Transcript Document

National Care Association
Annual Conference
The commissioning challenge
Jenny Owen CBE
Deputy Chief Executive and Executive Director for AHCW
Representing ADASS
21st October 2010
Financial Context
National
• National Government Debt £900billion.
Interest in 2010 estimated £42.9Billion
• National Government cuts £6.2 Billion for
2010-11
• An estimated £5.6 billion increase in the cost
of Adult Social care by 2015, to meet the
needs of Britain’s growing ageing population.
(LGA spending review, 2010)
• In Essex planning assumption is £62 m off
£350m budget in 4 years
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Some implications for
Local Government
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New deal between society, citizen and State
LAs to move from “delivery” mindset to outcomes
Engage people in agreeing outcomes
Lean process – focus on assurance not audit
Moving commissioning to a very local level
Government reform agenda
for Social care
• Vision – 5 “P”s:
– Prevention, personalisation, professionalism,
protection and partnership
• Concordat – building on “Putting People First”
• Commission on funding
• Review of law
• White paper 2011
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How do we respond ??
• Traditional model of operation is not sustainable
• Working in Partnership is key
• Drive out inefficiency and capitlise on opportunities from NHS
and social care changes
• Focus needs to be on cost effective interventions and most cost
effective models of care and support
• Embracing prevention and wellbeing agenda
• Better signposting and information about paying for social care
funding
• Self Funding means Self funding- Signposting to Financial
Advisors
• Personalisation- Creative solutions which are cost effectiveChoice that is cost effective.
• 5…..How are you positioning yourself?
“What” LA’s are going
to commission
6 components of an effective system:
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Prevention
Recovery
Continued support
Efficient process
Partnership
Contributions
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1. Prevention
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Access to mainstream life, prolonging independence
Access to information and advice (and digital)
Affordable and reliable practical support
Telecare and simple aids to daily living – without
assessment
Social contact – through informed support
networks/local voluntary efforts
Model to identify those most at risk
Targeted services for greatest impact e.g. podiatary,
incontinence, dehydration, falls
Crisis/rapid response service – health and social care
2. Recovery
• Reablement – from hospital and from community
• Targeted use of telecare and aids to daily living
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3. Continued support
• Using principles of self-directed support and including
RAS
• Full range of accommodation
• Active case management and reviews
• Selection of equipment from retail market
• Full use of telecare
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4. Efficient process
• Stop or minimise anything that does not add value to outcome
for person
• First point of contact easy to final, signposts and resolves
simple issues
• Assessments are proportionate to risks and needs, and
assessments of others are “trusted”
• Staff time is maximised for contact with customers
• Support planning maximises people’s own contributions and
makes creative use of community resources
• Brokerage is used to ensure support is available at right cost
and quality
• Staff are deployed to maximise scarce professional skills
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5. Partnership
• Health and social care work together locally in multi-disciplinary
teams and strategically to jointly commission services
• Councils expect full value for money from retained in-house
services – need a good reason why council is a provider (no
subsidies which constrain real choice)
• Independent sector providers are clear medium term
expectations on cost/price management and efficiencies so can
plan
• Councils work with main providers to seek ways of taking costs
out
• No inappropriate barriers to smaller and flexible organisations
being on provider lists
• Clear agreements with voluntary sector on how value is
assessed and paid for
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6. Contributions
• Fairer contributions policy which expects people to
pay if they can afford to
• Self directed support process is clear about
contributions in kind from families
• Council promotes and encourage wider social capital
e.g. Volunteering
• Culture of supporting people to take responsibility for
their likes to best of the ability
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“How” are we going to commission
• LAs as commissioning organisations (but with delivery
vehicles e.g. Essex Cares)
• With the new commissioners – GPs
• At personal level, at strategic market shaping level,
and in localities with “Place based budgets”
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Conceptual target operating model
Principles
Not assumed elements of
model will be inhouse
Focus on self service online
approach
Focus on light touch Risk
based approach
Significant reduction in public
sector resource
UIAG
Early intervention/Prevention
with Health
Single Access
Self or Supported Assessment
£Cash
Brokerage
Self
funders
“Market”
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What does it means for
you?
· Service users with cash
allocation
· Increased Competition
· Requirement to Market
business offer to service
users
· No Local Authority block
purchase
· Respond to service user
requirements/new
services
· Real choice from the
Service Users- Focus on
price, quality and
service
· Strengthening service
user relationships with
providers
Issues/Challenges
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Residential Markets
Improved quality of service required.
The markets need to help drive prevention and early intervention.
Costs must be removed from the supply chain to cope with
demographic growth
Assistive technology must be used to drive demand to other
market segments.
More flexible use of Housing required to provide a bridge
between residential and home care.
Some localities have supply shortages resulting in lack of choice
and little competition.
Costs are very high for providing services to working age adults.
Information on price and quality is not easily available to
customers.
The market is fragmented with a few national players and many
15one or two home companies.
Cont’d…
Home Support Markets
• Improved quality of service is required.
• Customer are likely to choose more innovative ways of having
their needs met under personalisation.
• Personalisation will only develop if products and services are
available in the market that meet customer needs and desired
outcomes.
• There is likely to be increased use of personal assistants and self
employed carers. Supply is not developed.
• Assistive technology, telecare and reablement services must be
used to delay entry to residential care.
• Demand must be driven to universal markets utilising social
capital if available funding needs to cover demographic growth.
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Future Market
• Key Features
• Demand modelling- Quantitative and qualitative picture of current
and future demand
• Service users have unbiased access to information and Financial
Advice
• Collaboration between CQC and ECC to drive up standards and
quality of care
• Shift to outcomes rather than cost and volume
• Increased collaboration- Providers as partners
• Diverse property market suitable for older people and into which
health and social care services can be delivered
• Greater financial planning and protection for self funders
• Move towards more holistic care
• Growth in personal assistants
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Feedback
• Provider feedback
– More information and frequency of information for
sharing updates in particular about how the services
are developing in line with regional/national changes
– Providers unsure how to engage with ECC in
innovation and service development
– Verbal communication is mainly with SPT, quality
monitoring and contract management team
– Inconsistent information is given
– Unsure of who the best person in ECC to contact is.
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Partnership
1) Engagement
Channels
What, when, how, who?
2) Concessions/
Support
What, when, how, value?
•Website, newsletters,
providers events, 1to1
meetings, telephone calls..
•Bank of Essex, CRB
check, training support,
consortia, use of ECC
contracts, staff
discounts….
Collaboration and
Engagement
3) Supply
Consortia
Structure, approach,
partnership,
collaboration?
•Collaboration of suppliers
•Full supply market
facilitated to exploit
collaboration opportunities
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4) SME
Development
How to support, current
offer, embed activity?
•Current support on
offer
•Communicate offer
•Pro-active support
•Embed as part of
wider collaboration
Combined approach
•Four areas aligned to
provide consistent
approach and offer
•Common engagement
channels defined and
established
•SME development to
be integrated into
approach rather than
separate
•Supply Consortia
developed as key
vehicle for engagement
and collaboration
•Concessions/support
defined and facilitated