Market Position Statement
Workshop
22 January 2015
Programme
Time
Activity
Person
12.00 – 12.15
Refreshments and registration
12.15 - 12.30
Welcome and introductions
Cathy Kerr
12.30 – 12.50
Update from last session
Cathy Kerr
12.50 – 13.10
The Care Act 2014 for Providers
Gill Ford
13.10 – 13.30
Update on Outcome Based Commissioning
David Sykes
13.30 – 14.00
Q&A Panel
David Sykes
Gill Ford
Amanda McGlennon
14.00 – 14.20
Coffee break
14.20 – 15.20
Group discussions:
1. Innovation
2. Partnership working
3. Quality and service standards
All
15.20 – 15.40
Feedback session
All
15.40 – 16.00
Evaluation and closure
David Sykes
Aim and Objectives
Aim
To engage local providers in order to inform our commissioning and
market shaping responsibilities
Objectives
1. Discuss Providers local development plans
2. Consider how the Council can support local provider market
3. Agree mechanisms for effective partnership working between
Council and local providers
Update from last session
Cathy Kerr – Director of ACS
Context
• Market Position Statement (MPS) event held 12th March 2014
• MPS document published on Richmond website at
http://www.richmond.gov.uk/lbrut_market_position_statement_2014.pdf
• Case for change:
• Council acknowledged the need to commission differently and engage
with Providers and Service Users in a meaningful way in order to
ensure Service Users` outcomes are met
• Focus on preventative services and enable Providers to be creative
• Real partnership working and co design with Providers and Service
Users and their Carers
Financial context
• Legislation largely reflects current best policy and practice but with
some significant and substantial changes
• Key areas of financial risk for 15/16, new rights for Carers
• Forecasting demand (future behaviours) is not an exact science
(managing the known unknown)
• Detailed metrics and financial modelling is only a part of the jigsaw
(‘soft’ evidence also required)
• Need to redirect financial resources to enable people to be
supported in their own homes and communities
• Exploring joint working with other Boroughs
What Service Users/Carers said to us…
Co design
services
Local
support
Accessible
services
Dignity
Choice of
services
Good quality of
Empowerment
life
Holistic
services
Integrated
care
Access to
info and
advice
Advocacy
Involved in
decisions
Take risks
Key worker
What Providers said to us...
Develop
capacity
locally
Career
opportunities
Relation
ship with
SU/Carer/fa
mily
Develop
Sub
contracting
Contracts
Flexible
delivery of
services
Empowered
staff
Focus on
outcomes
relationship
Staffing
Skilled staff
Promote
local
delivery
Proportionate
Innovation
monitoring
Partnership
working
What we did…
Preventative services
• Community Independent Living Service (CILS), commissioned
December 2013 (mobilisation completed April 2014)
• Richmond Response and Rehabilitation Service, commissioned
October 2013 (mobilisation completed January 2014)
• Review is in progress for the following provision:
• Information and advice offer including the Council's external website
• Advocacy provision
• Explored opportunities to use technology more innovatively e.g.
Older People Technology workshop
What we will do…
• Explore new opportunities to address the self funders market
• Commission services where Service Users/Carers take informed
risks
• Develop integrated services which promote choice and control
• Use the Co production group (Service Users, Carers
representatives) to understand people`s views and wishes
• Commission Outcome Based Services (e.g. Help to Live at Home,
Outcome Based Programme for community health services)
• Engage more with Providers to better understand and shape the
market
Help to Live at Home - objectives
• Allow as many people as possible to remain in their home after a
serious life crisis
• Allow people to exert choice over what happens next for them,
including:
• defining their own life outcomes; and
• agreeing and committing to a support plan intended to help them meet
their outcomes;
• Incentivise providers to help people to realise their outcomes by
paying providers by results
• To reduce the cost of the traditional home care service.
Residential Care Provision (Care UK)
• Re profiling beds in Care UK PFI contract
• Local need is for more intensive nursing and
dementia beds rather than residential
• Commission additional extra care provision locally
The Care Act 2014 for Providers
Gill Ford - Care Act Programme Manager
Context
• The Care Act came into law in May 2014
• Many new duties but also put on a statutory footing existing best practice
such as Personal budgets & direct payments (the latter still the preferred
option for personal budgets)
• Whilst the legislative base has changed totally, in practice much will
remain the same for providers
• Key change is that the Act encompasses the whole population
• This presentation is focussing on key changes for providers and what is
happening in Richmond
Implementation timescales
Key requirements
Timing
Duties on prevention and wellbeing
From April
2015
Duties on information & advice (inc paying for care)
Duty on market shaping
Assessments (including carers’ assessments)
National minimum threshold for eligibility
Personal budgets and care and support plans
Safeguarding
Universal deferred payment agreements
Extended means test
Care accounts
Capped charging system
From April
2016
Promoting Wellbeing
Whenever a local authority carries out any care and support functions,
it must promote wellbeing described as:
• Personal dignity including respect
• Physical and mental health and emotional wellbeing
• Protection from abuse and neglect
• Control by the individual over day-to-day life (including over care
and support and the way it is provided)
• Participation in work, education, training or recreation
• Social and economic wellbeing
• Domestic, family and personal relationships
• Suitability of living accommodation
Prevention
• Applies to all adults, including people who do not have any current
needs for care and support, or people with no eligible needs
• Three levels of prevention:
1. Prevent: primary prevention – promoting wellbeing
2. Reduce: secondary prevention – early intervention
3. Delay: tertiary prevention
Richmond Council is developing a prevention strategy with
Richmond CCG and other local partners; one outcome of this will
be a commissioning plan.
Information and Advice
Information and advice services for all residents, to include:
• How to access care and support locally
• The types of care and support locally and nationally and the
quality of locally provided care
• The likely costs to the person of the care and support services
available to them including costs that the Council pays
• How to access independent financial advice on matters relating to
care and support
• How to raise concerns about the safety or wellbeing of an adult
with care and support needs.
Richmond is implementing a local resource directory using Careplace.
Carers
Same rights for carers as those they care for example:
• Wellbeing principle
• Preventing needs for support
• Right to assessment
• Eligibility: national minimum threshold for carers
• Planning: rights to personal budgets, direct payment, support plan
• Market shaping - ensure appropriate services for carers
Richmond is developing a local carer’s offer
Market Shaping and commissioning
Duty on councils to facilitate diverse, sustainable, high quality
services in their area to provide people with meaningful choice
regardless of who pays for care – it covers the whole market.
Underpinned by these principles:
• Focusing on outcomes and wellbeing
• Promoting quality services, including workforce development and
remuneration and ensuring appropriately resourced care and support
• Supporting sustainability
• Ensuring choice
• Co-production with partners
Richmond is reshaping its Market Position Statement
Managing provider failure & market oversight
• Provider Failure: Triggered “when the service can no longer be provided”
Council has temporary duties to meet people`s needs. This already
happens (think of Southern Cross)
• Market oversight applies to largest and difficult to replace providers i.e.
domiciliary care providers delivering 30,000 hrs or 2.000+ people a week,
care home providers 2.000+ beds
• Providers have a duty to provide information to CQC who assess
sustainability and inform local authorities as early warning when they
consider a provider is likely to be unable to continue.
Richmond is waiting for CQC to issue guidance on market
oversight in January 2015 to understand Council responsibilities
Financial sustainability of other providers (not in the
CQC oversight regime)
• Will affect vast majority of small and medium providers.
• LAs must ensure continuity of care in respect of business failure of all
providers and so need to have contingency plans and an understanding of
the likelihood of failure of providers in their area
• Authorities need to have an understanding of current trading conditions
and the sustainability of their pool of providers in order to focus their
contingency planning
• Strengthens the need for contingency planning on all parties
Richmond is waiting for the LA toolkit for Contingency planning for
care provider failure to be issued April 2015
Advocacy
• New duty: Where the local authority considers that a person has
substantial difficulty in being involved with their care and support
then they must consider whether there is anyone appropriate who
can help the person to be fully involved, e.g. family member or
friend.
• If there is no one appropriate, then an independent advocate must
provide support and represent the person in the assessment,
support planning and review.
In Richmond we are reviewing current provision and will be going
out to tender for a new services in 2015.
Funding changes for 2015
• Deferred payments: People do not have to sell their homes in
their lifetime to pay for residential care
• Self-funders with care at home may ask their local authority (LA)
to arrange their care; the person cannot be charged more than the
cost the LA is able to secure, plus an admin charge.
• Rules on ‘top-up fees’ are re-enforced to make clear that all
arrangements must be through the LA. A provider must not seek
a ‘top-up fee’ directly with the person receiving LA funded care.
In Richmond we are consulting on our charging policy for
deferred payments and for arranging care for self funders
Funding changes for 2016
• Self-funders in a care home may ask their LA to arrange their care;
the person cannot be charged more than the cost the LA is able to
secure, plus an administration charge.
• Extension to the point at which means tested support becomes
available. This means more people eligible for Council funded care.
• Introduction of the cap on care costs (care accounts).
In Richmond work has not yet started. Waiting draft guidance from
DH and also results of national work on the impact of self funders
accessing care home beds at LA rates
Safeguarding
• Safeguarding now on statutory footing
• Providers have a duty to co-operate during a Safeguarding Adult
Review
• Providers must have a Designated Adult Safeguarding Manager
• All providers must have safeguarding policies and procedures
Richmond: Implementing Making Safeguarding Personal to ensure
service user is at the centre of the safeguarding process
Integration, cooperation & partnerships
Local authorities must:
• Carry out their care and support responsibilities with the aim of
promoting greater integration with NHS and other health-related
services
• Duties also apply from NHS bodies to LA
In Richmond; JCC set up to deliver joint commissioning and
working with CCG in delivering OBC through community provision
Summary for providers 2015
•
•
•
•
•
•
•
•
•
•
Market Shaping interaction with local authorities
CQC Market Oversight & Business Failure regime
Duty to arrange care for self funders at home using Council rates
Statutory Safeguarding
Information & Advice and Resource Directory
Services aimed at prevention
Independent advocacy
New & different services as a result of integration
More demand for carer services/support
National communication campaign starting February 2015
Summary for providers 2016
Duty to arrange care for self–funders in care homes at Council rates
Capital limits raised so more people eligible for Council funded care
Care account commences April 2016
Assessments of existing self funders in care homes to start autumn
2016
• More people known and potentially supported by the Council
• National communications campaign starting post general election
•
•
•
•
Outcome Based Commissioning
David Sykes – Interim Head of Joint Commissioning Collaborative
Commissioning for Better Outcomes
“Effective commissioning plays a central role
in driving up quality, enabling people to
meaningfully direct their own care, facilitating
integrated service delivery, and making the
most effective use of the available resources.”
Commissioning for Better Outcomes : A route map
What matters..
“What matters most to people?
The person at the centre, rather than fitting them into services
People who use services and carers treated as individuals
Empowering choice and control for people who use services, and carers
Setting goals for care and support with people who use services and carers
Having up to date accessible information about services
Emphasising the importance of the relationship between people who use services and
providers and staff
• Listening to people who use services and acting upon what they say
• A positive approach, which highlights what people who use services can do and might
be able to do with appropriate support, not what they cannot do
Clenton Farquharson MBE, Co Chair Thin Local Act Personal”
•
•
•
•
•
•
Standards for good commissioning..
• Are designed to ensure that everyone shapes and shares the vision
of excellent
• Support the development of a common focus and purpose across
the system, driven by shared values and behaviours care and
support
• Seen as a route map for that journey rather than the final
destination
What good commissioning means (1)
Domain
Covers the..
Standard
Person-centred and
outcome focused
Quality of experience of people
who use social care services,
their families and carers and local
communities.
1. Person-centred and focuses
on outcomes
2. Promotes health and
wellbeing
3. Delivers social value
Inclusive
Inclusivity of commissioning, both
in terms of the process and
outcomes.
4. Coproduced with local
people, their carers and
communities
5. Positive engagement with
providers
6. Promotes equality
What good commissioning means (2)
Domain
Covers the..
Standard
Well led
How well led commissioning is by
the Local Authority, including how
commissioning of social care is
supported by both the wider
organisation and partner
organisations.
7. Well led
8. A whole system approach
9. Uses evidence about what
works
Promotes a sustainable
and diverse market place
Promotion of a vibrant, diverse
and sustainable market,
where improving quality and
safety is integral to commissioning
decisions
10.A diverse and sustainable
market
11.Provides value for money
12.Develops the workforce
Outcome Based Commissioning (OBC) Programme
• OBC means thinking more about what the services we commission
achieve (outcomes for people) instead of how they operate
• Under OBC contracts, service providers are paid for delivering a set of
outcomes for people rather than for the amount of activities
undertaken
In Richmond, the OBC programme will run across five phases.
OBC Phases
Outcomes framework - generic outcomes (1)
Outcomes framework - generic outcomes (2)
Engagement process on OBC
• Engagement process with Service Users/Patients
and their Carers undertaken from July to
September 2014
• Development of an outcomes framework
• OBC contract not yet finalised, more important is
to work with providers about how to focus on
outcomes
What does this mean for Providers
• Different ways of working
• OBC moves back towards partnership relationship
and co design
• Moves the focus back to what Providers deliver for
the people they support
• Reduces admin tasks and monitoring
• Incentivises performance
Procurement exercises – 2015/2016
No.
Initiative
Est. Annual Value
1.
Learning Disabilities Residential and
Supported Living Services Phase 1
£4,500,000
2.
Learning Disabilities Residential and
Supported Living Services – Additional
Phases
£3,100,000
3.
Supporting people (Tenancy Support,
Domestic Abuse)
£442,636
4.
Help to live at home
£6,000,000
5.
Carers Hub Service
£421,000
September 2015
6.
Advocacy provision
£200,000
October 2015
7.
Home maintenance service
£80,000
January 2016
8.
Community Equipment
£1,100,000
Estimate date for tender
/Market engagement
February 2015
May- November 2015
May and November 2015
June 2015
April 2016
Next steps
David Sykes – Interim Head of Joint Commissioning Collaborative
Next steps
• This is just the first event in a series
• Engagement plan will be circulated by end March
2015
• Providers will be co-opted to help the Council codesign future services and contribute to shaping
future MPS (Provider Reference Group). We will
take into account Providers who volunteered in the
past
Evaluation