Providing quality support and care to enable people to remain at home is our single biggest challenge. The market is currently not delivering enough support to meet the demand. We are aware of the challenges but need to continue to work with providers to increase this capacity.
Since 2019 home care has been commissioned by the Council via an open framework agreement. CQC registered providers meeting the criteria can apply to join the framework at any time and are accepted after completion of a due diligence process. Individual packages of care are awarded after offers are evaluated and scored on quality and cost. As of March 2023, there are 48 providers accepted onto the framework, with some covering several areas of the county and some operating in a much smaller geographical area. The twelve providers with the most business account for over 70% of the hours commissioned, the largest two agencies provide 33% of the commissioned hours.
In common with other authorities there are a significant number of outstanding home care packages in the East Riding awaiting provision. This number has decreased in recent months but it is clear that although home care agencies have worked with the Council to make the most efficient use of their available resources, they have been unable to increase their capacity in line with demand.
The ‘open’ nature of the arrangement has enabled the Council to invite a limited number of new providers to join the framework in response to the current situation. Although some spot purchasing of care from CQC registered providers who are not on the framework has been necessary, this has largely been limited.
Although the recruitment and retention of staff remain the main barriers to increasing capacity in the market, the situation has improved to some extent in recent months. Recruitment of overseas staff using sponsorship schemes has brought greater capacity to the market.
Home Care supports our strategy of people remaining in their own homes for as long as possible and being supported to live as independently as possible. The model currently utilised by the Council is a time and task model whereby the Council commissions care calls from providers on the framework.
Intentions
To this end it is the Council’s intention to not make any significant changes to it’s home care contract from April 2023 so as to ensure that the market is stable and allows for the necessary development over the life of the new contract. In order to manage providers coming onto the framework we plan to open the framework every 6 months for new providers and will reserve the right not to open the framework in areas where capacity is deemed sufficient.
However, it is our intention to move to an outcome based commissioning model in the future and we will be working with the sector to move towards this model, including undertaking pilot projects over the next two years from April 2023. We will also continue to work towards using a Dynamic Purchasing System (DPS) to commission home care packages across all customer groups, ages and areas, which will increase the opportunity for providers to diversify services and gain efficiencies. In March 2023 the Council published it’s Market Sustainability Plan which sets out the plan to ensure that the East Riding has an efficient and sustainable plan for providing care in the future.
We look forward to working with providers to explore how we can deliver homecare differently to meet demand. We will support the use of micro-enterprises to deliver homecare through the Dynamic Purchasing System and work with providers to explore the use of technology enabled care where this can better meet the needs of service users.
Analysis
An analysis of the Yorkshire and Humber Region CQC ratings regulated activity of personal care shows that the ratings in East Riding are worse than England as a whole. As of 1 November 2021 81.3% (previously 84.4%) of agencies are rated good or outstanding which is below the England average of 88.5%. This is also worse than the overall position in the Yorkshire and Humber region average of 84.4% rated good or outstanding. East Riding are positioned 10th in the region (previously 9th). It is noteworthy that the not all providers operating in the East Riding are on the Council’s Home Care framework and some providers on the framework are registered in Hull, and other surrounding authorities.
It is our ambition through future contracting models to drive up the standards of care and this will be a key area of focus in future contracts.
To help us achieve this goal, we undertook research into the cost of care within the East Riding. Using the toolkit commissioned by the Care and Health Improvement Programme and developed by ARCC-HR Ltd we aimed to create a deeper understanding of the cost of care using information provided by providers, taking into consideration outlying costs.
After engaging with the market and holding multiple engagement sessions, the feedback on the ARCC tool was positive, with indications that those who attended would be taking part in the process. Although not all providers initially engaged, further efforts were made to encourage the remaining providers on the framework to participate.
The cost of care exercise cannot determine a value for the fair of cost of care which covers every provider’s individual circumstances. The results of such an exercise are a part of the considerations made in setting fees for domiciliary care. The sample size of this exercise, although reasonable, is a consideration and other factors will be assessed alongside the exercise in reaching decisions about a fair cost of care. There are also multiple other factors to consider including entrants and exits from the market and changes in national policy.
Future Developments
From 2025 we are looking to establish a new framework for homecare which better understands and meets the requirements of the market and addresses the shortage of homecare provision within the East Riding.
To do this we want to increase our understanding of the current market including supply and demand, the profile of of current and future cohort and identify and address the gaps in service provision.
We aim to increase our understanding of alternative models of homecare delivery through quality research and following this research, engage with system partners and the public to co-produce a new framework which addresses the needs of the market and delivers on our aspirations for the future.
The vision for Adult Social Care is to promote independence, wellbeing and choice that will support individuals in achieving their full potential in healthier communities. It is our aim to ensure our approach is person centred, accessible, flexible and responsive for those in greatest need and to enable people to maintain their independence for as long as possible in their own homes and local communities. The Council is dedicated to providing quality responses that are sustainable and flexible in order to meet current and future needs and demands.
