RE-COMMISSIONING OF THE REABLEMENT SERVICE IN YORK
Appendix C
PURPOSE OF REPORT
The purpose of this report is to provide performance data and information for our current service, York Reablement Services. The report also provides data regarding hours and referral outcomes, CQC performance and Safeguarding performance for our customers. 720 customers received the Reablement Services in 2022/2023 enabling them to return Home significantly reducing the need of higher costs services such as Residential care. 98% remained at home following short term intervention.
The service fully supports the Councils Home First approach to provide better outcomes for people in their own homes and enables the Council to deliver its statutory duties under the Care Act 2014.
CARE QUALITY COMMISSION (CQC) RATING
Human Support Group (HSG) currently delivers the York Reablement Services and have an overall service rating of ‘Good’. CQC definition of ‘Good’ is; the service is performing well and meeting our expectations.
The service is rated on four individual areas safe, effective, caring, responsive and well-led. The service is due an inspection from CQC.
Safe
Effective
Caring
Responsive
Well-Led
CONTRACT, COMMISSIONED HOURS AND PERFORMANCE
The current contract stipulates that 647 hours a week should be delivered. This service is a crucial delivery element of the intermediate pathway as the service plays a vital role in caring, supporting and rehabilitating customers. As part of this contract, TUPE costs are paid to support the staff that transferred from the Council when the service was outsourced to the market in October 2017. These monies pay for the Council conditions and pension contributions that was transferred with the staff. The rate that is paid per hour for the service is £25.79 and the remaining budget supports other overheads and costs associated with the service. Our current budget for 2023/2024 is £1,169,100.00 using expenditure code 34530. Table 1 demonstrates the budget distribution.
|
Area |
Hours |
Cost per week |
Cost per year |
|
Service delivery |
647 |
£16,686.13 |
£867,678.76 |
|
Other associated costs and Overheads |
n/a |
n/a |
£301,421.24 |
|
|
TOTAL BUDGET 23/24 |
£1,169,100 |
|
PERFORMANCE DATA
Diagram 2 above, is for a period of 24 weeks between January 2023 to June 2023 in terms of hours delivered. The total delivery for 24 weeks should be 15,528 hours and actual delivery was 11,555 a shortfall of 3,973, The shortfall in hours is at a total cost of £102,463.67. Therefore, for the new recommission we would need to fully explore cost implications and saving targets attributed against the contract.
Fluctuating hours of delivery are influenced by several factors such as levels of staff delivering the service, staff sickness, holidays taken by staff, number of referrals and allocation of care packages to HSG from different sources. If large care packages move on and patients have been discharged home and referrals reduce in numbers or are not allocated this has an impact on service hours delivered. Therefore, these elements must be explored as part of the new service to reduce these factors so that hours delivered do not impact on the target hours. The long-term list (over maximum of 6 weeks) has significantly reduced from 47 customer in 2022 to 11 at the beginning of 2023.
However, table 3 (below) demonstrates that the current contract is delivering preferred outcomes for people, returning home (Home First). Table 3 provides performance data relating to a customer’s destination once they have received their 1 – 6-week reablement.
|
Table 3 - Customer Outcomes once received HSG Reablement Services 1st January 2023 - June 2023 |
Number of Customer |
% |
|
|
Residential / Nursing home |
5 |
2 |
|
|
Own Home - Same care |
67 |
23 |
|
|
Own Home - Reduced care |
41 |
14 |
|
|
Own Home -Increased care |
5 |
2 |
|
|
Own Home - no ongoing care |
130 |
44 |
|
|
Independent Living Community |
0 |
0 |
|
|
Acute hospital |
47 |
16 |
|
|
Mental health hospital |
0 |
0 |
|
|
Hospice |
0 |
0 |
|
|
Died |
2 |
1 |
|
|
Another setting not mentioned above (please specify) |
0 |
0 |
|
|
Total Numbers |
297 |
100 |
|
|
The data above does not include people whom HSG have worked with that become medically unfit or people who are a delayed discharge due to many factors such as waiting for equipment, transport and/or medication provision.
CONTRACT MANAGEMENT Commissioners and Contract Managers and HSG are meeting fortnightly to work in partnership to improve the delivery of hours and to continue to deliver outcomes for customers as detailed in table 3 above.
One of the main areas of difficulty in terms of contract delivery throughout the lifetime of the contract has been securing and retaining workforce to fulfil the contract. The link below is information pertaining to the issues of workforce in York produced by Skills for Care. |
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HSG have reviewed their recruitment process and put in place improvements to help improve and streamline recruitment and screening activities. This has enabled them to recruit 2 new care workers with 5 carers booked into training. They have also recruited a new assessor to increase the number of assessments they can complete due to an increase in demand, and this will increase capacity to complete assessments and discharge people from the service.