University of Wolverhampton
MSc Commissioning
in Health and Social Care
Tuesday 23rd June 2015
Glen Mason
Director of People, Communities and
Local Government
Department of Health
Slide 1
Care Act implementation support – care markets and commissioning
Overview
• Context
• The Care Act
• Wellbeing, prevention and the whole population
• Market shaping
• Commissioning for Better Outcomes
• Care Act implementation support materials
• How do we make the most of our assets?
Slide 2
Care Act implementation support – care markets and commissioning
Care and Support affect a large number of people
Many people need some extra care and support during their adult years to lead an active
and independent life. Three-quarters of people aged 65 will need care and support in
their later years…
Who needs care? At age 65, what are your chances of
needing different types of care within your lifetime?
19 per cent of men and 34
per cent of women will
need residential care
48 per cent of men and 51
per cent of women will
need domiciliary care only
33 per cent of men and 15
per cent of women will
never need formal care
Slide 3
Care Act implementation support – care markets and commissioning
Drivers for Change in the English Care System
• Demographic pressure
• Unprecedented financial challenges
• Raising expectations
• Technological Change
• Systems failure eg: Mid Staffs Hospital and Winterbourne View
• A drive to integrate services
Slide 4
Care Act implementation support – care markets and commissioning
A shift in the care and support system
Slide 5
From
To
Repair
Prevention
Focusing only on response after a crisis
Acting earlier to prevent or delay needs
Fragmentation
Integration
Isolated services focused internally
Joined-up services working as partners
Paternal
Personal
State knows best
Person knows best
Exclusive
Inclusive
“Doing to”
“Doing with”
Care Act implementation support – care markets and commissioning
A brief history of care and support
Social care law and policy has evolved over more than 65 years, incorporating around 30
Acts of Parliament, but reform has usually been piecemeal.
National
Assistance Act
1948: established
the welfare state
and abolished the
Poor Laws
1948
NHS and Community Care
Act 1990: first major set
of reforms, including first
right to assessments and
start of commissioner/
provider split.
1960…
1970…
Chronically Sick and
Disabled Persons Act
1970: reforms to key
entitlements to
community services
Slide 6
1980…
Community Care
(Direct Payments)
Act 1996: new
powers to make
direct payments
1990…
Carers (Recognition
and Services) Act
1995: the first Act
to recognise carers
Health and Social
Care Act 2001:
updates on direct
payments
2000…
Carers and Disabled
Children Act 2000:
extending direct
payments to carers
Care Act implementation support – care markets and commissioning
2010…
Caring for our Future
The care and support White Paper was published in
July 2012 and set out the Government’s vision for the
future system.
If adult care and support in England is going to respond
to challenges it must help people to stay well and
independent:
• Promote people’s wellbeing
• Enable people to prevent and postpone the need
for care and support
• Put people in control of their lives so they can
pursue opportunities to realise their potential
Slide 7
Care Act implementation support – care markets and commissioning
• The Care Act represents the most significant reform
of care and support for a generation
• Puts well-being at heart of every decision
• puts carers on the same footing as those they care for;
• Prevents and delays need for care and support
• embeds rights to choice, personalised care plans and personal budgets, and ensuring a
range of high quality services are available locally
• Introduces a cap on care costs and provides for a new universal deferred payments
scheme;
• provides for a single national threshold for eligibility;
• supports people with information, advice and advocacy;
• ensures continuity of care when people move between areas;
• ensures that no one goes without care if their provider fails;
• Sets out duties on local authorities to facilitate a diverse, sustainable
high quality market for their area.
Slide 8
Care Act implementation support – care markets and commissioning
Market shaping and commissioning
ALL LOCAL PEOPLE
Wellbeing
Duty on local authorities to promote a
sustainable, diverse and vibrant market for care
and support that delivers high quality services
for all local people.
Sustainability
Slide 9
Care Act implementation support – care markets and commissioning
Diversity
Commissioning for Better Outcomes
• A framework of standards
• Designed for self-assessment
& peer challenge
• Prototype available now:
http://www.adass.org.uk/policy
-documents-commissioning-forbetter-outcomes/
• Designed for self-assessment
& peer challenge
Slide 10
Care Act implementation support – care markets and commissioning
Commissioning for Better Outcomes
Good commissioning….
• Promotes health and wellbeing for all
• “This covers… maximising people’s
capabilities and support within their
communities, commissioning services to
promote health, wellbeing, preventing,
delaying or reducing the need for
services…”
• Is coproduced with people, their carers and
their communities.
• Demonstrates a whole system approach
• “ensure[s] the best use of all resources in
a local area through joint approaches
between the public, voluntary and
private sectors”
Slide 11
Care Act implementation support – care markets and commissioning
The Standards
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Slide 12
Person-centred and focuses on outcomes
Promotes health and wellbeing
Delivers social value
Coproduced with local people, their carers and communities
Positive engagement with providers
Promotes equality
Well led
A whole system approach
Uses evidence about what works
A diverse and sustainable market
Provides value for money
Develops the workforce
Care Act implementation support – care markets and commissioning
Slide 13
Care Act implementation support – care markets and commissioning
Outcomes-based commissioning
• Fifteen-minutes visits vs “time & task”
• Reablement
• Prevention
• Personalisation
• System transformation
Slide 14
Care Act implementation support – care markets and commissioning
Market Shaping Toolkit (MaST)
• Supporting SME providers and LAs to work together
• Market Position Statements
Expected: June 2015
• Micro-providers
• Promoting innovation
• Case studies, and practical tools
• Meeting local need, procurement, workforce, sustainability,
technology…
Slide 15
Care Act implementation support – care markets and commissioning
Think Local Act Personal
• Top tips for commissioning for
diversity
 Asset based approaches
 Unpicking ‘diversity’
• Co-production in commissioning
Both expected: June 2015  Personal outcomes
Slide 16
Care Act implementation support – care markets and commissioning
Thoughts and questions?
Slide 17
Care Act implementation support – care markets and commissioning