Agenda item

The Executive Member for Adult Social Care and Public Health and the Director of Adult Social Care and Health Integration submitted a report for the Executive’s consideration. The purpose of the report was to request approval to develop an in-house care home brokerage and trusted assessor service, following the termination of a current contract

Care Home Selection, an independent provider, had been awarded a contract with Middlesbrough Council on 1 July 2019 for the purpose of delivering both a Trusted Assessor and Family Support service at James Cook University Hospital. The service supported family members in choosing an appropriate care home at the point of discharge from hospital for a loved one. The service would terminate on 1 July 2021

The service planned to also reduce any delays in discharge by conducting a trusted assessment on behalf of the care home, to enable the care home to determine whether it could accept the placement. Without the service, a care home would need to arrange to visit the ward and carry out their own assessment, which could often take time to arrange, contributing to delayed hospital discharges.

The purpose of the service was to reduce delays on leaving hospital by being the trusted link for the assessment between the care home and the hospital. That supported the hospital in ensuring there was no bed blocking and patients were supported through the process to their onward journey of care.

The main functions of the service were outlined at paragraph 6 of the submitted report.

OPTIONS

Alternative options were:

a)    Do nothing - The contract could have been terminated with no replacement service. Care Homes would have therefore been asked to assess patients within the hospital setting themselves and families would have been supported by the Council’s hospital social work team. That had been viewed as not a viable option due to a number of factors. Currently assessments were completed with a maximum 24 hours, but performance reporting showed those were usually completed within 4 hours. As a result, Middlesbrough was performing well in terms of minimal delayed hospital discharges. Care homes, due to demand pressures within the home environment, would have been unable to meet that target should they be required to attend the wards themselves. The hospital social work team was already under significant work pressures, and to add additional burden to their workload, in supporting family members to choose care homes, would have been unrealistic.

b)    Renegotiate current contract - Whilst performance of the current provider was very good, the unit cost of the contract was high, and it did not offer value for money. Renegotiation of the contract may have reduced the unit price slightly, however, it still would not have provided the flexibility needed, should there be change in service, or workflow. The ability to flex the model at short notice and mid-year was required without needing to consider impact on the budget per assessment.

The development of an in-house team would enable the service to be flexible without the risk of incurring additional costs. In addition, a 7 day costed model for an in-house service had been developed that would allow for 2 Trusted Assessors, a Co-ordinator, a Placement Assistant with management support which would still deliver savings when compared to the current contract costs. That model would deliver twice the trusted assessment time that the current model provided for offering significant opportunity to manage the current demands.

ORDERED

That development of an in-house care home brokerage and trusted assessor service, following the termination of a current contract, be approved.

REASON

The initial contract term expired on 1 July 2021. The contract arrangement provided for a block number of assessments per quarter, with a spot rate for any assessments needed in excess of the block. Despite the Covid 19 pandemic, the number of assessments had significantly exceeded the block per quarter.

Furthermore, the experience of the pandemic had highlighted the need for flexibility of service provision, the Government had introduced different workflows for hospital discharge, such as the requirement for designated settings, those were settings for 3 individuals discharged to residential care whom were Covid positive. Due to that change in workflow, those were different assessments and therefore chargeable under Middlesbrough Council’s care home selection contract, that was an unforeseen cost.

Those additional assessment costs resulted in the contract not providing overall value for money.