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Hertfordshire County Council

Overview of service

Hertfordshire’s Adult Care Service (ACS) vision is to ensure our services promote individual well-being, keep people safe, support people to do as much as they can for themselves and allow them to live as independently as possible in their own home and communities.

Homecare services are key to achieving these objectives and will be pivotal in preventing Service Users from going into bed based services such as residential homes, hospital, or other formal care settings.

 

Connected Lives and Service User Wellbeing

Hertfordshire’s Connected Lives approach aims to ensure that people are enabled to achieve the outcomes that matter to them with support that builds on their strengths and those of their friends, family and community.

•    Going forward our aim is to develop and deliver better, more integrated services that support individuals to stay independent and well. We want to engage with providers who want to develop innovative, more integrated services across health and social care that prevent hospital admission, reduce discharge delays and supports people to return home wherever possible.  

•    Key opportunities in this area will be the accreditation of our spot homecare contracts, short term beds in residential homes to support hospital discharge, dementia support services and a review of older people’s day services.



 

Current Situation

Our Lead Providers are contracted to deliver an agreed level of indicative hours per payment period.

Each Lead provider is responsible for its own geographical area, therefore ensuring local knowledge of the community exists. The remainder of the market is supported by our Spot providers and, when essential, non-contracted providers.

Our Spot providers only provide Support at Home, and this is when our Leads are unable to.

The Council commissions approximately 2 million hours of mainstream homecare a year to support approximately 3,600 adults living in Hertfordshire at any one time. Of this 2 million, 460,000 hours are from the Leads, and this is supported by the Spot market contributing approximately 1.4 million hours alongside.

Table 1: Hours (20/21)

Table 1: Services we commission from the voluntary and community service sector

LeadSpot

1,422,799

458,000


Table 2: Cost - £m (20/21)

Table 1: Services we commission from the voluntary and community service sector

LeadSpot

32.97

11.08



Commissioning has now aligned Reablement and Support at Home services under one contractual arrangement. This will enable the Council to stimulate a consistent approach to the delivery of services and ensure a more equitable access to services for individuals across the county.

Bringing services together will also develop a clearer pathway, with fewer transfers between services to improve continuity of care. Service Providers will also have greater flexibility and control to manage fluctuations in demand to meet assessed needs as defined by the Care Act 2014.

Our Services will support adults aged 18 or over who are ordinarily resident and living in Hertfordshire and have been assessed to meet the Council’s eligibility criteria for unmet needs. This will predominantly be older adults (65+), but will also include adults with learning disabilities, physical disabilities or mental health conditions.

Across Hertfordshire we want to see:

•    Joined-up health and social care services tailored around individual needs assessed locally by the right person at the right time

•    Those who work in vital caring roles to be valued and for the work that they do to be recognised for its importance to our community
•    Wellbeing promoted through prevention strategies; by developing and supporting services that can prevent, reduce or delay the need for health and social care

•    Fewer hospital admissions, with agencies working together so patients can be supported to return to their own homes wherever possible

•    Dignified and happy lives, safe from neglect and abuse with high quality care delivered in a respectful way




 

Impact of Covid and overall Demand

There continues to be an increase in demand on services, and providers, both for Leads and Spots. This has been reflected in the fact that we have delivered more than 200,000 extra hours of care during the pandemic. This continues to be reflected in the increases highlighted below;

Reablement Invoiced Hours has seen a near 18% rise from Oct-20 to Jul-21. The rise has been even across EV & WH:

•EN increase -18%
•WH increase -19%

Mainstream homecare commissioned hours have seen a near 40% rise from Oct-20 to Jul-21

However alongside this increase in demand Commissioning has managed to reduce the uncovered lists, which despite the increase in demands is at the lowest it has been since we started recording these figures in 2016.
In order to match demand we continue to address the market for any new providers that can support us, and this is reflective in the fact that over the last 2 months we have taken on 6 new providers.
Going forward a key part of Commissioning will be engaging in the provider market. Whether a provider is an existing Lead, Spot or Non-Contracted they will be held to the same model, as well as to our high quality assurance and monitoring standards.



 

Commissioning Intentions

Our intention going into 2022 and beyond is to have both our Spot and Lead providers operating to the same model;

•    Moving spot providers from “time & task” commissioning to the same outcomes focussed model as Lead Providers

•    Supporting referrals 7 days a week

•    Quicker response times

•    providers responding to referrals within 2 hours

•    start date within 24 hours where the requirement is for rapid support, otherwise 48 hours

•    same day restarts where the request is made before 12pm

•    Short-term 10% flex in hours without prior approval, to support acute episodes, e.g. prevention of admission or carer breakdown

•    Care practitioners staying the full duration of the planned visit to engage in conversation, reducing loneliness and building rapport, to support with identifying wellbeing needs

•    Providers working in an integrated way with our therapy partners

•    Delivering quality care in a local area – knowing their patch well, the professional teams who operate there and community resources available

•    Identifying any local specialisms, e.g. language & culture to support a local community

•    Supported through HCPA, CHIT team, professional colleagues to ensure people can be supported to remain at home as long as possible and prevent avoidable hospital admissions

•    Focus on providers with sufficient infrastructure and management in place to support complex cases with skilled staff.

•    Arrangements regarding commissioning Continuing Health Care to be reviewed during the lifetime of the Framework – this can be built in so providers are aware this is a possibility and avoid contract variations.

 

Pay Uplifts


With both Spot and Leads we have implemented the new pay uplifts, and this will be put in place with all new providers that come onto our framework, thus making it a fairer and more attractive place to work for care staff.

 

Quality Assurance and Monitoring


This element of Commissioning has not stopped during Covid, rather it has changed to suit the restrictions in place, but as we hopefully see a continued lifting there should be an increase in visits taking place thus enabling us to restart face to face monitoring on how providers are performing.

Monitoring Officers will once again carry out an unannounced annual monitoring visit, using the Provider Assessment and Market Management Solutions (PAMMS) tool to produce a rating for the service.

If there are serious concerns highlighted, we will work in a transparent and proactive way with service providers to improve quality and to ensure safe and effective care for all residents. We expect homes to work proactively with us to ensure timely support and interventions before risks/concerns escalate. If needed we can either hold providers accountable to the 90 days hand backs, or if the situation is more serious we can work alongside our Ops colleagues to put together a more immediate plan of support.

At the same time our Quality Monitoring Officers will continue to adapt their way of working through Covid. We foresee this role as remaining ‘online’ as we do not want to risk visiting individual service user’s health as they may be vulnerable.

Our key focus will remain ensuring that as many visits as possible take place.

 

Current Monitoring Ratings (year to date)

Table 3: % Residential Score Breakdown from 20/21

Table 1: Services we commission from the voluntary and community service sector

Residential Score Breakdown %

Excellent

2%

Good 

72%

Poor

0%

Requires Improvement

26%


Table 4: % HomeCare Providers Monitored

Table 1: Services we commission from the voluntary and community service sector

HomeCare Providers Monitored

Excellent

11%

Good

72%

Poor

2%

Requires Improvement

 15%

Table 5: % of Supported Living Providers Monitored

Table 1: Services we commission from the voluntary and community service sector

Supported Living Providers Monitored %

Excellent

0%

Good

93%

Poor

0%

Requires Improvement

7%

Percentage Data ACS 2021




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