Agenda item

To consider an update on performance and trends in the residential and nursing care sector in West Northamptonshire.

RESOLVED that: the People Overview and Scrutiny Committee:

a)     Agreed to write to the Leader of the Council and the Cabinet Member for Adult Care, Wellbeing and Health Integration supporting representations to the government concerning the need for adult social care to be funded at a level that recognises current pressures on services.

b)     Requested to be provided with a geographical breakdown of the care homes in West Northamptonshire subject to performance improvement plans or contract terminations in 2021/22.

c)     Requested to be provided with further information on the number of care home contract defaults and terminations in West Northamptonshire’s neighbouring authorities. 

d)     Requested that the further information to be provided to the Committee on Disabled Facilities Grant utilisation be circulated to Committee members as soon as it is available.

The Executive Director – Adults, Communities and Wellbeing introduced the agenda item and highlighted the following contextual points:

·         Mandatory COVID-19 vaccination for care home staff from 11 November 2021 increased recruitment and retention challenges in the care sector.  This requirement was due to be extended further to all services subject to inspection by the Care Quality Commission (CQC) from 1April 2022.

·         Vacancy levels in West Northamptonshire care homes were quite low.  However, there was a challenge in how data on this was captured.  Care homes were required to complete a national tracker, which reported vacancies but not the reasons for them.  This could lead acute care colleagues to question why delayed transfers of care occurred when there were apparently vacant care beds in the area.

·         There was a continuing need to lobby the government for a better settlement for adult social care, which would support recruitment and retention.

·         WNC needed to consider potential future scenarios that could arise from pressures on the care sector, given that service users could look to WNC as a provider of last resort.

The Assistant Director – Commissioning and Performance presented the report and gave an overview of current performance and trends relating to residential care provision in West Northamptonshire, highlighting the following points:

·         The profile of performance ratings for care homes took into account that the CQC had not been able to carry out inspection visits during the pandemic and was now working on a risk-led basis.

·         Comparisons of performance with neighboring authorities showed that WNC was not where it wanted to be but was broadly comparable with those authorities.

·         WNC had terminated seven contracts with providers in 2019 and two in 2020, reflecting that fewer monitoring visits were possible during the pandemic.  There had been five terminations so far in 2021.  This was due both to the situation of care homes after the pandemic and an increase in WNC monitoring capacity.

·         Approximately 60% of WNC’s contracted providers had been subject to recent assurance visits.  WNC was committed to reaching 100% by 31 March 2022.  Additional resources had been employed to support providers and to sustain performance improvement.

·         Four contracts had been terminated since July 2021 due to the quality of care.  WNC aimed to work with providers to ensure effective care and did not take this decision lightly.  However, the ultimate priority was to keep residents safe.

·         There were 16 providers currently subject to improvement plans, who were receiving additional support.

·         The current overall position regarding occupancy and declared vacancies in residential care homes for older people suggested that providers were declaring fewer unused beds or that some providers were ceasing to operate.  Providers were reporting concerns about accepting placements that WNC needed to make, due to pressures on staffing. 

·         WNC had worked with care homes following the announcement of mandatory vaccinations to support them in meeting this requirement and to mitigate associated risks as far as possible.  As of 1 November 2021, 96% of care home staff had received one vaccination dose, 92% had received both doses and 4% had not been vaccinated.  There was a lag in data reporting.  It was anticipated that an additional 4% of staff would go on to receive their second dose, but that a total of 143 staff would leave employment from the start of November 2021.  This position was reviewed on a daily basis.  WNC was working with care homes on options for providing extra support where necessary.

·         For the future WNC was encouraging providers to join a new Dynamic Purchasing System (DPS) procurement framework.  It needed to consider sustainable fee levels, including engaging with providers on this.  It was also considering potential alternative options to residential care such as extra care and hybrid models.

The Executive Director – Adults, Communities and Wellbeing advised that a care home being rated as inadequate could ultimately result in the closure of the home and the need for WNC to relocate residents.  However, pressures on staffing reduced the capacity to act in this way.  The current position was manageable but a significant increase in the number of care homes rated as inadequate would represent a challenge.  WNC would need to consider different responses involving sustaining providers whilst securing improved performance. 

The Committee considered the report and members raised the following points:

·         How did WNC capture data on people waiting to go into a care home but not able to do so due to a lack of capacity?

·         There were currently 16 providers subject to monitoring and five contracts had been terminated so far in 2021.  How was this affecting the geographical spread of care homes and was it increasing the likelihood of people having to move from one part of West Northamptonshire to another to receive care?

·         Concern was expressed regarding the increasing cost of care due to demand, both from a budget and an individual perspective.  WNC should look at increasing the number of local authority owned care homes: it currently owned eight homes whereas Derbyshire County Council (DCC) owned 23.  Doing this would reflect shortfall in private sector provision as well as increasing WNC’s ability to shape new developments in the authority.

·         Could comparison figures for care home contract terminations be provided for WNC and other neighboring authorities?

·         How would assurance visits to care homes be put back on schedule if current visits were only due to be completed in March 2022?

·         WNC needed to ensure that it was able to identify all care homes that were experiencing problems.

·         If WNC terminated a contract with a care home this could affect the provider’s ability to meet the needs of other clients not placed there by the local authority. How did WNC seek to manage this risk?

·         There was a clear need to increase the earnings for care workers but this would in turn increase providers’ operating costs.  WNC needed to work out the best way of managing these competing factors.

·         When a care home was rated inadequate was it an option for the facility to be taken into WNC’s control?

·         The Committee had previously requested an update on Disabled Facilities Grant (DFG) utilisation, which had not yet been received.  This should be provided as soon as possible.

The Executive Director – Adults, Communities and Wellbeing and the Assistant Director – Commissioning and Performance made the following points in response:

·         WNC operated a brokerage service that dealt with all care placements and would record when people were waiting for any form of care.  WNC worked with providers to address issues affecting care provision but also had an escalation process that could include the use of other providers of assured quality.  WNC would not leave an individual without necessary care, even if this resulted in the authority incurring additional costs.

·         Care homes were mostly located in and around Northampton.  Additional information regarding location could be provided to the Committee.  Reductions in provision increased existing pressures on choice.

·         DCC’s in-house residential care gave it greater capacity to step in and respond to current pressures on overall provision.  Until recently, the cost to local authorities of in-house provision had been too high compared to the independent sector. However, it was now more feasible for WNC to consider increasing in-house provision as an option for the future.  This would support its role of intervening when care was not meeting needs.  It could also assist in dealing with issues such as the limited availability of independent domiciliary care in Daventry and South Northamptonshire.

·         Additional resources would be used to support assurance visits to care homes until they were back on the normal schedule.  

·         Changes had been made to primary care contracts and as part of Integrated Care System development to improve day to day intelligence on care homes and collaborative working to support effective provision.

·         WNC would work to support all residents of a care home if cancelling a contract affected the home’s overall viability.  WNC had a statutory duty of care to all service users in the area, regardless of the source of funding for their individual care packages.

·         It was anticipated that WNC’s future approach to residential care would bring in a contractual requirement for providers to pay staff at a set level.  This would mean that higher funding provided by the authority would support staffing.  However, the ability to take this approach was affected by the fact that the likely increase in the adult social care precept would not cover the cost of increasing care staff pay to the level of the National Living Wage and above.  A 1% increase in Council Tax would raise £1.1m in West Northamptonshire: increasing care staff pay to £9.50 per hour would cost £5m and to £10.50 per hour in order to be competitive would cost much more.  There was also a question about whether it was fair to increase Council Tax in this way to meet the cost of adult social care.   

·         A cost of care exercise was due to be done in December 2021 – January 2022.

·         It was only financially viable for WNC to take over a care home if it was a unit of at least 60 beds that was constructed in the last 20 years.  Smaller and older or converted buildings were not ideal.

·         Relevant Cabinet Members were due to be briefed on the current position and planned action regarding DFG utilisation.  Further information could then be provided to the Committee.  

The Committee considered potential resolutions on this matter, including the scope for it to recommend further action by WNC to make the case for a better funding settlement for adult social care.  The Cabinet Member for Adult Care, Wellbeing and Health Integration advised that WNC was already highlighting this need and advised that he liaised regularly with Andrew Lewer MP, whose position on the Health and Social Care Select Committee gave WNC a good link into national discussion.

RESOLVED that: the People Overview and Scrutiny Committee:

a)    Agreed to write to the Leader of the Council and the Cabinet Member for Adult Care, Wellbeing and Health Integration supporting representations to the government concerning the need for adult social care to be funded at a level that recognises current pressures on services.

b)    Requested to be provided with a geographical breakdown of the care homes in West Northamptonshire subject to performance improvement plans or contract terminations in 2021/22.

c)    Requested to be provided with further information on the number of care home contract defaults and terminations in West Northamptonshire’s neighbouring authorities.

d)    Requested that the further information to be provided to the Committee on Disabled Facilities Grant utilisation be circulated to Committee members as soon as it is available.