Contact: Sally Trinder Ext: (01962) 833000 email: [email protected]

1. Summary:

The following decisions are sought:

1.1 That the Executive Member for Adult Social Care approves that the in-house home care service fully implements the re-ablement model of care across the county and ceases to provide traditional domiciliary care, which will now be commissioned wholly from the independent sector.

1.2 That the Executive Member for Adult Social Care approves the preferred approach of minimising redundancies by deploying the remaining workforce that are not required within the re-ablement service to the areas of employment outlined in Option 2.

1.3 That the Executive Member for Adult Social Care agrees to the appointment of a project manager to develop the agreed option as part of the next phase of the modernisation programme of the home care service

2. Reason

2.1 The re-ablement service developed during 2006 has been successful in the "right-sizing" of care packages and has played an important part in managing demand for services.

It was agreed that the home care service should no longer be providing long term domiciliary care similar to that provided by the independent sector, but should refocus its core business into the provision of short term care that would assist the care management process in determining the correct level of care to meet individual service user's needs.

The long term home care service has reduced in size and the continuation of this service is at risk owing to staff vacancies and the newly developing re- ablement teams. Unit costs of the home care service are higher compared with independent sector provision and likely to increase as productivity falls in the long term service.

This report makes recommendations to the Executive Member for Adult Social Care that the model of re-ablement care is implemented fully throughout the County. It seeks agreement to "downsize" the remaining service through the preferred approach of minimising redundancies by deploying the remaining workforce to the areas of employment as identified in option 2.

2.2 This report supports the Corporate Strategy aim of Maximising Well-being by

ensuring that vulnerable people have access to re-ablement services that will maximise their independence and enhance their quality of life.

3. Other Options considered and rejected:

3.1 Option 1 -Continue current model

The home care service continues in its current form developing the re- ablement service and integrating with care management teams.

3.2 Option 3 - TUPE

The remaining long term service could be transferred through a tendering process into the private sector. Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE) will therefore apply to affected staff

3.4 Option 4 - Redundancies / early retirement

Reductions in headcount to achieve the correct size of the re-ablement service are achieved through redundancies and early retirements.

4. Conflicts of Interest declared by the decision maker or other Executive member consulted

None

5. Dispensation granted by the Standards Committee

None

6. Reason(s) for the matter being dealt with if urgent

Not applicable

Approved by: ........................................... Date: ................

Councillor Patricia Banks

Executive Member for Adult Social Care

Contact: Sally Trinder (01962) 833000 email: [email protected]

1. Summary

1.1 The re-ablement service developed during 2006 has been successful in the "right-sizing" of care packages and has played an important part in managing demand for services.

The long term home care service has reduced in size and the continuation of this service is at risk owing to staff vacancies and the newly developing re-ablement teams.

Unit costs of the home care service are higher compared with independent sector provision and likely to increase as productivity falls in the long term service.

This report makes recommendations to the Executive Member for Adult Social Care that the model of re-ablement care is fully implemented throughout the County. It seeks agreement to "downsize" the remaining service through the preferred approach of minimising redundancies by deploying the remaining workforce to the three areas of employment as identified in option 2 (See 8. below).

1.2 The overall strategic direction for adult services, including home care, was agreed by Cabinet on 18 December 2006.

1.3 This report supports the Corporate Strategy aim of Maximising Well-being by

ensuring that vulnerable people have access to re-ablement services that will maximise their independence and enhance their quality of life.

2. Impact Assessment

2.1 In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. There is the potential for impact under the Race Relations (Amendment) Act in implementing option 2, but an approach will be taken to ensure that there is scope to prevent unfair impact on anyone due to their racial or ethnic identity.

3. Consultation with Local Members

3.1 The report represents changes to a county-wide service, therefore, discussions have been held with the Executive Member for Adult Social care and the Leader of the County Council. As changes are implemented, which have local implications, then officers from the Department will consult with local Members, as appropriate.

4. Background

4.1 In December 2005, the Executive Member for Adult Social Care gave agreement for proposals for the modernisation of the in-house home care service to commence. Research across the country had identified that a number of Local Authorities were moving their in-house home care services into the provision of short term re-ablement care.

4.2 It was agreed that the home care service should no longer be providing long term domiciliary care similar to that provided by the independent sector, but should refocus its core business into the provision of short term care that would assist the care management process in determining the correct level of care to meet individual service user's needs. It was identified that a critical success factor in achieving this service redesign would be the close realignment of the service to care management teams.

4.3 The in-house service currently holds 15% of the domiciliary care market in Hampshire which is a reduction of 7% since December 2005. 40% of the service is now providing short term re-ablement care.

5. The Re-ablement service

5.1 The new re-ablement teams, now called Community Response Teams, are closely linked with the Reception and Assessment services across the County and aim to take the maximum level of care approved through the panel process. The service works with service users over a period of six weeks providing intensive support to assist them in regaining confidence and returning their independence to the optimum level, thereby minimising the whole-life cost of care.

5.2 The staff within the re-ablement service are trained to encourage people to do things for themselves. This model of care is very different from the domiciliary care services that are purchased from the independent sector as these generally focus on doing specific tasks for people which in time can create further dependency.

5.3 The home care service has become a key partner and participant within the local resource allocation panels. The skills and expertise of team leaders are used to assist in the decision making process and there is evidence that this is contributing to the management of demand.

5.4 Team leaders within the Re-ablement service are now trained in entering data, provisions and profile notes onto SWIFT resulting in improved management information. Team leaders have also undertaken a programme of training in the care management process, which will lead onto Care Management Competencies. These staff are now contributing to the assessment and review of service users' needs. This includes assisting Care Managers who undertake the 28 day statutory reviews which will assist in enabling the Department to improve its performance on PAF Indicator D40.

5.5 Training

The skills required to deliver a re-ablement programme are very different to those required to deliver traditional personal care. The ability to allow people to take risks whilst increasing their independence is challenging and relies on good risk assessment and practical judgement. Therefore staff working within the re-ablement service are currently undertaking specialist training in `promoting independence and re-ablement'. This two day programme has been specifically designed by a qualified Occupational Therapist. This specialist training also involves a practical session with a physiotherapist and focuses on a range of long term conditions.

5.6 Service user outcomes

Analysis of Service User Outcomes

April - August 2006

Table 1

Between April 2006 and August 2006, 801 people were referred to the Re-ablement service. 326 people went out of the service either no longer requiring care or on a reduced care package. This represents 41% of the people receiving a service.

167 care packages have been reduced by an average of 2 hours following the intervention of the re-ablement service. This represents a saving of approximately £317,000 full year savings at current independent sector prices. This figure will increase as the service develops further and full re-enablement training has been completed.

5.7 Costs

The unit cost of the in-house home care service in 2004/2005 was £26 per hour. The unit cost of externally purchased care was £13.70 per hour. During 2005/2006, a significant number of care packages were moved out of the home care service to make way for the new re-ablement service. It is likely that this will impact negatively on the unit costs for this year. However as team leaders and team managers are now working within the care management teams a percentage of the management costs will be apportioned to the care management function and not to the home care service during this year.

In 2006/2007, £13,861,000 was allocated to the in house home care budget. Financial and efficiency savings targets were set at £800,000. In order to achieve these savings, vacancies have been frozen. At the end of October 2006, the number of full time equivalent staff had reduced by 66 since December 2005. In this current financial year, £1,070,643 is projected to be saved on the staffing budgets and an overall under spend being projected for the service of £1,228,115.

Summary of Reduction

in both total headcount and FTE

Since December 05

Table 2

5.8 Further research

In response to an independent consultant's report commissioned by the Director of Adult Services, a visit was undertaken to Coventry City Council to look at the model of re-ablement care that has been developed there. The report identified that significant savings were being made by the City Council through an occupational therapy led re- ablement service. It stated that 60% of people using the service did not require on going care.

The visit to Coventry identified that there were significant advantages to introducing dedicated Occupational Therapy time into a service that needs to optimise peoples' recovery and independence. However, the Coventry model targets people whose needs are relatively low. The Director of Adult Services in Coventry agreed that the figure of 60% of people not requiring on going care packages would not be as high if people accessing the service were assessed as having substantial or critical needs only.

The results identified in table 1 demonstrate that the Hampshire model of re-ablement is achieving similar outcomes to that of the Coventry model. However it is clear from discussions with front line staff in Coventry that the Occupational Therapy time dedicated to the re- ablement service was key to its success. The modernisation of Adult Services will provide opportunities for closer integration between Occupational Therapy, Care Management and the Community Response Teams, thereby increasing the potential for better outcomes for individuals.

6. Staffing

6.1 A critical part of the modernisation programme for the in-house home care service was to ensure that the service was "flexible" to meet the needs of people with high levels of dependency.

During 2006, a new County roster was introduced following consultation with Trades Unions and staff. It was agreed that the re-ablement service would develop from the current staff group and that staff would be given the option as to whether they would join the new roster.

6.2 Following meetings with individual staff 226 people have opted to join the new working patterns, and a further 67 staff are working within the re-ablement service on their original working patterns. The remaining staff have opted not to join the new service and are continuing to work with the 491 long term service users across the County that have not yet been transferred to the independent sector. However, this arrangement is now becoming unsustainable as the numbers of long term service users decline. The long term service is now showing an increase in the level of un-used hours as many of the staff are not working flexibly enough to respond to the needs of people requiring care seven days per week.

Breakdown of staff working with Community Response Teams and the number of staff who have adopted the new working roster

Table 3

7. Next phase of modernisation

7.1 The restructuring and modernisation of Adult Services now provides an opportunity for the in-house home care service to integrate further with locality based care management teams. In April 2007, the home care service will be de-centralised and will move into the Well-being and Community Services Directorate.

7.2 Re-ablement services have recently been commended and highlighted as good practice in CSCI's recent report "Time to Care?" Hampshire's in-house service is well ahead in developing this model of care and can demonstrate to partners and regulators a willingness to do things differently that give people a genuine opportunity to decide how they would like their care to be provided.

7.3 However, there are areas of the home care service that are not delivering cost effective and flexible care. There are 354 staff who have decided not to work in the re-ablement teams at this current time (100 staff only work Monday to Friday). The cost of continuing to provide mainstream domiciliary care is twice that of the care purchased in the independent sector and cannot be sustained in the current financial climate. Costs are likely to increase during the 07/08 financial year as long term service users continue to leave the service. The continuity of care for people remaining in the long term service is now becoming difficult to maintain as staff who are willing to work flexibly continue to move into the re-ablement service. As the re-ablement service progresses and develops, it is becoming increasingly difficult to continue to provide traditional long-term services both on cost and quality grounds. Therefore, the service has reached a turning point where it is necessary to make clear decisions about its future direction in order to realise the full benefit of this new model of care alongside achieving the efficiencies expected from the modernisation programme.

7.4 It is acknowledged that some service users will be concerned by the withdrawal of the in-house home care service, as this will result in a change of their carers. Adult Services will work closely with these service users to ensure that they receive appropriate assessment and support whilst transferring to an independent sector domiciliary care provider.

7.5 Initial analysis of panel forms and Care Management Activity statistics has shown that the level of service required to provide all new service users with a six week period of re-ablement care would require potentially between 50% and 70% of the current staffing levels. Therefore Executive Member - Adult Social Care is asked to consider a number of options for the next phase of the modernisation programme for in- house home care service that will support the continuation of an appropriately sized re-ablement service that will contribute further to the modernisation and financial recovery of the Adults Services Department.

8. Options

8.1 Option 1 -Continue current model

The home care service continues in its current form developing the re- ablement service and integrating with care management teams. The service is sized appropriately based on demand the remaining service continues to provide care to existing long term service users and is reduced in size through continued vacancy management and natural turnover.

This option carries a number of risks. The remaining workforce will need to adopt the new roster to enable the service to meet the needs of highly dependent people at the times that they most require it. Unproductive time will increase which will result in higher unit costs and potential redundancy situations owing to lack of work.

Management will have little control over the service design as staff will drive any future direction.

Natural turnover is likely to yield a further £500,000 next year but productivity within the service will decrease.

8.2 Option 2 - Alternative employment opportunities

Further reductions in headcount which to date have not been achieved by turnover could be achieved through alternative employment opportunities within Adult Services. This process would ensure that the headcount reduction is systematically managed and meets the requirements of the department and the modernisation agenda for home care.

Head count reduction

Table 4

Since April 2006, 38 FTE staff have left the home care service. Further staff turnover of approximately 24 FTE is anticipated to the end of March 2007. Therefore a further reduction of 172 FTE staff is required to meet a 50% reduction in staffing so that only the re-ablement service is provided.

This option identifies three alternative areas of employment for displaced staff and includes the option of voluntary early retirement and redundancy.

Proposals for the redeployment of 172 FTE staff

Table 5

The vacancies in the residential and nursing home sector are currently running at 125 FTE's. The numbers and costs identified in table 5 are based on an assumption that 90 of these vacancies will be filled by displaced staff.

The development of the new bank service for provider services would offer redeployment opportunities for 36 FTE staff. It is anticipated that the full year effect of this action would be a saving of £500,000 on projected agency spend.

The emergence of the well-being teams across the County in response to the LAA flagship initiative would provide the opportunity for 10 staff to be redeployed into this area of work. This would release £210,000 into the well-being agenda but would not provide savings in 2007.

Early retirements have been estimated at 10 FTE staff. At an approximate cost of £10,000 per person, one off costs of £100,000 will be needed to fund these retirements which it is anticipated will all be incurred during 2007/2008. Early retirements will give a year on year saving of £210,000, estimated at £105,000 during 2007/2008. An estimated 26 FTE voluntary redundancies would incur one off costs £78,000 and would provide a year on year saving of £546,000, estimated at £273,000 during 2007/2008.

The on-going annual net savings for option 2 will be £1,921,000 in addition to the savings already identified in paragraph 5.7. Of the £1,921,000 savings £753,000 is expected to be achieved in 2007/2008 during the implementation phase.

This option will require the recruitment of a temporary project manager to provide additional management capacity to support these, ensuring that the significant Human Resource implications are handled efficiently and sensitively.

8.3 Option 3 - TUPE

The remaining long term service could be transferred through a tendering process into the private sector. Transfer of Undertakings (Protection of Employment) Regulations 2006 (TUPE) will therefore apply to affected staff

This option will require an extensive consultation period with staff and Trades Unions. Existing staff would transfer to a new provider on their current terms and conditions. The financial gains are likely to be limited in the short term as any new provider will need to be able to support the terms and conditions of transferring staff which are generous in comparison those in the private sector.

8.4 Option 4 - Redundancies / early retirement

Reductions in headcount to achieve the correct size of the re-ablement service are achieved through redundancies and early retirements. Based on a downsizing of staffing levels by 50% (which is the maximum reduction that would be required), a gross saving would be made of £4,900,000 but this would be offset by one off costs of redundancy and early retirement as well as the ongoing cost of purchasing replacement packages. An initial estimate for redundancy and early retirement would be £600,000 and for replacement packages £2,200,000 (but the replacement package figure would depend on how the market would react to additional demand). This would result in a full year saving of £2,100,000; this is an additional £1,600,000 savings to the current budget proposals.

This option carries risks regarding the high level of publicity and political concern that redundancies would bring, particularly as the majority of staff affected have been employed by the County Council for many years and are some of the lowest paid workers. This option would however, contribute significantly to the remaining deficit identified in the budget plans for 2007/2008.

8.5 Officers have considered all four options and propose that Option 2 is recommended by the Executive Member. This option provides a suitable balance between supporting our staff and ensuring that the Department modernises its services to meet the needs of current and future service users and to support the Department's financial recovery. This option will ensure that the headcount reduction is systematically managed in a way which reduces the risk to staff and to the department.

Recommendations

1. That the Executive Member for Adult Social Care approves that the in-house home care service fully implements the re-ablement model of care across the county and ceases to provide traditional domiciliary care, which will now be commissioned wholly from the independent sector.

2. That Executive Member for Adult Social Care approves the preferred approach of minimising redundancies by deploying the remaining workforce that are not required within the re-ablement service to the three areas outlined in Option 2.

3. That Executive Member for Adult Social Care agrees to the appointment of a project manager to develop the agreed option as part of the next phase of the modernisation programme of the home care service.

Section 100 D - Local Government Act 1972 - background documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB: the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act.

None