need of adult social care is undertaken by a social worker. Half of all referrals are for people who have been discharged from hospital. There is a greater emphasis now on supporting people to live independently in their own homes whereas in the past residents would have remained in hospital. Members reported that some residents had raised concerns regarding the depth and quality of initial assessments. Mr Boyle undertook to raise this with the relevant team. He explained that if a resident lacks the capacity to make an informed choice about their care someone appointed can assist them to pick an appropriate provider.

7.7     With regards to DBS checks, Mr Boyle explained that about 18 months ago there had been significant delays by the external authority responsible for providing DBS clearance. Some potential carers had to wait up to 8 months to receive a certificate resulted in people not being able to take up positions leading to staffing issues. To mitigate this providers paired staff awaiting clearance with those who had already been cleared to undertake double handed visits, where such need identified in care packages was increasing, so that anyone who had yet to receive a DBS clearance did not have unsupervised access to clients.

7.8     The Committee then turned its attention to the performance of the currently commissioned providers. Mr Boyle was asked about the safeguarding alerts. He explained that this meant that somebody had potentially been placed at risk because, for instance, they had not received their medication at the appropriate time.

7.9     Mr Boyle explained that nationally, and across London, the home care market is fragile.  Directors across London recently commissioned an external review of the market and the conclusions were that margins are very tight, recruitment and workforce development is challenging, and there is little or no scope for achieving savings by reducing the hourly rate paid to home care providers. 

7.10    Given the negligible profit margins of providers the committee considered that there should not be any attempt by the Council to reduce costs for this service as there are no realistic opportunities to realise financial savings while the impact on provider viability could lead to potentially significant risks to vulnerable people and consequently reputational damage to the authority. Members commented that provider viability needs to be considered as part of the future commissioning process. They also commented on the challenges of recruiting staff and suggested that greater emphasis should be placed on trying to recruit more directly from local colleges. Mr Boyle agreed that greater emphasis should be placed on establishing Home Care as an entry-level vocation into other types of health and social care roles. He advised that directors across London do not see any scope for saving on the hourly rate paid to carers. The London Living Wage has recently increased and the City Council will look at how it can fund the uplift for block providers whose carers are paid at this standard.