Agenda item

4.1     Dee Carlin (Head of Joint Commissioning), Corinne Moocarme (Joint Commissioner) and Fiona Jolly (Direct Payments Manager) introduced the report to the Committee. The following key points were noted:

·       The provision of adult social care is changing so the need for residential care is avoided where possible. As care for residents who live at home has changed and improved, people tend to stay at home longer and are much frailer once they require a residential or nursing bed.

·       The process of personalisation is part of the Care Act. The Council is offering information and advice about the care and support services available for people with a personal budget. This advice is offered to people who are able to select their appropriate care themselves.

·       The Council has a website with information and advice on adult social care services. Members of the Healthier Communities Select Committee will receive the link to the website. Officers are actively seeking feedback on the website.

·       A new role within the Council’s adult social care has been created for support planning. Support Planners advise people on available care services and activities that could suit their needs and preferences. They also have a vital role in shaping the market by identifying gaps, as they will be aware of what people want and need in terms of care services. The work done by the Council in creating community connections is important to this role.

·       The Council is in the process of re-procuring its domiciliary care contracts. The tenders for the domiciliary care contract are being evaluated. The Council’s procurement has been based on an outcome focused approach where the success of a service is measured by results that matter to residents as opposed to time spent on activities.

4.2     Dee Carlin, Corinne Moocarme and Fiona Jolly answered questions from the Committee. The following key points were noted:

·       Performance indicator LP1254 1C (2) captured in the Council’s management report indicates that the Council is not meeting its aim of increasing the percentage of people using social care who receive direct payments. There has previously been a problem with the IT, but this has now been resolved. There have been reviews of people using direct payments, who are subsequently no longer using direct payments. The percentage of people using direct payments has been increasing week on week, but this data wasn’t available in time for the Council’s latest management report. One of the difficulties in encouraging people to use direct payments, is many people require a small number of hours of care for specific times. There isn’t an excess of supply of care workers for whom such working conditions are favourable.

·       The award of the contracts for domiciliary care provide options to Mayor and Cabinet (Contracts). They can decide to include a requirement in the contracts for providers to pay the London Living Wage (LLW) to their staff and increase the cost of the contract for the Council. They can also decide to require providers to pay care workers for travel time and therefore also increase the cost of the contract for the Council. If the Council’s requires its providers to pay the LLW and travel time, it could then decide to sign up to Unison’s Ethical Care Charter.

·       Direct payments mean that residents pay people directly to provide them with care. Any arrangements about the pay and working conditions including paying LLW or paying for travel time are part of the employment contract between the resident and the care worker. The Council cannot impose any conditions for care workers paid via direct payments. The direct payments the Council provides to people using social care who receive a direct payment cover the full cost of employment, including provision for maternity leave and sick pay. If residents require specialist care, the Council has a process in place to review whether increased payment for travel time under that specific direct payment is appropriate.

·       Any new provider awarded a contract by the Council for domiciliary work would be expected to reduce any zero hour contracts with their staff. Providers would also be required to provide training and development for their staff.

·       Support planners review on an individual basis whether it is appropriate to refer residents to existing support networks, either family and friends or community based. The aim is to not take people’s independence away. The other role of support officers is to identify what services are missing from the current supply and feed this back to commissioners.

·       The Council also employs care planners or brokers, who plan and arrange placements for people with long term care needs. Their work is different from that of support planners. Support brokers are not required to have a specific qualification. The employees come from a range of backgrounds with a range of skills. The majority have worked for the Council for many years.

·       The support planners receive extensive training to reach a specific Qualification Credit Framework (QCF) Level. It was clarified after the meeting this was QCF 3. This method of working by the Council has been published as a model of good practice at the Association of Directors of Adult Social Services (ADASS) conference.

·       People can use their direct payments to access services that anyone else would be able to. They can for instance use their payment to enable them to access a specific restaurant. The Council does review whether direct payments are used to pay for appropriate support services, but isn’t able to review and monitor every single provider of such support. Support planners maintain a registered list of activities and providers that they use to advise people of suitable support available.

·       The Council is developing a function on its website that allows residents to exchange information on services they’ve used and advise each other on the quality of service they’ve experienced. Residents would also be able to use this online service to plan group activities together.

·       Ensuring the payment of LLW in care homes is complicated. Most placements of residents in nursing or residential homes is done by spot-purchasing beds. A local authority may only pay for a small number of the beds provided in one home and one home may provide beds to more than 10 different local authorities at once. Requiring the payment of LLW for the staff employed on just the beds for one Council, could mean unfair treatment of staff across one care home or significantly increased prices for the beds used by that one authority to cover the costs of paying LLW to all staff employed by a home. Unfortunately not all local authorities are committed to LLW or to ensuring their contractors pay LLW.

·       A number of nursing and residential care providers have exited the market due to a number of factors: the costs of staff, the difficulties in recruiting and maintaining staff, the difficulties in providing appropriate training for staff and the requirements of the CQC’s inspection regime.  

RESOLVED: to note the report.