Wales’ care and social services inspectorate this week published online reports on home care in six areas of the country including Monmouthshire.

The reports are part of a wider review by Care and Social Services Inspectorate Wales (CSSIW) into domiciliary care due to be published later this year.

The reports on Monmouthshire, Carmarthenshire, Wrexham, Cardiff, Denbighshire and Swansea will feed into the national report, in which inspectors will provide recommendations to those commissioning or providing services based on their findings, and to the Welsh Government on the future regulation of domiciliary care.

Good overall

The review set out to examine how the way home care services are commissioned affects the way agencies arrange the delivery of care in Wales. It involved service users, care workers, providers and those who commissioned services.

Monmouthshire County Council has a commissioning plan for 2014 to 2017 which supports the principles of the Welsh Government’s ‘Fulfilled Lives, Supportive Communities’ guidance.

The inspectorate’s report concludes that MCC’s procurement systems and processes are ‘good overall’.

The introduction of a new computer application designed specifically for the sector to capture feedback from social workers on the quality of provision is a positive step. And people are receiving a service that generally meets their needs and is provided in a consistent way.

But there were also some recommendations for improvements including:

• working more collaboratively with providers to find solutions for how the service can move forward;

• carrying out a review of the effectiveness and sustainability of the council’s commissioning model;

• giving further consideration to the impact of UK Government imperatives such as the national living wage and pension contributions on the sector’s business in the local market;

• the need, in developing individual packages of care, to move from a time- and task-orientated approach to a more holistic one better suited to people’s individual circumstances.

• using the knowledge and skills of the sector more effectively by inviting care providers to regularly contribute to individual planning and reviews of packages of care for individuals for whom they provide a service.

MCC is divided into three geographical hubs - Abergavenny, Chepstow and Monmouth - covered by 25 providers.

Inspectors met with eight of those providers and found that there is commitment in principle to the local authority’s future direction but that they have significant fears around medium to long-term survival of their businesses.

Flat hourly rates, alongside the impact of the national living wage and pensions, are in their view ‘crippling’ them.

They feel that additional enhancements are needed to attract care workers to an ‘under-valued profession’.

The inspectors were also told that some of the small providers had left the market because of the way in which contracts were constructed with rigid terms and conditions.

Comments included, ‘They want to change the world but don’t want to pay for it’ and ‘We know that whatever we put forward we are not going to get, if it costs anything’.

Timely, respectful and friendly

Inspectors also visited six service users living across Monmouthshire and, for a fair balance, selected a combination of provider agencies.

People said the most important aspects for them were reliability, continuity of carers and consistency in the care provided.

One family member described care provided to his relative as ‘timely, respectful, friendly and very caring and competent’.

The inspectors were told that agencies never miss calls and some agencies, although not all, make contact if care workers are running late.

They were also told that care workers stay for the allocated time, but that sometimes care feels ‘rushed’ and there is no time for a chat. And some expressed a preference for more mature female carers.

The inspectors found that dignity and rights were respected and the principles of the Social Services and Well-being (Wales) Act were evident.

An example was given where a service user who had the mental capacity to make decisions wished to remain in their local community, against the wishes of their family, whose preference was residential care.

The social worker challenged this and as a result ensured that the service user retained their independence.

Among the comments received were: ‘The time goes quickly when they are here but they never cut calls or stay for shorter periods than they should’ and ‘They are pretty good. I’ve no complaints. I would like to stay with this agency’.

Future reform needed

The report states that over the next 20 years the number of people aged 85 and older will grow significantly and the corresponding demand for social care services will become unaffordable and will also be unsustainable due to budget pressures, as well as complex care packages.

It concludes that MCC’s position statement and plans in relation to home support recognise the need to radically transform the way in which it supports people at home.

It also finds that managers acknowledge the need to encourage and develop the sector with the introduction of new providers to the market, as well as strengthening the approach to partnership working with existing businesses - something which is already progressing through workshops and individual provider and commissioner meetings.