Social Care Commissioning Mr David Petticrew Social Care Commissioning Lead Northern Ireland Health and Social Care Board

Some Principles Strategic regional overview Longer term considered approach to the needs of the population Information Continuous cycle of review and improvement Local variations Market analysis and developing a provider base Pilot projects before regional roll-out Outcomes

A Formal Process Joint HSCB and PHA ‘Annual Commissioning Plan’ A response to Minister’s ‘Commissioning Plan Direction’ and targets Translation of Minister’s Regional Priorities into Performance Areas Trust response via Trust Delivery Plans

Commissioning Drivers Legislative and policy context Regional Strategies – Dementia, Disability Demographics Inspections Public Interest Stakeholders

Drivers Ongoing Process: 3 and 5 year strategies Procurement (efficiency, quality, VFM) New learning Iterative process – speed of change and forward planning Financial Context

Issue of Scale HSC Residential, Nursing and Care home expenditure is circa £500m pa Predictive and responsive process 25,000 people receive domiciliary care 13,000 HSC care home residents 465 homes with 16,000 registered places

Regional Review of Domiciliary Care ‘A Managed Change An Agenda for Creating a Sustainable Basis for Domiciliary Care in Northern Ireland’

Focus Domiciliary Care = ‘Home Help’? ‘The range of services put in place to support an individual in their own home. Services may involve routine household tasks within or outside the home, personal care of the client and other domestic services necessary to maintain an individual in an acceptable level of health, hygiene, dignity, safety and ease in their home’ DHSSPSNI Project May 2014 – November 2015 Review of Trust and Independent sector provision Excluded ‘private arrangements’ and family /informal carers  

£206,000,000 p.a. 250,000 hrs p.w. Complexity ++ 25,000 Clients+

Aims Identify a more coordinated regional model for the development and procurement of domiciliary care Analyse & compare existing Trust arrangements for delivering domiciliary care and identify best practice Examine service interfaces with domiciliary care Consult with stakeholders with regard to experience of domiciliary care services Undertake an analysis of the market Improve information relating to domiciliary care

Context Information - Community Indicators Project Market - Evidence of increasing pressures Stakeholders - Trade Unions, Independent Sector, COPNI, Age NI, Patient Client Council, Age Sector Platform, Users/Carers Interfaces - Reablement, Self Directed Support, Direct Payments, Telecare Trust arrangements - Procurement, Rates

What People Told us Broad consensus of views across a range of stakeholders – users, carers, providers, Trade Unions Highly valued service Plays a vital role in effective delivery of community care services (including impact on hospital services, carers etc) Significant challenges (1) future procurement of the service (2) availability and development of the workforce (staff retention) Drivers for Reform – Gill Smith

A highly valued service Users and carers tell us the service impacts positively on the quality of their lives Supports carers to keep their loved ones at home Patient Client Council research found that 80% + of respondents rated the quality of care as “good” or “very good” Through the PHA and HSCB jointly commissioned ‘10,000 Voices’ initiative 1330 client stories were captured in relation to domiciliary care and 78% of respondents reported a positive experience of the service and 82% stated that domiciliary support in their own home had impacted positively on their lives Trust feedback highlighted the compassionate care and help received

User Views - Overview Users would like to see better communication and information between carers More continuity of staff Improved timing of calls and allocation of time Ensuring the privacy and dignity of users is respected by staff Ensuring staff are adequately trained to care for people with dementia Maximising opportunities for client choice

The challenges to us from users/carers A service ‘fit for the future’ Addressing workforce related issues will be key to sustainability – current recruitment/retention Partnership working – Independent Sector and Trusts A model for the future that promotes independence and choice

Current Trust Arrangements Good degree of similarity in underlying management and organisation of the service User/ Carer satisfaction/ quality Limited Inter-Trust liaison Limited evidence of a ‘best practice’ approach Individualised procurement/ rates Workforce – recruitment, retention & training

Differences/Anomalies Number of Providers NHSCT -17 BHSCT- 23 SHSCT – 23 SEHSCT- 36 WHSCT– 12 Sector Split (S v IS) NHSCT 50:50 BHSCT 25:75 SHSCT 40:60 SEHSCT 15:85 WHSCT 35:65

Pressures Tendering exercises Workforce ‘National Living Wage’ Rates paid/ variations Squeeze on smaller providers (procurement ‘Lots’)

Procurement as a future service model driver Reduction in the number of providers Testing the market price for care Market share Provides a basis for moving from ‘time and task’ to an ‘outcomes’ based approach

Review Recommendations Structure – A ‘Task Force’ approach to future Domiciliary/Community Care development Funding – Coordinated approach to funding domiciliary care services to address cost pressures Procurement – Management of tendering processes to co-ordinate and monitor change Financial Modelling – Assessment of the impact of the living wage and the hourly cost of care provided by the statutory/independent sectors Workforce – Consistent, Trained, Valued, Rewarded

Service Model – No ‘perfect’ model identified Information - Develop improved domiciliary care information Finance – Make the case for investment in domiciliary care Communication – all stakeholders

Future of Commissioning: Change Closure of the Board in March 2017 Trusts will take responsibility for planning and meeting the future needs of their populations DHSSPS adopt a more proactive role with Trusts ie performance management DHSSPS will assume budgetary control

Opportunity New model for HSC – shift away from hospital to community based care Shift from statutory to private sector provision? Out-workings of DHSSPS ‘Who Cares’ consultation? Risk and opportunity