Agenda item

To consider the report.

To accept the report, and:

1.    Note concern about the waiting lists for domiciliary care in some areas of the County.

2.    Request data regarding waiting lists across the County in order to facilitate comparison between areas.

3.    Ask the Cabinet Member to update the Committee on the work of the Domiciliary Care Project to include information about reducing costs and improving the quality of data.

 

A report was presented by the Cabinet Member for Adults, Health and Well-being, Head of Adults, Health and Well-being Department, Assistant Head - Supporting Communities, Health and Well-being and Assistant Head - Adults Services.

 

It was explained that a series of changes were currently under way within domiciliary care. Some issues had been acknowledged as needing to be addressed for some time but it was confirmed that they were now being implemented. It was explained that these modifications were now being introduced in line with the Ffordd Gwynedd review. It was noted that officers looked at the services from a citizen's perspective to assess whether or not services were effective.

 

It was declared that an agreement adopted with external providers, which had been adopted since November 2022, implemented a new way of working. It was noted that all providers collaborated effectively with the social workers and wider communities to offer users domiciliary care of the highest standard. This was compared to the previous working model where there was not as much collaboration and domiciliary care providers were required to work in a monotonous way to provide care at the same time of day without really considering adjustments to the user's schedule. It was emphasised that the current model allowed employees to build relationships with users and that solving any problem or need that needed to be addressed could be achieved more easily, with the support of partners.

 

However, it was recognised that adjusting working patterns between the above two models was challenging and it was confirmed that the department was currently still in that transition period. It was assured that employees believed that their terms of working had changed for the better in recent years and it was noted that starting to implement the new model of working had resulted in improved cooperation in community hubs deriving additional community value from the agreements. Examples were shared of how terms of working had been able to be modified such as changes in holidays and travel expenses and adjustments to shift patterns. It was acknowledged that some employees believed they were on their own and did not feel involved in relevant decisions and therefore it was ensured that the Department continued to find new ways of presenting ideas and communicating with employees to ensure input.

 

It was confirmed that all external agreements were now with third sector or small third sector families. It was emphasised that money was not being spent beyond the local area of the County.

 

In response to a query on modifications to ICT systems, the Assistant Head of Supporting Communities, Health and Well-being confirmed that four of the domiciliary care services systems needed to be modified due to the change in the working model. It was explained that the service's current systems followed the old working model and needed to be adapted to ensure that arrangements for care planning, scheduling staff hours and recording user mobility were formulated according to the new working model. Work to look into adapting these systems by a Swansea University Professor would be starting soon and the findings were expected to be published by March 2025.

 

It was explained that the problems with the domiciliary care provision were more challenging in some areas than others. It was elaborated that approximately three areas had high numbers on the waiting list for domiciliary care and had experienced recruitment difficulties over the past two years. It was noted that officers had investigated any possible patterns to these deficiencies but it was noted that there were no patterns between internal and external providers or geographical patterns. However, it was emphasised that five or fewer individuals were waiting for domiciliary care in the vast majority of County areas.

 

It was announced that a new internal Project Board had been established led by the Head of the Adults, Health and Well-being Department. Members were encouraged to contact the officers with any query regarding this subject.

 

During the discussion, the following observations were noted: 

 

Members were reminded of the commitment given to the Council's care workers in the lead up to the current agreements, that if the new agreements resulted in a change in domiciliary care management which meant that their current work location was transferred to an external provider, they would be able to continue to work for the Council in an area near their current work location. It was also noted that those employees would have been able to move to work for the external providers if they wished.

 

The Assistant Head of Supporting Communities, Health and Well-being explained that the external company had failed to recruit enough employees in some areas to address the demand for a service, therefore the Council had continued to offer services. Pride was expressed that domiciliary care provision could continue to be delivered in those areas, but it was noted that this was also having an impact on nearby areas operating with fewer employees until the recruitment problems were resolved. It was emphasised that there was no single customary arrangement for resolving problems of this type in communities and it was noted that officers and partners were constantly looking at the market to try to find solutions to problems that arose. It was elaborated that staff had regular conversations with officers to identify any concerns and resolve them as quickly as possible.

 

Following the response, it was asked whether the Council had saved money through these adjustments or whether the costs of providing domiciliary care were now higher for the Department. In a further response, the Head of Department confirmed that the cross-county percentage split of who provided the domiciliary care service had not changed much. It was explained that the Council, private sector and third sector operated within specific areas within the County rather than working together across the County as a whole as part of the new model. The view was shared that this had given the third sector more opportunities to operate within the County and the Council was keen to see that. Savings made as a result of this change were reported in detail, noting that no direct significant savings had been achieved to date. It was explained that there was an initial increase in starting to implement the model but that the Department had plans and processes to ensure a saving over the next period. It was emphasised that these changes to the working model were not driven by financial savings but ensuring that service users and their needs were at the heart of the arrangements.

 

It was elaborated that there were financial challenges within the current system, and it was emphasised that officers were working with Audit Wales to ensure tight financial systems were put in place. It was confirmed that the cost of providing domiciliary care internally by the Council was being monitored on an ongoing basis. It was trusted that adhering to these steps would reduce the cost of overspending that currently exists in the field. Examples where some services had transitioned easily to the new model were drawn out, but it was noted that some services were struggling to adopt changes in procedures. It was ensured that the Department as a whole assessed the care provided internally and externally to ensure that financial difficulties were kept within control and to ensure reduced expenditure and increased savings in this field in the near future.

 

In response to a query and concerns about the Tywyn area identified in the report, the Assistant Head of Supporting Communities, Health and Well-being confirmed that 24 individuals were awaiting care in this area. It was reported that this was 20% of the demand for a domiciliary care service in that area. It was explained that around 8800 hours of care were met by the County but around 920 hours were not. It was noted that this meant that around 10% of those who required domiciliary care were not currently receiving provision and it was emphasised that this was a concern for the Department. It was emphasised that the Department had adapted its data collection systems in the last period to highlight when the information provided by different databases was inconsistent so that it could be investigated and understood, and this had resulted in shorter waiting lists in general in the County and in this particular area. It was acknowledged that there were extremes where some areas saw longer waiting lists than others. It was stressed that a domiciliary care group meeting was held in the area recently to gather ideas on how to address this deficiency such as adjusting working hours, collaborating with the local community hubs, etc. Reference was also made to the fact that staff training and gaining essential skills were key to meeting the demand for these services. Pride was expressed that the new model was a success in this area before committing to the contracts and it was hoped that the deficiency could be resolved as soon as possible.

 

It was pointed out that Gwynedd provided more domiciliary care per 100,000 of the population than most counties in Wales. In response to this, the Head of Department confirmed that this was not necessarily something of a positive nature. It was elaborated that this was an indication that Gwynedd was over-providing domiciliary care services, and it was hoped that this new model would lead to a change in this statistic in the future.

 

A recent awareness-raising event on direct payments held in the Porthmadog area was highlighted. It was considered that making use of these arrangements would reduce waiting lists for domiciliary care by supporting individuals who had adapted their way of life to provide care for their loved ones due to the lack of carers available within the County to undertake the work. In response to the observations, the Assistant Head of Supporting Communities, Health and Well-being confirmed that significant work was ongoing to develop this service and that it was a very complex process. It was elaborated that the Department was collaborating with the Community Catalysts company and had established an in-house Catalyst Officer to support individuals within the County's communities who were interested in setting up small businesses that offered care – and were paid through a direct payment system. It was reported that 17 small enterprises had been established so far and more were currently under development. It was acknowledged that direct payments could not be provided to individuals living with the person being looked after due to statutory restrictions, but families were encouraged to have a conversation with care providers and social workers about this challenge if this was the main element of why individuals did not use the services.

 

The Department was thanked for presenting an honest Report with clear information on successes and challenges arising within the field. Information was requested on the numbers of care providers who were able to provide care through the medium of Welsh. It was explained that this was a challenge within the Department and that the figures of Welsh speakers were not as high as would be wished. It was elaborated that the Department supported staff with language training but noted that it was a challenge in general.

 

In response to observations on employee support, the Assistant Head of Supporting Communities, Health and Well-being confirmed that a Project Board had been established within the Department to address the issues that teams and service providers believed needed to be addressed. It was elaborated that the Project Board (and the Council in general) received external support to realise objectives through the IMPACT (Improving Adults Care Together) project. It was noted that this project supported workers from the same fields and shared good practice so that everyone across Wales and England became aware of what kind of systems worked and how improvements could be made.

 

Reference was made to the PERCY questionnaire which assessed the quality of life of care service users to ensure that they felt their life had purpose and that their well-being was improving. In response to the observations, the Assistant Head of Supporting Communities, Health and Well-being confirmed that a project group had been set up to look into the questionnaire to see if it would benefit domiciliary care users in Gwynedd.

 

The officers and all care workers were thanked for their hard work within the field.

 

RESOLVED

To accept the report and:

1.    Note concern about the waiting lists for domiciliary care in some areas of the County.

2.    Request data on waiting lists across the County for easier comparison of areas.

3.    Ask the Cabinet Member to update the Committee on the work of the Domiciliary Care Project to include information about reducing costs and improving the quality of data.