Report of the Strategic Director Service Group 2

Part 1 ITEM NO.

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REPORT OF THE STRATEGIC DIRECTOR SERVICE GROUP 2 COMMUNITY HEALTH AND SOCIAL CARE ______

TO THE ASSISTANT MAYOR FOR Adult Services and Services for Older People ON 12.6.13 ______

TITLE: Re-commission Intermediate Home Support Service from Independent Domiciliary Care Agencies ______

RECOMMENDATION:

1. To continue with the Section 75 Intermediate Care joint arrangements to ensure effective delivery of health and social care, maximising people’s independence and preventing unnecessary hospital admissions or placements into long term care 2. To approve reconfiguration of the Intermediate Home Support Service, which is part of Intermediate Care, to provide an assessment and review function, and quality assurance as detailed in the report 3. To approve the service commissioning arrangements with independent domiciliary care providers for direct care as detailed in the report.

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EXECUTIVE SUMMARY:

Salford has a Section 75 agreement is in place to deliver Intermediate Care which comprises a range of services. . Intermediate Home Support is one of the services providing short term domiciliary care, maximising people’s independence through a process of reablement for up to six weeks. It supports people being discharged from hospital or at risk of going into hospital or long term care (detail on page 4).

The objective of the proposal is to transfer the delivery of direct care work by the Intermediate Home Support Service and commission this aspect of provision from the independent sector domiciliary care providers – a model that is utilised in general terms across adult social care via the provision of domiciliary care.

Salford City Council will retain accountability for statutory duty of care through the new arrangements.

AM IHSS report Version9 – 4th June 20 13 1 The Intermediate Home Support service will be reconfigured to deliver a referral, assessment and care planning function.

Financial profiling indicates that Salford City Council will make estimated annual savings of £653,000 in 2013/14 and £812,000 from 2014/15.

Consultation has taken place with the Trade Union regarding possible options for service options prior to this proposal. Following decision the Council will commence the formal consultation process with staff and the Trade Unions and consultation with the independent sector domiciliary care providers to manage the transfer of direct service delivery capacity from the council to the independent sector. ______

BACKGROUND DOCUMENTS: (Available for public inspection) ______

KEY DECISION: Yes ______

DETAILS:

1. Commissioning arrangements

The Intermediate Home Support Service is part of the Section 75 Intermediate Care formal partnership arrangements, the primary outcomes of which include but not limited to:

 Reduce unnecessarily prolonged hospital stays or inappropriate admission to acute inpatient care, long term residential care or continuing care NHS inpatient care  Maximise independence and enable patients and service users to remain or resume living at home.  Deliver a personalised response to meet need.

The Section 75 agreement includes the following health and social care service areas:

Service name Provider Main purpose and focus of service agency Single Entry Point (SEP) SRFT Provides one consistent access point into intermediate care services to ensure patients/clients are channelled into Intermediate Care Services efficiently Rapid Response Service SRFT To prevent avoidable admissions to hospital, facilitate timely discharge and prevent admissions into long term residential care, Provides a response to calls in under 4 hours; operating Salford city wide.

AM IHSS report Version9 – 4th June 20 13 2 Community SRFT Provides home based assessment and therapy Rehabilitation & & based rehabilitation. Also provides clinical Supported Discharge sessions for falls and amputee clinics in order to Team maximise individual potential for independence. Service aimed at admissions avoidance and timely discharge from hospital or residential settings. Hospital Discharge SRFT Hospital based clinical discharge team, mainly Team ward based and working closely with S/W hospital team whose main purpose is to ensure the safe and timely transfer of care of those patients requiring post discharge support in the community. Multi Disciplinary SRFT To deliver rehabilitative therapy to patients Therapy Team admitted to community based nursing and residential Intermediate Care Units Heartly Green Nursing SRFT Team to deliver nursing care on 29 bedded Team Community based unit for patients requiring on going assessment, rehabilitation and/or recuperation needs requiring 24 hour nursing support. IV Therapy Team SRFT Provide community based service to patients who would otherwise require IV treatment in a hospital setting. Intermediate Home SCC Team to provide co-ordination, commissioning Support Service and monitoring of home care and enablement support to people in their own homes in order to reduce dependency on services and maintain maximum potential for independence & reduce admissions to permanent residential care. Intermediate Care Social SCC Team provides assessment to service Work team users and carers for service users receiving care in on an IC unit or in their own homes. Focus on optimising service user potential for independence and reduction in avoidable residential admissions. Intermediate Care Mental To ensure service user and their carers potential Health Service for independence is maximised. Providing support for specialist mental health and capacity assessments GP Service SRFT To provide medical care to patients for the duration of their stay on Intermediate Care Units. Heartly Green SRFT To provide step down step up nursing beds in Residential Nursing Contract the community to prevent avoidable admissions Care to residential or hospital care and support timely discharge. Swinton Hall SRFT To provide step down step up nursing beds in Residential Nursing Contract the community to prevent avoidable admissions Care to residential or hospital care and support timely discharge. The Limes Residential SCC To provide step down step up residential beds in Care the community to prevent avoidable admissions to residential or hospital care and support timely discharge.

AM IHSS report Version9 – 4th June 20 13 3 The funding allocations for the financial year 2012/13 are:

NHS Salford: £6.151m Salford City Council: £2.317m Total: £8.468m

2. Scope of the service

The principle aim of Intermediate Support Service is to provide short term free domiciliary support to people living in Salford who require up to six weeks intervention following a period of acute hospital care or to support and address developing social care needs and prevent hospital admission. The service offers holistic reablement and assessment to identify long term care needs and the most efficient means of delivery. The service provides reablement, care and support closer to home to maintain independence and prevent premature admission to long- term care, inclusive of promoting early supported discharge and in order to improve and maintain independence.

The service provides high quality, skilled care and support in the community as a safe alternative to acute based services. The provision works closely with other Intermediate Care services to provide a model of intervention and support tailored to meet the needs of individuals in order to maintain their optimum independence, ensuring the right reablement care and support is provided in the right place at the right time.

The service will support people (clients and patients) with:

 All aspects of daily living  Building confidence and assisting with reablement programmes  Promoting independence  Reducing dependency on high packages of health and social care  Reducing admissions to residential and acute care  Facilitating timely discharge

3. Current Service establishment including new commissioning arrangements

The current ‘in-house’ Intermediate Home Support Service delivers both the assessment and reablement/care function, with the team divided to manage both these functions.

The assessment, care coordination and reablement/care delivery function is managed through a team of a Team Manager, three Home Support Managers and 11 Home Support Coordinators (10 Home Support Coordinators are currently in post with one vacancy).

During 2011/12, a number requests for voluntary severance/voluntary retirement (VS/VR) applications from staff were received, in response and in order to achieve

AM IHSS report Version9 – 4th June 20 13 4 continued efficiency the reablement/care function of the service was subject to a review and redesign. The VR/VS requests and the review resulted in a reduction in the staffing allocation to deliver the reablement/care function of 29 (87 to 58). An additional six staff left in March 2012 leaving 52 support assistants (2 vacant posts).

To maintain the service activity of the reablement/care component, agreements were reached with the local independent sector domiciliary care providers to provide additional capacity and accept referrals from Intermediate Home Support, following an assessment and care support plan coordination.

The outcome of the new ‘commissioning’ arrangements with the independent sector domiciliary care providers was to:

 Commission home support hours from four independent providers at an agreed financial rate.  Embed reablement outcomes within support plans.  Monitor and review the commissioned service activity.  Redesign the assessment and care coordination function of the service to ensure it was fit for purpose within the new model.

The new commissioning arrangements have been developed with a range of new management procedures:

 Updated assessment and care coordination procedures, including documentation  Revised referral procedures  A recognition that review and quality assurance processes between Intermediate Home Support and the independent provider need to be further developed  Case closure and discharge arrangements

The changes to the service were communicated to staff and union representative through staff meetings and briefings.

Throughout the implementation of the new model the arrangements have been reviewed. The model is working effectively and the ‘in house’ service reports the outcomes for clients have been unaffected.

In addition, the service carried out a further assessment and review of the remaining ‘in-house’ reablement/care function. The service has used additional ‘reablement’ investment to support the redesign of the care model and this has resulted in further efficiencies in the reablement/care function of the service. This includes changes to rotas to reduce ‘down time’ and the inclusion of lone working after 6pm. A clearer ‘referral in’ criteria has been developed and changes to service documentation has given a greater reablement and outcome emphasis. The use of equipment has been introduced into the service to support the aim to create greater client independence. Training has been provided for all staff on the new processes and associated documentation.

AM IHSS report Version9 – 4th June 20 13 5 4. Recommissioning of service ‘care’ component and impact on existing service/team

The roll-out and assessment of the new commissioning arrangements has demonstrated that the independent sector domiciliary care providers are able to deliver the desired level of service to clients referred to the providers.

It is proposed to further develop and expand this function with the independent sector such that the remaining ‘care’ delivery component of the in-house service will be transferred in totality to the independent sector. It is also proposed to retain the assessment and care coordination function within the in-house service and that this team will be redesigned to reflect the new ‘commissioning’ function of the model.

In recommissioning the service there will be an impact on the staffing establishment for the current team. The ‘care’ component of the in house service is made up of 54 posts that delivery direct care work, one Team Manager and three Home Support Managers’ posts.

In analysing the demand for direct reablement/care service and the current level of supply provided by the in house service, it is calculated, based on past delivery, that an average of 660 hours per week of direct contact time would be required to meet the current level of need. There will need to be an additional 90 hours per week available as a contingency to allow for any fluctuation in demand and ensure service delivery. The 660 and 90 contingency hours per week would be commissioned from the independent sector under the established arrangements that have been developed through the service redesign that has taken place in 2012.

The recommissioning of the ‘care’ component of the service will remove the need to provide direct management support to the staff providing this service. However a new role will be required to process referrals/allocation and deliver quality assurance and performance monitoring support to the commissioning arrangements with the independent sector to ensure the service providers deliver quality outcomes within a performance management framework. This reconfiguration will result in the disestablishment of one of the manager posts, who manage the staff providing the direct ‘care’ component. There are also three care coordination posts that will be disestablished through voluntary arrangements (currently one post is vacant).

5. New Model – In house team reconfiguration.

In order to deliver the new ‘commissioning’ model a new service structure will need to be established. The function of this new model will be divided into to specific areas of a) quality, performance and staff management b) assessment and coordination

The quality, performance and staff management function will delivered through the Team Manager role

 provide staff management, supervision and appraisal to remaining SCC staff.  manage referrals and the interface with referrers and the independent sector domiciliary care providers

AM IHSS report Version9 – 4th June 20 13 6  allocate work to Coordinators  ensure Coordinators are given professional guidance to deliver a safe, quality service  understand, manage and maximise capacity within the independent sector domiciliary care providers  engage with the independent sector domiciliary care providers to ensure services are delivered within a specified quality and performance management framework. This will include setting up quality assurance service monitoring and measuring outcomes against performance targets.  ensure the independent sector domiciliary care providers deliver reablement programmes including support for workforce development  continue to ensure appropriate interface with other Intermediate Care and reablement services and other health and social care initiatives that complement the service

It is recognised that the primary staff management function of the existing Home Support Manager role will not be required. There will be a need to focus on managing the interface with referrers and providers, ensuring outcomes are delivered within a performance management framework. This role is provisionally called Quality Assurance Officer and will:

 undertake assessments to identify service requirements to meet needs, reablement goals and risks  set up appropriate support plans and reablement programmes with clearly defined outcomes  identify and put in place equipment and telecare in order to maximise independence  monitor, review and adjust support plans and discharge from the service  work in partnership with social workers and therapists to identify ongoing eligible long term needs  signpost to other services  liaise with independent providers regarding changes to support plan and progress of service users against outcomes

In order to deliver the functions the following staffing establishment will be required:

1 Team Manager (management function) 2 Qualtiy Assurance Officer(management function) 8 Home Support Coordinators (coordination function)

Team Structure: March 2013 Proposed Team Structure Job Title No. Job Title No. Team Manager 1 Team Manager 1 Impact: No change Home Support Manager 3 Quality Assurance Officer 2 Loss of one post Home Support Coordinator 11 Home Support Coordinator 8 Vacancy (1)

AM IHSS report Version9 – 4th June 20 13 7 Impact: Loss of three posts with one of these posts being vacant. Home Support Assistant 54 Vacancy (2) Impact: Loss of 54 posts with two of these posts being vacant Total Posts 69 Total Posts 11

The integrated referral system for Intermediate Care will support the establishment of the new model such that all initial referral will be managed through the Single Entry Point (SEP) system. The new service model will ensure that the quality of care in the market is scrutinised and monitored to ensure Salford people are provided with high quality care, support and reablement consistent with their assessed need.

Transition planning for the service change will be a function of the Team Manager. The development of a transition plan, including risk management will provide focus and direction to support the proposed changes to the service.

6. Timescales – Outline

The actions below represent the high level critical actions that need to be addressed in order to deliver the proposed service redesign. The project team will be responsible for developing a more detailed project plan.

Action Date Establish project team, agreed membership, define the scope and January 2013 plan of work and schedule meetings. Begin HR processes – briefings with staff and unions January 2013 Begin discussions with Independent Sector Domiciliary Care January 2013 Providers Arrange staff and HR briefings February 2013 Consultation with Unison re proposed model and possible options April-May 2013 Contract variation completed July 2013 Conclude internal (council) service redesign July 2013 Redesign project team to support the implementation of the new June- July 2013 model Conclude HR consultations June-July 2013 Confirm establishment of internal (council) team July 2013 New service provider(s) take up service July-Aug 2013

7. Commissioning function

The commissioning system that is delivered through the existing contractual arrangements between the council and the independent sector domiciliary care providers will be applied to the model described in this proposal. The commissioning arrangements ensure that the council retains accountability for delivering its statutory duty of care. The system for managing the contractual arrangement will be supported by the council’s procurement function.

AM IHSS report Version9 – 4th June 20 13 8 The new model creates additional ‘capacity’ demands on the independent sector domiciliary care providers that operate in the city. The demand increase will be mitigated through TUPE arrangements, existing capacity and recruitment. The scope of the service that will be required will be consistent with the scope of the service specification of the existing contract.

The commissioning function and the relationship between the operation functions that will be delivered by the council in the proposal and the independent sector domiciliary care providers will be consistent with the current arrangements that have been delivered by those parties for the past 12 months. This means the practical arrangements of commissioning a ‘package of care’ from the independent sector domiciliary care providers will follow the current arrangements.

In order for the proposal to be implemented a transition plan will be developed by the council that will describe the process for engaging with the independent sector domiciliary care providers to manage the changes. The council will be required to make a formal variation to the contract to reflect the changes brought about through the new arrangements. The operational aspects of the change process will be similar to those implemented during 2011/12 and will be managed through the remodelled Intermediate Home Support Service.

There has been engagement with all independent sector domiciliary care providers regarding these proposals with clear indication that the required provision will be met in all areas. The risk of any shortfall of provision will be mitigated through the delivery of the transition plan with the independent sector domiciliary care providers. Council staff who are currently employed to provide direct service delivery will only be released from their employment contract with the council once the capacity of the independent sector domiciliary care providers is sufficient and confirmed with the council to meet the service demand.

8. Trade union consultation and Option Appraisal

A period of consultation with Unison regarding the proposals for the service has taken place including three formal meetings 22nd April, 3rd and 10th May 2013. At the meeting held on 22nd April the process and timeframe for consultation was outlined. Trade unions and managers identified a number of proposals/options for achieving the £623k savings for 2013/14 whilst still meeting the demand for the Intermediate Home Support Service described as 660 direct contact hours. At the meeting 3rd May the offer was made for the staff Unison representative to meet with the IHSS Team Manager to consider working practices, rotas, and at a meeting on the 9th May 2013 Unison undertook to consult with staff on those options.

A further meeting was held on the 29th May 2013 with staff, trade unions, managers and the Assistant Mayor for Adults and Older People’s to discuss the options which are set out below.

Option 1 For the City Council working with Salford Clinical Commissioning Group to identify potential funding sources which could support the workforce to utilise their skills to prevent hospital admission, support discharge and maintain people within their own homes.

AM IHSS report Version9 – 4th June 20 13 9 Option 2: To consider utilising the capacity of Intermediate Home Support with the remaining workforce by considering for example patterns of working which may deliver the contact hours requirement whilst still achieving the budget efficiency.

Option 3: Any other proposals which may arise during this consultation process

At the meeting 10th May there were no further options proposed by Unison.

In order to evaluate these proposals the existing service was described and an assessment of other existing services to support hospital admission avoidance and expedite early hospital discharge.

8.1 Options Appraisal

Option 1: Utilising Existing Staff in Current Services or New Funding

Rapid Response, Intermediate Care

The Rapid Response Team is a multidisciplinary team comprising health and social care professionals. The team has a 4 hour response time to assessments in the community and a 1 hour response time to assessments in the hospital’s emergency areas. The aim of the service is to prevent unnecessary hospital admission through a holistic approach for those experiencing an acute episode of illness or injury who are in a health and social care crisis. The team operates from 8am – 12 midnight 7 days a week . The service undertakes comprehensive assessments of patients including health and social care needs. The service allows patients to be treated by the multidisciplinary team in their own homes for up to 2 weeks, to maintain their independence and maximize function. When it is not possible to do this within the 2 week remit, referral processes are in place to handover to other teams within Intermediate care or care agencies to continue care and treatment.

Option 1a: Rapid Response Team

The Rapid Response team has health and social care support workers. These workers are multi skilled in completing health and social care assessments and delivering interventions and care. The team has 13 (12.06 WTE) support workers. Agency and locum staff are used infrequently and for 2012/13 agency spend was a total of £3k for these staff members.

Option 1b: Funding Streams

 Reablement Funding

The City Council is working with Salford Clinical Commissioning Group currently to develop services which support reablement through a Reablement Investment Plan. The plan reviews current uses of funding, outlines the intended use of additional resources for post-discharge and re-ablement services, and describes the process of

AM IHSS report Version9 – 4th June 20 13 10 agreeing the plan between Salford City Council, Salford Royal Foundation Trust and NHS Salford Clinical Commissioning Group, It also documents the principles by which these organizations will work together to effectively utilise this new resource and minimise risk to all parties.As it is the investment plan for 2013/14 currently show an over commitment of £166, 000.

 Integrated Care Programme

The four main Health and Social Care partners (SRFT, GMW, Salford CCG, and the City Council have embarked on a whole system Integrated Care programme. Within the programme a non-recurrent £515k investment has been identified to support the delivery of a new Integrated Model of Care Delivery across the system. Specific models of intervention are being identified during 2013/14 through a PDSA (Plan Do Study Act) methodology and therefore does not enable there to be a current commitment to provision of service.

Option 2: Improving Existing Capacity

Current IHSS service information

25 hour contracts. Shift pattern in am/pm blocks. No split shifts.

 Reduced capacity as staff on shift at times when there is no work

 Average current non contact time (April 12 to Jan 13) 56%

 Average current level of miss match between shift pattern and service demand (April 12 to Jan 13) 20%

 Low level of contact time per staff member per week (average 12 hours)

 Difficulty in covering shifts across the city with existing work force (ability to cover shifts

Options 2a: Remain on 25 hour contracts and introduce split shifts

Shift pattern split into 3 slots: breakfast/lunch/tea or breakfast/lunch/bed. To be worked over 7 days (with rest days).

Implications for staff

 Staff will need to be available in smaller time slots over a longer part of day  Number of weekends worked will increase (depending on rota)

 Increased travel costs if don’t pay mileage between split shifts  Time spent on each ‘slot’ would be determined on a week to week basis.

AM IHSS report Version9 – 4th June 20 13 11 Implications for service

 Will give more capacity at key times and increased productive time  Will reduce level of miss match between shift patterns and service demand  Will give continuity of care/support – improved customer journey  Possible increase in shift allowance  Increase in travel costs if do pay mileage between split shifts  Will be more difficult to cover the work for absences (3 times in day)  Cannot guarantee increased productivity with 36% non-contact time

Options 2b: Reducing to 20 hour Contracts and introduce split shifts

Shift pattern stays in am/pm blocks but with a split within each block. To be worked over 7 days (with rest days).

Implications for staff

 Staff will need to be available to work in smaller time slots in one shift  Number of weekends worked will increase (depending on rota)  Reduction in pay  Increase in travel costs if don’t pay for mileage between the split shifts  Time spent on each ‘slot’ would be determined on a week to week basis  Hours may be worked over a 2/4 week period (am shifts are busier than pm shifts)

Implications for service

 Will give more capacity at keys times and increase productive time  Will reduce level of miss match between shift patterns and service demand  Increase in shift allowance  Increase in travel costs if do pay mileage between split shifts  Additional cost of compensating staff for reduction in hours  Cannot guarantee increased productivity with 36% non-contact time  Cost of compensation due to reduced hours

8.2 Consultation outcomes

 Option 1a:

This was not considered viable due to no identified current shortfall in staffing and the use of locum and agency staff was confirmed to be minimal over the last financial year.

AM IHSS report Version9 – 4th June 20 13 12  Option 1b:

There was no identified gap in service or available funds from the integrated care programme or reablement funding. In addition a formal approach was made to the Chief Operating Officer of Salford Clinical Commissioning Group for additional investment into this service to assist the Council in achieving its efficiency target. Salford Clinical Commissioning Group were unable to commit funding due to the current pressures on Accident and Emergency Services.

 Option 2a and 2b:

During the consultation the staffing complement reduced to 28 following two further requests for VER/VS. On the 9th May 2013 options 2 (a) and 2 (b) were presented to staff by Trade Unions but were rejected due to the need to work ‘split shifts’ and reduction in contract hours. Following the meeting with staff, unions and the Assistant Mayor on 29th May 2013 the options were considered once more and further guidance was given by managers that if approximately 20 members of staff wish to accept either option the service could remain viable and the Assistant Mayor could give due consideration to the service remaining within Salford City Council.

Following consideration by the 28 remaining staff, a further 22 have requested VER/VS, 4 members of staff wanted to take option 2 (b) however they have stated that if the decision is to commission the service from Domiciliary Agencies they too, wish to access VER/VS. One member of staff has not communicated their preferences, indicating that they are prepared to work within either option, and one member of staff has asked to revisit the option to TUPE to the new provider. .

9. Financial Modelling

The commissioning of the Intermediate Home Support Service from the independent sector is included in the Community, Health and Social Care service group’s savings proposals recently approved by Council. The savings requirement is therefore built into the revenue budget from 2013/14.

The estimated saving is based on the differential between the current budget for the in house service and the total estimated cost of the proposed retained team structure and the service to be commissioned from the independent sector. As stated above it has been calculated that 750 hours (comprising 660 hours and an additional contingency of 90 hours) will need to be commissioned. The original calculations to support the development of the savings proposal assumed that TUPE would apply for the total hours commissioned from the independent sector. Assumptions were built into the model in relation to the percentage of contact time compared to paid time and the hourly rate which would be required by the providers.

Based on the updated staffing position following the consultation, there are now only 2 members of staff who may transfer under TUPE and the costings have therefore been updated to reflect this.

AM IHSS report Version9 – 4th June 20 13 13 In addition to the budget for the 52 posts, a separate budget is held based on an equivalent 10 posts. The budget is used to fund additional hours for staff to cover absences related to sickness and leave. Whilst approximately 70% of this budget is currently being used, the financial model assumes that this will be saved in full, as the cost of commissioning 750 hours is already provided for in the calculations.

The updated estimates for 2013/14 take into account the part year effect where appropriate of the various elements of the savings proposal. This therefore includes the savings achieved to date from the 24 members of staff who have left the service and the deletion of 2 vacant posts, net of the additional hours that have been commissioned from the independent sector. Estimates have also been included to reflect the interim arrangements between now and the full implementation of the new service model.

The new commissioning arrangements implemented during 2012/13 have already achieved significant savings. The current arrangements have overachieved the previous savings targets by £191k and this has also been taken into account in the updated estimates.

A summary of the estimated savings is shown below: 2013/14 2014/15 £ £ Budget for 52 Home Support Assistants 757,606 757,606 Additional "bank" hours equivalent to 10 posts 138,330 138,330 Total 895,936 895,936

Cost of staffing interim arrangements April to August -265,318 0 Hours commissioned from the independent sector -256,905 -392,463 Provision for expenses and contribution to supervision/overheads -13,064 -22,395 Total -535,287 -414,858

Estimated Savings 360,649 481,078

Further savings 2 vacant Home Support Assistants 27,416 27,416 1 Home Support Manager 15,826 37,982 3 Home Support Co-ordinators 58,088 74,810 Total 101,329 140,208

Total Savings from New Proposal 461,978 621,286

Overachieved savings from arrangements implemented during 2012/13 191,060 191,060

TOTAL SAVINGS 653,038 812,346

AM IHSS report Version9 – 4th June 20 13 14 The estimated savings have increased to £653k in 2013/14, compared to the target of £623k , and £812k from 2014/15, compared to the target of £639k. This estimate is still based on a number of assumptions and is subject to agreement with external providers. The estimates above include the additional 90 hours contingency at a cost of £57k.

Recommendation

From consideration of the options it is recommended that the proposal is supported to recommission the IHSS contact hours to independent sector providers. ______

HUMAN RESOURCE IMPLICATIONS supplied by Danielle Roscoe

In accordance with these proposals, elements of this function will transfer to external providers and TUPE is likely to apply. Those staff who are assigned to the elements of the service transferring are likely to transfer to the new service providers.

For the elements of the service that are retained, there will be a reduction in the staffing numbers which will be managed through existing creating capacity arrangements. Should redeployment opportunities not be available for those staff that become displaced, this could result in a redundancy situation. It will be necessary to review the current job descriptions of the staff remaining in the Council managed service against the functions of the new service and this may result in the development of new job descriptions for the roles in the new service. If this is required the job descriptions will need to be evaluated in line with the Council’s agreed job evaluation scheme.

Following staff/union briefings and consultation regarding the proposed new model and possible other options all of the 52 Home Support Assistants have applied for VER or VS figures. As at the 4th June 22 of the 52 have left on VER/VS. Two other Home Support Assistants have moved to other jobs. This will leave 28 staff delivering the service at 7th June. The option of taking VER/VS remains but any staff remaining with the service would be subject to TUPE. One Co-ordinator has left on VER.

The proposals will require formal consultation with staff and Trade Unions. In respect to the new service which will remain within the Council, this will require a minimum of 30 days consultation and then 12 weeks notice of implementation of the changes to contract for staff, as a matter of HR best practice. There is not a requirement to have minimum consultation and notice periods in TUPE situations, however staff should be consulted appropriately. In effect, there would be separate but parallel consultations on the TUPE transfer and on redundancy.

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KEY COUNCIL POLICIES:  Budget efficiency programme 2013/14  All those that apply to Adult Social Care

AM IHSS report Version9 – 4th June 20 13 15 ______

EQUALITY IMPACT ASSESSMENT AND IMPLICATIONS:

The Intermediate Home Support Service provides services to adults age 18+ who are either living in Salford or registered with a Salford GP. The service is provided on the basis of assessed need. The assessment process takes account of the client’s ability to understand and engage with the assessment process and additional support will be offered to those clients who require this. For example, if a client requires translation support. The commissioning arrangements with the independent sector domiciliary care providers requires the providers to delivery their services within an equality framework. The services works city-wide and received referrals from professional health and social care colleagues working across all communities in the city. An initial equality impact assessment of the proposal has been undertaken and the trade unions will be invited to contribute to further assessment. The Council will continuously monitor the impact of the proposal and where necessary take measures to mitigate any anticipated and adverse impact.

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ASSESSMENT OF RISK:

HR - Low Risk:  The proposal will require further consultation with staff and Trade Unions which may result in staff and service challenges.  The legal risk associated with HR issues is also considered to be low.  The proposal is based on implementation in June 2013. There is limited time to finalise the proposal and implement a programme of work to deliver an approved scheme within timescales.

Finance – Medium Risk  The financial modelling in the proposal is based on a number of assumptions about the current demand for the service from the market. These demand assumptions are partly supply driven. Whilst the modelling has allowed for this fact, it means there are some inherent uncertainties within the assumptions. It is possible that both current and future demand for the service might be different from those suggested in financial modelling in this proposal.  There needs to be management of the transition of service delivery hours from SCC to the independent sector domiciliary care providers.

Procurement/Contract – Low Risk  There is a potential risk to external challenge in implementing the proposal with the terms of the current contract between the council and independent sector domiciliary care providers.  There is risk regarding the capacity of the independent sector domiciliary care providers to deliver the required supply of service. However there has been engagement with all providers regarding these proposals with clear indication that the required provision will be met in all areas. The risk of any shortfall of

AM IHSS report Version9 – 4th June 20 13 16 provision will be mitigated through the delivery of the transition plan with the providers ensuring staff are released to meet demand.

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SOURCE OF FUNDING: The Intermediate Home Support Service is funded under the pooled budget arrangements of the Intermediate Care Section 75 agreement. The funding is jointly provided by Salford City Council and NHS Salford. ______

LEGAL IMPLICATIONS Supplied by Tony Hatton, Principal Solicitor 0161 219 6323 Additional advice on TUPE supplied by Gareth James, Principal Solicitor (Employment Team) 0161 234 3725.

The comments made under the Commissioning Function section in the Report are echoed and endorsed.

The service delivery is proposed to be transferred to independent domiciliary care providers as part of the reconfiguration of the IHSS package, and the existing commissioning arrangements currently delivered through the contractual relationship between the council and the providers will be varied as described in the report.

Whilst the proposals create supplementary requirements domiciliary care providers, the nature of the service going forward will be consistent with the content of the service specification of the existing contracts. As a result, it is recommended and proposed that the commissioning of the care component will follow the existing arrangements.

To enable the changes to be implemented, the City Council and the independent providers will be required to make formal variations to the current contracts to reflect those changes. In doing so and varying the contracts in this way, the Council is at risk of challenge from aggrieved providers who were not given the opportunity to bid for the contracts in the usual way.

However, the associated risks are reduced as the value of the increased costs payable to the existing providers would arguably not be seen to be significant enough to warrant a new tender being required, when considered against the total value of the existing domiciliary care contracts (in percentage terms). In addition, the nature of the additional commissioned services are so similar to those already commissioned, the City Council would have a defence to any such challenge.

In respect of the TUPE and staffing implications referred to in the report, which HR will no doubt detail further, unless the tasks currently being carried out by the domiciliary care providers will be fundamentally different, the posts transfer and TUPE is likely to apply. There is a broad geographical alignment between the way in which the work of the Home Support Assistants is currently organised and the areas that the new service providers will take on. There should be no issue as to whether staff are assigned to a particular element of the service transferring to a new service provider.

AM IHSS report Version9 – 4th June 20 13 17 Staff who are assigned to the elements of work transferring to the new service providers would be entitled to transfer employment without detrimental effect on their terms and conditions. However, the majority of the Home Support Assistants have applied for VER or VS. They are expected to leave prior to the transfer date. However, the staff would have had the opportunity to transfer to the new service providers. It is not anticipated that this will result in claims against the Council or the new service providers.

In order to minimise any potential claims, it is recommended that staff leave on VER or VS prior to the transfer date. In the event that the leaving date is agreed to take place after the transfer date, the new service providers will expect the Council to indemnify them against redundancy costs and against claims.

In respect of any staff who are in scope to transfer and who do not wish to take VER or VS, they should be allowed to transfer as it is their legal right to do so. The new service provider would be obliged to take them, unless it can establish an economic, technical or organisational reason connected to the transfer, which entails changes in the workforce: in effect, the new provider might argue that it needs to make redundancies, either amongst staff transferring or its existing employees.

The City Council ought to consider not dismissing any employees prior to the transfer, as those dismissals would be because of the transfer, and therefore would be seen to be automatically unfair. The ETO reason (above) is a defence to a claim for automatic unfair dismissal as it is connected with the transfer rather than because of the transfer, and which entails changes in the workforce e.g. reduced numbers of staff.

As noted in section 10 (HR Implications) the consultation requirements around TUPE are not onerous. There are no minimum timescales. In essence, the trade unions need to be informed of the transfer and the fact that their members will transfer to the new service providers, unless they have chosen to take VER or VS prior to transfer. The offer of VER and VS is part of a wider offer to staff and is not designed to prevent the staff from transferring. The extent to which any further consultation would be required depends on the position adopted by each of the new service providers.

Should the proposals be accepted, the City Council would be committed to a further two year period and would be obliged to adhere to the terms and conditions of the variation to the contract. ______

FINANCIAL IMPLICATIONS Supplied by Dianne Blamire, Principal Group Accountant.

The service reconfiguration referred to in this report relates to the saving proposal CL2-23 Recommission the intermediate home support service from domiciliary care agencies. This proposal was approved by Council in February 2013 and therefore forms part of the Community, Health and Social Care revenue budget from 2013/14. The required savings are £623k in 2013/14 increasing to £639k from 2014/15.

AM IHSS report Version9 – 4th June 20 13 18 The financial modelling provided in section 8 of this report indicates a savings level of £653k in 2013/14 and £812k from 2014/15. This takes into account the total estimated cost of the proposed retained team structure and 750 hours of care being commissioned from the independent sector. For 2013/14, the calculations also provide for interim arrangements between April and August. The annual savings estimate (as shown for 2014/15) is £172k higher than the original savings estimate of £639k as there has been an increase in the overachievement of the 2012/13 savings (£38k), a reduction in the estimated cost of the care commissioned from the independent sector (£147k) offset by an increase in the cost of the retained team structure (£13k).

In respect of the care to be commissioned from the independent sector there are 3 main reasons for the estimated reduction in cost of £147k.  The original estimate was based on a requirement of 750 hours in addition to the care already commissioned following the service reconfiguration during 2012/13. However it is now proposed that 750 hours in total will be required, therefore an increase of 612.  The original estimate provided for an increase in the hourly rate for the services to be commissioned (above the £12.24 standard rate), which was based on the current salary levels for the staff potentially transferring under TUPE. As there are now only 2 members of staff potentially transferring under TUPE, the majority of the hours to be commissioned are assumed to be at the £12.24 level.  A contribution to supervision/overheads based on the numbers of staff transferring under TUPE was originally included as a potential cost. This is no longer built into the estimates due to only 2 members of staff potentially transferring.

As mentioned in the financial modelling section of the report, the estimates are still based on a number of assumptions and is subject to agreement with external providers. The calculations will continue to be updated as further information is made available.

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PROCUREMENT IMPLICATIONS

There is always a risk that any award of business, if made outside of a full competitive process, could be subject to challenge by an aggrieved supplier on the basis that it ought to have been advertised and put out to competition.

This risk cannot be eliminated, but in terms of any potential challenge by other suppliers denied access to “compete” for these services, the basis for defence would be:

1. The nature of the additional services to be commissioned through the contract variation is consistent with the nature of the services commissioned under the existing service specification.

AM IHSS report Version9 – 4th June 20 13 19 2. The value of the additional services is unlikely to be deemed “significant” in the context of the estimated value of the service at the point of tender over 2 years ago or the overall current value of the business being commissioned under the current contracts. This is based on the assumption that the hourly contract rate of £12.24 currently payable to the market is viable for the 7 providers and will be accepted by them. At this level the estimated increase of the contract variations across the city will be in the region of £500,000. The current value of the contracts is approximately £5.5 million, representing an increase of approximately 9%.

The Council is under a best value duty to carry out its functions economically, efficiently and effectively with the objective of achieving value for money in all public procurement. Unless the current structure of the domiciliary care contract does not permit the intermediate care service to be delivered effectively, it would not be best use of Council resources to undertake a competitive tender to deliver the same type of service. Having the same provider delivering the short term and ongoing packages of care in a locality should also provide some efficiencies.

However there are some inherent risks that need to be considered

1. The additional value of the variation is based upon an assumption that it will be viable for the current suppliers to deliver the services at the current rate of £12.24. Further work is required to understand the cost implications of the variation. This cannot be determined until this proposal is agreed and discussions with providers can take place. Although this is unlikely to increase the overall contract value beyond a level that is deemed “significant”, it may impact on anticipated savings. 2. If the providers agree to such a variation, the Council will be committed to this Service being delivered in this way until the existing domiciliary contract ends - unless a further variation can be mutually agreed with providers to rescind this variation and revert to the current arrangement of delivering long term packages of care only. The domiciliary contract expires on 31/10/13, but has options to extend for 2 years until 2015 and then again for a further 2 years to 2017. Commissioners should be aware of the constraints that this variation may bring in how these services are procured in the future. 3. Five of the seven Domiciliary Providers have delivered the required service within this model during the last 12 months. If one or more neighbourhood providers do not wish to engage in this process, further consideration will be required as to how the services are procured in those localities using the tier 2 (back up) providers without incurring a challenge.

The TUPE transfer of Council employees will create a financial liability for which Providers will almost certainly seek a guaranteed commitment from the Council to meet that liability. Given the structure of the current contract this is likely to reduce the flexibilities of moving staff across neighbourhood boundaries to meet fluctuating demand. If this proposal is approved by the Assistant Mayor, negotiations with providers can explore a more flexible approach but this cannot be guaranteed in which case a robust assessment of where resources need to be re-deployed will be required to maximise the effectiveness of the variation.

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OTHER DIRECTORATES CONSULTED: Other than those noted in the report, no other Directorates at this stage have been consulted ______

CONTACT OFFICER: Jennifer McGovern TEL. NO. 0161 793 2202 ______

WARD(S) TO WHICH REPORT RELATE(S): All

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