Meeting documents

1 THE ISSUE

1.1 This report makes proposals for the future arrangements for the provision of domiciliary care services funded by Bath & North East Somerset Council.

2 RECOMMENDATION

2.1 A tendering process be undertaken to enable a decision to be made on future providers for long term domiciliary services under best value principles.

2.2 The Director of Adult & Health Services and Assistant Director, Adult Care & Health be authorised to take all action necessary including and up to awarding of the contract or contracts.

3  FINANCIAL IMPLICATIONS

3.1 Long term home care is currently provided by the in-house service and through the independent sector via block and spot contracts. The current mix of provision has built up over a number of years. The current block contracts were established in January 2003 when it was originally intended that blocks would be 50% of care purchased. It is now in fact 32%.of purchased care hours. There is a healthy independent sector market with 18 independent sector agencies accredited with the Council to provide care and regular applications from new agencies to join the list.

3.2 Block contracts provide approximately 24% of the overall hours provided but costs 16% of the total spend on domiciliary care. The spots provide 34% of the overall hours and cost 32% of the overall spend. The in-house service provides 42% of the hours of care but costs 52% of total spend.

3.3 The cost of the in-house home care service is greater than the cost of services purchased from the independent sector. Currently in-house home care costs approximately £17 per hour whereas the Council purchases home care from a range of independent sector domiciliary care providers for between £12.40 and £15.40. On average the council purchases home care at approximately £13.50 per hour.

3.4 The current mix of provision does not necessarily demonstrate best value. Current policy is that all care packages go to the in -house team, then to the designated block Provider for that geographical location and then to spot Providers. The block prices are pegged to annual inflation increases and the spot prices are agreed each year and purchasing teams have this information . The council service is more costly than could be purchased and it would appear that due to the significant difference in costs a tendering process would not increase costs and would be likely to lead to long term savings. The tendering process will enable the Council to ensure that the service in the longer term will meet the needs of its service users in the most cost effective way.

4 COMMUNITY STRATEGY OUTCOMES

5 CORPORATE IMPROVEMENT PRIORITIES

6 CPA KEY LINES OF ENQUIRY

Managing and improving value for money through

o Monitoring and reviewing value for money;

o Improving value for money and achieving efficiency gains;

o Procurement and other spending decisions take account of full long term costs

7 THE REPORT

7.1 Background

7.2 Work began in September 2003 to change the Council's Home Care service in order to meet the growing need for more intensive home care for people with higher levels of dependency. A pattern of service was developing whereby care plans requiring evening and weekend work were being increasingly purchased from the independent sector and the overall demand for domiciliary care was growing.

7.3 In April 2004 the Executive Member for Social Services agreed proposals to re-shape the Home Care service. The two key changes agreed for the Council's home care service were, in brief: a) the establishment of an "intake and re-enablement" service; and b) a refocusing of the long-term service to provide intensive home care for people with higher levels of dependency.

7.4 Between April 2004 and April 2005 service managers sought, through consultation with staff and Trades Unions, flexibility in the times of day and days of week staff worked. This flexibility is needed in order to provide care to people with higher levels of dependency when care is needed. In general terms, people with higher levels of dependency need care seven days a week and in the evenings.

7.5 Attempts were made to establish the in-take and re-enablement team from within the existing staff group. This did not prove feasible as insufficient staff came forward preferring to opt for what was perceived as the status quo (ie the long term service). External recruitment was not an option as it would have increased the overall revenue budget and/or acquired redundancy costs. Plans for this service were therefore postponed pending the outcome of negotiations on more flexible working.

7.6 A range of ways were used to try and achieve the necessary changes including presentations to staff groups, one to one meetings with staff and regular meetings with Trade Union representatives to seek agreement on flexible working. It was believed through this lengthy process that a significant amount of flexibility had been achieved, although expenditure on independent sector care continued to grow.

7.7 Management of the in-house home care service transferred between the then Heads of Service in June 2005 in preparation for being part of the new Community Resource Centres' service. At this time, it was understood that 7 staff were still refusing to work flexibly and that it would be necessary to impose contractual changes on these members of staff in order to achieve flexibly working.

7.8 In August 2005 action commenced to impose changes to the contracts of those staff who had expressly and steadfastly refused to work flexibly. This resulted in on Trades Union lodging a formal dispute and action was suspended.

7.9 By October 2005 the "Care Time" rostering system module of the new "Care First" IT system was operational. This led to a significant improvement in the quality, accuracy and timeliness of performance information for the in-house home care service.

7.10 The improved performance information appeared to be showing that staff were not working sufficiently flexibly to enable the service to deliver packages of home care where and when they were needed. As a consequence there is a high level of "downtime" or un-used care hours in the service. Therefore a detailed review of each member of staff's working patterns was launched.

7.11 Using the definition of flexibility as "working two weekends in four, at least one evening per week and prepared to work at least half of the bank holidays if necessary", the review of contractual hours and working practices, which concluded in July 2006 found that despite protracted efforts and consultation only 42% of staff were working flexibly.

7.12 Current Position and Proposal

7.13 For any domiciliary care service to be cost-effective in meeting service users' needs, care staff must be prepared to work when the service is needed and there must be sufficient staff employed at key times of the day. Despite negotiation and consultation with Trades Unions and staff over a period of more than two years this is not the case for 58% of the Council's home care staff.

7.14 The establishment of an intake & re-enablement service remains a key requirement in the provision of domiciliary care services that meet the needs of the local population. Indeed, such a service is likely to be an important first step in further developing integrated community services for older people with the Primary Care Trust. Work has re-commenced to establish the intake and enablement service from within the existing service and it is believed a more positive response will be achieved from existing staff, within the current climate, than occurred 2 years ago.

7.15 The Council has four "block contracts" with Independent Sector providers of domiciliary care. These block contracts currently account for 24% of domiciliary care services provided in Bath & North East Somerset and a further 34% is "spot purchased. The block contracts end in January 2007. It is proposed to extend these for 3 months pending the outcome of a tendering process for all long term services.

7.16 In view of the above there is a strong argument for a tendering process for long-term home care service that is able to meet all current needs and is sufficiently flexible to adapt to meet future needs. A competitive tendering process would also provide an opportunity for the Council to achieve best value for money from the long-term home care service in a way that is not currently being achieved.

7.17

7.18 The Council will continue to work with the Trades Unions and the staff during the consultation process, and during any period of transfer to keep them informed of their rights, responsibilities, what is planned and anticipated and timings. The Council will also provide relevant information on the domiciliary care contract, including information about terms and conditions of employment relating to the transferring staff, as part of the preparation for TUPE.

8 RISK MANAGEMENT

8.1 The report author and Lead Executive member have fully reviewed the risk assessment related to the issue and recommendations, in compliance with the Council's decision making risk management guidance.

9 RATIONALE

9.1 Efforts have been made for more than 2 years to transform the Bath & North East Somerset provided service into one more able to meet the domiciliary care needs of its population and that provides best value. These have not been successful and it is therefore believed that placing a tender for the provision of these services will produce a more flexible and cost effective service.

10 OTHER OPTIONS CONSIDERED

10.1 The alternative is to retain the status quo. This is not considered an option as it is unaffordable and not fit for purpose.

11 CONSULTATION

11.1 Executive Councillor; Trades Unions; Staff; Stakeholders/Partners; Section 151 Finance Officer; Chief Executive; Monitoring Officer.

11.2 Regular discussions with the Trades Unions over two years (see above) they were informed of this new proposal at a local JCC on 14^th August and have received a copy of this report on 24^th August. Staff have been consulted through staff meetings, which took place during the week commencing 14^th August.

11.3 Provided the Executive agrees the recommendation of this report, a programme of staff, Trades Union and stakeholder consultation will be developed. This programme will include any statutory consultation requirements. The Executive Member has been fully informed of the previous negotiations and current proposal. The Chief Executive was consulted ahead of report.

12 ISSUES TO CONSIDER IN REACHING THE DECISION

12.1 Social Inclusion; Customer Focus; Human Resources; Equality (age, race, disability, religion/belief, gender, sexual orientation); Impact on Staff; Other Legal Considerations.

13 ADVICE SOUGHT

13.1 The Council's Monitoring Officer (Council Solicitor) and Section 151 Officer (Resources Director) have had the opportunity to input to this report and have cleared it for publication.