A council is to take back control of social work services from an employee-run social enterprise because of performance concerns, financial pressures and NHS policy changes.
Swindon council has given notice on its contract with SEQOL to deliver adult social care services on the council’s behalf, including assessment and care management services for older people and hospital social work.
These social work services will be taken back in-house by the council, a decision which follows the authority’s “insourcing” of the learning disability care management function previously undertaken by SEQOL last year. Social work staff will be transferred to the council though a report to the council’s cabinet in February said there would be “significant implications” for senior and back office staff and potential redundancies.
Other social care services run by SEQOL – including day services, two residential homes, Shared Lives, telecare and reablement – will be retendered, with the existing provider able to bid.
SEQOL, which was set up in 2011, is an integrated social enterprise delivering adult social care and community health services on behalf of the council and Swindon Clinical Commissioning Group. The two organisations have a block contract with SEQOL – of which the council’s share is £9.4m and the CCG’s £17m a year – which was due to finish this month. Both have now given 12 months’ notice to SEQOL, which will continue providing the services until February 2017.
The decision not to recommission SEQOL has been driven by performance problems, including increasing levels of delayed discharges, residential care admissions and high-cost home care packages, financial pressures on Swindon’s health and social care system and changes in NHS policy.
“The insourcing of social work is based on quality and management oversight,” head of commissioning – children and adults Sue Wald told last week’s Association of Directors of Adult Social Services spring seminar. “We don’t think there’s enough management oversight of cases and not enough social work expertise within the social enterprise.”
The council cabinet paper published in February acknowledged that SEQOL had done innovative work in redesigning day services for learning disabled people and won a number of awards. However, it said a number of performance issues emerged last year.
The average daily rate of delayed discharges from hospital attributable to social care, or to both health and social care, per 100,000 population was 6.9 in Swindon, compared to a national average of 3.7, in 2014-15. The costs of excess bed days to the NHS in Swindon rose by £400,000 last year.
Also, there was an increase in the number of high-cost care packages, with the number of monthly domiciliary care hours purchased rising from 7,000 in January to 8,500 in December 2015. Also, the number of funded care home placements rose from 320 to 350 during that time.
“Commissioners have repeatedly raised the perceived lack of social work management in quality assuring assessments, which has led to high care packages in contract meetings and formal letters,” said the report to Swindon council’s cabinet in February. “The budget impact of this is a projected overspend in older people packages of £1.7m in 2015/16.”
An analysis of hospital discharge systems by consultants Newton Europe for the council found that there was a need to streamline assessments and for social workers to make better use of alternative services to residential care and high cost care packages such as reablement, technology, support for carers and the voluntary sector.
The decision has also been driven by wider financial pressures, with Swindon’s population due to grow at a faster rate than the national average over the next five years, leading to additional demand for health and social care.
The council said the pressures on services meant that they could not continue to be delivered in the same way. It estimated that £1m could be released by retendering for services currently run by SEQOL while a further £1.6m could be released for frontline health and social care services by removing the management and back office costs of the SEQOL contract.
NHS policy shift
Also, the SEQOL model of integrating community health and adult social care does not fit with the CCG’s plan to commission integrated acute and community health services in future. This is in line with the intent set by NHS England in its 2014 policy blueprint, the Five Year Forward View, to break down the barriers between different parts of the health service in order to provide coordinated care for patients within local populations.
The CCG said its proposed integrated provider model would seek to shift the emphasis of care towards prevention, while it is also estimated that an integrated acute and community provider would save about £1.5m a year through reduced management and back office costs.
There would be the option for such an integrated health provider to take responsibility for social care or social work functions in future, said the paper to February’s council cabinet meeting.
Bringing back social work
In a statement on behalf of the council this week, commissioning head Sue Wald said: “The planned insourcing of social work services will allow social workers to be based within adult social care commissioning, carrying out assessments which focus on building the individual’s strengths and factor in support available within the family and wider community. This approach will help manage the challenge of increasing demand whilst also improving outcomes for people through more joined-up and coordinated ways of working.”
SEQOL chief executive Heather Mitchell said: “We are glad that our commissioners recognise that SEQOL strives to provide good quality services and that they recognise the innovative work we have undertaken in the redesign of day services for people with a learning disability. We are also pleased that this innovation has been recognised through the winning of several national awards. We are proud that we have also been able to redesign many other services to provide efficiencies and, importantly enhanced quality of care while meeting ever increasing demand. However we fully understand that national financial pressures on health and social care require commissioners to consider new ways of working with partners and we are working closely with them to support them in that.”