Elderly Care at Home: how far have officers kept councillors in the loop?

[Updated below 15th February] With Argyll and Bute Council’s proposed budget coming up for debate and decision tomorrow, 14th February 2013, the issue of care for the elderly and care at home for the elderly are together an area raising the greatest popular concern.

The budget proposes to cut £4.5 million from the Adult Care budget over the following three years and to cut around £250,000 each year from the home care budget.

The privatisation of home care in Argyll and Bute

While this has not been kept secret as such, very little has been said about it – but over the course of 2012 Argyll and Bute Council has privatised Care at Home provision across Argyll.

In August 2012, it awarded contracts for four areas – Lorn, Cowal , Bute and Helensburgh and Lomond.

There is a story of its own as to why not all of the areas in Argyll have had these services privatised – and we may return to that at another time.

Anyway, the Council awarded these contracts to three ranked providers for each of the four areas named above. Several providers feature in awards in more than one area and across the spectrum of types of contracts.

The tenders were for a total contact value of £2.1 million and the overall care at home provided in Argyll and Bute  is 600,000 hours per annum, at an estimated cost of £8.5 million.

The 2012 contracts were awarded,  not on the lowest price but to the most economically advantageous tender weighted 60% on quality and 40% on price.

The rank order of the awards in each area indicates  that:

  • the 1st ranked provider gets all the current services provided by the Council home help service and 60% of all subsequent work and clients;
  • the 2nd ranked provider gets 25% of all subsequent work;
  • the 3rd ranked provider gets 15% of all subsequent work.

Future work is certain, so the second and third ranked contracts are valuable. With Argyll’s high and increasing elderly population, potential new clients for care are being referred regularly to social services.

These 2012 contract awards were as follows:

  • Helensburgh and Lomond:  1. Care UK. 2. Allied Healthcare 3. Carr Gomm
  • Cowal: 1. Care UK. 2. Allied Healthcare. 3. Carr Gomm
  • Bute: 1. Allied Healthcare.  2. Carr Gomm. 3. CareWatch
  • Lorn: 1. Carr Gomm. 2. Mears Care. 3. Hazelhead Homecare

The immediately remarkable omission from the selection process is the absense of local care providers. It wojld be interesting to hear the reasons for officers’ lack of interest in engaging with local businesses. Time has shown the hard way that bigger and more distant is not the universal panacea the gullible used to imagine it was.

The August 2012 contract awards produce the following picture:

  • Carr Gomm: 4 contracts – one topline immediate,one for 25% of future work and two for 15% of future work.
  • Allied Healthcare: 3 contracts – one topline immediate, two for 25% of future work.
  • Care UK: 2 contracts – both  topline immediate contracts.
  • Mears Care: 1 contract – for 25% of future work.
  • Carewatch: 1 contract – for 15% of future work.
  • Hazelbank Homecare: 1 contract – for 15% of future work.

And this reflects:

  • 4 national providers, headquartered outside Scotland:  Care UK, Allied Healthcare, Carr Gomm & Mears Care – with the first three of these taking all the immediately major contracts, and one of them taking two of the four.
  • 1 national franchised provider, headquartered outside Scotland – CareWatch, with one contract for 15% of all subsequent work in the area.
  • 1 medium sized provider from outwith the region – HazelHead Homecare, with another such contract. We understand Hazelhead pulled out after being offered the contract. We do not know if a replacement contract for 15% of future cover has been issued yet for Lorn.

Profiles of the contract winners

So who are the winners of these contracts. They are a pretty mixed bag, when you look into it.

The concern has to be with the big national providers who are moving into Scotland with profit in target and with substantial marketing budgets and a strong lobbying presence.

Two of the three national providers awarded the principal contracts across the four areas here are new to Scotland. One has to ask why they targeted Argyll and Bute. Soft touch?

One  – Care UK, the major winner with two topline contracts – appears not even to be registered with the Care Commission, the Scottish regulatory body, although it is registered with the Care Inspectorate in England.

Care UK was also outed by The Guardian just under a year ago, as one of the big national healthcare providers who take active measures to avoid paying UK tax. This is activity the hard pressed general public are not prepared to tolerate. Care UK cuts its tax bill by taking out loans through the Channel Islands stock exchange and coming to an agreement with HMRC.

Carr Gomm – another of the national providers winning contracts now in Argyll and Bute, is relatively unknown in the older person sector in Scotland, with its origins in delivering contracts in England in working with people with learning difficulties. Yet it is the major winner in this tender round. We understand that they presented themselves to the council as an opportunity to work with the third sector since, although they market and lobby aggressively, they are a registered charity.

The third, Allied Healthcare [now taken over by Saga] is the national provider that we understand had been the focus of the most complaints the council has received for this service over the past two years. We understand that there is internal concern in the council on the poor level of care this company provides and that protective measures may be in train. So why award them more contracts – including the frontline one for Bute?

Were councillors informed by officers of the level of complaints and the concerns around this provider? Allied Healthcare now has major contracts for home care for the elderly across the entire Bute and Cowal area, the one whose percentage of elderly folk is above even Argyll’s high average.

The fourth  national provider, Mears Care, was awarded a contract for 25% of future work in Lorn. Mears has shown a recorded decline in the standards of its provision and it is questionable whether council officers have kept up to date with this.

Mears also has a reported history of neglect of clients which, on at least one occasion, led to the death of the client.  The Care Commission is also aware and has set Mears numerous requirements to meet.

The Care Commission report on Mears Care Oban in 2010 showed them as scoring good/good/good, which is a decent score -  but in October 2012 when they were re-inspected, their grades had plummeted to weak/adequate/adequate. This is not reassuring, especially when a company with falling standards is about to take on a large Council contract here in Argyll.

The issue

The issue in the award of these contracts is that they shift the major responsibilities to the charge of national companies headquartered outside Scotland, two new to operating in this country; and one the focus for notable levels of complaint from current service users and also a matter of concern to council staff. These companies neither know about nor care about Argyll and its people. They are simply chasing the dollar.

These contracts effectively shut down work for local providers, the vast majority of which are doing good work. While the council will deny this and say that they will work with local providers to mitigate the impacts – the extent to which any such token gestures can make any difference is zero.

Contracts which turn over to one private sector operator all existing council run services for care at home in an area – and then share all new work between that operator – at 60%, with the remaining 40% contractually shared between two other private sector providers is – sort of all tied up, isn’t it? 100% is 100%.

This situation unarguably leave local providers – giving the nature of the work – looking at an annually shrinking service business, with no possibility whatsover of replacement business. Local providers are, in practice, being progressively shut out of the provision of this service in Argyll.

Is this what councillors want to see?

Have councillors been made aware of this situation by the officers who have brought it about? If they have, they will need to defend their judgment in approving it in the budget debate at tomorrow’s council meeting.

Local providers are known, accessible and directly affected by local concerns on standards of care. The nationals are not.

These privatisations to national providers outside Argyll leave Argyll’s most vulnerable – and their families – even more vulnerable to poor care, with inadequate serious recourse to protection.

The Council has its own complaints structure which is fairly regularly used – where the client or relative has been made aware of it.  Clients can also complain to the Care Commission – if they are aware of it.

A little known means of individual control of care at home

Self-directed funding has been around for some time now, although few are aware of it. At the moment, it is a focus of council effort and has much to commend it. It is one of the options available to those who need care at home.

It enables a person to choose their own care at home provider. They may choose this provider from anywhere but may, if they wish, go for a local one. The council then pays direct to the person in need of care, an amount equivalent to the cheapest service on offer within the area; and the person pays their chosen care at home provider directly.

This gives choice and control to the person who needs the care. If it isn’t good enough they can complain directly or choose another provider.

If they appoint a relative or neighbour who they know will reliably be good to them, the Council pay the ‘client’ a minimum self-directed funding payment of just over £9 hour which they then pay to the care provider.

If the ‘client’ chooses a care at home provider which costs more than the self-directed funding payment the council makes available, they pay the difference themselves.

This seems a seriously beneficial option. It keep the control in the hands of the one who needs the care – and it saves the council money in an unarguably proper way.

Failure to make efficiency savings

The privatisation of care at home services, in the way it has been done, is a highly questionable matter with a range of undesirable impacts here in Argyll – to the standard of care provided, to genuine accountability, to jobs and to businesses – although all of these negatives could be deflected if those needing care at home took the self-directed funding option.

But looking at the pattern of provision the August 2012 contracts set in train, these were not accompanied by the other cost saving measures available – and which could, at a stroke have saved more money than budgeted, while not reducing the frontline service, as is planned.

The council employs 15 Homecare Managers. The outsourcing of care at home now in place in the contracted areas substantially reduces the need for these posts – since there is no in-house homecare to manage.

There is, however, a need for staff to monitor the operations of the outside providers now contracted and to allocate ‘care packages’ – the care programme for each individual.

There are only six of contracted providers – as listed above. Monitoring these is not a very staff hungry operation.

But the council has simply retained and renamed all 15 Homecare Managers at a cost of around £28,000 per annum each, including National Insurance and pension contributions.

They are now Homecare Procurement Officers, responsible for monitoring the contracted providers and for allocating care packages. This sees 15 staff monitoring 6 providers. Efficiency gains?

In the Council budget  – to be debated tomorrow, 14th February – the officers propose reducing the number of care at home clients to save around £230,000 per annum. They could have saved at least £275,000 in salaries by appointing one Homecare Procurement Officer for each of the four areas whose services have now been contracted out. One officer would then have a decent job monitoring the contractors’ delivery performance and allocating the care packages for their given area.

This solution – which would have been efficient management, would have prevented the need to cut the number of ‘clients’. And quite how you do that anyway is beyond understanding, It can only mean finding ways to deny care to some who need it.

The question is whether and to what extent councilors are aware of any of this – and are either ignorant of it or  are actually accepting of it.

Tomorrow’s budget debate should see a major focus on this single issue. It will be interesting to see how well informed it is.

Only the administration councillors will know if they regard as satisfactory the information and analysis provided to them by council officers in the decisions and proposals they are making. Are they happy with the officer’s defence of their management of this service and with the consequences of it?

If their necessary contentment in these matters is absent, new Council Leader, James Robb, will appreciate just what else he has to do to assert the authority of elected members in the service they have been given – and may still be being given – by unelected officers.

Update 15th February: Local services – the Carewatch example

We have had the following  helpful information from the Chair of Carewatch, Mr JeremyHouston. Carewatch was mentioned above,  in a list and in passing, simply as: ‘1 national franchised provider, headquartered outside Scotland – CareWatch, with one contract for 15% of all subsequent work in the area.’

Jeremy Houston, Chair of Carewatch, has provided, below, an interesting account of the nature and work of Carewatch.

He argues for and establishes the greater potential value to local care services of good local providers – which is a major element in the argument of this article.

Mr Houston says: ‘Carewatch is one of the companies who won a small part of the contract to which you refer. Nationally, Carewatch Care Services Ltd is a franchised organisation.

‘Locally,  and in the case of Argyll & Bute, the franchise is owned and operated by Inverclyde & North Ayrshire Care Services Ltd (INACS),  a family owned private limited company,  registered in Scotland with its headquarters in Greenock and the company’s Registered Office in Argyll.

‘The company’s directors live and work in the West of Scotland – in Argyll and in Stirlingshire.   Since 2001,  INACS has been providing domiciliary care services to people across Argyll & Bute,  East and West Dunbartonshire,  Inverclyde and North,  East and South Ayrshire.

‘As a local business,  we provide local employment for about 200 people in the communities where we provide services,   and work closely with local partners.

‘INACS is regulated and inspected by the Care Inspectorate,  and has consistently been awarded grades of 4 (Good) and 5 (Very Good).    INACS has maintained this high level of quality over the last 11 years – a consistency which is underpinned by our commitment to those we support, those who provide that support, and to the local community in which we serve.

‘The company – directors,  managers,  supervisors and care support workers all take great pride in their work in helping those in need to lead as full,  active and independent a life as possible in their own homes.

‘Our staff retention rate is 95% (well above the industry norm) and many employees have been with us for over 10 years.   Our business is local,  of the highest quality,  and centred on the care and support we provide,  which is at the heart of everything we do.    In addition,  INACS has had Investor in People status since 2006    The company receives many expressions of thanks and appreciation for its work from service users and their families,  which is testimony to the quality of work we provide.

The home care market is a competitive one,  and currently at the forefront of many political debates.   Those that emerge as the providers of the future will need to be local,  consistently good at what they do,  and keep their focus on what really matters – the people they support.   This philosophy has served INACS well over the last 11 years and will continue to do so. ‘

Background reading:

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10 Responses to Elderly Care at Home: how far have officers kept councillors in the loop?

  1. Quite impressive bit of ‘newspeak’ there; ‘reducing the number of care at home clients’. Are they proposing to boil them down for glue, or just sell them on for inclusion in Tesco Value Lasagne*? Perhaps it’s the less Orwellian but no less uncompassionate means of disposal; plain old neglect, which we’re reading and hearing about so much of late.

    *Other vendors of poorly quality-controlled meat products are available.

    I think it’s safe to assume the council’s hands are at least partially tied when it comes to tendering; the EU’s rules are such that it requires imagination and talent to dance around them, contract writing skills are not the natural forte of local government officers. Demanding that employees be sourced locally may be a restraint of trade, even if it is a benign one, so the EU rules will say ‘non’.

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  2. Several things spring to mind here but I guess the main one is that if the service is good, who cares about the company delivering it? Is FA saying that a local company would be better?
    Some time ago I asked the council why they did not undertake customer surveys on the services that clients were receiving. At the time, I was told that it was because they choose from a list of companies that that had already been vetted. I was mystified and, as I was aware of several people that were unhappy with their care, then asked that the council undertake an independent customer survey. I don’t know whether or not this has happened.
    However, more recently I was told (by someone who saw this at first hand), that some responses from a social work survey and that were seen as negative, had been simply put in the bin and excluded from the results. I must add that I did not witness this personally but perhaps newsroom is correct when questioning what information some council officers are passing on to elected members.

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    • You’re absolutely right – original vettng is no substitute for constant monitoring, inspection and following up complaints.
      It’s not that local providers are, per se, better – but they are much more accessible and therefore much more potentially accountable.
      Fouling up your own nest is simply stupid.
      In general, people need not to be constrained by feeling unnecessarily grateful for being given anything, however poor its standard – but to make sure they get the decent service that they and every taxpayer pays for.
      We need to see more sustained complaints – on all aspects of health care for all ages. This entire industry has been a sacred cow for far too long and it’s nowhere near good enough.

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  3. It is perhaps also worth mentioning that, in the report for the closure of Struan, there does not seem to be a recommendation for independent advocacy to be made available for each resident. Surely that’s the least they should do to ensure each resident is given the best support and whose views should be included in the closure.

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  4. Well the SNP Council today voted to close Struan Lodge. Cllr Breslin for all his grandstanding and protests did not vote against it – he rtook the easy way out and abstained as did Cllr Gordn Blair and Cllr Donald Kelly from Argyll First.

    The winning margin was one vote. So it looks like the ‘protest’ was stage managed.

    You can read all about it here right now – http://www.cowalcourier.com/council-votes-to-shut-struan-lodge/

    Or in the local Dunoon paper tomorrow.

    Gawd knows when Newsie will get around to reporting it…

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  5. I did notice thsat there was NO recommendation from officials to close Struan Lodgae. This was purely a SNP/Argyll First political decision.

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  6. Would be interesting if FA could do analysis of Care Homes (and associated companies etc..) in Argyll rather than Home Care, and explored the various links.

    Might uncover some intersting and alarming facts as well as a potential ticking time bomb…

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  7. There is an easy way for Breslin and Blair to show they have confidence in what they did.
    Let both resign..then seek re-election.
    Risky? Yes, but if they truly believe that their actions have public support then they will be confident that the public will vote for them. Of course the public could abstain

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  8. my elderly relative is cared for in her own home, she has been overdosed which resulted in an admission to A&E by ambulance also has had medication missed for months although written on a legal document as given. left in a soiled bed for over 15 hours on a regular basis continual missed visits(4 in the last week) and visits she does get are continually cut short as carers don’t have time. The first time i phoned the company head office they didn’t know where oban was!

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