Adult social care is reaching a national tipping point with providers battling stringent budget constraints while the demand for these vital services increases.
While health care at Harrogate and District Hospital continues to be lauded as an example of “best practice”, the town continues to face the same social care pressures as elsewhere.
Now, it seems North Yorkshire County Council’s (NYCC) attempts to reform how domiciliary care is provided in Harrogate is facing an early, unexpected crisis.
Last week, it was revealed that the second of the three home care providers chosen by the county council have been forced to pull out of their four-year contracts.
After just over 18 months of working under the new system, and with only one provider remaining, fears have been raised that Harrogate is facing a home care crisis.
Despite the worrying outlook, the county council has stressed that they retain the same commitment to providing clients with the same standard of quality care.
Home care shake-up
In April 2015, the county council announced major changes to its home care system by awarding care contracts to just three providers.
Under the previous system, more than 20 domiciliary care companies had council contracts to provide care for elderly people at home across the district.
Kathy Clark, assistant director of commissioning in Health and Adult Services at NYCC, said the previous system only served as a “patchwork offering”.
She said: “We recognised that it had been difficult to build a strong relationship with providers and work on issues that were a concern to them and the county council.
“The contract focuses on Harrogate town, not the district, and we felt it was a good opportunity to form stronger relationships with providers.
“This would help us deal with challenges better and get the quality we wanted to see but also ensuring we had the best value for money.”
The new contracts were eventually awarded to Harrogate-based Continued Care as well as The Mears Group and Castle Rock Group.
However, care companies raised immediate concerns about the drawbacks of the system after seeing it implemented in other parts of the country.
A source who has spent more than ten years working with national and regional care providers warned that recruiting staff would be the most significant challenge.
They explained that the new companies awarded the contracts could apply to transfer staff over from providers who had lost out in the tender process.
However, many firms would instead continue to offer their services to clients through direct payments meaning clients and staff would be less likely to move.
A source said said: “When you move to a new tender, you can’t necessarily transfer all the new carers to the new providers.
“This is because a carer may be looking after a service user from the local authority but also a private user or someone on direct payments.
“The local authority does not have the power to transfer these staff across. They can ask but there might be a number of issues, potentially with pay.”
Despite these warnings, the county council assured residents that there would be as little disruption as possible under the new contract.
Although budgetary pressures remained, the county council said that the three new providers were chosen on a 60-40 per cent quality/cost basis.
Care plans were put forward by all three providers, identifying how they would mobilise and how they would be able to deliver their services.
The county council explained that they were aware that the situation would be a “bigger ask” for their new providers, CRG and the Mears Group.
However, Ms Clark said that the challenge proved to be bigger than either of the companies anticipated with the Mears Group proving the first casualty.
In February, just under one year into their contract, the company decided to pull out with just 24 clients signed up to the service.
Ms Clark confirmed that difficulties attracting workforce and clients had been a problem but said they were surprised by how many had chosen to continue with direct payments.
She said: “Before we went to the new contacts, we talked to other areas that had gone down this route and got some indication about how many used direct payments.
“However, these numbers proved to be considerably lower than the amount of people who opted to do it in Harrogate.
“There were some working assumptions that there would be more people to transfer over than how many chose to do so in the end.
“But we need to offer a choice to clients and if they want to stay with their current providers then they are not going to be forced to move.”
Just nine months after The Mears Group announced they were handing their home care contract back to NYCC, further problems emerged.
The county council revealed that concerns had been raised that provision by CRG was “falling short” of the mutually agreed plan for care in Harrogate.
Despite working closely with CRG over several months, the county council announced they had agreed with CRG to end its involvement in home care in Harrogate.
Ms Clark said that the county council had been confident that CRG had a “clear plan” to establish itself in the area when they were awarded the contract.
However, “changing market conditions” were blamed for the company being unable to make the necessary changes to provide a quality standard of care.
“We took references from other places and we were assured by these and their plans that they were reasonably equipped to mobilise,” Ms Clark said.
“However, there were some issues and I think this goes back to their recruitment difficulties but we came to the conclusion that the length of time to resolve this was not right for either party.”
Doubts abut the system
John Kneller, owner of St Margaret’s Home Care, has staunchly criticised the viability and success of the contract since its introduction.
After witnessing its failure in other parts of the county, Mr Kneller raised concerns about why the county council had introduced it in Harrogate.
In April 2015, he predicted that the system would be a “mess” and questioned the providers’ ability to replace the experience of the 23 companies previously operating.
However, Ms Clark challenged the claim that the system had been discredited nationally and stressed it could still work with just one provider.
She said: “At the point of initiation, the view was that it was a positive approach and that was the message we were getting from other authorities.
“Clearly as we have gone on we have learnt about the challenges and some of the other authorities are learning about the challenges as well.
“But as we know there are still other authorities that are pursuing it and considering it fresh because they can see the benefits.”
Continued Care will continue with their contract and have confirmed that it will take up responsibility for CRG’s clients as well as taking on its staff.
Continued Care’s challenge
Continued Care, a family-run business based on Hornbeam Park, has been running since 1993 and is the only provider left on the county council’s contract.
The company will now work with Disability Action Yorkshire (DAY) in a sub contracting role to help provide domiciliary care on behalf of the county council.
Director Samantha Harrison said staff from CRG have already come in for training and face-to-face meetings are currently ongoing with its clients.
She said: “This is not how I envisaged this two years ago and I’m sure this is not how the county council envisaged it either.
“There’s going to be a lot of joint working with DAY and a lot of training, but we both have the same approach. We’re local providers and we’re quite positive about it.
“It’s a period of change for staff and for clients moving over from CRG and it’s about trying to give both parties support.
“For clients, it’s important to focus on building and forging relationships with them as they are sometimes old and vulnerable.”
Despite two of the three providers already pulling out of the system, Ms Harrison said Continued Care has witnessed first-hand the advantages of it.
“Prior to the contract, you would never know when work was coming to you,” she explained.
“You wouldn’t know whether you would have work for staff and how long it would stay with you. There was no real continuity to plan as a business.
“Now, staffing levels are in line with what we are doing and we have much better communication with the council and much greater scrutiny.
“As a business we thrive on that and we want to continually improve.”
Future of home care
In its latest ‘State of Care’ report, the CQC said that the sustainability of adult social care was on a “tipping point”.
Funding pressures and growth in demand has prompted a concern over the industry’s fragility with large providers already handing back care contracts.
The county council already spends 42 per cent of its budget on adult social care but Ms Clark said they still do not have the flexibility to be more creative with care.
Despite the “bleak” picture, the county council is undertaking more partnership work with the Vanguard project with a greater focus on prevention.
“Wherever we can help people stay independent for longer then that’s in our best interest and means we can focus our resources on those with the greatest need,” Ms Clark said.
“We are committed to ensuring the residents of Harrogate get the support they need and we are proud to work with companies like Continued Care.”
Ms Harrison said: “It’s a bleak picture for social care and health but we’re in a very honoured position looking after these clients and we have to do the best we can.”
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