Agenda and minutes

Select Committee - Commissioning - Friday, 7th February, 2014 10.00 am

Venue: Wantsum Room, Sessions House, County Hall, Maidstone. View directions

Contact: Denise Fitch  01622 694269

No. Item


10.00am - Christy Holden, Head of Strategic Commissioning (Accommodation Solutions) pdf icon PDF 24 KB


(1)       Ms Holden introduced herself as the Head of the Accommodation Solutions Team of 24 FTEs.  The Team’s responsibilities are to commission accommodation for those who needed care homes / extra care / supported housing.  One of her tasks was to review the current care home contracts.  Most of these are twelve years old and as a consequence unfit for purpose.  In particular, there is no link between cost and quality and homes that are just above ‘adequate’ regulatory provision are not receiving the support to improve from the Team.


(2)       KCC has serious funding issues - currently spent £180m on residential care for adults and £100m on older people.  It therefore has a responsibility to look at a fair cost of care and to look at demand for services.  To this end, an Accommodation Strategy is being developed, based on people’s needs.  This does not necessarily mean new build, as care could also be provided in remodelled schemes.


(3)       Question – Insufficient money has been spent on care homes over the years.  Now these same homes are being required to provide higher quality, limiting the number of people who can be accommodated.  KCC owns and manages 9 care homes and 5 for learning disability.  How will it meet its obligations?


(4)       The Accommodation Strategy will identify the amount and type of long term provision that will be required in the future.   The Care Quality Commission (CQC) has introduced the requirement for all new builds to have ensuites.  We would therefore expect ensuite provision to be available in most cases (bearing in mind that people have the right to choose not to have it). Our strategy is to inform the market of KCC’s needs in the long term future.


(5)       It is probably true to say that we started this process too late.  We now have to ensure that we have sufficient care homes so that we can provide a managed approach to arranging new accommodation whenever a home becomes unviable for an older person.  


(6)       We expect the number of Community Interest Companies to grow in future.  We have already had expressions of interest from this sector (for example, Samson Court in Dover when that closed).


(7)       Question – You say that you will introduce regular monitoring of performance indicators.  This is to be carried out by KCC.  Would it be better if we commissioned independent monitors who are not bound by cost concerns?


(8)       When CQC rated their assessments, we would only place people in care homes that had an “Excellent”, “Good” or “Adequate” rating.  KCC’s in-house services have recently received very good inspections. We have a responsibility to monitor and challenge any issue directly with the care home staff or manager. Our Case Management staff have been reporting to us rather than challenging bad practice directly. We are now giving front line staff the skills to do so. 


(9)       Question – How do you ensure that the Commissioning Body can have confidence in the standard and  ...  view the full minutes text for item 25.


11.00am - Kent Care Homes Panel pdf icon PDF 25 KB

(1) Adrian Adams, Chief Operating Officer, Kent & Medway Care Association & Research Fellow at University of Kent 

(2) Gill Gibb, Kent Care Homes Association / Chief Executive officer, Canterbury Oast Trust (Learning Disability)

(3) Ann Taylor Chief Executive, Kent and Medway Care Alliance

(4) Clare Swan, Board Member, Kent Community Care Association

Additional documents:


(1)       The Chairman welcomed Mr Adams, Ms Gibb, Ms Taylor and Ms Swan to the meeting and asked them to introduce themselves before answering questions from Members of the Committee.


(2)       Mr Adams said elaborated on some of the points made in the briefing paper received by the Committee.  In particular he said the care homes sector considered there was a “disconnect” within KCC between commissioning, operations and procurement as well as a “disconnect” between the commissioning officers and service providers.  He said that when tenders were published they tended to be more prescriptive about methods and outcomes than anticipated during discussions. Frequently there were no references to social value or to the possibility of providing services in different or innovative ways in the tender documents.  


(3)       Ms Gibb said there was a need to consider long term outputs.  For example her organisation had been very successful getting adults with learning difficulties into supported living arrangements but that it could take a very long time to do this.  As a charity they could add extra value by looking at work and volunteering opportunities.


(4)       Ms Gibb applauded the KCC Stakeholder Board but thought it was too bureaucratic and took too long to make decisions.  She said collaboration was important and that she would like to see better quality outputs and recognition that commissioning services imposed a cost on charities. 


(5)       Ms Swan said that she represented the KCHA on the KCC quality board and worked as a provider of residential and nursing care with large and small providers.  The creative and innovative work done by smaller providers could be overlooked and many such organisations had concluded they were not able to work with the local authority.  She agreed that the KCC Stakeholder Board took a long time to reach decisions.  She also thought that many of the commissioners of services were out of touch with reality particularly about the cost associated with providing services and expressed concern that no additional funding or “top-up” funding was available for support that would enhance an individual’s life.


Question – How could whole life care be achieved within the system?


(6)       Usually care packages would be reviewed annually with the care manager, the provider, the individual and his/her family and usually more support was required initially.  


Question – Does the care manager hold the budget?


(7)       No. Care managers usually have to persuade the Care Committee that an individual needs a particular type of support and the process is bureaucratic and “clunky”.


(8)       In the case of older people such decisions are taken by a panel and it is especially difficult when the support required is funded from health care budgets.


Question – Is the health and wellbeing architecture helping?


(9)       The flexi-care contract gave care managers to re-act immediately to meet needs and it worked well as it built trust. 


Question – In the written submission you talk about prime integration providers coming to dominate the market.  What do you mean by that?  ...  view the full minutes text for item 26.