Agenda item

Financial Assessments and the Strategic Risk - Market Supply

(To receive a verbal update from Glen Garrod (Executive Director – Adult Care and Community Wellbeing) on Financial Assessments and the Strategic Risk - Market Supply, further to Minutes 21 and 22 of the last meeting of the Committee (Agenda Item 3 of this agenda refers))

Minutes:

(NOTE:           Mr Andrew Middleton wished it to be noted that he was a lay vice chairman of South West Lincolnshire Clinical Commissioning Group and lay member of a Care Quality Commission inspection team, but had not completed any inspections in Lincolnshire.)

 

Pursuant to Minutes 21 and 22 of the previous meeting, the Executive Director of Adult Care and Community Wellbeing provided an oral update on Financial Assessments; and Strategic Risk – Market Supply.

 

The Committee was advised that the Adult Care and Community Wellbeing directorate had a budget of £300 million, which included income of £40 million.

 

Financial Assessments

 

The Executive Director stated that financial assessments were a requirement for all local authorities with adult social care responsibilities.  Approximately 300 people per month were in receipt of a financial assessment for both residential and non-residential services. 

 

Reference was made to the performance indicator in the corporate support services contract between the County Council and Serco, who undertook the assessments on behalf of the County Council.  This indicator penalised Serco for taking longer than fifteen days to complete an assessment, but rewarded Serco if assessments had been completed within fifteen days.  The unintended outcome of the indicator had been that there was no incentive for Serco to prioritise and complete assessments once they had exceeded fifteen days, which had resulted in a significant backlog of financial assessments.  

 

The Council's charging policy was also burdensome and included a requirement for hard copies of forms to be posted to the client for completion, via second class post, which had adversely affected the fifteen day deadline.

 

The Executive Director made reference to the following improvements:

 

  • revisions had been made to the charging policy for both residential and non-residential clients, which had simplified the process and introduced electronic ways of working; 
  • revisions had been made to the performance indicator, which would ensure that all financial assessments were completed in an accurate and timely manner;
  • the recent focus of the financial assessment team had been on the backlog which exceeded 28 days and in the first eight days, the backlog had been halved in number;
  • the introduction and use of electronic systems once fully implemented was expected to significantly improve the time taken to complete a financial assessment.  The electronic systems had also avoided postal delays, as previously within the fifteen days postage time had been included, and second class post had been used; and
  • support had been provided to Serco in terms of staff resilience and capabilities, with staff turnover reducing significantly.

 

The Director assured the Committee that the backlog would be cleared by early January 2020.  An update would be provided on the backlog as part of the combined assurance report on 10 February 2020.

 

Market Supply

 

The Executive Director referred to the Council's emphasis on the procurement of Adult Care and Public Health services through a total of 740 providers, largely through long term 'block-purchase' contracts, which provided stability to the market.  Lincolnshire compared well to other local authorities, who had tended to rely on more expensive one-year 'spot-purchase' contracts, which did not necessarily allow providers to plan for the future and was deemed less stable.  It was highlighted that the Council's residential care contract, one of the largest to be renewed, was due for re-procurement in 2020.

 

It was highlighted that there was considerable fragility in the market nationally as a number of suppliers had ceased to operate in recent years.  However, Lincolnshire had not been affected as adversely as most other areas because of its procurement approach and the relationship it had with providers. 

 

It was highlighted that the Care Quality Commission had rated 7% of the adult social care providers in Lincolnshire as 'outstanding'; 82% as 'good'; 9%-10% as 'requires improvement'; and 1%-2% 'inadequate'. 

 

Approximately 60,000 home visits were carried out per week.  A sample survey of 389 home care clients had scored the quality of care in Lincolnshire as, on average 4.5 out of 5.  The survey had identified some issues with administration and communication and these were being addressed by managers.

 

Brexit

 

It was advised that in Lincolnshire, approximately 11% of the carers working in adult social care were EU nationals, compared to over 20% in London.  Similarly, some 11% of NHS clinical staff were EU nationals.

 

It was highlighted that the supply of medication was not an area of concern, as preparations were being made nationally to ensure its supply via the NHS.  However, adult care providers remained concerned about the supply of incontinence aids and machine parts, for example for washing machines, as these were vital for these services. 

 

The following responses were given to questions from the Committee:

 

·         It was acknowledged that the corporate support services contract, particularly the performance indicator for financial assessments, and the Council's charging policy should have been reviewed sooner. 

·         The review into financial assessments had been prompted by feedback from field work teams; and the complaints process. The review had been carried out over a period of 2-3 months with a further 18 months to implement the required changes, particularly the implementation of electronic working processes. 

·         The role of the audit team was discussed and it was clarified that it was important that the team remained independent and acted as the second line of assurance.  The team had highlighted limited assurance for market supply adult care, which was discussed by the Committee at its previous meeting.   

·         It was recognised that for adult care services to compete for staffing, an increase in salary would be required to ensure the service could compete, for example with retail and the NHS. 

 

RESOLVED

 

(1)  That the oral update be noted.

 

(2)  That a further update on the financial assessment backlog be provided as part of the combined assurance report update on 10 February 2020. 

 

 
 
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