Agenda item

Transforming NNC Adult Social Care Provider Services - Strategy and Case for Change

Decision:

RESOLVED

KEY DECISIONS

That the Executive:

a) Considered the strategy and case for change and approve the proposal recommended option 3 (set out in section 3.3 of this report), to consult withregular users of NNC CQC regulated provider services on the futureproposed strategy and implications

b) Approved the request to engage with Unions and staff affected on thestrategy, case for change and the four proposed phases of transformation

c) Delegated final decision making, following consultation, to the ExecutiveMember for Adults, Health and Wellbeing, in Consultation with Executive Director for Adults, Communities and Wellbeing, to conclude the statutory consultation with people that use those services

d) Delegated the final decision, to the Executive Member for Adults, Health and Wellbeing, in Consultation with the Executive Director for Adults,Communities and Wellbeing, as to whether to implement the strategy and phased proposals and after that decision to enter into formal consultation with unions and affected staff

e) Noted that as part of phase 1 proposals that due diligence is being undertaken to consider and make recommendations to the Executive on the business case for running a Specialist Care Centre. It is anticipated that final proposals will be brought to the Executive for consideration at its meeting on 10^thNovember 2022

Reason for recommendations:

a) The main physical buildings involved in delivering two of the services weretransferred to the council on vesting day having had insufficient investmentnecessary to develop the sites for the future.

b) Investing in newer facilities will enable us to provide the environments for ourstaff to deliver better quality services & the right environments to maximiseassessment, re-ablement, enablement and opportunities for independentliving for people that use the services

c) The current facilities are in poor condition and require significant investmentto return them to an acceptable level of quality, and even if that decision were made the buildings would need to be vacated for significant periods of timeto enable the level of works required to be completed and would still struggle to achieve the desired outcomes for the services due to limitations within both sites

d) Our own staff had experienced impacts on their pay and reward growth overthe last decade, and their training and development has been minimal within previous organisations

e) We have a finite budget within which to work with, which will require a phasedapproach to transforming ASC Provider Services over the coming threeyears and will focus initially on those Care Quality Commission (CQC) regulated services.

f) There is a role for the local authority in delivering services that we struggleto get from the independent sector, or that with more direct control over there is the opportunity to significantly improve outcomes.

g) It is beneficial for the local authority to retain some services to enable it to bea provider of last resort should that ever be required e.g., following provider failure.

h) The people that use the services will get a clear understanding of theintended vision and strategy to invest in these services for the future and intended benefits to different stakeholders are explored in this report and the strategy and case for change.

i) With a clear strategy, strong leadership, improved environments andinvestment in care and support staff, there should be a marked improvement in recruitment and retention. There should also be a demonstrable impact in areas of improvement required as identified in recent CQC inspection reports.

Alternative Options Considered:

Option 1 – Invest in existing services to make them fit for purpose and address

all building issues to maximise capacity.

• All options considered require significant, prohibitive investment

• There is an inability to pay our staff the market rates, as we have a finite

budget within which to work with

• We have difficulty in competing with other sectors

• There is also retention and recruitment difficulties in ASC Provider Services

• Residents that live in Beech Close or use Pine Lodge would have to vacate

the buildings for the entire period of refurbishment

• Whilst improving the environment this would not achieve the optimum

building environment for either of the building-based services due to

constraints on working within the existing footprints and building designs

• For example, an options appraisal commissioned in March 2022 for the

Beech Close site explored the following potential options, costs and

timescales:

Option	Scope of works		Rooms/ units	Estimated project costs*	Duration
Current provision (do nothing)	42 Bedded residential care home (currently only 21 beds are used due to works required in other areas)		21 current 42 maximum	N/A	N/A
1a	Invest in existing property to make fit for purpose and address all existing building issues, reduce number of beds to provide en-suite facilities		24 ensuite	£6,070,000	33 months
1b	Invest in existing property to make fit for purpose, but with elements of new build to maximise the number of beds		33 ensuite	£7,480,000	35 months
2	Rebuild new residential home fit for purpose with en-suite facilities, and focused delivery for acute dementia beds		41 ensuite	£8,455,000	40 months
3	Rebuild Extra Care provision with individual flats on existing site		20 apartments	£7,515,000	40 months
4	Demolish the existing building to enable the sale of the site		0	£410,000	12 months

		*Estimated project costs for each of the proposed option include Professional and Design fees, Planning costs and Employer Risk Allowances

Option Scope of works Rooms/

Option 2 – Continue as currently (do nothing)

This option is not recommended, as this will:

• Continue to compound recruitment and retention issues experienced by

the service

• Continued undesirable inspection outcomes of Regulated Services and

possible closure

• Poor working conditions for our staff

• Poor outcomes for our users

• Poor quality of support

• Increasing building repair costs, including critical failure of certain

aspects of the building-based services including hot water and heating.

• Uncertainty for staff

• Inability to control reablement delivery and outcomes

Option 3 – Consult on a new strategy for our in-house services and phased

approach to transformation

This is the recommended option as it will:

• Ensure that there is a clear, strategy and vision for our in-house provider

services that is clear to people that use those services and to staff that work in

them.

• Fulfils a gap in the market and places our own services at the heart of

maximising independence for people in North Northamptonshire

• Provides a generational change and investment in the direction of travel for our provider services, creating a fit for purpose offer with clear ambitions.

• Improve working conditions for our provider services staff

• Create strong foundations on which to evolve our provider services

Minutes:

The Chair invited Cllr Dorothy Maxwell to address the meeting in relation to this item. Cllr Maxwell stated that in terms of social care, the Council should ensure staff received suitable training and pay as well as recognition for their work as this was vital in ensuring retention and allowed the Council to offer a quality of service that was to a level expected by residents.

The Chair then invited Cllr Lyn Buckingham to address the meeting. Cllr Buckingham welcomed the report and the focus on the case for change but noted that a “one size fits all” approach should not be adopted given the breadth of services that Adult Social Care encompassed.

The Chair thanked both speakers for their input before inviting Cllr Helen Harrison, Executive Member for Adults, Health and Wellbeing to introduce a report that sought Executive approval to consult on the proposed strategy for transforming in-house Adult Social Care Provider Services with the people using those services with a view to allowing the Council to deliver the highest quality assessment, re-ablement and enablement to support people to live their lives independently and be ambitious for their future.

It was heard that approval of the strategy would transform services for the user, improve training, pay and career progression for staff and allow for the provisions of up-to-date facilities to provide the enhanced care required in North Northamptonshire. Members heard that the strategy was not a cost-cutting exercise, rather a strategy to provide an improved, better value service.

An honest assessment of the current service position was outlined, with members noting that the legacy service had suffered from poor investment and was not currently fit for purpose, with care staff low paid, receiving minimal training and development and working in poorly rated facilities. It was noted that the Council was competing with a well-established care market and struggled to access this level of quality for its own users. In addition, the Council faced a struggle to recruit and retain staff based on the issues outlined above and it was imperative that a plan was enacted to address these problems.

The Council had the opportunity to completely transform its service and it was proposed that this would be achieved through a phased approach. A number of options for service improvement had been considered, with Option 3 as outlined in the report recommended. Further recommendations to the Executive on the business case for running a Specialist Care Centre would be submitted to 10^th November meeting for consideration.

The Chair welcomed the report as it would begin the process of improving outcomes for residents and valued staff members. The Chair thanked Cllr Harrison and David Watts for driving the Council’s vision of an enhanced service offer.

Cllrs Lawman, Brackenbury, Edwards and Howes also spoke strongly in support of the proposed strategy in aiming to provide a service that would be fit for purpose and reward the hard work of staff.