Minutes:
The committee had requested a report on domiciliary care following their scrutiny meeting in September. The committee recognised that "Turning the World Upside Down" is the Council’s approach to developing sustainable domiciliary care provision, however, having understood from previous discussions that the market is somewhat fragile, they agreed that an overview of the state of play in the social care sector at a future scrutiny meeting would be helpful. The committee agreed to focus on the challenges within the sector and understanding how the council would respond to those challenges. Two care providers had been invited to attend the meeting.
Members heard that domiciliary care provision is a recognised challenge across UK, but that specific challenges for Monmouthshire were:
The committee heard that this posed challenges as to how the workforce can meet the demand. Adult Services have been working on a model (Turning the World Upside Down), which will be implemented in April 2020. The report provided a contextual analysis of the challenges posed, supported by data on which highlighted issues with sourcing longer term care provision. Officers explained that traditional models of care have been based on the provision of care in a transactional way and that whilst has met personal needs, it doesn’t contribute to the longer term health and well-being needs of an individual or their families and carers. The new model intends to build meaningful relationships and provide a model of support that delivers better outcomes for people. The committee heard that the patch based approach should enable twelve patches to provide support for individuals and their carers through a mix of in house care and independent provision and that the success of the patch based approach will be evaluated. The benefits of the approach are to develop the relationships between all stakeholders working within the patch and to ensure care plans are focused on what matters to the individual and the way in which they choose to live their life. It is hoped that the approach will greatly improve experiences for service users, will support their carers and will provide fulfilling roles for staff.
Challenge:
Officers explained that at the moment, there are people who need some level of support and that at the moment, we are unable to meet that need in its entirety and that whilst people are not without any support, the support being provided may not be the ideal support package.
Officers confirmed that the council is suitably prepared for
inclement weather and that the right vehicles are in place. They
explained that they work with other service areas, for example,
district nurses to ensure that people on the council’s
priority list are assisted.
Officers advised that whilst pay is a key issue, the major challenge is also recruiting the right people and making the role attractive. The incentives that could attract people could also be the ability to make meaningful connections with people and to coordinate your day, so the plan is to grow staff as a resource within the patches. In terms of accommodation and transport, conversations are being held with our housing department and Monmouthshire Housing Association. A project is being tested in the south of the county in a crisis area where 39 people who are needing care, has enabled a ‘live in’ model to be tested for home care using 2 properties in Chepstow. This has created a care supply close to the properties and the carer is paid a weekly wage to devise a plan to meet people’s needs until April when ‘turning the world upside down’ will be implemented. Other models are also being trialled in Chepstow.
Officers responded saying that there wasn’t a framework for evaluation at the moment but that they had held discussions with CIW on this could be evaluated and that they were fully aware of the plans. They explained that it would be challenging as the model is very different and that given that the new model will be based on relationships as opposed to task, this will pose difficulties in terms of measuring its success, given that task is easier to measure. Developing quality assurance methods focussing on outcomes will be important, as will gathering information through different measuring techniques, considering the wider consequences, such as fewer people going to hospital or visiting GP’s that may arise out of the changes. In terms of research, a partner has not been sought to evaluate this, but discussion with colleagues implementing different procuring models suggests that there would need to be thought given to the point at which research would be useful. The favoured approach would be to talk to service users to see if their experience matches our expected outcomes. They explained that some of the complaints in the past such as a lack of continuity in the carer or carers not turning up are no longer common complaints, which demonstrates how the model is changing experiences. Welsh Government have developed a digital tool named “measuring the mountain” that can help analyse the difference made.
Officers advised that they had considered opportunities to set up a co-operative and staff felt that the model currently being piloted is working really well and that if something is working well, why would you change it. Also the early exploration of this had concluded that whilst Monmouthshire was fertile ground for a co-operative scheme, it does not have the economies of scale and that there wasn’t the appetite in the market. Officers explained that they had the advantage of flexibility at the moment given that there are large and small providers, specialist providers, therefore offering a good balance.
Outcome and Chair’s Conclusion:
The chair concluded that the care provider’s contribution at the meeting had been really helpful and that the committee felt reassured that Monmouthshire is considered to be leading the way in terms of delivering this model. The relationship with providers was clearly regarded to be positive. Acknowledging that there are complicating factors, such as qualifications, the new registration process and the low rates of pay, the chair stated that it was pleasing to see that the council is placing a high value on the role and is considering ways in which to incentivise. The committee agreed they were content with the Usk pilot which appears to be working well and asked that the care providers be sighted on the payment model as soon as practicable. The committee is interested in how the model will be evaluated, given the change from measuring ‘task and time’ to measuring ‘relationship based outcomes’. The chair concluded that the ‘placed based approach’ will be an important step forwards in ensuring service users see a familiar face and develop relationships through continuity in service provision. The committee requests a progress update in 6 months’ time.
Supporting documents: