Agenda item

This report provides an update on Virgin Care’s performance against national and local standards and indicators (year end 2019/20 and Quarter 1 2020/2021) and financial position at year end 2019/20.

The Director of Adult Social Care, Complex and Specialist Commissioning and the Head of Contracting & Performance introduced this report to the Panel, a summary is set out below.

The report seeks to address the issues raised at the previous Panel meeting and provides additional information on Delayed Transfers of Care, Recruitment and Retention and Virgin Care’s staff appraisal system.

Contract Update

We are in year four of the seven year term with the option to extend for a further three years (2024/2025, 2025/2026 and 2026/2027).  If a decision were taken to exercise the option to extend the contract term the Co-ordinating Commissioner must give written notice to Virgin Care no later than 24 months prior to the original expiry date (end of year 5 2021/2022 – March 2022 being the latest date).

COVID-19 has resulted in year four contracting being approached differently, by BaNES, Swindon and Wiltshire Clinical Commissioning (BSWCCG) Group and the Council as joint commissioner.  In the first instance the finance and reporting schedules have been prioritised for inclusion in 2020/21 contract with remaining schedules to be agreed and incorporated into the contract by end October 2020 through a local variation. 

Governance of the Contract – changes relating to COVID-19

Due to the impact of COVID-19 the decision was taken to suspend some contract governance meetings in April and May 2020 to enable Virgin Care as the prime provider for health care and social care in Bath and North East Somerset to concentrate resources to respond to the public health emergency. 

The contract governance meetings continued after April 2020 for Council statutory functions adult social care.  In June 2020 the Contract, Quality and Performance Meeting (CQPM), Finance Information Group (FIG) and Quality Sub-Group (QSG) meetings resumed.  It was also agreed with Virgin Care to recommence service level performance meetings (SLPM) from this time, recognising that some services were being delivered differently or had ceased in line with national guidance. During the initial part of the outbreak lockdown commissioners and service providers including Virgin Care held daily virtual meetings to ensure safe delivery of services. 

Virgin Care Role and Response During COVID-19

Virgin Care have provided a prompt and responsive approach to the COVID-19 pandemic and have fully contributed to both Bath and North East Somerset locality and B&NES, Swindon and Wiltshire system activity. Some key activity has included:

• Implemented at speed the new Discharge to Assess Model in response to the DHSC Discharge Guidance published on 19^th March 2020 (updated 21^st August 2020). Service users and patients have benefited from an integrated health and social care response as the service was able to respond quickly to the challenge. The new guidance was implemented from 1^st September 2020

• All Business Continuity Plans updated in line with available COVID-19 information

• Critical services list and service priorities identified linked to business continuity were put in place and routinely updated and shared

• Colleagues were redeployed from services that were no longer being provided or were working at a reduced level undertook training and induction into their new work area. Virgin Care introduced a training passport which then indicated what training has been completed should colleagues be required to redeploy in future (200 colleagues were redeployed to critical services).

• Collaboration with the Council, Clinical Commissioning Group and third sector to establish the Compassionate Community Hub

Adult Social Care

Adult Social Care teams responded quickly and effectively during COVID-19.

·  The Virgin Care Principal Social Worker undertook risk assessments of the service areas to ensure that risks to service delivery from COVID-19 restrictions were mitigated. Professional practice guidance for home visits during COVID-19 was produced using the British Association of Social Work guidance and shared widely across social care teams. This was to ensure consistency across teams when undertaking home visits and aimed to keep colleagues and individuals we support safe

·  Learning Disability and Autism Teams pro-actively conducted ‘welfare checks’ on people who were known to the service

·  Supporting people with a Direct Payment - a small team contacted the individuals (prioritised according to risk) to update their contingency plans to reflect COVID-19 and the potential challenges they may face as well as offering practical advice, such as how to order PPE. The team also conducted ‘welfare phone calls’ to check in on Direct Payments users and responded to any questions or concerns that they had in relation to their care or responsibilities as an employer.

·  Maintained safeguarding arrangements - despite the challenges, excellent performance was maintained by the Adult Safeguarding Team throughout the period. 100% of all decisions during the COVID-19 period were made within the expected timescales. This exceeded the performance target of 95%. Safeguarding meetings (virtually) and community visits continued throughout lockdown to ensure that the most vulnerable were safeguarded from abuse and neglect. 

Adult Health Services

As with adult social care, health specific services responded quickly some of the highlights include:

·  Setting up a community swabbing team in response to initial request from Public Health England (PHE), this then developed into a drive through testing facility at St Martins in the early stages of the pandemic

·  Continuing Health Care service supported infection control training in Care homes as new CHC assessments ceased in line with the guidance

Children’s Health Services

·  Children’s Health Services have maintained strong performance throughout this period

·  Colleagues redeployed from services that were no longer being provided or were working at a reduced level undertook training and induction into their new work area. In Children’s Services this primarily affected the Children’s Speech and Language Therapy Service

·  Community Children’s Nurses have been extremely helpful and supportive to Personal Health Budget holders providing extra support where required and have often gone above and beyond the commissioned service to support children and young people and their families

Compassionate Community Hub (CCH)

Virgin Care have been instrumental in leading the development and operation of the Compassionate Community Hub, alongside colleagues from 3SG, their members, BSW CCG and the Council.  The Hub has provided a single point of access for community response and provides the most appropriate, joined-up intervention for anyone seeking support or guidance on COVID-19.  Response teams include; food support, welfare support, mental wellbeing, housing support and physical wellbeing advice. Since 20th March to 28th August 2020 the service has supported over 7,500 calls, the coordination of over 1,500 volunteer tasks, delivered over 330 food parcels and over 17,000 frozen meals.

The Hub was set up in response to COVID-19 but its effectiveness has meant that it will now develop into an ongoing service for joined-up community response to support the wellbeing of residents into the long term.

Performance and Activity

Adult Social Care Outcomes Framework (ASCOF) – annual results

B&NES’ 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. Reporting is at a total local-authority level, so national results are not filtered by provider.

For the majority of measures calculated from the SALT return, the estimated outputs for 2019/20 indicate that B&NES continues to perform in line with national or regional averages from 2018/19. The areas of concern remain in line with those reported in the previous scrutiny report:

·  Data quality is impacting on reporting for two key measures: the outcome of short term services and long term needs met by admission to residential and nursing care. Virgin Care is working with commissioners to align recording with the requirements of SALT, so the expectation is that data quality will improve for 2020/21.

·  Numbers of people in receipt of direct payments:  as noted in the last report, an urgent review of service users with direct payments (DP) in 2018 led to a significant drop in the rate. Subsequently, the focus has remained on offering DPs only where it is appropriate to do so. Training has continued to support service users to improve their confidence in managing DPs themselves. 2019/20 was the first full year after the review, so results were expected to be lower than 2018/19.

·  Delayed Transfers of Care per day per 100,000 population - national reporting on delays was ceased in March 2020 by NHS Digital. Before reporting ceased there had been an increase in the delays during Quarter 4.

The main reason for delays in community hospitals delivered by Virgin Care was for people awaiting home care or reablement, accounting for 57% of delays in this setting. Before the pandemic, the launch of the Independence At Home Framework was expected to help improve the timeliness of arranging home care packages and therefore reduce delays for this reason.

However, the onset of the COVID-19 Discharge to Assess procedures means that its direct impact can’t be identified. Delays for people awaiting care home placements were also a significant factor, with 28% of community hospital delayed days attributed to this reason. The framework for Care Homes was also expected to have some impact on the time to hospital discharge but, again, (setting aside the challenges that care homes have faced over the period since March) the significantly different discharge arrangements in place from March mean that any effect could not be identified in practice.

Local reporting for Key Adult Social Care measures

·  Social Care Assessments: the overall improvement in the waiting list since contract commencement noted in the last report still remains lower than January 2020 position and B&NES continues to seek assurance through Adult Social Care and Safeguarding SLPM that there is a robust risk management and prioritisation process in place for those awaiting assessment. All assessments requests continue to be reviewed against the risk stratification process Virgin Care have in place to ensure that if someone’s needs increase they are seen more urgently.

·  Annual Social Care Reviews: the methodology for calculating the proportion of Virgin Care service users with up-to-date reviews has been revised following discussion between Council and Virgin Care Business Intelligence teams. Firstly, it has not been possible to review people in care settings and those shielding at home have also declined reviews. People have been offered telephone reviews and reviews using virtual platforms and these have been taken up by some people. Secondly, a number of colleagues from the review team were asked to support the reablement teams for a number of weeks to support the hospital discharge process.  These impacts were monitored through weekly and now monthly performance discussions between Virgin Care and the Council.

·  Occupational Therapist Health Assessments: the month-end waiting list for people requiring an Occupational Therapist (OT) assessment continues to be low for people in the highest priority category (priority 1). The waiting list for people at priority 2 has remained high but remains lower than its peak in July 2019. A Recovery Action Plan is in place to improve the position, and it is monitored on a monthly basis by the commissioner. It remains the case that those people in the highest category of need are assessed promptly.

Virgin Care Performance for Key NHS Constitution and Quality Standards

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

·  Referral to Treatment Time - As with all RTT services nationally, COVID-19 restrictions have significantly impacted on RTT performance. While the overall rate for Virgin Care is 66.2% in July 2020 against a 92% target, it is better than the latest national rate of 52.0%. At service level, Community Paediatrics has remained on target in spite of the challenges of operating during the pandemic.

Quality Assurance 

The number of social care complaints received by Virgin Care remains consistent: 12 in 2018/19 and 11 in 2019/20.  During 2019/20 one complaint was escalated to the Council for review under the supervision of the Principal Social Worker compared with 3 the previous year.  This complaint was referred to the Ombudsman with an outcome of ‘Upheld’. 

Pressure Ulcers are a trend in serious incident reporting across BSW, particularly learning linked to personalised care planning and escalation when condition/skin condition changes. This trend mainly affects community providers; however, it is a system wide theme. Providers have quality improvement plans in place which are discussed with Quality Leads. A system wide work stream is being scoped to support quality improvement in this area and Virgin Care is actively engaged in this having recently completed their own thematic review of category three pressure ulcers.

Workforce

Headcount - Over the last four months there has been a decrease in 12 WTE’s (Whole Time Equivalent), this in line with transformational change and creating efficiencies whilst ensuring quality of service is maintained.

There has been an improvement in staff retention. Virgin Care colleague retention comparator:

April – July 2019: 54 staff left

April – July 2020: 48 staff left

Sickness - both long term sickness (LTS) and short term sickness (STS) since April 2020 - Virgin Care sickness rates have been low during COVID-19. Work has been done to support all colleagues during the pandemic especially around health and wellbeing and working from home. In addition to this, Virgin Care have also put in place additional support for Black, Asian and Minority Ethnic (BAME) colleagues to ensure they maintain their safety whilst working.

Appraisal and How Are You (HAY) conversations

In 2019/20 Virgin Care increased focus on conducting effective appraisals for all colleagues.  This included workshops and training for managers on how to carry out appraisals at both mid-year and end of year. Completion rates were high, with over 80% of colleagues receiving a mid-year and end of year appraisal, even through the pandemic.

Virgin Care also introduced a ”how are you” (HAY) conversation, which is still a structured conversation about the colleague’s performance but doesn’t need to be as detailed as the full appraisal. Virgin Care worked with the managers of all services to give the option to conduct either a full appraisal or the new HAY conversation. 

Colleague satisfaction 

Virgin Care have continued to work to improve colleague satisfaction within the service.  Initiatives that have been introduced include; listening events, a regular partnership forum, increased training opportunities, a service specific newsletter, a regular weekly manager’s briefing and local awards.  These sit alongside our annual colleague survey which this year will be conducted in September.  

Have Your Say Survey

The ‘have your say’ colleague survey for this year will commence on the 28th September 2020 and close on the 16th October 2020, like last year it will be delivered by Fabric. This is the same company that delivered the survey last year which was conducted well.  The aim is to have all results of the colleague survey by middle of November.

Social Work/Care ‘Health Check’ Survey

The Social Work/Care Heath Check survey is undertaken annually in October/ November. The survey is overseen by the Virgin Care Principal Social Worker and focuses on Social Care workforce wellbeing and development.

Recruitment since April 2020

In the last four months Virgin Care have posted 96 adverts for which they have had 435 applicants. Due to the high number of applicants Virgin Care have made 63 offers, 29 of these have already started whilst the remainder are going through ‘on boarding’. The key successes have been in Community Nursing, Community Hospitals and Estates.

Transformation and Service Development Improvement Plan (SDIP)

The contract requires the 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. 

Overall in 2019/20 69% of the milestones have been achieved, 17% partially achieved with 14% not achieved.

The three milestones reported as not achieved in Q4 are in relation to the Integrated Care Record Project.  However, the ICR project has moved forward significantly over the last year, successfully delivering a live integrated care record in-year. The project now has all BaNES Community data, adults social care data, GP SystmOne data (23 out of 24 practices) and Royal United Hospital Data.  This integration has allowed practitioners to start to have appropriate visibility over an individuals care record in order to make the best decisions about their care. 

The ICR project has also in-year been developing the technical ability to provide risk stratification and population health analytics. This is important in the prevention agenda to provide essential information about identifying people who may need support now or in the future. 

The SDIP for 2020/21 has not yet been agreed with Virgin Care.  The delay in the production and agreement of the SDIP for year four of the contract is in relation to the impact of COVID-19 and this will be included as a schedule via local variation later in the year. 

Financial Position

Virgin Care’s original bid planned for losses in the early years of the contract as a result of investment in transformation to allow ongoing investment into the services, increasing demand and the annual efficiency requirement for services of c1%.

In 2018/2019 the contract was £1.4 million overspend and in 2019/2020 £0.7million.  It is anticipated that in March 2021 a balanced position will be achieved, however, we remain early in the financial year to confirm this will be the case.

Next Steps

The Panel are asked to note the content of the report and to identify any areas of focus for the next report which will be provided in six months.

The Chairman commented that he felt that a particular focus on reablement and finance would suit the next scheduled report.

Kevin Burnett commented that the Virgin contract seemed to be going well overall and asked were there any areas of particular concern.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that it was good overall and acknowledged that some performance levels were not being achieved and that they were working with Virgin Care on those areas. She added that she would supply a written answer to confirm which areas still need targeting.

Kevin Burnett asked how the recovery was going in terms of the Children’s Audiology service as the report had shown that it had been hit hard by capacity levels due to Covid19. 

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she would need to supply a written answer to this question.

In relation to Covid-19, Councillor Ruth Malloy asked for further information regarding the additional support for Black, Asian and Minority Ethnic (BAME) colleagues to ensure they maintain their safety whilst working.

The Head of Contracting & Performance said that she would reply in writing with further information.

Councillor Liz Hardman asked how Virgin Care were going to achieve a balanced budget for the coming year. She added that the reply could come in writing.

Kevin Burnett asked how / if the responses of service users are gathered.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that a number of mechanisms are in place and could provide more detail in writing.

Councillor Andrew Wait asked what impact will the new arrangements have on the delayed transfers of care.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that from September 1^st the reporting system changed nationally. She added that reporting is to move away from the current bed-based delays to reporting on the flow through the reablement and assessment process. She said that the changes mean that any comparisons of pre- and post-COVID periods will not be made on a like-for-like basis.

The Panel RESOLVED to note the content of the report and requested a focus on Reablement and Finance for the next update report.

·  At this point in the meeting the Panel discussed deferring their remaining agenda items to an interim meeting as a number of them had indicated that they would be unable to carry on past 1.00pm

·  The Panel agreed to adjourn the meeting and asked the Democratic Services Officer to arrange an interim meeting.