Good Commissioning?
Wendy Fabbro
Strategic Director, People Group
Warwickshire County Council
Commissioning and Contracting conference
11 September 2014
“The vision for social care is clear.
This is a care system which seeks through
prevention to keep people as independent as
possible with good advice and information,
preventative approaches such as reablement
and enablement before personal budgets
provide as much choice and control as
possible for service users and carers. There is
a strong momentum for joining up
commissioning, and where appropriate,
provision with health and other services such
as housing”
• Current picture of use of
resources and demand..
What do the budget surveys tell us?
Impact to date
• Total annual savings from adult social care of £2.68bn
by March 2014 – 20% of net spending
• Most of the savings are through “Efficiency savings”
but significant pain involved:
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providers squeezed on prices;
care packages reviewed;
services outsourced;
providers changed
• Quality maintained so far: 86 per cent of councils said
that the quality of life for services users had not been
lowered, while only 5 per cent thought that the quality
of care had fallen
What do the budget surveys tell us?
Fears about the future
• 19 per cent councils think quality of care will be lower
• 50 per cent think that fewer people will be able to
access adult social care services in two years time
(26% fewer OP received a public funded service in 12/13 than
5 years previously)
• 50 per cent fear that people will be getting smaller
personal budgets
• 57 per cent think providers will be facing greater
financial difficulty
• 42 per cent anticipate more legal challenges
Demographic Pressures
• Budget survey has consistently shown that demographic pressures
are about 3% a year (and this may be understated)
• This is not just about an ageing population but also the increased
costs of caring for younger adults as their needs become more
complex and informal care arrangements breakdown
• There is also unmet need. A summary of national research into
unmet need (Southampton University) identified
– only 20% of people who report difficulties with dressing and bathing
receive support from social services.
– 50% are supported by their family and friends;
– 3% pay privately for support and
– 32% do not receive any support.
• A substantial proportion of care for people is provided by informal
carers whose willingness and ability to perform a caring role is
reducing. Over the next 20 years the supply of care by adult children
will grow by 13% (assuming unchanging propensity to care) while
demand for care will increase by 55%
Position of local government
•Net spending on adult social care £13bn
•34% of total local government spending (£39bn)
Projected 1.9 million gap prior to Care Act
•Local government is faced with funding reductions of 33% over 4 years
– approximately 8% a year.
•In contrast, total public spending is being reduced by 8% over 4 years
Significant reductions in local government funding will impact on adult
social care. There is no choice in that.
And then there is the Care Act and service for self funders…
A new settlement for health and social
care
what does the Care Act says
about commissioning?
What the Care Act 2014 (section 5)
says..
• Must ensure that the wellbeing of patients and carers, and
their required outcomes are central to enable people to stay
independent as long as possible
• Must facilitate markets to continuously improve quality,
innovative services including fostering a workforce
• Must comply with Equality Act 2010
• Must develop markets for care and support
• Must step in to ensure continuity of care if a provider fails
• Must encourage a variety of providers and services
• Must ensure sufficiency of provision
• Must facilitate information and advice to support choice
• Must have regard to co produced guidance on integration
Market shaping and commissioning of
adult social care and support
Local authority
H i
Strategic commissioning
H i
g h Q u a
Market Position
Statements
g h Q u a
Market
intervention
i
i
Market
l
l
t
t
Vibrant
Diverse
y S e
y S e
r
r
Sustainable
v
v
i
i
c e s
c e s
• Supplementing and
supporting (incentivising)
informal care, facilitating
whole market
• Analysing and
forecasting sustainability
• Market balancesufficiency, sectors
included,
• Co produced and
integrated
ALL LOCAL PEOPLE
how will we demonstrate
excellence in commissioning?
Healthwatch,
Assembly
Health and wellbeing
Peer reviewers
Case reviews
feedback
Surveys, collating
reviews,
reference groups
Contract decision
Well led commissioning:
-understand needs, including
self funders and forecast needs
-secure sufficient supply and
choice of appropriate service
-Assure quality
-strategies to meet need
-workforce strategies( pay, t&c,
training
-transparency
Person centred and outcome
focused:
-Promotion wellbeing/prevent
/reduce/delay need for care
-consider ASCOF/NICE&
Outcomes are central, to
payments
Sustainable and diverse
market:Engage with providers and
facilitate/ understand the
market and business plans
-Financial viability and vfm
-monitor quality
-flexible to fluctuating care
needs
Inclusive and co produced:
-Integrate with partners where
it makes sense
-co produce with Sf and SU
ADASS/DH/TLAP Commissioning
standards
• 4 domains:– Sustainable and diverse market
– Well led commissioning function, promoting
quality
– Person centred / outcome focused
– Inclusive and co produced
Advice sources
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TLAP Leadership framework for empowered and healthy communities
TLAP Commissioning for Provider diversity
Making it Real “I” statements
Guidance on outcome based commissioning-Better commissioning (Kerslake), and IPC
website(ipc.brookes.ac.uk)
Preventive – Leeds MPS
ADASS top 10 tips for home care commissioning
SCIE guide to commissioning home care for OP
How to commission the ASC workforce ipc
Developing care markets for quality and choice (ipc website)
LGA peer review KLOE
UKHCA min price for home care
Laing and Buisson
ADASS paying for care calculator
Commissioning for provider diversity- shared lives plus
Mencap- commissioing for profound and multiple disabilities
Hertsdirect.org emarketplace
Gov.uk/the-commissioning-academy
Nao.org.uk/successful-commissioning
National Skills Academy & Commissioning Now