Agenda item

11:40

Report by Corporate Director of Adult and Housing Services (PSC8)

Homecare is a key service which helps people to live well at home, and forms part of the Council’s care and support offer for people with an assessed eligible need. It is also purchased privately by people who fund their own care.

Spend on homecare forms a significant part of the Adult Social Care budget, this is a potentially growing area due to ageing demography in the County and associated increasing acuity of need.

Oxfordshire is recognised as a high payer for homecare relative to neighbouring and regional comparators, this position is described further in this paper including our thinking regarding contributory factors.

Significant work is underway to address this position and to deliver a sustainable commercial model for homecare contracting in the future. This forms part of the Adult Social Care vision for a strength-based approach in working with communities and provider partners.

The Committee is recommended to note and discuss the report.

Rachel Pirie introduced the report which explains the workforce pressures which contribute to the Council being a high payer for home care.  The Covid-19 crisis saw some of the highest levels of home care requirements and the Council is grateful to the providers for their increased service during this period.

We expect that we will continue with the current providers into the future so it is important to bring them in and discuss to understand their cost pressures and ensure that they understand the pressures on the Council.  They have a lot of valuable expertise in the area and know the care recipients very well.

A procurement exercise will start in the autumn as part of the normal cycle.  A third party has been engaged to conduct a fair cost of care exercise in advance of that.

Members asked questions on the report and the officers responded as follows:

·         There has been successful recruitment recently and work is in progress on a recruitment campaign that will be led locally but linked in to a national campaign.

·         New contracts will require providers to be transparent on the payments to their workers to ensure fair remuneration.

·         Twenty percent of the Infection Control Fund will be allocated to home care providers on a per-head basis to assist in extra costs such as providing PPE.

·         Members were urged to lobby nationally for more sustainable funding for social care that will recognise workforce benefits both financially and professionally.

·         The same fair cost of care exercise will be carried out in relation to care homes.

·         Officers believe that care may be over-prescribed in Oxfordshire.  There should be a broader range of options which would reduce reliance on higher level support.  Following the problems in care homes with Covid-19, it is anticipated that more people will opt for home care.  But the Covid-19 crisis also introduced some new options not available before such as live-in support.

·         The county is not performing well on reablement and officers are working with the sector to understand why.

·         The care providers’ representative organisations are supportive of the fair cost of care process as they believe it will clearly demonstrate the real costs of providing care in Oxfordshire.

·         The Council is working with the care providers who have been rated as ‘requires improvement’ to help them achieve the necessary standard.

·         Officers agreed that local links and continuity of service are important factors in providing quality service and that is why they are focussing a lot of attention on retention of staff.

·         Communities, volunteers and technology all have a part to play.  Extra-care housing also provides fantastic support.  There is a need to think outside of existing services, for example there could be a role for micro-providers, individuals who can provide a small number of hours per week.

·         There is a focus on apprenticeship in the team and they have a lead person for apprenticeships who is working with colleges and training providers.

The Chairman suggested encouraging providers in the social care sector to avail of the government scheme to employ young people.  She added that she was aware that the Growth Board is looking at provision of extra-care housing and some had been provided already in West Oxfordshire.

Delayed Transfers of Care (DToC)

Stephen Chandler updated the Committee on this issue as it evolved over the Covid-19 crisis.  He stated that the Council ensured that the government guidance issued on the 19 March 2020 was followed and they went beyond those requirements and continued to provide full assessments.  Nobody was forced to discharge.  It was all decided on a medical basis.

On 15 April 2020 the government guidance required a Covid-19 test before discharge.  Of 188 discharges over the five-week period up to that, 112 transferred home and 76 went to permanent placements or hub beds that the Council purchased in care homes.  Of the 188, eleven people have died since – 4 attributed to Covid-19. 

The number of DToCs reduced from 90 in January to half a dozen in April and May.  If there is any suggestion that this was achieved by forcing people into care homes then this is not borne out by the data.  The number of transfers to care homes was actually lower than for the same period last year.

More home care became available and was commissioned.  The hours rose from under 21,000 at the end of March to 22,500 in June.

There is still a lot of analysis to be done but some contributory factors in the spread of infection have been identified nationally including the size of care homes and the use of agency staff moving between care homes.  The majority of care homes in Oxfordshire have over 50 beds and over a quarter have more than 100.

The Chairman asked how the learning from Covid-19 can help ensure that the high levels of DToC are never seen again.

Stephen Chandler responded that the first aspect being worked on is admission avoidance which is NHS led.  Secondly reablement is currently not effective so the current contract will not be renewed and work is ongoing to improve it in the next contract.

Councillor Jenny Hannaby asked if care homes had asked for tests in the period before the guidance made them compulsory.  Stephen Chandler answered that he could not recall any requests but that he would ask staff about that.  Rachel Pirie added that most of their work with care homes was on PPE and infection control.  All care homes can register for testing and it is hoped to be able to provide it more regularly going forward.

Councillor Glynis Phillips asked how many of the 188 people discharged tested positive for Covid.  Stephen Chandler responded that they would have to go through the care homes and Public Health England to get that information but it may be possible to find it.

The Chairman thanked officers for the updates and thanked all staff for going way beyond the call of duty during the crisis.