Market Position Statement Workshop

22 January 2015

ProgrammeTime Activity Person

12.00 – 12.15 Refreshments and registration

12.15 - 12.30 Welcome and introductions Cathy Kerr

12.30 – 12.50 Update from last session Cathy Kerr

12.50 – 13.10 The Care Act 2014 for Providers Gill Ford

13.10 – 13.30 Update on Outcome Based Commissioning David Sykes

13.30 – 14.00 Q&A Panel David SykesGill FordAmanda McGlennon

14.00 – 14.20 Coffee break

14.20 – 15.20 Group discussions:1. Innovation 2. Partnership working 3. Quality and service standards

All

15.20 – 15.40 Feedback session All

15.40 – 16.00 Evaluation and closure David Sykes

Aim and ObjectivesAim

To engage local providers in order to inform our commissioning and market shaping responsibilities

Objectives

1.Discuss Providers local development plans2.Consider how the Council can support local provider market3.Agree mechanisms for effective partnership working between Council and local providers

Update from last sessionCathy Kerr – Director of ACS

Context• Market Position Statement (MPS) event held 12th March 2014 • MPS document published on Richmond website at

http://www.richmond.gov.uk/lbrut_market_position_statement_2014.pdf• Case for change:

• Council acknowledged the need to commission differently and engage with Providers and Service Users in a meaningful way in order to ensure Service Users` outcomes are met

• Focus on preventative services and enable Providers to be creative• Real partnership working and co design with Providers and Service

Users and their Carers

Financial context

• Legislation largely reflects current best policy and practice but with some significant and substantial changes

• Key areas of financial risk for 15/16, new rights for Carers• Forecasting demand (future behaviours) is not an exact science

(managing the known unknown)• Detailed metrics and financial modelling is only a part of the jigsaw

(‘soft’ evidence also required)• Need to redirect financial resources to enable people to be

supported in their own homes and communities• Exploring joint working with other Boroughs

What Service Users/Carers said to us…

What Providers said to us...

What we did…Preventative services•Community Independent Living Service (CILS), commissioned December 2013 (mobilisation completed April 2014)•Richmond Response and Rehabilitation Service, commissioned October 2013 (mobilisation completed January 2014)•Review is in progress for the following provision:

• Information and advice offer including the Council's external website• Advocacy provision

•Explored opportunities to use technology more innovatively e.g. Older People Technology workshop

What we will do…

• Explore new opportunities to address the self funders market• Commission services where Service Users/Carers take informed

risks• Develop integrated services which promote choice and control• Use the Co production group (Service Users, Carers

representatives) to understand people`s views and wishes • Commission Outcome Based Services (e.g. Help to Live at Home,

Outcome Based Programme for community health services)• Engage more with Providers to better understand and shape the

market

Help to Live at Home - objectives

• Allow as many people as possible to remain in their home after a serious life crisis

• Allow people to exert choice over what happens next for them, including:• defining their own life outcomes; and• agreeing and committing to a support plan intended to help them meet

their outcomes;• Incentivise providers to help people to realise their outcomes by

paying providers by results• To reduce the cost of the traditional home care service.

Residential Care Provision (Care UK)

• Re profiling beds in Care UK PFI contract• Local need is for more intensive nursing and

dementia beds rather than residential• Commission additional extra care provision locally

The Care Act 2014 for ProvidersGill Ford - Care Act Programme Manager

Context

• The Care Act came into law in May 2014• Many new duties but also put on a statutory footing existing best practice

such as Personal budgets & direct payments (the latter still the preferred option for personal budgets)

• Whilst the legislative base has changed totally, in practice much will remain the same for providers

• Key change is that the Act encompasses the whole population• This presentation is focussing on key changes for providers and what is

happening in Richmond

Implementation timescalesKey requirements Timing

Duties on prevention and wellbeing From April 2015Duties on information & advice (inc paying for care)

Duty on market shaping

Assessments (including carers’ assessments)

National minimum threshold for eligibility

Personal budgets and care and support plans

Safeguarding

Universal deferred payment agreements

Extended means test From April 2016Care accounts

Capped charging system

Promoting WellbeingWhenever a local authority carries out any care and support functions, it must promote wellbeing described as:•Personal dignity including respect•Physical and mental health and emotional wellbeing•Protection from abuse and neglect•Control by the individual over day-to-day life (including over care and support and the way it is provided)•Participation in work, education, training or recreation•Social and economic wellbeing•Domestic, family and personal relationships•Suitability of living accommodation

Prevention• Applies to all adults, including people who do not have any current

needs for care and support, or people with no eligible needs• Three levels of prevention:

1. Prevent: primary prevention – promoting wellbeing2. Reduce: secondary prevention – early intervention3. Delay: tertiary prevention

Richmond Council is developing a prevention strategy with Richmond CCG and other local partners; one outcome of this will be a commissioning plan.

Information and AdviceInformation and advice services for all residents, to include:

• How to access care and support locally• The types of care and support locally and nationally and the

quality of locally provided care• The likely costs to the person of the care and support services

available to them including costs that the Council pays• How to access independent financial advice on matters relating to

care and support• How to raise concerns about the safety or wellbeing of an adult with

care and support needs.Richmond is implementing a local resource directory using Careplace.

CarersSame rights for carers as those they care for example:•Wellbeing principle •Preventing needs for support•Right to assessment•Eligibility: national minimum threshold for carers •Planning: rights to personal budgets, direct payment, support plan•Market shaping - ensure appropriate services for carers

Richmond is developing a local carer’s offer

Market Shaping and commissioningDuty on councils to facilitate diverse, sustainable, high quality services in their area to provide people with meaningful choice regardless of who pays for care – it covers the whole market. Underpinned by these principles:

• Focusing on outcomes and wellbeing• Promoting quality services, including workforce development and

remuneration and ensuring appropriately resourced care and support• Supporting sustainability• Ensuring choice• Co-production with partners

Richmond is reshaping its Market Position Statement

Managing provider failure & market oversight

• Provider Failure: Triggered “when the service can no longer be provided” Council has temporary duties to meet people`s needs. This already happens (think of Southern Cross)

• Market oversight applies to largest and difficult to replace providers i.e. domiciliary care providers delivering 30,000 hrs or 2.000+ people a week, care home providers 2.000+ beds

• Providers have a duty to provide information to CQC who assess sustainability and inform local authorities as early warning when they consider a provider is likely to be unable to continue.

Richmond is waiting for CQC to issue guidance on market oversight in January 2015 to understand Council responsibilities

Financial sustainability of other providers (not in the CQC oversight regime)

• Will affect vast majority of small and medium providers.• LAs must ensure continuity of care in respect of business failure of all

providers and so need to have contingency plans and an understanding of the likelihood of failure of providers in their area

• Authorities need to have an understanding of current trading conditions and the sustainability of their pool of providers in order to focus their contingency planning

• Strengthens the need for contingency planning on all parties

Richmond is waiting for the LA toolkit for Contingency planning for care provider failure to be issued April 2015

Advocacy• New duty: Where the local authority considers that a person has

substantial difficulty in being involved with their care and support then they must consider whether there is anyone appropriate who can help the person to be fully involved, e.g. family member or friend.

• If there is no one appropriate, then an independent advocate must provide support and represent the person in the assessment, support planning and review.

In Richmond we are reviewing current provision and will be going out to tender for a new services in 2015.

Funding changes for 2015• Deferred payments: People do not have to sell their homes in their

lifetime to pay for residential care

• Self-funders with care at home may ask their local authority (LA) to arrange their care; the person cannot be charged more than the cost the LA is able to secure, plus an admin charge.

• Rules on ‘top-up fees’ are re-enforced to make clear that all arrangements must be through the LA. A provider must not seek a ‘top-up fee’ directly with the person receiving LA funded care.

In Richmond we are consulting on our charging policy for deferred payments and for arranging care for self funders

Funding changes for 2016• Self-funders in a care home may ask their LA to arrange their care;

the person cannot be charged more than the cost the LA is able to secure, plus an administration charge.

• Extension to the point at which means tested support becomes available. This means more people eligible for Council funded care.

• Introduction of the cap on care costs (care accounts).

In Richmond work has not yet started. Waiting draft guidance from DH and also results of national work on the impact of self funders accessing care home beds at LA rates

Safeguarding

• Safeguarding now on statutory footing• Providers have a duty to co-operate during a Safeguarding Adult

Review • Providers must have a Designated Adult Safeguarding Manager• All providers must have safeguarding policies and procedures

Richmond: Implementing Making Safeguarding Personal to ensure service user is at the centre of the safeguarding process

Integration, cooperation & partnerships

Local authorities must:•Carry out their care and support responsibilities with the aim of promoting greater integration with NHS and other health-related services•Duties also apply from NHS bodies to LA

In Richmond; JCC set up to deliver joint commissioning and working with CCG in delivering OBC through community provision

Summary for providers 2015• Market Shaping interaction with local authorities• CQC Market Oversight & Business Failure regime• Duty to arrange care for self funders at home using Council rates• Statutory Safeguarding • Information & Advice and Resource Directory• Services aimed at prevention • Independent advocacy• New & different services as a result of integration• More demand for carer services/support• National communication campaign starting February 2015

Summary for providers 2016

• Duty to arrange care for self–funders in care homes at Council rates • Capital limits raised so more people eligible for Council funded care• Care account commences April 2016• Assessments of existing self funders in care homes to start autumn

2016• More people known and potentially supported by the Council• National communications campaign starting post general election

Outcome Based CommissioningDavid Sykes – Interim Head of Joint Commissioning Collaborative

Commissioning for Better Outcomes

“Effective commissioning plays a central role in driving up quality, enabling people to meaningfully direct their own care, facilitating integrated service delivery, and making the most effective use of the available resources.”

Commissioning for Better Outcomes : A route map

What matters..“What matters most to people? •The person at the centre, rather than fitting them into services•People who use services and carers treated as individuals•Empowering choice and control for people who use services, and carers•Setting goals for care and support with people who use services and carers•Having up to date accessible information about services•Emphasising the importance of the relationship between people who use services and providers and staff•Listening to people who use services and acting upon what they say•A positive approach, which highlights what people who use services can do and might be able to do with appropriate support, not what they cannot do

Clenton Farquharson MBE, Co Chair Thin Local Act Personal”

Standards for good commissioning..

• Are designed to ensure that everyone shapes and shares the vision of excellent

• Support the development of a common focus and purpose across the system, driven by shared values and behaviours care and support

• Seen as a route map for that journey rather than the final destination

What good commissioning means (1)Domain Covers the.. Standard

Person-centred and outcome focused

Quality of experience of people who use social care services, their families and carers and local communities.

1. Person-centred and focuses on outcomes

2. Promotes health and wellbeing

3. Delivers social value

Inclusive Inclusivity of commissioning, both in terms of the process and outcomes.

4. Coproduced with local people, their carers and communities

5. Positive engagement with providers

6. Promotes equality

What good commissioning means (2)Domain Covers the.. Standard

Well led How well led commissioning is by the Local Authority, including how commissioning of social care is supported by both the wider organisation and partner organisations.

7. Well led8. A whole system approach9. Uses evidence about what works

Promotes a sustainable and diverse market place

Promotion of a vibrant, diverse and sustainable market,where improving quality and safety is integral to commissioning decisions

10.A diverse and sustainable market

11.Provides value for money12.Develops the workforce

Outcome Based Commissioning (OBC) Programme

• OBC means thinking more about what the services we commission achieve (outcomes for people) instead of how they operate

• Under OBC contracts, service providers are paid for delivering a set of outcomes for people rather than for the amount of activities undertaken

In Richmond, the OBC programme will run across five phases.

OBC Phases

Outcomes framework - generic outcomes (1)

Outcomes framework - generic outcomes (2)

Engagement process on OBC

• Engagement process with Service Users/Patients and their Carers undertaken from July to September 2014

• Development of an outcomes framework• OBC contract not yet finalised, more important is

to work with providers about how to focus on outcomes

What does this mean for Providers

• Different ways of working• OBC moves back towards partnership relationship

and co design• Moves the focus back to what Providers deliver for

the people they support• Reduces admin tasks and monitoring• Incentivises performance

Procurement exercises – 2015/2016No. Initiative Est. Annual Value Estimate date for tender

/Market engagement

1. Learning Disabilities Residential and Supported Living Services Phase 1 £4,500,000

February 2015

2. Learning Disabilities Residential and Supported Living Services – Additional Phases

£3,100,000 May- November 2015

3. Supporting people (Tenancy Support, Domestic Abuse) £442,636

May and November 2015

4. Help to live at home £6,000,000 June 2015

5. Carers Hub Service £421,000 September 2015

6. Advocacy provision £200,000 October 2015

7. Home maintenance service £80,000 January 2016

8. Community Equipment £1,100,000

April 2016

Next stepsDavid Sykes – Interim Head of Joint Commissioning Collaborative

Next steps

• This is just the first event in a series • Engagement plan will be circulated by end March

2015• Providers will be co-opted to help the Council co-

design future services and contribute to shaping future MPS (Provider Reference Group). We will take into account Providers who volunteered in the past

Evaluation