Agenda item

Following on from the previous report to Panel in September 2020, attached is an update report on Virgin Care. The report has focussed on the Integrated Reablement Service and the financial performance of the contract in year 4 of the 7 year term as requested by the Panel.

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

COVID-19 Impact

COVID-19 has had a significant impact on the Reablement Service and the delivery of reablement within B&NES. Following the release of the Hospital Discharge Guidance by the Department of Health and Social Care, all health and care systems were required to deliver the ambitions of Discharge to Assess (D2A) to ensure the safe and timely discharge of people who no longer needed to stay in hospital.

In response to the D2A requirements, it was agreed in B&NES that the

Integrated Reablement Service would be the service that would support

individuals being discharged on Pathway 1 (home with additional support).

This meant the Service would support all individuals who needed a new or

increased package of care on discharge to be supported and assessed by the

Service, prior to their long-term care needs being determined and arranged. In

addition, the Service would be responsible for the case management of such

individuals, including the administrative processes associated with this.

Due to this change, people who would have traditionally been discharged

from hospital directly into a local authority/self-funded long-term package of

care now have an assessment and support offer from Reablement for up to

six weeks.

Performance

Performance and activity for the Reablement Service has been significantly impacted by COVID-19.

After an initial fall in referrals in April 2020, as services and services users were adapting to the national lockdown, the trend since then has been a significant increase. In the year to date to the end of January 2021, average monthly referrals are 7.9% higher than the 2019/20 average. In parallel, the number of discharges from the Service has seen an increase over the past year since January 2020.

While the number of people receiving a service per month has dropped compared to the 2019/20 average by 6.4%, the number of contacts has risen

significantly, with 20.4% more contacts on average per month than the

2019/20 average. As a consequence, length of stay in the Service has increased above average levels for the three years prior to April 2020. While

the monthly average in 2020/21 is 4.0% above the 2019/20 average, the

shorter length of stay in the first quarter of 2020/21 is offsetting the high levels

seen currently. To put this in context, the latest value for January 2021 is

24.2% above the 2019/20 average.

The peak caseload in November 2020, at 662 people, is 37.1% higher than the 2019/20 peak of 483 (January 2020). The latest data shows that the caseload is reducing but it remains high relative to previous years.

Despite the pressures on the Service, performance for the ASCOF measure

(which reviews whether people remain in their usual place of residence 91

days after discharge into reablement from hospital) remains close (82.1%) to the targeted level of 85%.

Reablement Next Steps

For the Integrated Reablement Service there are a number of key milestones

and priorities over the coming financial year (2021/22):

(Q1/Q2)

• Continue to support the COVID-19 response and recovery, with a

review of long term D2A requirements as they become clear nationally

(Q1/Q2/Q3)

• Deliver the new reablement model and the transformation requirements

for the service, with specific reference to Length of Stay and two-week

review points

(Q3/Q4)

• Support the delivery of the Councils financial savings programme and

aim of increasing independence and minimising the number of people

needing long term funded care

(Q4)

• Support the delivery of the NHS Long Term Plan requirements

regarding access timelines for crisis response and reablement

Finance

During 2020-21, Virgin Care received a total income of approximately £56

million from the Council and BSWCCG for the delivery of the health care

and social care services specified in the contract.

It should be noted that for Council funded services the contract does not

permit for increases linked with inflation as this is a flat cash funding profile.

In 2018/2019 (year 2 of the contract term) the contract was £1.4 million

overspent and in 2019/2020 (year 3 of the contract term) the overspend

was £0.7million. The forecast for 2020/21 is an overspend of £0.3million,

which demonstrates and improving trend for Virgin Care.

Both the Council and BSWCCG have supported the initial financing of the physical building housing the Community Wellbeing Hub and ongoing funding for 18 months has been identified from within existing Virgin Care and Council resources along with additional third-party funding.

Virgin Care have responded to the Council’s financial position, as a result of

COVID-19, through pro-active engagement on ways to appropriately reduce

spend within the Council’s purchasing budgets for 2020/21 and beyond. To

date £1.2m has been identified as cost savings and/or cost avoidance from

care and support packages or placements. Additionally, a business case to

expand Virgin Care’s Supported Living Service has been supported by the

Council which will reduce out of area placements bring individuals back to

B&NES and reducing expenditure in 2021-22.

Performance and Service Overview, Impact of COVID-19

Performance for the percentage of people waiting over six weeks for

Diagnostic testing has been significantly challenged since the first wave of

COVID-19, prior to which the 1% target was being achieved by Virgin Care.

While performance saw some recovery as services reopened in summer

2020, since November 2020 the rate has been rising away from the national standard.

The main area of challenge over the winter has been Audiology performance

(for both Adults and Children) but the Heart Failure service has returned 0%

breaches during the past four months.

Innovation for Outpatients as a Result of COVID-19

Early work on a long term COVID-19 pathway by some allied Health Professionals in the Service, enabled BSW CCG to commence their services to support people with long COVID-19 as soon as this was identified.

Parkinson’s Disease Nurse Feedback groups with service users have

ran virtually.

Speech and Language Therapy are using video calls successfully to

treat individuals especially in Nursing Homes.

Falls clinic are trialling video exercise classes with elderly people.

Children’s Health Services

All services are operating within waiting time targets excepting Paediatric

Audiology and Autism Assessments. Business continuity plans are in place,

but have not yet been called upon, to maintain provision of priority services

such as Children’s Continuing Care. Children’s Immunisation programme (non

COVID-19) is continuing to be delivered with the support of schools –

adolescent immunisations catch up programme in place.

Adult Social Care Services

·  Social Care Assessments: Since the last report, the number of people waiting for assessment has increased over the second wave of the COVID-19 pandemic, albeit there has been a reduction in January 2021. As previously reported, assessments have taken longer to complete during the pandemic, with challenges such as social distancing requirements affecting the completion time. Where possible, assessments have been carried out virtually to mitigate this as far as possible.

·  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 Priority 2 cases remains high although it is on an improving trend since June 2020 but has again been impacted by people’s COVID-19 concerns.

·  Annual Social Care Reviews: Since October 2020, the trend in performance has started to improve gradually. The Council has agreed a prioritisation for reviews, priority 1. focus on those living out of the area and on level of need and priority 2. people with a “stable” care and support plan.

·  Timeliness of Hospital Discharges: The focus of reporting on the timeliness of discharges has changed to the “criteria to reside”. These criteria establish whether care in the acute setting is necessary; if the criteria are not met, the patient should be discharged to a less acute setting.

Contract Extension

The Virgin Care contract is a seven-year contract from 2017/18 to 2023/2024

with the option for the Council and BSW CCG to extend the contract term by

three years, taking the contract term to 2026/2027. Virgin Care would need to

be notified of the decision to extend or not to extend the contract by no later

than March 2022. It is recognised that it is important to ensure that Virgin

Care are notified of the final decision well in advance of the contractual

deadline of March 2022.

The Panel is asked to note the contract extension is under consideration and will be notified when the Cabinet and BSW CCG have informed Virgin Care of

their decision regarding this.

Conclusion

The report has focused on the areas Panel requested from its last update in

September 2020. The next report will be in six months time and will give a

detailed update on the workforce and service user feedback.

Kevin Burnett commented that he would welcome an updated statement on any key focus areas or areas of concern regarding the Virgin Care contract.

Councillor Liz Hardman asked which care homes were identified for additional Care Home Support Reablement Workers and how they were chosen.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that ten care homes had been identified but did not feel it was right to name them publicly. She added that they were chosen through staff availability and capability.

The Senior Commissioning Manager for Community Health & Care Services added that there are ongoing meetings with homes to assess capacity to meet needs going forward.

Councillor Alison Born asked if there was confidence in the new model to deliver savings.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that a steering group has been put in place to monitor this and that it will be covered in the next update report.

Councillor Alison Born asked if the waiting time targets for Paediatric

Audiology and Autism Assessments could be given to the Panel.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that she would ask for a response to be circulated to them.

Referring to section 4.1 of the report Councillor Jess David asked if stress was also a factor to consider alongside staff pressures and sickness.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that this would be picked up in more detail in the workforce report that was due to be submitted to the Panel in September 2021.

Jo Scammell, Virgin Care added that they do track staff absences due to Covid-19 and that this peaked in September 2020.

Councillor Andy Wait commented that with the 5^th year of the contract approaching the balance was currently -£2.4m and asked if after 7 years a balanced scenario was expected. He also asked for more information on the proposed £1.2m of cost savings from care and support packages or placements.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that information on the proposed savings could be sent to the Panel. She added that a business case to expand Virgin Care’s Supported Living Service has been supported by the Council which will reduce out of area placements, bring individuals back to B&NES and reducing expenditure in 2021-22.

Councillor Ruth Malloy asked if the next update report could include information on how to ensure consistency of practice and processes between the Locality

Reablement Teams (Bath, Midsomer Norton and Keynsham).

Councillor Paul May asked if it was known whether Virgin Care wish to take up the offer to extend the contract.

The Director of Adult Social Care, Complex and Specialist Commissioning replied that there has been no indication that they do not want to continue to provide their services.

Councillor May wished to acknowledge and thank Virgin Care for all of their work during the pandemic.

The Panel RESOLVED to note the content of the report and identified the following areas of focus for the next update report.

·  Workforce – particularly interested in sickness / morale

·  Service user feedback

·  Reablement – general update but also detail on monitoring the transformation; wanting to know what is happening in each of the different locations (MSN, Keynsham and Bath) and what the difference in practice is and how is this being unified.

·  Finances – general and also more information on the £1.2 million gap and how this was managed.

·  Case examples on service changes and how these have not impacted adversely on the service users and families whilst managing within the contract value bearing in mind council flat cash but not for CCG

·  Performance section to focus on:

o  Criteria to reside if available, RTT, 6 week diagnostics, ASC reviews, OT assessments, care act assessments.