Service Users of Home Care - Ministerial Response - 7 April 2017

Findings

Comments

1

The Health and Social Services Department and FNHC appear to have operated for years without  full  knowledge  of  the  costs attributable to home care. As a result, it has been  difficult  to  disentangle  the  funding utilised  for  home  care  services  from  the remainder  of  the  commissioned  services. The subsidy and how it is broken down has been a sticking point in negotiations.

It  is  correct  that  the  Health  and  Social Services  Department  and  FNHC  have operated for years without full knowledge of the  costs  attributable  to  home  care.  The evidence  presented  indicates  that  my Department  has  been  requesting  clarity regarding  the  apportionment  of  costs  for some time; this is evidenced in the note of 28th November 2014, and in the letter to FNHC requesting clarity regarding funding sources  and  individual  service  lines  in October 2015 – both of which are presented in the Appendix of the report.

I cannot see any evidence in the report that the breakdown of the subsidy has been the sticking point in negotiations'. Indeed, the main sticking point was FNHC's reluctance to accept the changes in funding for home care in 2016, which were first signalled in 2014 and then again in 2015.

2

Negotiations for the removal of the subsidy between  Health  and  Social  Services  and FNHC were slow, with long gaps evident in the process. Both Health and Social Services

I  agree  that  negotiations  have  been protracted.  However,  the  statement  that HSS  failed  to  clearly  communicate  its change  in  position  to  FNHC  and  then

Findings

Comments

and  FNHC  bear  responsibility  for  this. Health and Social Services failed to clearly communicate  its  change  in  position  to FNHC and then attempted to make changes in a short timeframe. On the part of FNHC there was a seeming reluctance to accept and engage  with  the  changes.  This  failure  to agree  led  to  FNHC's  announcement  in September 2016 with regards to their staff terms and conditions.

attempted  to  make  changes  in  a  short timeframe'  does  not  accord  with  the evidence in the report. Indeed, I believe that the  evidence  demonstrates  that  my Department has been mindful of the need to ensure  the  change  is  accepted  and  well managed:

The chronology on pages 18 and 20 shows that the intention to change and reduce the funding  for  Home  Care  was  signalled  in 2014. In a  meeting in early 2015, FNHC requested  that  my  Department  did  not withdraw  the  funding  until  after  their strategy was published in March 2015. We agreed to this and, as the evidence shows, we did not suddenly withdraw' the funding after receiving FNHC's letter in November 2015.

The  report  notes  that  the  position  was reiterated'  by the  Minister in  April  2016 (i.e.  that  this  was  not  the  first  time  the withdrawal of funding had been stated), and the detail was agreed in July 2016 following confirmation of funding reduction in April.

On page 6 of the report it is stated that HSS told the Panel that it began discussing the removal of funding in 2014, however, FNHC told the Panel that discussions began much later. The Panel has not been able to discern which  is  correct'.  However,  the  first document referred to on page 17 (evidence) is  notes  of  a  meeting  from  July  2014  in which funding was discussed. I am therefore unsure why the Panel was unable to confirm that the funding was discussed in 2014.

3

Letters inviting FNHC clients to be assessed for the Long-Term Care Scheme were sent out in September, only 4 months prior to the planned  removal  of  the  subsidy.  As  of August  2016,  there  were  no  clear instructions  for  the  new  flexible  care component.  This  was  not  a  realistic timeframe in which to complete the work required. It is appropriate therefore to extend the funding until this is resolved.

I  agree  that  letters  were  sent  to  FNHC clients in September. However, the finding infers that this is the first time FNHC clients were eligible to be assessed under the Long- Term Care Benefit or had been invited to be assessed under the Long-Term Care Benefit. This  is  an  incorrect  inference;  like  all Islanders, FNHC clients were eligible to be assessed from 2014, when the Long-Term Care  Benefit  was  introduced.  In  fact  the letter  invited  FNHC  clients  to  have  an updated care needs assessment, which may or may not have resulted in them becoming eligible for the long-term care scheme.

Findings

Comments

Page 9 of the report notes that FNHC did not inform its staff until September, when it was aware  of  the  funding  reduction  in  April. Whilst  the  reluctance  to  accept  change  is noted  in  the  report,  this  delay  in communicating to staff is omitted from the report's findings.

I  am  also  pleased  to  note  that  all  of  the FNHC clients who requested an assessment were assessed; we secured additional staff in order to cope with the increase in demand for assessments.

Recommendations

To

Accept/ Reject

Comments

Target date of action/ completion

1

It is unsatisfactory that

there is no information as to how the subsidy is allocated  to  services. The Minister for Health and  Social  Services should confirm how the block grant for the core commissioned  services is broken down by the end of the first quarter in 2017.

HSS

Accept

As noted at the Scrutiny Panel hearing on 10th  November  2016,  my  Department's intention was to fully fund District Nursing, Children's  Services  and  Rapid  Response and  Reablement  from  2017.  This  is  a Service  Level  Agreement,  not  a  Grant. Service  specifications,  including  metrics, have been agreed for each element of the service.

My Department has now signed the 2017 contract and, in agreement with FNHC, has shared  the  contract,  including  financial schedule, with the Panel on the basis that the  document  is  commercially  in confidence.

31st March 2017