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.
Performance issues
“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.
Financial drivers
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.”
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I started reading this article feeling that the Council’s decision gave the lie to the ideology that Council Social Care Depts cannot do a good job and all the work must be out-sourced. Here is proof, I thought, that other organisations struggle too – it’s not Local Authority incompetence; delivering social care is just very hard. I was left feeling a little sorry for SEQL and wondering whether the Council had been quite fair – the increase in delayed discharges may be due to many factors, not necessarily SEQL not doing their job properly, and the budget being overspent – well, that’s because of increased need in terms of numbers of people and complexity of situations. Maybe SEQL should not have tendered for the job and said they could do it for a certain price when they presumably couldn’t, but maybe the Council should have realised that this was the case. The bottom line is that adult social care is hugely underfunded and no organisation can possibly deliver a high standard and equitable service to all those in need with what money is available. In the meantime who suffers from this in, out, in, out-sourcing – service users and hard working hands-on staff, I guess.
“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.”
Something fishy here. I find it unlikely that the workers ignored these possibilities. Admission to reablement is gatekept largely by clinical staff, technology has its limitation, support for carers is thin with very little of solid use to carers available, day care and sitting services are very limited and not enough to enable a distraught stressed out carer to continue in their role mostly. As to the voluntary sector they are mostly up to their ears in work anyway. It sounds like getting consultants in to cobble up excuses for pulling the services back in house because that is what they council wanted to do. Or is it that the all powerful CCG want something different, as we are told a few lines down?
We are writing in response to this article, which we believe gives an unbalanced picture of SEQOL.
The article relied largely on a report to Swindon Borough Council’s Cabinet meeting that took place on 10 February 2016, and a workshop delivered at the ADASS conference.
We wish to clarify a number of points, which the reporter could not have known:
In addition to the evidence presented in the Cabinet report, the Council Lead Member responsible for Adult Social Care, Cllr Brian Mattock, also recognised in the meeting that SEQOL’s integrated service delivery model had achieved benefits for the community of Swindon as a whole.
SEQOL is an independent employee-owned social enterprise that was set up jointly by Swindon Borough Council and Swindon Primary Care Trust in October 2011. Over the period of the contract SEQOL has achieved efficiency and cashable savings and cost avoidance in each year of the contract. We acknowledge that during this time SEQOL has traded with a small surplus.
In 2016/17 SEQOL is working to deliver £523k savings to support the council’s programme of cost reduction. The Cabinet paper also stated that £1.6m could be released for frontline health and social care services by removing the management and back office costs of the SEQOL contract. In fact, much of SEQOL’s back office costs are shared with Swindon Borough Council or outsourced to NHS shared business services, to reduce duplication. SEQOL has made additional proposals on how these costs can be further reduced, which are being considered by the council.
Notwithstanding performance issues SEQOL has increased the number of social care reviews and assessments, raising the number of social workers in its workforce from 28 when it was set up in 2011 to the current number of 41. SEQOL consistently signposts 50 to 55 per cent of all calls received elsewhere.
SEQOL has rebuilt and reshaped the Learning Disability Team before it transferred to Swindon Borough Council, and in partnership with the council SEQOL delivered savings in the learning disability service.
Regarding the reference to a lack of social work expertise within SEQOL, in fact all social care staff have benefited from comprehensive training and development programmes, and as an employee owned company, SEQOL ensures that staff give direct feedback to management on their working arrangements and the models of service provided.
Like most organisations SEQOL experiences quality issues in some of its services but there are also good quality services. Swindon Borough Council recognises that SEQOL’s success has also been acknowledged on the national stage, through a number of award wins across a wide range of disciplines, and citations accompanying these awards repeatedly commend SEQOL’s innovation, indicating that experts find SEQOL’s approach to community care exemplary.
Swindon Borough Council and SEQOL continue to work together to deliver new service models.
Sue Wald, Swindon Borough Council Interim Director Adult Social Services and Heather Mitchell, SEQOL Chief Executive