We will all be aware of the recent reports in the press in relation to the difficulties experienced in some parts of Powys in resourcing domiciliary care for people who have care and support needs. Can the Portfolio Holder for ASC inform Council what the current position is in relation to people waiting for services; how many people are currently waiting for domiciliary care without support? What is the average wait for a domiciliary care and what is the longest wait? In addition, can the Portfolio holder advise Council what is being done to address this?
Minutes:
We will all be aware of the recent reports in the press in relation to the difficulties experienced in some parts of Powys in resourcing domiciliary care for people who have care and support needs. Can the Portfolio Holder for ASC inform Council what the current position is in relation to people waiting for services; how many people are currently waiting for domiciliary care without support? What is the average wait for a domiciliary care and what is the longest wait? In addition, can the Portfolio holder advise Council what is being done to address this?
Response
As all Councillors, and especially as the Portfolio Holder for Adult Social Care, I am concerned about the difficulties we are having in providing domiciliary care for individuals within Powys. The service works hard to ensure that individuals who need care are supported appropriately.
As at 1st February 2020, Powys County Council provides/commissions 12,285 hours of domiciliary care per week to 749 individuals across the county. This is made up of direct domiciliary care provision, commissioned domiciliary care services, 24/7 care at home services and sitting services. As of the 1st February 2020, the in-house domiciliary care service delivered 1418 hours of care and support per week, which equates to 14.01% of the market. The remaining 85.99% is delivered by private and charitable organisations.
There are also 490 individuals who receive direct payments to purchase care every week, along with people who receive care and support through their extra care living arrangements.
For a variety of reasons, including the failure of the domiciliary care commissioning of 2014, the Council's financial pressures, and the demographic pressures impacting on recruitment, provision of domiciliary care in Powys is challenging.
Significant work is being undertaken to manage the demand for domiciliary care; to provide support from other sources and to meet demand differently; as well as to increase capacity.
At the time of writing the number of individuals awaiting care with no current provision is 35 (403 hours per week). This was 40 individuals in September 2019. Of the current 35 individuals, seven of them have either refused offers of care for a variety of reasons, or have decided that other care provision would be more suitable to meet their needs. Of those who have been waiting and have not received any offers of care, there is one individual who has been waiting 169 days. This is exceptional, however, with this individual being one of two who have been waiting for longer than 100 days without an offer of care provision.
The average time for providers to provide care from brokerage start in Quarter 3 of 2018/19 was 28 days. In Quarter 3 of 2019/20 it was 33 days. This demonstrates the challenges in procuring care and reflects the rural challenges also felt by neighbouring authorities.
Work already undertaken is showing some signs of success. The total number of individuals in receipt of domiciliary care has reduced and the number of hours provided has also reduced. The average package of domiciliary care in February 2018 was 15.1 hours per week per person. It is now 14.5 hours per week. At the end of 2017 the percentage of domiciliary care calls which were doubled handed was 42%. It is now 36%.
The work being undertaken to support the situation includes:
Reshaping Demand
o TEC (Technology Enabled Care) – Powys County Council has invested heavily in new forms of support at home and this includes Technology Enabled Care. The number of unique individuals supported since April 2019 is over 500; The projected total net cost avoidance to social care for 2019/20 for the 510 individuals prescribed with TEC, is estimated at £420k;
o Moving with Dignity (Singled Handed Care) – following a successful pilot, the Council has invested in two occupational therapists and equipment to enable reduction in the need for two care workers to visit some service users;
o Strengths Based Working – The social services department in general has adopted a strengths-based approach to social care and aims to empower people and support them to re-engage with their communities.
o Community Connectors & 3rd Sector Capacity – The Powys Teaching Health Board in partnership with Powys County Council have commissioned a further 4 (total 13) Community Connectors who work across the county aiming to support individuals’ engagement with community groups and societies;
o Ask Sara – The Council is investing in its information and advice services in order to enable people to make informed decisions as to their needs and how to meet them. This includes the commissioning of “AskSara”;
o Home Based Support Pilots – The Council has invested in pilots across Radnorshire and the south of Montgomeryshire which provide 24/7 proactive floating support and rapid response service for people who use their Technology Enabled Care alarms;
o Reviews – the Council is working to ensure that reviews of care services are undertaken in a timely and regular manner, alongside providers, and are effective in releasing domiciliary care capacity where appropriate.
Meeting Demand
o Reablement – the reablement service works with therapists from the health board and is very successful at supporting people returning home and in reducing dependency;
o Direct Payments – Powys is one of the leaders in Wales in provision of direct payments (currently 490 people with a Direct Payment, purchasing their own self-directed care. The numbers continue to increase, and the value of the care provided by direct payments is now approximately half of the domiciliary care budget. We intend to put in place a digital solution to create further incentives and efficiencies in the processing and take up of Direct Payments and enabling people using Direct Payments to be matched with potential Personal Assistants;
o Dynamic Purchasing System (DPS) – Social Services’ Commissioning Unit have adopted a new method of procuring from domiciliary care providers.
o Outcome Focused Care – we are working with a provider to develop an outcome focused care service in one area of north Powys.
o Short Term alternatives – we have booked residential care beds so that people may move out of hospital nearer to home while they await provision of domiciliary care. These are used regularly;
o Supporting Providers •
RISCA Registration – We have paid the registration fees of all domiciliary care workers in Powys;
Recruitment – We have been working with providers to hold recruitment events in different areas of Powys. These have been well attended and are ongoing;
o Best use of existing capacity – we are working on different ways of providing medication visits, lunch preparation visits and home-based respite.
o Extra care - Powys are developing Extra Care Housing alternatives
Increasing Capacity
o Micro Enterprise work – we have commissioned a not for profit company called Community Catalysts who work to support development of small care businesses in rural areas.
o Increase in-house care provision – we have increased the hours available to the in-house domiciliary care service over the winter period in order to support transfers of care from hospital;
o The prioritisation criteria for the in-house ‘’bridging’ team has been reviewed and updated. Priority is given to people who have been waiting for care and support for longer periods.
o Package swapping – we are working with domiciliary care providers to swap packages between providers where possible to make more efficient ‘runs’. This increases the capacity of the wider market;
o A communications plan has been developed and is currently being implemented in order to raise awareness and attract more people to work in social care.
Work is also being undertaken to prepare a strategic approach to funding domiciliary care in Powys for the longer term.
I trust, therefore, that it is clear that much work is being undertaken to improve the situation around provision of domiciliary care in Powys.
Finally, it is also worth noting that Powys is not alone in this situation. The shortage of domiciliary carers and challenges around service provision are faced across Wales as recent national media coverage of challenges in a neighbouring authority confirms. The funding of social care is a national challenge and it is pleasing to note that work is ongoing at Welsh Government level to consider how best to fund social care into the future.
In response to Councillor Jump’s supplementary question as to Social Services plans for responding to the coronavirus outbreak, the Portfolio Holder for Adult Social Care advised that the service was planning for the worst case scenario. The Corporate Director (Childrens and Adults) explained that the service was looking at scenario planning and identifying mission critical activities to prioritise essential care visits. PTHB had advised that they would carry out home visits to those in isolation. Members would be kept informed.
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