1 Home Care Support Outcome Based Specification Workshop Output Notes 10 th December 2009

2 Definitions “The impact or end result of services on a persons life. Outcome focused services facilitate providers and service users in achieving the aspirations, goals and priorities identified by all parties. All personal outcome focused services will be measurable and affordable”

3 Creating Outcome Focused Services Current position; Moving from commissioning for volume and price to commissioning for better quality and outcomes, with payment linked to work done, is a vision to achieve the Personalisation Agenda. Yet there is still much confusion between outcomes, outputs and inputs, and few practical mainstream examples of how social care and health agencies can purchase services based on an outcomes approach.

4 Service Specification for Home care Support Simon R Clarke

5 The following are usually seen as key functions of a service specification. To set the value base within which the service should be provided. To describe the nature and parameters of the service to be bought. To define the people for whom that service should be provided. To set standards to which the service should be delivered. To define where and what elements of discretion are given to the provider. To define and describe what control service users might have with regard to the content and delivery of the service. To describe the monitoring arrangements to determine whether or not all the requirements are being met.

6 National minimum standards and service specifications Given that existing service specifications currently represent a range of relationships with national minimum standards (NMS) it is legitimate to ask the following question. What are specifications intended to achieve over and above NMS in terms of outcomes and standards to be achieved and monitored? The following are summaries of statements taken from other local authority specifications. NOW IT’S UP TO YOU TO DECIDE!

7 Specification or Not ? Table Break Out Session

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9 Authority A Has dispensed with specifications completely for Home Care Support on the basis that they are no longer needed since the introduction of NMS ( National minimum standards). The team did not believe this is the appropriate for Birmingham and its Service Users.

10 Authority B Makes frequent references to NMS ( National minimum standards ) throughout and makes clear that this is the key point of reference for all aspects of the services provided, and restates this several times through the document with otherwise brief details under a series of key sections. The team did not believe this is the appropriate for Birmingham and its Service Users.

11 Authority C States that “the service provider will at all times meet the requirements of the NMS ( National minimum standards ) for Home Care Support” at the end of a 40+ page specification, but nonetheless still covers the same ground in detail and includes additional expectations of the Authority. The team did not believe this is the appropriate for Birmingham and its Service Users.

12 Table # ___All Tables________ Stated that there is a need to quote the National Minimum Standards but Birmingham City Council requires an higher standard quality of Home Care Support and this should be detailed within the new Outcome Focused Specification

13 Options A.Has dispensed with specifications completely for Home Care Support on the basis that they are no longer needed since the introduction of NMS (National minimum standards). NO B.Makes frequent references to NMS (National minimum standards) throughout and makes clear that this is the key point of reference for all aspects of the services provided, and restates this several times through the document with otherwise brief details under a series of key sections. NO C.States that “the service provider will at all times meet the requirements of the NMS (National minimum standards) for Home Care Support” at the end of a 40+ page specification, but nonetheless still covers the same ground in detail and includes additional expectations of the Authority. NO D.Stated that there is a need to quote the National Minimum Standards but Birmingham City Council requires an higher standard quality of Home Care Support and this should be detailed within the new Outcome Focused Specification. YES

14 What’s needed within our Specification ? Table Break Out Session

15 Required Service Outcomes A general outcome for the service may help commissioners and providers concentrate on the purpose behind commissioning it. It also helps in maintaining a focus above that of particular tasks and times. Specific outcomes for each service user would be detailed on their care plan, and could be used to describe what is being bought for each individual. Reference to the outcomes as set out in the White Paper Our Health, Our Care, Our Say will ground the specification in the national agenda for purchasers and be helpful to providers who will be inspected against these outcomes by the care regulator. The team recommended that; The clause is needed. Very simple description of what we want to achieve. Make reference to outcomes including White Paper (Personalisation) and the National Minimum Standards.

16 Core principles The purpose of core principles is to confirm the overall approach to be adopted in delivering the service. For some authorities there will already be a set of values or principles that should apply to all contact with service users. In that case they would be used in the specification. The team recommended that; As per suggested principals in the Oxford Brookes document Are they covered in the National Minimum Standards Include brief summary to ensure user understanding. See West Midlands Common Standards (from Corporate Purchasing)

17 Service User Groups This tells the provider who the service is for. The example is for older people. If specialist services are to be provided, the individual needs to be specified. The specification should note that direct payment/individual budget recipients may choose to use this service. The team recommended that; Do not need to be Identified? But you have to match Service Users to providers. Providers need to be flexible + provide training to meet specialist needs. But CQC is service user specific so don’t we need to match? How will we know which providers have the specialist skills. Register of specialisms (competencies) (non – service user groups) Service Users need access to a catalogue of providers who are able to meet their needs. Ensure Core Principals linked to service user groups.

18 Hours of service availability To be effective in maintaining people at home, and to afford a reasonable quality of life, domiciliary care services need to be available flexibly. The expectations should set out to enable the provider to ensure that they are able to recruit and support care staff to deliver the service. If services are being commissioned outside the core hours, this also needs to be stated. The team recommended that; Link it back to support plan (catalogue to state core hours etc.)

19 Geographical coverage Some contracts will be for delivery of service across the whole of a local authority area, others for particular districts or zones. The latter will often apply, for example, in large shire counties. There may be differential payment for covering difficult areas such as rural, to reflect the additional travelling time or recruitment problems – any such payment issues would be covered in the terms and conditions. The geographical area to be covered should be made clear to the provider. It is also important for commissioners to make clear to care managers, or other commissioners of individual care packages, the referral route for each address to ensure that the correct provider is approached. It should not be left to the provider to gate keep the referral routes. The team recommended that; Cost implications of insisting on city-wide services Do we need to specify constituencies? But sometimes difficult to start-up in some constituencies. Quality improvements if providers limit to specific areas. Constituencies could be at risk – short sighted to look at constituency based providers. Agreed City-wide but catalogue specifies areas of expertise and relevance.

20 Accessing the service It needs to be clear to providers from the specification where referrals will come from, the information they can expect to accompany them, and the relevant timescales and criteria around acceptance or rejection of referrals and the commencement of the service. Recipients of direct payments or individual budgets may choose to purchase from this provider. If so, they may also wish to receive their service according to the terms of this specification. This should be noted although falling outside the formal contractual relationship between the provider and the local authority. The team recommended that; Needs to be following an assessment? What about self – Funders? A statement describing the routes users can take to receive care. NEEDS TO PART OF THE FRAMEWORK NOT THE SPEC.!

21 Service standards As stated previously, standards will be those set by the Department of Health and inspected by the care regulator. The specification should reference the relevant document. The team recommended that; Framework needs to state that BCC and Service Users expectations and standards change!

22 Monitoring and review To be captured within Module 3 of the workshop (January 2010). This will be captured fully in Module 3 of both workshops. Also the accreditation process needs to be developed within this workshop to ensure BCC start off with a Quality Provider base signed up to the Framework model and expectations.

23 Linking the services to achieve outcomes with the Department of Health 7 Quality Outcomes

24 Department of Health 7 Outcomes 1.Personal Dignity 2. Economic Well Being 3. Quality of Life 4. Choice and Control 5. Health and Well Being 6. Making a Positive Contribution 7. Freedom from Discrimination and Harassment