Jenny Owen CBEDeputy Chief Executive and Executive Director for AHCW

Representing ADASS

National Care Association Annual ConferenceThe commissioning challenge

21st October 2010

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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

• 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

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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 effective- Choice that is cost

effective.

• …..How are you positioning yourself?

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“What” LA’s are going to commission

6 components of an effective system:

• Prevention• Recovery• Continued support• Efficient process• Partnership• Contributions

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1. Prevention

• 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

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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

UIAG

Single Access

Self or Supported Assessment

“Market”

Brokerage

£Cash

Early intervention/Prevention with Health

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

PrinciplesNot assumed elements of model will be inhouseFocus on self service online approachFocus on light touch Risk based approachSignificant reduction in public sector resource

Self funders

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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 one or two home companies.

Issues/Challenges

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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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• 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

Future Market

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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 ChannelsWhat, when, how, who?

•Website, newsletters, providers events, 1to1 meetings, telephone calls..

4) SME DevelopmentHow to support, current offer, embed activity?

3) Supply ConsortiaStructure, approach, partnership, collaboration?

2) Concessions/SupportWhat, when, how, value?

Collaboration and Engagement

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

•Bank of Essex, CRB check, training support, consortia, use of ECC contracts, staff discounts….

•Collaboration of suppliers•Full supply market facilitated to exploit collaboration opportunities

•Current support on offer•Communicate offer•Pro-active support•Embed as part of wider collaboration