1. Home Based Care UpdateSurrey Care Association19th September 2013 Jean Boddy, Senior Commissioning Manager Older People KirstyMalak, Assistant Senior Manager Emily Parker, Assistant Category Specialist.

2. 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

3. 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

4. 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

5. 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

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

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

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

9. 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

10. 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

11. Demographic Data

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

13. Budgeted spend on home based care

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

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

16. Bariatric population 2008

17. Supply and Demand Data Commissioning and Procurement

18. Where do people supported by home based care live?

19. SCC-funded HBC Hours– North West

20. SCC-funded HBC Hours– South West

21. SCC-funded HBC Hours– Mid Surrey

22. SCC-funded HBC Hours– East Surrey

23. 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 visits Response 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 areas

24. 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.

25. Options Analysis Recommendation September 2013 • 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. • 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 • Review the potential options for structuring the contract which enables SCC and the CCG’s to support the development of domiciliary providers

27. Home Based Care Re-Tender – Potential Timescales Stage One – Options Analysis (May –Nov 2013) Stage Two – Extend & Exit Exercise (Dec 2013) Review Provider Performance Issue Extend/Exit Notification to Providers Finalise Options & Obtain Approval Undertake Options Analysis Market Shaping Prepare for Re-tender Go Live (Aug - Oct) Award & Implement Contract (July) Conduct Tender Exercise (April – June) Stage Three – Prepare for Tender (Jan – March 2014) Stage Four – Full/Partial Re-Tender (April – Sep 2014)