Transcript Slide 1

Developing Independence, Choice and
Control – 20 January 2011
“The Task of Developing the Market”
– An approach to market facilitation
Trudi Wright – Yorkshire & Humber JIP, Community
Capacity Building Project
PPF – a four part ambition
Leisure, transport etc
Information advice
and advocacy
Volunteers
Neighbours
Community networks
User-led organisations
Enablement
Assistive
technologies
Better housing
options
Personal budgets
Person-centred
support plans
Responsive, flexible services
The Y & H Region / Regional
Commissioning Group and IPC
• JIP
• RCG
• IPC – a national leader on commissioning
and social care
• Managing a two year programme on
improving commissioning across the
region.
• One strand of the work focuses on Market
Development and facilitation.
Today – Briefly look at...
• National drivers –
– size and state of the social care market
– Policy and assumptions
• Market facilitation activities
– Market intelligence
– Market structuring
– Market intervention
• Points to “ponder”
Demand and Demography (UK)
• In 1984, there were around 660,000 people in the UK
aged 85 and over, by 2009 that number has reached 1.4
million
• By 2034 the number of people aged 85 and over is
projected to be 2.5 times larger than in 2009, reaching
3.5 million, some 5% of the total population.
• Population with a LD also rising albeit slowly.
• 70% of acute hospital beds are occupied by older
people, 40% of this group have a dementia.
• Different views about whether longevity will continue
Demand and Demography
(Kirklees)
• Population aged 80 and over is 17,000. This is
projected to grow to 31,000 by 2030, an
increase of 82%.
• Within that number those aged 85 and over will
grow from just over 8,000 to 15,500 an increase
of 93%.
• Over the same time period the number of people
aged 65 and over predicted to have a dementia
will grow from just over 4,000 to 7,000.
Sources POPP
Supply - the size of the market
• Care market still diverse; as of March 2007:
– There were 4,735 home care agencies
registered with the CSCI
– There were 18,577 registered care homes for
adults of all ages, with 441,958 places
• In 2005 there were some 378,000 units of
sheltered housing and 20,462 units of extra
care. Does not cover the private sector. Likely
the latter has grown and the former diminished.
Supply - funding & finance
(England)
• Public-sector spending should be reduced by £83bn by
2014. Comprehensive spending review dictates the
precise cuts in each area
• Projected sceanario for social care to reduce by a third
over the next four years
• By 2013-14 the NHS should have cut its management
costs by 46 per cent – equivalent to £850m – on 2009-10
levels, according to the revised operating framework.
Sources IFS, Community Care, Health Services Journal
Supply - funding &
finance(Kirklees)
• Kirklees spends £100 million on social
care, of which £55million is spent on older
people and £26 million on adults with a LD
(the second highest spend within the
region).
Sources NASCIS,
Supply - The state of the market
• The current economic climate makes it harder for
providers to raise funding to start new developments,
initiate change and be experimental in their approach to
social care. Recession may encourage a retreat to
traditional forms of care delivery and funding
• If the amount of social care funding per person available
diminishes then some providers may prefer to only
supply to self funders or diminish their proportion of
publicly funded service users
• Equally, some providers in their desire to secure
contracts may be tempted to agree to conditions and
prices that they will be unable to deliver
Supply - The state of the market
• Costs are likely to increase through greater
transaction costs
• Danger of ECH market stalling and where it
continues of ECH becoming residential care in
flats rather than a lifetime home of choice with
diversity in design and tenure being key
• Issues of regulation home care v personal
assistants.
• Greater purchasing by individuals may increase
uncertainty over future guarantees of business
Supply - The state of the market
• Overall, to make the consumer king - calls
for supply to exceed demand, plentiful
competition, and price being the overriding
consideration in purchases. It holds true
for the grocery business but does it hold
true for the care business?
Policy – Social Care
Transformation
• Capable Communities and Active Citizens
– Practical approaches to market and provider
development (DH Nov 2010)
– Set a framework for shaping the local market
of care and support (4 x elements)
•
•
•
•
Strong engagement
Market intelligence
Provider development
Flexible arrangements
Policy - NHS White Paper,
Local Authorities’ new functions
• Transfer of PCT Health Improvement functions to LA’s
and abolish PCT’s
– Better alignment with local health and well being
responsibilities.
– Establish Health and Wellbeing Boards.
– Joint commissioning of social care and health
improvement.
– Strategic integration across health and adult social
care, children’s services and wider local authority
agenda.
Summary of Policy Aspirations
• Greater integration and partnership working - NHS, social care,
public health and other local services and strategies
• That more service users will purchase their own care through
personal budgets
• That services users will in general have greater control over their
care provision
• That the local authority will continue to move away from being a
direct provider of care and from being a block purchaser of services.
• That the local authority’s primary task is to ensure that there is
sufficiency of supply to offer choice within the market place
• That this is achieved through a lower level of funding
Assumptions about the market
that need supporting
• That a view needs to be taken of the whole market not
just services that are funded, or delivered, by, social care
• That the local authority and the public do not benefit from
the market diminishing in volume
• That the market will not get to where it needs to be just
through users purchasing
• That existing tendering and procurement processes
need to change
• Need to recognise that expertise has increasingly shifted
towards providers
Assumptions about the market
that need challenging
• That we can continue to afford high cost / low delivery inhouse provision
• That choice is paramount and available and will be
exercised
• That GPs as commissioners can deliver, what the
government desires and that PCTs can control the acute
sector
• That providers will be amenable to local authority
influence
• That market intelligence and influence is a cost free
activity
The activities of market facilitation
The interventions commissioners
make in order to deliver the kind
of market believed to be
necessary for any
given community.
Market
intervention
Market
intelligence
The development of a common
and shared perspective of supply
and demand, leading
to an evidenced, published,
market position statement
for a given market.
Market
structuring
The activities designed to give the market shape and
structure, where commissioner behaviour is visible
and the outcomes they are trying to achieve
agreed, or at least accepted.
Market Intelligence – Assessing
demand
• What is the relationship between populations and people
who currently receive a social care service (past, now
and in the future, between self funders and those
receiving state assisted care)?
• Is it possible to distinguish between populations that are
known, those that the social care function should know
and those that are likely to remain unknown?
• What surveys of the general public and of service users
have been conducted? Can these be brought together
with material from inspection reports and national
research into clear indications about future trends and
desires?
Market Intelligence – Assessing
supply
• Review the size, location and range of the local market
(s)
• Review the quality of services and identify what are the
local market pressures
• What are providers view of demand and the impact this
might have on their business?
• Develop a view of good practice (in particular not just the
shape of individual services but their overall
configuration).
• Have an effective grasp of simple cost-benefit analysis.
The Market Intelligence Product- A
market position statement
The product from the review of demand and supply should
be a public, published document which should describe:
• The overall market direction the local authority (LA)
wishes to see taken
• The LA’s view and predictions of future demand,
identifying key pressure points
• The LA’s picture of the current state of supply covering
both strengths and weaknesses within the market
The Market Intelligence Product- A
market position statement
• The areas where the LA wishes to see services develop
and those areas where it is less likely to purchase or
provide in the future or encourage service users to
purchase
• Identified models of practice the LA will support at what
price
• The support the LA will offer towards innovation and
development
Market structuring – external
activities (1)
• Publish the MPS and use it as a ‘calling card’ for
meetings and discussions with current and potential
future providers
• Actively promote the model of what the range of care
should look like based on good practice
• Develop an awareness of providers long term business
plans and where future support might be needed.
Identify business cycles across the third and private
sectors.
Market structuring – external
activities (2)
• Discuss whether support to strategic business planning
is needed
• Work with providers to assess the impact that greater
choice, via personal budgets and direct payments, might
have on costs and availability of service provision
• Where demand for a service exists and where the
provider is vulnerable, then identify how commissioners
can reduce that vulnerability
Market structuring – external
activities (3)
• Identify where there are barriers to market entry where
new resources are needed and identify with providers
how these might be overcome
• Look for potential diversification amongst existing
organisations’, e.g., can RSLs do care and repair, can
home care agencies deliver assistive technology
• Work with providers on an open book accounting model
to cost out new developments and innovations
Market structuring – internal
activities
• If there is ‘in house’ service provision, be clear about
where and why the LA is a provider. Diminish
differences between in-house and external systems
where these potentially compete in the same market
• Open up discussions with planning, business support
and regeneration
• Review tendering and procurement processes, evaluate
their impact on provider communities and explore how
improvements can be made that will help drive the
market
Market intervention
• Refocus local authority business support initiatives on to
the health and social care market
• Explore how local projects can attract capital investment
and what guarantees may be needed
• Develop social enterprise organisations
• Explore where planning barriers exist and negotiate how
that process can be improved for providers
• Offer access to training that commissioners and
providers agree can improve performance
• Promote local ‘Which type’ care guides which
emphasise a consumer perspective
Points to ponder - together
• What do we need to do to develop quality market
position statements and what should we do with these
once developed?
• Do we know what the range of services should look like
to meet demand?
• Have we modelled the potential impact of change, eg,
the impact PA’s might have on the home care market?
• What do we need to do to reduce reliance on residential
care?
• What financial stimulus package needs to be on offer to
the market if we are going to have influence?
For more information or to talk
• Trudi Wright, JIP Project Manager
– [email protected]
– 07980 911 654
– www.yohrspace.org.uk