Agenda item

Report of the Head of Legal and Governance.

Christine Oliver, Head of Commissioning, Clare Gilbert, Commissioning Lead, and Linda Sellars, Director for Quality and Change, all from NCC, were in attendance to provide the Committee with an update on the implementation of the new Homecare Services model that has been operating for six months.

A presentation was delivered and is included with the initial publication of the informal notes. 

The presentation outlined:

o  the structure of the new model;

o  the 4 appointed lead organisations;

o  what elements of the model are and are not working well;

o  Nottingham’s ranking against nearest neighbour comparators;

o  The current position and what is planned for the future. 

The following additional information was presented during the item and questions from members responded to:

(a)  Whilst there are 4 Lead Provider Organisations, a list of accredited providers is maintained and used when Lead Providers (LPs) do not have capacity to meet demand. However, this is the exception as a close relationship must be maintained with LPs which also helps to ensure that quality standards are maintained;

(b)  There are National problems with recruiting and retaining staff for homecare and it is anticipated that the Brexit outcome may further exacerbate staffing issues.  Nottingham’s issues are further complicated as the City provides multiple opportunities for less demanding work at the same pay level. In addition, the County Home Care Services generally offer a higher wage;

(c)  It is noted that whilst Nottingham City Council has openly challenged the offer of zero hours contracts, some workers prefer the flexibility of not having set hours. In addition, the affordable provision of child care can be a significant influence with potential workers;

(d)  Patient access to the re-enablement service can take up to 6 weeks and is reviewed by Level 3 Community Care Officers after 2 weeks to ensure that the appropriate support is in place, to assess re-enablement progress, and determine if longer term support is required;

(e)  Due to the formal boundary of Nottingham City not including some of the wealthier suburban areas within the greater city area, there are 11% fewer self-funding clients who pay more and help support the local home care market. This results in added pressure;

(f)  There is potential for a pilot of an accredited pay list for personal assistants as the market exists to create an initiative for carers to have more than one person to care for and therefore enough accumulate working hours to make a living;

(g)  As of today, there are now 8 people in acute beds who are medically safe for discharge and are awaiting for a homecare date (compared to 20 on 23/11), and there are 15 people at home with no formal support (compared to 12 as of 23/11);

(h)  Quality of care is monitored closely with spot checks taking place. This is in addition to the requirements of the Care Quality Commission. Where delays may occur, it is sometimes as a result of a safeguarding concern;

(i)  Internal staff who leave are asked for feedback in exit interviews but although requested of external providers, it cannot be required. It appears that most staff who leave are changing jobs, however, there is a small number who leave jobs to care for their children during the school holidays. A pilot scheme of subsidised childcare is being trialled over the Christmas period 2018. Some councillors in attendance believed that providing reduced cost childcare to carers may be beneficial to staff recruitment and retention;

(j)  There is an aspiration to maximise the use of technology to support home care and reduce the necessity for citizens to enter hospital and, where admission cannot be avoided, to leave hospital as soon as is safely possible;

(k)  As the provider contracts run on a yearly basis, as a result of the constant monitoring, it is possible to improve services each year;

(l)  A recruitment campaign was held in October and November and included films of workers explaining what the job involved and why they liked it. A national homecare staff recruitment campaign will start in January 2019 and members of the Committee are requested to promote the opportunities available.

Councillors in attendance suggested that in addition to exit interviews, remaining staff are asked what they like about the job and why they are happy to stay. The information gathered may then be used in recruitment material.

The Chair welcomed the significant progress achieved from the position a few years ago.

AGREED

(1)  to thank Christine Oliver, Clare Gilbert and Linda Sellars for their attendance and presentation;

(2)  for a further update to be submitted in approximately 12 months’ time, particularly regarding the pilot childcare scheme.