Commissioning social care Angela Canning & Cathy MacGregor, 15 March 2012.

Commissioning social care

Angela Canning & Cathy MacGregor, 15 March 2012

Social care in Scotland

215 March 2012Commissioning social care – CCPS members meeting

Commissioning is…


Key message: Strategic commissioning


Councils and NHS boards need to get better at commissioning social care services

•This is not just about procuring services from providers

•It includes strategic planning:

working jointly with NHS boards and other bodies

involving local communities, service users and carers

involving providers

developing services that achieve good outcomes

planning for the longer term



Councils and NHS boards need to get better at commissioning social care services

•Commissioning is complex and is made more challenging due to:

reducing budgets

changing demographics

rising demands and expectations

developing policies and legislation on:

• integrating health and social care

• self-directed support



Recommendations:

• Develop commissioning strategies

• Work collaboratively with other councils and NHS boards

• Have professional skills in both procurement and social care commissioning

• Train commissioning staff

Key message: Preventative services


There is a risk of councils not investing in low-level and preventative services

•Indications that councils are focussing resources on people who have the most intensive support needs:

13 councils have tightened their eligibility criteria

7 councils now charge for services previously free, or have increased charges

home care hours have increased by 74% over the last decade but home care clients receiving less than 4 hours a week have decreased by 41%

Key message: Preventative services


Councils are targeting their resources at people who need more intensive home care - number of clients (000s)

Key message: Provider involvement


There is scope to improve provider involvement

• Councils and NHS boards do not always involve voluntary and private providers in:

planning which services are needed in the local area

how best to provide them

developing new, more flexible services




• When things are going well…

Providers’ information and expertise are valued

Providers are kept informed and are involved in improvements and developments

• When things are not going well…

o Providers are seen as outwith the commissioning process

o Providers are not engaged and not involved so services are not developed in line with plans




• Focus groups with providers

• Things work well when:

Clarity and fairness

Support and feedback

Take account of evidence of quality / performance

Procure to achieve good outcomes

Reasonable timescales




• Challenges for providers:

Consistency of decision-making

Procurement administration

Capacity of providers

Communication, awareness, joint working

Balancing quality and price

Equalities

Assessing long-term implications of procurement decisions



Arrangements are sporadic and patchy

The impacts for staff are massive

The council rarely asks service users

You sometimes feel that you are going through the motions

There is no communication or information from commissioners

The commissioning process doesn’t do anything to improve quality



Recommendations

• Maintain good working relationships with providers

• Map out current provision - understand quality, effectiveness, costs and challenges for providers

• Base decisions about in-house vs external on understanding costs, quality and outcomes

• Develop transparent procurement processes

Key message: Managing risks


More needs to be done to manage the risks to users when a provider closes, including having contingency plans and monitoring providers’ financial health

• The risks to users are high

• It’s hard to monitor providers’ financial health

• In the case of large operators, it’s inefficient for both councils and providers

• What would councils do if they found financial difficulties?

Key message: Managing risks


Recommendations:

•Contingency plans

•Periodic expert assessment of the social care markets

•Understanding the financial and business impact of commissioning decisions on providers

•Monitor the impact that services have on people’s lives as well as the quality of services

Key message: Involving users/carers


Users and carers need to be more involved in commissioning

• Large majority are happy with services

• Most issues raised relate to home care:

Carers feel under pressure to supplement home care

10 minute visits too short

Time of day of visits

Pushing and fighting to get the services they need

Inflexibility

Key message: Involving users & carers


We were told what we could get

I don’t feel I have control over what I get

It has made a great difference – I can get out now

You sometimes feel that you are going through the motions

Going through a financial assessment has been scary and stressful

They help you with anything – you name it and they’ll help you

In my house, I’m the boss

Key message: Self-directed support


Councils may need a significant amount of support to implement self-directed support effectively

• Users and carers need information, advice and support

• Implications include disinvestment in some services

• Councils are at very different stages in implementing SDS

• They may need support to do so effectively:

low use of direct payments (4,400)

need to develop commissioning skills and capacity

need to improve partnership working with providers

need to improve consultation with users and carers

Audit Scotland

2015 March 2012

[email protected]

Tel: 0131 625 1865

Website: www.audit-scotland.gov.uk

Commissioning social care – CCPS members meeting

Commissioning social care Angela Canning & Cathy MacGregor, 15 March 2012.

Documents

Transcript of Commissioning social care Angela Canning & Cathy MacGregor, 15 March 2012.