Agenda item

The purpose of the report is to give an overview of the Virgin Care contract; Virgin Cares performance against national and local standards and also key performance indicators, and, the governance arrangements in place to ensure these are delivered.

The Director of Adult Social Care, Complex and Specialist Commissioning and the Head of Contracting & Performance introduced this report to the Panel.

The Director of Adult Social Care, Complex and Specialist Commissioning explained that the report was intentionally long and sought to address the queries raised previously by Protect our NHS BANES.

She summarised the following points from the report.

Between January and December 2015, BaNES Clinical Commissioning Group (CCG) and B&NES Council carried out a review of community heath and care services for children, young people and adults.  The review, known as Your Care, Your Way, looked at the wide range of services providing care and support in people’s homes and communities.

The top five priorities identified through the engagement process with our residents were:

1.  A person not a condition

2.  A single plan

3.  Invest in the workforce

4.  Join up the information

5.  Focus on prevention

Over 200 different community services were within the scope of the Your Care, Your Way review which were provided by over 60 different organisations.  The commissioning and contract management of these services were at the time of the review all carried out by the CCG and Council.

Following the identification of the priorities of our local population, a new approach to contracting community services was identified as being required. A detailed assessment was undertaken and legal guidance sought; this resulted in the ‘prime provider model’ being chosen as the best contracting method for delivering the community’s priorities.  Under this model, the CCG and Council would enter into a contract with a single prime provider and this organisation would have responsibility for the delivery and coordination of services, they would also have sub-contracting responsibility for some specialist, third sector provider and small and medium-sized enterprises (SME’s).

In addition to the five priorities (listed above) identified through public consultation the following three areas also formed part of the assessment used during the procurement:

1.  Social value

2.  Value for money and affordability

3.  Delivering transformational change

The Virgin Care contract is a seven-year contract which commenced from 1st April 2017 to 31st March 2024 with the option to extend the contract term by three years (2024/2025, 2025/2026 and 2026/2027). 

The Council have the co-ordinating commissioning role for the contract and currently the contract is made up of a total of 56 community services:

•  36 delivered directly by Virgin Care

•  14 services are sub-contracted

•  6 services are delivered by both Virgin Care and a sub-contractor

Three of the 36 services directly delivered by Virgin Care cannot be sub-contracted at any point whereas the other 33 can be via negotiation in line with contract regulations. The three which must be delivered by Virgin Care (referred to as delegated functions) are:

•  PD1 Adult Social Care Statutory Services

•  PD2 Continuing Healthcare

•  PD3 Children’s Health Statutory Services

The Virgin Care contract is organised through the following contract governance structure:

Contract Quality Performance Meeting (CQPM) – Bi-monthly

Finance and Information Group (FIG) – Bi-monthly

The Quality Subgroup (QSG) – 6 weekly

Service Level Performance Meetings (SLPM) (9) – Range from monthly to quarterly

Under the current governance arrangements, QSG, FIG, SLPMs and the Sub Contracted Services are all reported into the CQPM.

Other standard items for the CQPM meeting include reporting on transformation, other deep dives eg workforce, key areas of risk/assurance, contract management and forward work plan.

The Council and CCG auditors routinely undertake audits of services. Currently Council auditors, Audit West, are auditing the contract governance management arrangements for Virgin Care and sub-contracted services including their performance and financial management information and how this is presented to CQPM and FIG. This audit commenced in Quarter 3 2019/20. The findings and recommendations of this audit are expected in Spring 2020. Audit West are also conducting a Community Care Data Management audit which is focusing on the project governance of the Integrated Care Record.

In addition, the Clinical Commissioning Group (CCG) appointed auditors, KPMG (Klynveld Peat Marwick Goerdeler), have jointly agreed to undertake an audit of the governance arrangements in place for the Virgin Care contract across new Bath, Swindon and Wiltshire (BSW) CCG. This is being led by KPMG and commences March 2020. This audit also will focus on stakeholders and the role of Virgin Care as a prime provider; the auditors will visit a number of sub-contractors to inform the audit process.

The outcomes and resulting recommendations of each of these audits will be considered and implemented.

The latest financial position at December 2019 is that the contract is overspent by £584k with a forecast over-performance of up to £700k by the end of March 2020.  The original bid indicated that losses were expected in the early years of the contract and transformation benefits estimated by Virgin Care in their growth bid at circa £3m per year were expected to be realised from year 4. The current financial risk is currently absorbed by Virgin Care.

The Chairman commented that the Panel had flagged this as a concern at their October 2019 meeting where Kirsty Matthews, Managing Director, BANES Bath and North East Somerset Community Health and Care Services said they would be in balance by the end of this financial year.

Virgin Care are still to complete their full transformation programme as a result of delays in some enablers.  The move to mobile working for example took a year longer to implement given the base line found in year 1 and the Integrated Care Record (ICR) project experienced delays outside of their control.  We should see these fully implemented in year 4 (2020/21) and it is anticipated that this in turn will return a balanced budget by the end of year 4.

A new platform has now been secured for the ICR.

Dr Ian Orpen said that the new platform was robust, user friendly and live across 23 out of 24 practices. He added that the RUH and AWP were not yet included. He said that AWP were experiencing some technical issues and that it was hoped that the RUH would be ready within the next month.

The Chairman commented that he felt that given the length of time the project had been ongoing that both the RUH and AWP should have been ready with their information.

Dr Orpen replied that unfortunately IT systems don’t always talk to each other in the same way.

Councillor Michelle O’Doherty asked for future reports to include matters such as timescales, risks and priorities.

Councillor Andrew Wait asked for a year on year breakdown of their budget balance.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she would research that information for the Panel.

Kirsty Matthews said that Virgin Care will aim to achieve a balanced budget in future years and cited agency costs as a contributing factor.

Councillor Jess David asked if agency costs could increase because of the Covid-19 virus outbreak.

Dr Orpen replied that the Chancellor has stated that the Government will make resources available to assist with matters associated with Covid-19.

Councillor Paul May said that it was positive to see that Community Paediatrics and Paediatric Audiology routinely perform well in terms of access to treatment.

B&NES’ Adult Social Care Outcomes Framework (ASCOF) performance is derived from a statutory submission of key activity data, the Short and Long Term (SALT) return and responses from service users and carers to annual and biennial surveys respectively. 

In general, B&NES’ performance against ASCOF measures is good. Of the 29 measures reported in the 2018/19 ASCOF B&NES was:

•  Better than the national average in 23 measures

•  Better than the regional average for 21 measures

•  In the top quartile of all local authorities for 11 measures

Conversely there are three measures for which B&NES is in the bottom quartile of all authorities, though this is not wholly attributable to Virgin Care.

•  Delayed transfers of care (DTOC) per 100,000 population

•  DTOC attributable to adult social care per 100,000

•  The proportion of people who don’t require long-term funded services after receiving short-term services such as reablement.

Councillor Liz Hardman asked for further information on these measures to be shared with the Panel.

Social Care Assessments: Significant work has been undertaken over the term of the contract to date to reduce the waiting list for people awaiting social care assessment. The waiting list was high at contract commencement, peaked in the early months of the contract, and the scale of reduction has been significant since the start of year 2. The improvement in this area has continued on the whole.

Annual Social Care Reviews: The proportion of Virgin Care service users with up-to-date reviews remains high. While national benchmarking isn’t available for this measure, anecdotal discussions indicate that B&NES is performing well relative to its peers. It is anticipated that the improvement will continue as the benefits of the establishment of the Adult Care Social Care, which expanded from the Learning Disability Reviewing Team, are realised. Further action is required to capture the work undertaken through ‘unscheduled reviews.

The national Safeguarding Adults Collection (SAC) is the source of benchmarking for Safeguarding Adults. B&NES is performing better than the national average in many areas:

·  Identifying risk and taking action to address - performance at 92% against the national average of 68.5%

·  Individuals (or their representative) asked what their desired outcome was - 72% achieved against the 63% national average

Alongside nationally benchmarked data, B&NES has a range of additional local measures to provide assurance that enquiries and concerns are managed effectively.

·  86.2% of decisions for new concerns made within 4 days continues to be good for Virgin Care

·  79.8% of Planning meetings for new enquiries are held within the 10 days procedural timescale

Virgin Care contributes positively to a number of national targets for health services.

·  Referral to Treatment Time - Virgin Care provides Consultant-led services which are subject to the 18-week Referral To Treatment (RTT) target: Orthopaedic Interface Service, Falls and Movement services (Clara Cross), Community Paediatrics and Paediatric Audiology. RTT performance is significantly above the target of 92% at 99.2% for January 2020.

·  Length of stay in community hospitals - particular area of improvement has been seen in community hospitals. Length of stay has improved from an average of 36 days in the first year of the contract to a year-to-date position of 29 days in 2019/20. The current pilot for offering therapy-led beds in community hospitals, to facilitate reablement, is having a positive impact on length of stay as well, while promoting independence for patients.

·  Children’s Speech and Language Therapy access times are generally good, with 92% of children seen within 16 weeks in the latest results, against the 18-week target.

Virgin Care delivers a range of Health and Wellbeing services aimed at improving the physical and mental health of the B&NES population.

·  The B&NES Stop Smoking service supported over 500 people to set a ‘quit date’ in 18/19 and of these 68% successfully quit smoking at 4 weeks. Smoking prevalence in B&NES is 11.7%, significantly better than regional or national prevalence and smoking in pregnancy is the lowest in the region at 6.8%.

·  The wellbeing services support over 1,500 adults a year to access services to help them lose weight. During 18/19 over 800 people took part in either a structured 12-week weight management programme or 1-1 weight management support via the wellbeing service. The average weight loss on the 12-week programme so far in 19/20 is 4.8Kg.

The Contract requires a Service Development Improvement Plan (SDIP) to be agreed, monitored and delivered annually. Updates on progress are provided at the CQPM meetings. The 2019/20 SDIP has been reviewed on a quarterly basis to monitor the transformation progress in year three of the Virgin Care contract.

By the end of December 2019 Virgin Care had achieved 77% of the milestone and a further 12.5% partially achieved in the intended period. The significant number of SDIP milestones achieved in contract year 2019/20 have included activity across a number of key workstreams.

The Quarter 4 (January to March 2020) progress report is due on 6th May 2020 with 11 milestones in scope for review as well as updated assurance on completion of any milestones that were reported as partially or not achieved throughout the year. Once the full year SDIP review is complete a full assurance report will be submitted to CQPM in June 2020.

Under the Local Authority Social Services and National Health Service Complaints (England) Regulations 2009 the Council and CCG must have a process for handling feedback about adult social care services and adult and children’s community health care services from servicer users, families and carers which is received in the form of complaints, concerns and compliments.

The majority of this feedback is dealt with in the first instance by Virgin Care.

Of the social care complaints (10) two were substantiated and had learning outcomes which have been actioned; two exceeded the expected response time. The number of social care complaints dealt with by Virgin Care remains consistent with previous years.  In 2018/19 there were 12 complaints of which three were escalated to the Council for review.  The review is undertaken under the supervision of the Principal Social Worker (PSW).

Health and Social Care Compliments – April to December 2019: Health Care 314 / Social Care 151

Virgin Care are required to produce information on their Workforce as part of the Quality Schedule; below highlights some of the key information.

Head count at the start of the Virgin Care contract: 915 FTE (1315 staff) at 01.04.2018

Current head count: 820 FTE (1215 staff) key areas of reduction have been in active ageing, district nursing, administration and reablement at 30.01.2020

Current vacancies: 43 FTE (mainly wards, reablement, physiotherapy / Orthopaedic Interface Service, social care) as at 30.01.2020

Leavers in the last 12 months: 152 of which 31 have retired as at 30.01.2020

The recruitment of Social Workers continues to be a challenge, replicated across social care nationally.  Virgin Care, in considering workforce sustainability, acknowledged their need to place themselves more competitively in the market and reviewed the pay and management post structure across the organisation, resulting in adjusted pay scales and a structure that has attracted a greater number of Social Workers.

To address vacancy rates, Virgin Care has held a number of recruitment days for the following areas; Community Hospital wards, Social Care including Learning Disabilities, Therapists and District Nursing. Each of these service areas has a bespoke recruitment plan in place and agency and bank staff is being used to ensure service requirements are met.

Councillor Michelle O’Doherty asked what impact the recruitment days have had.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that they would look to include this information in a future report.

Highlights from the most recent annual Have Your Say staff survey (carried out in May 2019) are as follows:

·  An increase from 67% to 79% of staff reported they are enthusiastic about coming to work

·  An increase from 80% to 93% in performance appraisals on the previous year for all staff

·  Increase from 72% to 93% of staff reported that their manager had supported them to receive some learning and development

·  Only 12% of staff identified that the performance appraisal had helped them improve how they would do their role. This has decreased from 22% in the previous year

·  74% of staff reported that someone at work cares about their mental and physical health – this has remained the same as last year

·  Only 10% of staff reported they were confident things would change as a result of the survey findings

Virgin Care have shared a detailed action plan with commissioners about steps they are taking to improve staff survey results to yield improvements next year.

Councillor Paul May commented that he felt that there was a good team of officers in place within the Council that will check on the contract status.

Councillor Liz Hardman welcomed the thoroughness of the report. She asked for the issues relating to staff dissatisfaction, the appraisal system and staff recruitment / retention to covered in a future report.

Kevin Burnett asked for the Audit West report to be shared when it has been completed.

The Panel RESOLVED to;

(i) Note the report and agree that an update report be issued to the Panel in six months’ time and include the following information:

·  Performance and activity data (comparator benchmarks)

·  Workforce data

·  Complaints information

·  Financial update

·  Transformation update

And additionally:

·  Delayed transfers of care

·  Staff dissatisfaction

·  The appraisal system  

·  Staff recruitment / retention