Transcript Title Page (with Photos)

Homecare Tender
Tim Wilde
Tameside MBC
Homecare Tender Process Evaluation
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Tameside
• Compact borough
• Population approx. 217,000
– 19.5% children
– 64.7% aged between 16-65
– 15.8% aged over 65
• No major issues with ‘rural areas’
• No vast differences in socio-economic status
across the borough
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Background
• 2006 reconfiguration to 28 post code zones with a Provider
delivering a range of postcodes
• 4 external & 1 internal Provider
• 2009 in-house Provider zones tendered (8 zones)
• Increase to 9 external Providers with in-house provision for
night service only
• At the time that the tendering process began there were
1341 homecare users receiving 15,105 hours per week
(aged over 65 years of age)
• At the time of tender the cost of the service was £6,554,000.
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Rational for Tender
• The initial contract period to operate within a zoning
framework ended in March 2010
• Authority had been sought to continue with the existing
arrangement until 31 March 2011 by means of a waiver
report. This was given on the understanding that the
outcomes of the Putting People First work would shape the
future of home support services
• Market testing of the service by way of a tender exercise
was therefore necessary to remain within procurement
standing order guidance
• Providers ‘outside the zoning’ asking about tendering
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Tender Process Part 1
•
Consultation took place with key stakeholders to look at future service
models- Service Users RIQ, Provider Forums and Adult Services
Teams
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Key points from the re design of the service
The pricing structure
- Previous System only allowed for 30 min or hourly calls at fixed
rates (Council set) - £10.49/hour; £6.05/ ½ hour
- New System - Hourly rate (council set max of £11.20) with the Price
for part hours calculated pro-rata (minimum 15 min call duration)
- Spend £6,554,000
- New contract identified savings of £276,000 (4.2%)
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Tender Process Part 1
Focus on outcomes
• Moving to an outcome focus away from the standard day /evening delivery
times that were tied into specific times and tasks
• To become more flexible and offer more continuity to Service Users, the
specification to include delivery between 6am and 10pm, the provision of night
and day sitting services, sleep-ins and a through the night service.
Locality Areas
• Reconfiguration of Adult Services into locality areas.
• Postcodes as per four localities business continuity
• Award the work to two providers per locality, with no provider having more than
70% of the work in any one locality or more than 30% of the total number of
hours available across Tameside (based on the current activity)
• It had been decided that implementing this model would give organisations
much closer postcodes to deliver the service, encourage collaborative working
with the 2nd organisation within their locality and maintain and improve
continuity for Service Users.
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Tender Process Part 1
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Invitations to tender were submitted to the 23 organisations currently on the
Councils Approved Provider List and operating within a Framework Agreement
70:30 Quality:Cost weighting
Minimum quality threshold of 70%; providers needed to be within 10% of highest
tenderer
11 submissions were received
5 panel – Adult Services Managers, Contracts and Service User evaluated the
tender - 10 questions and method statement
Only one organisation met the 70 % quality threshold
Legal advice was sought with confirmation that the tender could not be awarded
as stipulated criteria had not been achieved and a re-tender would be required.
A waiver report requesting up to a 6 month extension was authorised
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Interim
Interim Measures
• Some concerns were raised around issues of extending contracts with current
Providers who had not demonstrated in the tender process that they met the
quality required.
• It was recognised that this did not necessarily reflect current standards of
service delivery but rather that organisations did not demonstrate their abilities
within the tender submissions.
• Council had safeguards in place – Performance monitoring, homecare quality
forum and Provider forum.
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Review
• What Worked
– Tender documentation and weighting criteria
• Lessons Learnt
– Clearer briefing sessions for providers
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What is expected
Type of information required
How evaluated and marker
More information on the new service delivery model
– Evaluation of 11 tenders was time consuming for panel
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Tender Process Part 2
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Further briefing session with Providers from the Approved List took place. This
covered expectations for tender submissions and service delivery. This included
reference to what organisations needed to consider in completing a submission
especially around giving examples and their track record in delivering this type
of service
Invitations again went to approved provider list
15 organisations submitted
Due to the high numbers of applicants it was felt necessary to refine how the
panel were to evaluate the submissions to ensure there was not a repeat
situation of a retender.
Firstly, each panel member would mark 2 identified questions from a total of 10
Secondly, Providers would also attend an interview as part of the process. The
interviews were to allow the providers the opportunity to clarify points from their
written questionnaire and allow panel members to calculate an overall score.
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Tender Process Part 2
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The cost element was given a weighting of 30%
Council set maximum rates (see below) and providers asked to consider
submitting a lower price
2011/2012
Maximum
£
Standard Hourly Rate
£11.20
Night Sit
£86.46
Sleep In
£50.86
Night Service
Standard
Hourly Rate +
33.3%
Bank Holiday
Increase
+50%
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Tender Process Part 2
• 9 Providers met the quality threshold
• A total of 8 Providers were proposed for award of
the contracts across the locality zones
• Submitted rates varied from £10.45/hour up to
£11.20/hour
• Based on tender information (14k hours) an
additional saving of approx. £155K
•
Note: 2 local providers lost significant work
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Review
• What worked
– Tender documentation and weightings
– Providers were appointed
– Additional savings were made
• Lessons Learnt
– Interview stage was very time consuming (especially for SU
representative)
– Note taking in interviews was challenging
– Feedback to providers was challenging; aggregation of 5 sets of
notes
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Change Over of Provision
Five key areas of work:
• Communication and contact with Service Users
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Communication with providers
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The reassessment process
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Identification of new hours to be provided
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Contract Commencement
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Change Over of Provision
Communication and contact with Service Users
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Award of new contracts communicated to Service Users via letter in 2 stages:
– An initial letter informing service users that there was to be a change
– Followed some weeks later by a detailed letter with more information and
the names of the new providers
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Helpline was set up to try and alleviate Service User concerns - channelled calls
needing further attention through to locality social work teams who contacted
users and families to answer their questions
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Main query from Service Users was not about change of Provider but asking to
keep current care workers
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Change Over of Provision
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Communication with Providers
8 providers
– 4 were established in Tameside having already provided contracted homecare
services
– 2 had been approved by Tameside and were providing services on an ad-hoc basis
– 2 providers were not operating in the Tameside area prior to the award of the contract
but were successful in providing homecare services elsewhere in the country.
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Communication with providers in 2 phases:
Phase 1 was a meeting with all providers – main issues:
– timescales planned for providers to receive detailed information about Service Users
in their designated areas
– Providers expressed concern regarding TUPE arrangements for staff
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Phase 2 - individual Provider meetings 4 weeks prior to the commencement of
the new provision. Companies were asked a number of questions regarding
their set up plans and implementation details.
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Change Over of Provision
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The Reassessment Process
May until August 2011 the majority of Service Users (over 1000 people) in
receipt of homecare services were reassessed.
– to facilitate this task 8 agency social workers were employed
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not felt useful to carry out reassessments too far away from proposed
changeover dates
process took much longer and was more difficult than planned.
– social workers often had to spend some initial time with Service Users reassuring
them and their carers about the process and addressing their concerns with regard to
future provision.
– One of the care agencies who had been unsuccessful in the retender process took
the decision to offer all the service users they supported the opportunity to remain
with them using a direct payment. The information they provided to service users was
misleading and in many cases added to the confusion being experienced by service
users and considerably delayed the reassessment process.
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Change Over of Provision
• Identification of New Hours to be Provided
• One of the major goals of the project was to move our commissioning
model from hours and task orientated, to weekly and outcome focussed.
• More robust in assessment
• A number of Service Users in receipt of homecare provision had not
been reassessed for many years and this opportunity meant that some
no longer met the eligibility criteria for services or no longer needed as
many hours as they had previously been assessed for
• Hours reduced from 14,366 to 10,300 per week (28% reduction)
– Due to reassessments
– Uptake of Direct Payments
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Change Over of Provision
• Ceased commissioning new care packages two weeks
before change over (unless an emergency)
• Liaison with incumbent providers to ensure that all Service
Users have been accounted for
• Several lists (with updates) of Service User information sent
to new providers
• Several checks to ensure that we hadn’t missed anyone
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Change Over of Provision
• Due to staff leaving one provider handed back all
the work prior to the formal handover
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Review
• What worked
– Good communication with stakeholders
– Reduction in number of hours commissioned made additional
savings for the Council
• Lessons learnt
– Council was naïve in expecting providers to ‘accept’ decision, i.e.
one provider ‘pro-actively’ marketing direct payments to Service
Users
– Need to have a clearer process to manage the transition for direct
payments
– Need to ensure that incumbent providers share the appropriate
staffing information with incoming providers
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D-Day
• Contract started as planned at 6.00am on the 4
July 2011
• Emailed all providers to ensure that all Service
Users received visits
• Responses from providers noted that all planned
visits had gone ahead
• Hurray!!! Sort of….
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Contract Commencement
• 977 Service Users had their visit on that day (approx.
10,300 hours)
• Should have been 979 Service Users
• What Happened?
– 1 provider failed to inform us that a Service User still required support
(missed off their information to us); fortunately family was on hand and
supported SU
– 1 provider informed us that their planned visits had gone ahead;
unfortunately they hadn’t planned to visit one Service User who was left
unattended for 3 days –made national press
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Review
• What worked
– Vast majority of Service Users receive their visits as
planned
• Lessons Learnt
– Internal review identified areas for improvement
(contained in this presentation)
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Contract Performance
• Over the following weeks there were a number of phone
calls re: late or missing calls
• Ongoing issues occurred with 2 of the 8 providers –
resulted in default notices issued around calls being
missed, inadequate phone lines, insufficient staff to cover
weekends, poor management
• Council & providers worked closely to resolve situation
• Providers recognised they couldn’t provide the appropriate
quality of care and gave notice
• Work allocated to other providers who had been awarded
contracts
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The Contract
• Contract focused on Outcomes
– Provider to work with Service User to identify best times to visit to
meet outcomes
– To be flexible
• Social Workers assessment of need is based on hours
required
– Service Users informed of Outcomes and time assessed to meet
outcomes
• Billing Service Users is based on hours
– Complaints that haven’t received all the hours (even though
outcomes achieved
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Review
• What worked
– Tender process noted that we wanted between 6 & 8 providers,
therefore able to allocate the work readily without tendering
– When providers gave notice they worked closely with Council and
new provider
• Lessons Learnt
– To be more focused in checking that the providers are doing what
they said they would do, i.e. establishing a local office
– To start the review of Service Users sooner - the reduction in hours
commissioned affected the performance of two providers
– Need fundamental changes in way Council operates to make
‘outcomes’ work as ‘time & task’ is ingrained in process
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Summary
• The tender was a success
– It saved money!
– We have six providers who (generally) deliver the
appropriate service
– Stability within the market
• Ongoing issues
– Contract isn’t reflective of practice
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The Future
• Introduction of ECM
• To work with children’s services
• To change practice?
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