Transcript SEWIC HIGH COST ADULT PLACEMENTS

BETTER OUTCOMES, SUSTAINABLE
SERVICES
MARK SAUNDERS SEWIC PROJECT MANAGER
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1. The Business Case
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2. Better Outcomes, Sustainable Services
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3. The Brokerage Service
Business case used data from all placements
above £600
 Approximately 1,500 placements at a cost in
excess of £86M across the 10 LAs
 Recognised need to manage existing
placements costs – ‘Better Outcomes,
Sustainable Services’
 Brokerage service to manage future costs &
maintain ‘right sized’ existing placement
costs
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Significant resources attached to AWS
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Current market reflects resettlement
programme of 1980s & 1990s
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High proportion of SMEs in this sector
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History of unsophisticated approaches to
commissioning accommodation services
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Poor historical cost control
Legacy Issues:
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LA/NHS Inefficiency
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LA/NHS Inconsistency
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LA/NHS risk adverse culture
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LA/NHS lack of commerciality
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Lack of a full understanding of provider costs
Little evidence of a logical connection between
costs and needs, especially in registered settings
Variable service quality
Care plans not sufficiently detailed in some cases
Number of small providers vulnerable to voids
Limited differentiation between supported living
and registered residential schemes in some areas
Limited separation of landlord and care functions
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Void level (vacancies in schemes) – overall around
9% across Gwent for e.g.
Demographic profile shows highest number of
placements are in age range 50 – 70 (around 39%
of total). People are living longer/young people
less willing to live in shared living schemes
Aging profile of service users
Market sector moving into ‘old age’ phase
Shared living model – is this model fit for the
future?
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Good collegiate support from ADSS Pan Wales
Commissioning Network
Learning from Far South West of England
Children's Commissioning
Mid & South West Improvement Collaborative
– high cost placements project
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Joint Gwent commissioning and operational
managers met to develop a common
approach to shared issues
All Gwent LD placements mapped
Invitation to NHS colleagues to join work
programme
Agreement to use standard costing model to
understand provider costs
Agreement to ensure that all care packages
are consistent with individual needs
0% increases while reviews undertaken
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Findings of Gwent work presented to SEWIC
Programme Board as part of Adults Brokerage
Service Business case
9 of the 10 Authorities now participating
Opportunity for an all Wales approach using the
same methodology
Established support network to share learning &
pilot approaches e.g. residential tools
Regular meetings to problem solve & plot progress
3 monthly progress reports to SEWIC Board
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Analysis of business accounts to assess financial position
of company & identify nominal hourly rate
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Analysis of management accounts to identify spend &
challenge where necessary
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Rotas used to compare real activity against spend
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Social work reassessments/reviews to ‘right-size’ care
packages
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Meetings to discuss findings with providers including
hourly rates
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Issue new care plan contracts/individual service contracts
(ISC)
Project team consists of commissioners, care
management & finance
 Dedicated time bound resources to function
outside of other priorities
 Consider creating a time limited ‘change
agent’ for care management role
 Important to meet with providers early on to
introduce methodology & ideally headed up
by Head of Service
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Desk top exercise to:
 Assess financial position of the entity
 Analysis & challenge of management accounts
 Comparison of financial data & rotas
 Establish nominal current & potential future hourly
rates
 Highlight areas where entity might become more
efficient
 Assessment of impact of proposed changes on
viability of entity
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If possible reviews headed up by practitioner
independent of day to day care management
May need to question past practice & manage
cultural change
Specification of actual support hours required for
each person placed within each care setting
Each setting assessed as a whole & shared care
hours plotted & removed using a matrix
Recognition that care hours can increase as well as
decrease
New ISCs/care plans drafted
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Meeting held with provider to inform of
outcome of the review
Headed up by senior manager responsible for
the project
Purpose to present new ISCs & negotiate new
hourly rate where required
Opportunity for provider to challenge &/or
amend revised care plans
New hourly rates & ISCs issued
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Some providers have welcomed the approach
Identified double funding – shared care hours, sleep-ins &
day activities
Care plans need to be more detailed – e.g. to specify hours of
support required
Hourly rates ranged from £11.00 to £35.00 +
Identified long term voids – query if service model is
sustainable in the longer term
Hidden inappropriate costs e.g. mortgage payments to
landlord by care provider
Supported living – landlord & care provider often one & the
same – creates co-dependency and locks commissioners &
service users into existing services
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Efficiencies are greater when internal
resources are redirected towards review
Change agent role increases efficiencies &
embeds long term change
Financial expertise is important
Input of care professionals is critical
Providers have largely accepted significant
reduction in funding levels
Service users are receiving the support they
require
Collaboration:
 Lasting change needs leadership & internal &
external partnership working
 Stress that the approach is about better
outcomes for individuals within services that
are sustainable
 Skill mix of team is critical especially role of
‘change agent’
 Consider establishment of an internal ‘Board’
to lead & drive process
Commissioning, procurement & finance
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Correct mix of specialist input to undertake
financial & business assessments within a
social care context
Specialists need to understand services that
are being commissioned & to develop positive
relationships with practitioners
Care management & the role of the ‘change
agent’
 Senior operational managers to drive change
process
 Acknowledged that some practitioners may
feel challenged
 Focuses on need to modernise services within
context of sustainability, user-centred
services that promote independence, positive
risk taking & are evidence based
Change Agent
 Team or ATM level located in operational team but works
closely with commissioners
 Understands care management, UAP, eligibility,
commissioning, ILF & SP etc.
 Credibility & positive relationships with operational staff
 Pivotal role & acts as link between care managers,
commissioners, providers & service users
 Provides care managers with the model for ‘right sizing’
 Acts as critical friend, provides professional challenge &
becomes a catalyst for cultural change
Change Agent
 Ensures that reviews are person centred,
apply consistent eligibility, meets assessed
needs, clearly specifies how much & type of
support required
 Plots scheme matrices, calculates overall
scheme support hours, validates care plans
with care managers & providers, liaises
closely with commissioners
 Attends meetings with providers
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Business case agreed by Programme Board
July 2011
Cabinet/political ascent November 2011
Staff in post February 2012
Project Plan & Terms of Reference drafted
Project Implementation Board in place
MoU & Contracts drafted
Agreed co-location with 4Cs
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Business case to be developed to create an
all-Wales database ACSR
Developed business process map
Development of provider list
Search criteria drafted
Placement search request forms – based on
‘right sizing’
Statement of Needs Form drafted
Expression of Interest Form drafted
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Workshops for providers completed
Workshops for social workers &
commissioners completed
Service Operational 18th June 2012
Review November/December 2012
Official launch spring 2013
RA identifies need for placement based on
assessment of Service User
Short listed Providers complete SNF &
EOI forms & return to ABS
Placement made. Feedback form
completed & sent to ABS
Placement approved by RA internal
process
ABS receives completed SNF & EOI forms
from shortlisted providers
ABS feedback to unsuccessful shortlisted
providers
SNF completed & sent to ABS
ABS checks returned SNF & EOI forms &
sends to RA
ABS search Approved Providers database
using SNF matching criteria
Six week review of placement
RA assess returned SNF & EOI forms to
identify a preferred provider
RA periodically completes monitoring
information & sends to ABS
ABS assume overarching monitoring role
Provider shortlist created
RA contacts preferred provider
KEY
ABS: Adults Brokerage Service
SNF & EOI sent to shortlisted providers
Funding approved & individual contract
completed & copy sent to ABS
RA: Referring Agency
Option for ABS to negotiate price with
preferred provider
Provider
SNF: Statement of Needs Form
EOI: Expression of Interest
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Create a brokerage system that works
regionally & nationally
Open book approach to making all high cost
adult placements
Ensure that professional judgement is at the
heart of delivering real service change
New & positive engagement with providers
Deliver change to MH, PD, Residential
Colleges & ‘out of region’ placements
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CAN THIS APPROACH BE APPLIED TO
CHILDRENS SERVICE PROVIDERS?