Agenda item

To set out the outcome of a review of the Tendring’s Careline Service in the context of the change in the market landscape, a number of on-going challenges, including its future financial sustainability, and to present a preferred option for the future provision for public consultation.

RESOLVED that Cabinet –

(a) notes the outcome of the review of the service as set out in the Portfolio Holder’s report (A.8) and its appendices and agrees the decision, in principle, to adopt Option 2, that is to cease the telecare and lifting/response provision of the Careline Service, in its entirety, including service delivery under third-party contracts and that the remaining service provision will solely relate to the Council’s Out-of-Hours and CCTV service;

(b) approves the necessary consultation to be undertaken with customers, residents and key stakeholders. This consultation to be based upon balancing best value principles with the needs of the Council’s existing customers, who now have a wider range of options available on the open market, at more comparable rates than the Council can continue to supply the service for;

(c) delegates the format and design of the consultation to the Leader of the Council and the Portfolio Holder for Partnerships, in consultation with the Assistant Director (Partnerships) and the Assistant Director (Governance);

(d) agrees the Communication and Engagement Plan with an overriding objective to encourage and support active engagement with services users to understand the principles of Option 2 and the alternative providers available, as well as understanding why Option 2 is the preferred option;

(e) requests that the outcome of the consultation be reported back to the Cabinet in either October or November 2024, for a decision as to the future provision of Careline Services (telecare/lifting/response service), which will include a detailed transition plan as necessary; and

(f) subject to the associated funding being agreed as part of report item A.9 elsewhere on the agenda, sets aside a total budget of £0.746m to meet the potential implementation costs.

Earlier on in the meeting as detailed under Minute 24 above, Councillors Chapman BEM and P B Honeywood had both declared an interest in agenda item 16 (report A.8) insofar as they both had relatives who were users of the Careline service.

Cabinet considered a report of the Partnerships Portfolio Holder (A.8), whichset out the outcome of a review of the Tendring’s Careline Service in the context of the change in the market landscape, a number of on-going challenges, including its future financial sustainability, and to present a preferred option for the future provision for public consultation.

Cabinet was informed that Tendring’s Careline Service (Careline) had been operational since 1987. When it was established, it had provided a unique service to Tendring residents, allowing service users to maintain independent living through 24/7 monitoring and response. The service had been highly regarded by both customers and their family members. However, the telecare landscape had since changed, with several alternative providers now in the market offering similar services (including telecare and lifting/response) at comparable fees.

Careline was an in-house service (not a state entity, or Local Delivery Vehicle) which allowed service users to remain living independently in their homes. An additional lifting service had been established in 2016, which allowed responders to lift service users, if appropriate, thereby providing complementary support to Emergency Services.

In addition to its regular operations (as outlined above), the Careline team supported the Authority’s Out-of-Hours service. This service provided a Council response to resident queriesincluding Housing, Environmental Health, Emergency Planning, and CCTV during evenings, weekends, and bank holidays. It was noted that the Out-of-Hours service was a completely separate working function to the Careline service. Outside of Out-of-Hours arrangements, CCTV was currently monitored by the Careline team and footage was downloaded as requested by Essex Police.

Cabinet was informed that the last review of the service had been reported to Cabinet in June 2022, where the future sustainability of the service had been considered. Cabinet was informed at that time, the preferred course of action would be Option 4: an orderly and sustainable growth of the number of service users to increase income. Initially, the service would concentrate on the recruitment and training of enough staff to ensure a safe service was delivered to customers and that the TSA Accreditation was maintained at the next review in July 2022. Simultaneously, a marketing strategy would be drawn up to include online advertising, promotion of a new website with online retail capabilities, and demonstration appearances at relevant groups across Tendring. This strategy would be put into action once the service was fully staffed. Finally, fees and charges would be re-appraised towards the end of 2023 in time for implementation in April 2024. As Option 4 allowed time for the service to stabilise, an advertising campaign to take effect, and start generating new customers, whilst delaying fee increases for service users until April 2024, it was considered the lowest risk to the Authority and to Tendring residents. At the time, it was hoped that by increasing customer numbers and associated fees, the reported subsidy could be reduced. However, since that date, it had not been possible to deliver on those proposals to the extent that it had sufficiently reduced the subsidy to the service. It was also important to highlight wider economic factors that had been experienced since this earlier decision, including significant inflationary impacts in areas such as staff and other operational costs along with staff recruitment and retention challenges, all of which had an impact on the underlying ‘economies of scale’ for the Service.

It was also noted that there had been a significant increase in the number of non-Tendring residents, accessing service provision, via the Authority’s contractual/commercial arrangements. The Careline service supported approximately 2,000 direct service users and supplied third-party provision serving approximately 7,500 service users.

Notwithstanding the above, it was important to highlight that there were a range of alternative providers, who were better placed to provide services, in the market, which provided a different context for the future provision of the Council’s own service. Service users were now likely to be able to access more cost-effective provision in the market; Essex County Council provided a free of charge service if a resident was referred to them through a statutory provider e.g. Adult Social Care or a health care provider.

Members were made aware that in terms of the financial impact of the above, the total required subsidy was £0.494m in 2022/23 and £0.403m in 23/24. Based on the service continuing in its current form an additional £0.296m budget had been included within the 2024/25 forecast. It was also important to highlight the continuing capacity challenges to meet the needs of a range of customers, including the Authority’s contractual commitments to other third-party companies.

Based on the above, and the continued development of the market in terms of other alternative providers, it was therefore timely to consider the future of the Careline (telecare/lifting/response) service within this changing context.

Over the past 12 months, a detailed review of the Careline service had been undertaken in light of the above, with the following considerations taken into account:

· The provision of a quality, consistent, compliant service to customers;

· The delivery of a financially sustainable service; and

· Consideration and fairness to staff.

Although there would be a number of permutations in relation to the options going forward, five underlying options had been identified (within the context above) which were summarised as follows:-

Option 1 – Maintain current position (remain in the market, which will require on-going financial support).

Option 2 – Provide an Out-of-Hours Council service only (leave the market, focussing on the Council’s core business and ceasing telecare and response/lifting).

Option 3 –- Reduce shift pattern to 6 hourly shifts (remain in the market, staffing changes required, which will require on-going, additional financial support).

Option 4 – Remove the responder/lifting service (remain in the market, removal of one element of the service, which will require on-going, additional financial support).

Option 5 – Termination of third-party contracts (remain in the market and service Tendring District Council residents only via the Careline scheme, which will require on-going, additional financial support) and cessation of the TSA accreditation.

Detailed financial information relating to the five options was summarised in the following table:

Table A

Option	Potential Budget Required (£)	Potential Cost Pressure Required (£)	Potential One-off Costs required (£)	Alternative Providers in the Market	Comments/Considerations
1	487,538	262,468	286,830	Yes	Recruitment/Retention challenges would remain along with challenges of a competitive market.
2	151,934	(72,956)	746,000	N/A	N/A
3	350,303	125,413	306,830	Yes	Recruitment/Retention challenges would remain along with challenges of a competitive market.
4	425,577	200, 687	378,395	Yes	Recruitment/Retention challenges would remain along with challenges of a competitive market.
5	403,435	178,545	286,830	Yes	Recruitment/Retention challenges would remain along with challenges of a competitive market.

It was noted that, although there was an increased one-off cost associated with Option 2, the pay-back period ranged from 2.22 years to 3.76 years when compared with on-going cost pressures for the other 4 options. (1.20 years to 1.48 years if also taking into account the one-off costs associated with the other 4 options).

Following the detailed review, Option 2 had been identified as the recommended option; that was to cease the telecare and lifting/response provision of the Careline Service with the service solely providing the Council’s Out-of-Hours and CCTV service. The proposal would allow current service users to transfer to an alternative provider within the market, in line with their individual needs and as best fit the customer. The Council’s Out-of-Hours service and CCTV would remain in place as a contact line supporting residents with Out-of-Hours emergencies.

Cabinet was informed that, in fulfilling its statutory Best Value Duty, a period of public consultation would need to be undertaken with customers, residents and other key stakeholders, which would also include the organisations that the Council was currently providing services to contractually. Subject to the decision proposed within the Portfolio Holder’s report, potentially impacted staff would also be consulted with, acknowledging that the final decision on the future of the service had yet to be made.

A further report would be presented to Cabinet once the necessary consultation had taken place, to enable the outcome to be considered. During this period of consultation, there would be a pause on on-boarding new customers, pending the outcome of the consultation. This would avoid a disrupted service to new customers who could potentially be quickly transferred to an alternative provider. This applied only if Option 2 was agreed as the preferred option, as per the recommendations of the Portfolio Holder.

It was further noted that if Option 2 remained the preferred option, following consultation, an additional £300k would be set aside for transitional costs; this would also include developing a detailed transition plan which would include the following:

· Contacting service users and/or their next of kin to explain the impact of the change and provide information about alternative providers.

· Redeployment options would be explored for affected staff, with redundancy considered only as a last resort.

· One month’s notice of termination would be given to Careline customers as per their contract.

That transition plan would be based on the following key principles:

· Ensuring openness, transparency, and encouraging active engagement with Careline customers so that they were aware of the choices available to them;

· Ensuring transparency and supporting customers and staff through the associated processes;

· Aiming for the withdrawal from the provision of Careline service by 31 March 2025 and terminating any associated contracts and not entering into any further agreements or contracts. No additional customers would be permitted to join the current telecare/lifting/response scheme;

· Limiting where possible, the financial risks to the Council;

· Transferring the focus to the Council’s core business e.g. Out-of-Hours, for Emergency Planning, Environmental Services and Housing.

One-off funding would support the transition plan based on the above key principles which were likely to be informed by the associated consultation process.

Cabinet was satisfied that:-

(i) given the changing market context, the recommendations of the Portfolio Holder were based on what was considered to be the best option for both service users and the Council;

(ii) several other providers on the open market offered a like for like service, at a comparable price. Furthermore, Essex County Council provided a free of charge service, if a resident was referred to them through a statutory provider, such as Adult Social Care or a health care provider; and

(iii) it was also important to highlight the continuing capacity challenges the Authority faced in meeting the needs of a range of service users, including those supported by third-party contractual arrangements.

It was moved by Councillor Placey, seconded by Councillor M E Stephensonand:-