MINUTES of the meeting of the HOME CARE TOPIC GROUP held on Tuesday 6 February 2007 at 2.00pm

ATTENDANCE

Members of the Topic Group

R S Clements, N Hollinghurst, T G M Kent, B J Lamb, E Roach

Officers

Lauren Agnew, Hospital Social Worker, QEII Hospital

Tim Anfilogoff, Policy Manager (Users & Carers), Adult Care Services

Linda Gahagan, Senior Practitioner, St Albans & Hertsmere EPD

Mark Janes, Head of Strategic Commissioning, Adult Care Services

Emma Lund, Democratic Services Officer

Guy Pettengell, Head of Operational Contracts, Adult Care Services

Natalie Rotherham, Scrutiny Officer

1. / MINUTES
1.1 / The minutes of the meeting held on 10 January 2007 were confirmed as a correct record and signed by the Chairman.
2. / HOME CARE ASSESSMENT PROCESS
2.1 / Linda Gahagan, Senior Practitioner, St Albans and Hertsmere EPD and Lauren Agnew, Hospital Social Worker, QEII, attended the topic group and described the assessment process from both an area team and hospital perspective. The topic group also heard examples of case studies which illustrated how the assessment / re-assessment process has worked in practice.
2.2 / Linda Gahagan explained the single assessment process, in place since 2004, by which the health and social care agencies work together to provide input to the assessment process. Linda described how, on first contact either with the client or their relative, an initial ‘contact assessment’ is made, which records personal details of the client (e.g. name, address, GP) and the nature of the problem. This may be the only assessment completed if there is no further action or the need and solution are straightforward.
2.3 / If further exploration is needed the contact assessment will be passed to the Referral Management Team for consideration, and at this stage a care plan is drawn-up. If non-complex, the referral will pass to the relevant Adult Care Services area team to carry out an overview assessment. Once needs have been identified it is the responsibility of the Service Solutions Team to procure care.
2.4 / Lauren Agnew described the hospital assessment process and highlighted the need to ensure that the assessment centres around the client’s rather than the hospital’s needs. For hospital social workers the contact assessment is received from ward staff. In response to Member questions Lauren advised that communication between medical and social care staff is generally good, with multi-disciplinary meetings taking place each week. However, it was acknowledged that improvements could be made in multi-disciplinary working. Lauren also advised that whilst there may be occasional instances when medical staff want to discharge a patient in order to release a bed this now occurs more rarely, and the multi-disciplinary approach means that any pressure to release a patient before support is in place can usually be resisted. In response to questions about seven-day working and weekend discharges Members were advised that some agencies already do Saturday discharges, and Friday discharges are now more frequent provided appropriate support is in place, although assessments are not currently carried out at weekends. It was acknowledged that a move towards seven day working may be inevitable, and Mark Janes emphasised that there would be considerable cost implications to this.
2.5 / In response to Member questions both Lauren and Linda stated that they felt that establishment of the Service Support Team had constituted an improvement in freeing up staff to carry out assessments, and also that the direct payments system is working well. Both agreed that having more home carers would improve the service still further, and that the provision of more ‘step down’ intermediate care beds would be helpful.
3. / CONTRACT MANAGEMENT AND QUALITY ASSURANCE
3.1 / Guy Pettengell, Head of Operational Contracts, and Tim Anfilogoff, Policy Manager, Users and Carers, attended the topic group and spoke about the approval and monitoring processes for home care, what service users and carers say about the service and the work of Quality Monitoring Officers. Copies of slides prepared to support the presentations were circulated to Members.
3.2 / Members noted the procedures for approval of home care providers and the monitoring processes described in Guy Pettengell’s presentation, and the following arose in discussion:
· All providers with which HCC contracts must by law be registered with the Commission for Social Care Inspection (CSCI) – the regulatory body for homecare providers. This means that agencies must submit to two types of monitoring, i.e. that carried out directly by HCC and that required by CSCI. HCC approval and monitoring processes have been adapted to ‘dovetail’ with CSCI’s, but provision has been retained within contracts to carry out checks as required and to de-regulate a provider if necessary. CSCI rates providers on a scale of 1 (poor) to 4 (excellent) and HCC would look to stop purchasing services from a provider with a ‘1’ CSCI rating;
· Every member of staff who visits clients must be Criminal Records Bureau (CRB) checked;
· All the home care agencies with which HCC contracts must be principal (i.e. employers) - HCC will not contract with self-employed carers or with agents;
· All of HCC’s contracts with home care providers have termination clauses. ‘Spot’ contracts can usually be terminated with 90 days’ notice by either party; ‘block’ contracts are usually for five years with an optional two year extension period, although these can be terminated if clauses are breached;
· The monitoring processes used by the Contracts Unit have achieved recognition as an example of best practice by the Audit Commission.
3.3 / Tim Anfilogoff’s presentation focused on users’ and carers’ views of the homecare service; how these are obtained and how performance data is used. The following arose in discussion:
·  53% of users indicated in a DH survey carried out in Spring 2006 that they were extremely or very satisfied with homecare. Members considered that this figure was quite low, although noted that it does not include those who were just ‘satisfied’ with the service;
· Electronic monitoring has brought about an improvement in reducing the volume of missed visits and some agencies now have systems which can alert the agency if a care worker has not called in within 15 minutes of their scheduled arrival time. HCC does not regularly monitor whether careworkers attend clients; if a careworker has missed an appointment this would not be picked up by HCC until the invoicing stage when a discrepancy between the number of 15-minute blocks requested and the number delivered would become apparent;
· Members expressed concern at a figure contained within the presentation that when asked by a Quality Monitoring Officer 35%-40% of clients had reported at least one missed visit in the last three months. It was recognised that this information had been obtained verbally and was reliant upon a client’s recollection, and also that when faced with service pressures agencies have to make decisions about how best to deploy staff. In response to questions about whether it would be possible for agencies to be fined if careworkers miss appointments, Guy Pettengell advised that to impose financial penalties on agencies for missed appointments would not be enforceable under English law; however, newer contracts require agencies to reach pre-agreed efficiency targets and in future if these are missed agencies may have to forfeit a fee percentage.
· Members were concerned by the increase in the percentage where a client’s medication policy was not properly implemented.
3.4 / Members were advised that approximately 50% of carers are now on shift pay rather than being paid according to contact time. This has lead to improved reliability, and retention of carers has also improved. Members were also advised that there are often instances where carers undertake tasks which they are not required to do, in order to improve client care.
4. / WORK PROGRAMME
4.1 / The group considered a paper which outlined the proposed work programme for the group, together with a timeline for its activities.
4.2 / The group agreed to use, if possible, the date of the afternoon of 6 March 2007 for a site visits to an agency; a discussion on the outcomes of agency visits will be held at the next meeting.
4.3 / The group agreed that a visit to a client, and possibly also a visit to a client with a Quality Monitoring Officer, would be useful. It was agreed that Mark Janes and Tim Anfilogoff would meet with Natalie Rotherham to consider the options and the timescales/dates for visits. / Natalie Rotherham /Mark Janes/ Tim Anfilogoff
5. / DATES FOR FUTURE MEETINGS
5.1 / The topic group agreed to meet on Monday 19 March at 2pm and Tuesday 10 April at 2pm, both meetings to be held in the Mimram Bar.

Emma Lund

Topic Group Administrator

February 2007

Home Care TG 070206 Minutes

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