Stockton-on-Tees Borough Council

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Cabinet Decision: 19th May 2016
Title of Item/Report
Development of a Social Enterprise - Home Care Services
Record of the Decision
Consideration was given to a report that detailed the proposal to develop a social enterprise as an additional provider of home care services within the borough.

Members were aware there were some significant challenges within Adult Social Care. Inflationary pressures on service provision (Including the national living wage), increasing demand for services (ageing population, increased life expectancy etc. and continued strain on financial resources all present a high level of risk to the Authority. Ensuring quality of service provision was also a key issue.

Home care was a service provided by paid care workers to provide help in the home to a person who needs support for assessed unmet needs. The service was arranged following a social care assessment carried out by a social worker. This included practical support to help with activities of daily living.

Home care provision was designed to enable people and to promote independence by assisting individuals to remain within their home, delaying, preventing, where appropriate, the need for acute care and residential care. Locally we provide around 10,000 hours of home care a week for around 1,000 service users, 80% of which was provided by two companies (both private sector). The annual value of the work was 4.745 million (2014/15 costs). The current model of home care was in the main traditional and focused on meeting identified and eligible needs as part of an adult social care assessment process rather than on reabling or preventing needs from escalating.

Within the home care services there were some specific pressures
• Fees (service providers nationally and locally were facing challenges from the National Living Wage, pension reforms and pressure from HMRC over travel)
• Growth in the volume of hours being commissioned
• Service providers facing problems such as recruitment and retention of staff and expectations of service users and families.

The Care Act 2014 placed new duties on Local Authorities to facilitate and shaped their market for adult care and support. Market shaping activity should stimulate a diverse range of high quality services (both in terms of types, volumes and quality of services and the types of provider organisations) and ensure the market as a whole remains vibrant and sustainable. There was an emphasis on outcome based commissioning which in the case of homecare could emphasise prevention, enablement, ways of reducing loneliness and social isolation and promoting independence as ways of achieving desired outcomes.

Just under 20% of home care calls were 15 minute calls, which were classified as ‘welfare calls' that was low level interventions to check someone was well with no personal care. Such visits could involve for example prompting someone to take medication. This provided an opportunity for an alternative service delivery model.

Considering the national and local challenges to home care and the risks these pose to the market, there was an opportunity to consider alternative homecare service provision by seeking a partner who could develop a third sector social enterprise. Such a provider would still deliver registered personal care services but could add value by providing some of the welfare calls through volunteering and potentially also providing a personal Assistant ‘checking and matching' service plus developing personal assistant peer support. The organisation would be not for profit with any surplus reinvested back into the business to support the growth and development of the business and could for example assist with enhanced staff training/retention, support for volunteers etc. Staff turnover in homecare was high with each new staff member costing circa 4k to get trained and ready to work independently; constant staff turnover can disrupt service delivery and was not desirable from the user perspective as clients generally prefer the same staff to visit. Investment in staff pays proven dividends, and a social enterprise would concentrate on this, resulting in improved quality and consistency of service delivery.

It was identified a local voluntary and community sector partner, Five Lamps, who we intend to work with on a twelve month pilot basis initially operating within a defined area of the borough. This would be consistent with the Council's approach to further developing the voluntary and community sector to enable organisation to have improved access to business opportunities. The intention was Five Lamps would:

(a) Put additional resource into creating a qualified, motivated high performing workforce reducing staff turnover (and the impact this has on service users)
(b) Work in partnership with Stockton Riverside College to develop a professional care workforce
(c) Be more flexible to the needs of individuals and help facilitate independence and wellbeing
(d) Be rooted in the community

Using a local social enterprise within a profit for social purpose model where profits were reinvested back in to further develop the enterprise and its employees and volunteers was compliant with our Sustainable Procurement Policy and the social value element in particular.

It also supported a model of social capital where the existence and quality of the relationships, social networks and attributes that exist amongst the families, organisations and the local community are built on and developed as an underlying and essential ingredient that supports healthy communities.

The report of the Adult Social Care and Health Select Committee in February 2015 identified the need to continuously improve the quality of home care in our borough. The committee recommended we further diversify the provider market by working with the voluntary and community sector (VCSE) to develop new services. The report was in line with that recommendation.

There were a number of requirements in order for the social enterprise to become operational and to meet Care Quality Commission registration standards. A detailed implementation project plan would be drawn up in conjunction with the Council which allowed the social enterprise to be an active provider as soon as was practical.

The existing contracts for the delivery of homecare end 30th September 2016 with a one year optional extension. The Council were considering taking the optional year extension with the existing eligible providers, but carving out a number of clients, possibly based on a geographical area and awarding a contract to the new social enterprise provider as a pilot scheme. This would allow the Council to test out new ways of working and specifically develop a welfare approach with the aim of increasing independence and community support. This approach would allow Five Lamps to establish CQC registration and to commence service delivery with a manageable number of clients. Subject to the pilot being successful, Five Lamps would be in a position to compete when the next contracts were tendered for commencement 1st October 2017.

The commencement of a new service had to dovetail with current contract arrangements to prevent duplication or gaps in service.

Although initially home care would be the focus of the social enterprise other areas may be developed for example residential care. Colleagues from health may be interested in the development of our new home care model as there could be aspects of health care that could be delivered in the community as part of the welfare visits. The Council would approach colleagues in health and establish a dialogue around this.

RSOLVED that the proposals be supported.
Reasons for the Decision
The Care Act requires Local Authority's to shape the market for the provision of adult care and support. Introducing a new third sector player/players to develop a social enterprise in relation to the delivery of homecare services will provide additional choice and further enable prevention and independence.
Alternative Options Considered and Rejected
Declared (Cabinet Member) Conflicts of Interest
Councillor Steve Nelson declared a personal non prejudicial interest in agenda item 7 - Development of a Social Enterprise - Home Care Services as he was a board Director of Catalyst.

Councillor Nigel Cooke declared a personal non prejudicial interest in agenda item 7 - Development of a Social Enterprise - Home Care Services as he was a Member of Tees Valley Music Alliance.

Councillor Norma Wilburn declared a personal non prejudicial interest in agenda item 7 - Development of a Social Enterprise - Home Care Services as she was Member of Corner House and Stockton Riverside College.
Details of any Dispensations
Date and Time by which Call In must be executed
Midnight, 27th May 2016

Date of Publication: 23 May 2016

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