Report CS17068

The Committee considered a report outlining the quality monitoring arrangements for agencies delivering domiciliary care across the Borough. 

The Local Authority commissioned domiciliary care services from external agencies with 79% of the service delivered by 24 agencies on a Framework and the remainder provided by agencies that had spot contracts with the Local Authority.  The quality of service provision was monitored by the Contract Compliance Team, and was focused on providers with most users and those with CQC ratings of ‘Requires Improvement’ or ‘Inadequate’.  A total of 41 complaints had been received from service users and their families during 2016/17 in relation to domiciliary care services.  Service users and their families were encouraged to resolve their complaints directly with providers, but of the 41 formal complaints received by the Local Authority in 2016/17, 22 were being investigated under the safeguarding regime, and of the 13 investigations completed, five had been fully or partially upheld, six were not substantiated and two had no clear outcome, with 28 investigations remaining unresolved.

In response to a concern raised by a Member around the number of formal complaints received regarding negligence including length and time of calls, the Head of Contract Compliance and Monitoring confirmed that providers used an electronic recording system for the timing of visits and that this was monitored by the Local Authority.  The Local Authority monitored the quality of domiciliary care providers across a range of measures including CQC scores, the annual user satisfaction survey and by conducting visits with service users, and worked with providers where concerns were identified.  A Co-opted Member underlined the need to continue to engage with service users around their experiences of service provision.

A Member noted that the recruitment and retention of domiciliary care staff was an ongoing issue for providers in Bromley as a number of neighbouring local authorities paid the London Living Wage.  The Portfolio Holder for Care Services confirmed that the Local Authority aimed to provide a value-for-money provision, but that value was placed on service quality as well as cost in commissioning providers to deliver services.  The Member asked that it be noted that the care services run directly by the Local Authority currently had ‘Good’ CQC ratings.  The Chairman highlighted that domiciliary care services were increasingly delivered by small and medium sized enterprises.  As a geographically large Borough, this had the potential to benefit distinct communities across Bromley, but there was a need to ensure that provision was sustainable into the future.

In considering the quality of service provision, the CQC was placing an increasingly emphasis on the proper recording and supply of medication to service users, including pain relief.  In discussion, Members generally agreed that this was a safeguarding issue, as care workers did not have the relevant medical training to fully understand the different medications.  Pharmacists in some neighbouring local authorities were commissioned to produce pre-populated medication administration charts for care workers to complete, which might be included as part of the work being undertaken by Bromley Clinical Commissioning Group to transform the way that pharmacies operated over the next two years.  The Committee requested that a letter be drafted referring this issue to the Bromley Safeguarding Adults Board and the Bromley Clinical Commissioning Group, and that progress be reported back to the Committee.

The Chairman requested that further information also be provided to Members following the meeting regarding the complaints received by the Local Authority in relation to domiciliary care services during 2016/17, such as whether the complaints were upheld, as well as details of the annual user satisfaction survey and any available user experience information. 

RESOLVED that:

1)  The action taken to ensure that providers maintained and improved the quality of the service delivered be noted; and,

2)  Arrangements made for the Portfolio Holder for Care Services and his Executive Support Assistant to visit domiciliary care agencies during 2016/17 be noted.