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Hertfordshire County Council

Overview of service


This section highlights Hertfordshire County Council’s (HCC) anticipated market requirements for residential care for the next 3 years. Any questions, please do get in contact with us at olderpeoplemps@hertfordshire.gov.uk

 

Current Challenges


There are several significant influences that are expected to continue impacting the delivery of care in the older people’s residential and nursing care market over the coming years.  Whilst these may be considered structural, they have been accelerated and deepened by COVID19, resulting in significant challenges for service providers and commissioners.

Unprecedented demand for care

Prior to COVID19 there were pockets of reductions in referrals that services were highlighting, which coincided with our strategic approach of providing care at home for more people.  From May 2021, the numbers of placements with the sector are over and above pre COVID levels and this trend is likely to continue.

Increasing prevalence of high frailty/dementia/complex comorbidity

The growth in demand has not been uniform.  Demand has particularly accelerated for services that can support extremely vulnerable people with multiple conditions.  This has been driven predominantly by hospital discharges, but also by what can be considered as ‘pent up’ demand from her community, where informal caring arrangements are coming to an end, for example.

Impact of COVID 19 on and our communities and individual care needs

As the wider economy rebounds from the economic shock of COVID, more and more people are making choices about their future.  This may be due to the increasing logistical economy, furlough coming to an end, the re-opening of some offices and expectations on people to return to their workplaces. This may also lead to a contraction of the role families and communities played in supporting vulnerable people.  These needs may manifest as increased complexity, possibly driven by a point or period of crisis.

Workforce, quality, and resilience challenges

Clap for carers was a welcome recognition for the care sector and the individuals who had, and are continuing to, put themselves on the line to care for our loved ones.  However, the structural workforce issues remain; recruitment and retention, pay and reward, support, training and career progression, proposed increase in National Insurance.  This has increased the risk to services to ongoing or further shocks that require micro and macro resilience planning to safeguard people in receipt of care.

Care reform impact on fees and self-funder arrangements

Recent announcements, ahead of a planned White Paper on this issue, will have an (as yet unquantified) impact on the sector.  A removal of the ‘cross-subsidy’ of public and private fees has been proposed that will be worked through at all levels to fully understand the impact locally.

Financial pressure on providers and local government

Recent announcements to increase funding for the NHS are welcome and this will support the local care economy in Hertfordshire. The social care contribution remains proportionally less and the release of future monies are more closely linked or aligned with NHS priorities on discharges, to tackle the backlog on elective procedures. Combined with the care reforms, there is significant work to ensure sustainability of the sector to focus effort and services in the right places to achieve the right outcomes, for both people and systems.   

Developments in the procurement environment

Councils and the residential and nursing sector have a limited procurement relationship; in Hertfordshire there is a heavy reliance on spot contracting arrangements.  There is now an increasing desire to maximise social value within contracts and procurement and increase the emphasis on environmental sustainability. 

 

Where is Hertfordshire now?


•    A strong residential care offer, but with growing vacancy levels in many homes.

•    Shortage of high frailty/nursing care, which has become critical in some areas.

•    Care workforce shortage.

•    Financial pressure (providers/HCC)

 

Future Commissioning Intentions


Hertfordshire’s Ambitions for residential care are:

•    For all services to deliver Connected lives

•    To achieve outcomes-based commissioning

•    To drive for coproduction

•    To establish a strategic nursing partnership

•    To support nursing care growth, including by making a major capital intervention (including existing HCC sites)

•    To significantly review Discharge to Assess in order to achieve better outcomes and a sustainable model.

The commissioners will be focusing on the following priorities between 2020/23.


 

The Hertfordshire Spot Contract

The overwhelming majority of Hertfordshire long stay residential and nursing placements are made by spot contract. Hertfordshire has adopted the ADASS East of England Contract Standard for social care services like all local Authorities within the East of England region.

The commissioning of good quality nursing/high frailty dementia nursing care continues to be a very high priority for Hertfordshire’s commissioners in all areas. The county council is seeking providers that:

1)    Can facilitate safe, same day admissions for residents from community and hospital settings following national guidance

2)    Can make important equipment such as profiling beds available for timely admission.

3)    Are able to make admissions until 8pm in the evening over 7 days per week.

4)    Are able to work within a trusted assessment process

5)    Consistently use the NHS bed tracker/Herts care search to show vacancies.

6)    Hertfordshire has agreed to develop a joint nursing care contract with East and North Herts CCG. In 2020/21 the market will be engaged around future opportunities to provide residential nursing care under a single contract with Hertfordshire and the NHS.

 

Discharge to Assess pathway 2

Hertfordshire’s County Council and NHS work in close partnership to commission Residential and Nursing Discharge to Assess services for adults leaving hospital. There are several established services already in place, but we are keen to develop new partnerships with providers that may not have delivered this service to date to ensure the right care for people leaving hospital. We would like to hear from providers that may be able to offer these services, and those who are able to provide nursing care for older adults with dementia, including those who walk with purpose.

The criteria and service specification are attached for your reference. The infection prevention guidance available at the link below will apply to any DTA setting:

If you would like an informal discussion about this service, and to receive the criteria and service specification, please contact olderpeoplemps@hertfordshire.gov.uk

 

Contract Monitoring and Quality Assurance

Hertfordshire carries out regular monitoring of commissioned services to ensure that care standards are met and decisions on future commissioning are informed by strong evidence on quality. Hertfordshire uses an approach which is standardised across the East of England ADASS region

Commissioning Monitoring Officers usually carry out an unannounced annual monitoring visit using the Provider Assessment and Market Management Solutions (PAMMs) tool to produce a rating for the service. Due to the restrictions around COVID-19, Hertfordshire introduced an interim remote programme of monitoring but is now returning, in a phased way, to business as usual.

 

Workforce Development Programme

In recognition of the importance of the care workforce Hertfordshire County Council directly invests £450,000 annually in learning and development programmes for private and voluntary sector adult care providers. This programme continues in close partnership with HCPA and includes:  

•    A training offer for staff members at all levels within organisations and covering mandatory, leadership and management training, health & social care qualifications, study days, network events and forums.

•    The new Skills, Training and Needs tool (STAN+), developed in partnership with Hertfordshire Care Providers Association (HCPA). This training needs analysis tool supports providers to identify competency and training needs within their workforce.

•    Extra targeted support for providers experiencing significant quality challenges.

•    Newsletters and quarterly key themes updates.

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