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Agenda 9:15 Registration, Tea and Coffee 9:30 Welcome and Introduction David Williams, Chief Officer, Glasgow City Health & Social Care Partnership 9:40 Proof of Concept Overview Allison Eccles, Head of Business Development, GCHSCP 9:50 Contracting and Contract Management Craig Cowan, Principal Officer, Business Development, GCHSCP 10:05 Care Management Chris Melling And Jacqui McGoldrick, Service Managers, Adult Services, GCHSCP 10.20 Coffee Break 10:35 Provider Solutions and Participation in the POC Ann Marie Docherty (CEO), Fair Deal on behalf of POC Provider 11:05 Table Discussion: Immediate Thoughts/Reflections Facilitators and Participants 11.45 Question and Answer Session POC Workstream Leads, POC Providers and All Participants 12.30 Close David Williams

Welcome and Introduction David Williams Chief Officer Glasgow City Health & Social Care Partnership 07 April 2017

Proof of Concept Overview Allison Eccles Head of Business Development Glasgow City Health & Social Care Partnership 07 April 2017

Context c£160m pa purchased community-based social care services New National Minimum Wage 2020 – £9ph c17% gap between current and future wage levels Uplift in SWS budget – c£21m

Current Arrangements Purchasing on hourly rate basis Need to ‘follow the public pound’ Commissioning, procurement and audit/monitoring arrangements on an ‘inputs’ and ‘outputs’ basis Arrangements, processes and staff involved are significant

Proof of Concept Approval of a ‘Proof of Concept’ with a small number of providers over an 18-month period Proposals to assist in meeting new NWM 2020 and 5% savings Evidence base to be extended across all providers

Project Arrangements and Engagement Integration Transformation Project Involvement from Partnership and Council staff and providers (5) Project groups and workstreams Co-produced proposals Engagement with a range of stakeholders

Proof of Concept Proposals Alternative and/or leaner arrangements by the Partnership contracting contract management (incl. service outcomes framework) care management finance Individual social care provider solutions Range of outcomes seeking to achieve Business pressures (e.g., SLW) Proposals developed with some testing

Next Steps Share proposals with providers (Provider Event) (April 2017) Finalise proposals (April/May 2017) Report on outcome (June 2017)

Contracts & Commissioning Workstream Craig Cowan Principal Officer Business Development, Glasgow City Health & Social Care Partnership 07 April 2017

Workstream scope Review CMF: Provider Quarterly Return, Risk assessment and monitoring, Review, Care Manager Concerns, Performance Framework Link commissioner model Outcomes based contract Service outcomes Co-production!! Your Support Your Way Glasgow: CMF

Provider Quarterly Return Electronic survey every 3 months Generic questions irrespective of provider Providers have one week to return Response mandatory Feedback suggested: too frequent too many questions/resource intensive Purpose unclear overly complicated to complete (e.g. whole time equivalent)

Proposals: PQR (PSR) Reduce no’/simplify questions (42 to 12) Reduce to 6-monthly (rename PSR) Increase the completion window (1 to 2 weeks) Generic questions Progress Provider Portal for submission Tested & implemented with POC providers

Risk assessment/monitoring Current Risk reviewed quarterly (risk matrix, PQR data and professional judgement) Scrutiny level and frequency determined by risk Monitoring sessions once a year minimum Activity captured in CM1 and updated quarterly PQR data Risk

Risk & monitoring Proposal Retain risk matrix tool Risk/monitoring expectations 6-monthly (min) Risk rating revised when necessary Changes to risk notified to the relevant PO Autonomy to aggregate CM1’s

Reviews Current Service reviews once per contract term Every 2 years if cross-commissioning team Scope of review determined by staff and context Generic sign off process Proposal Review timescales for review Tiered approach to sign off

Concerns reporting Current Limited to concerns from care managers only Submitted via central mailbox managed by Business Development Action by contract manager (not always well communicated) Generic Care Managers Concerns Form (needed updated) Logged on team Concerns Log (limited reporting capability) Proposal Expand process to external agencies and stakeholders (e.g. Health, Police Scotland, Fire Service and members of the public) Must inform concerned parties of outcome of concerns Improve concerns form and concerns logs to improve efficiency

Lead Commissioner Model Current Commissioners organised by care group Contract mgrs allocated to service providers More than 1 contract mgr across/within teams Providers can work to different NHS and Council contracting arrangements Provider preference 1 link officer Rationalisation of contract mgt regime

Lead Commissioner Model Proposal 1 lead commissioning officer per provider Covering all services/care groups Focus on contract management and review GCC procurement and contracting regime the “default” Leaner, more efficient contract management Reduced bureaucratic burden for providers Consistency of approach

Outcomes based contract Proposal Contracts which require providers to have outcomes based planning tool Part of the evaluation of tender exercises Contracts specify outcomes obligations/autonomy & performance mgt ITT/service spec’s/contracts to be outcomes or inputs specific  

Service Outcomes Framework Current Service user outcomes not embedded in service outcomes FWork POC sought to develop measurable service outcomes Reviewed a range of frameworks (e.g. GIRFEC, Better Future and Carista, ROW) No standard framework or tool used to monitor outcomes GCHSCP compared current frameworks to develop proposed framework that: reflects strategic priorities safeguards service user rights and preferences delivers improved outcomes

Service Outcomes Framework Proposal Standard but flexible service outcomes framework Six core service outcomes Care group specific outcomes if relevant Common indicators for each core service outcome Types of evidence agreed to present outcomes Providers report at 6 monthly contract mgt meetings Next steps POC providers to test model GCHSCP to explore IT requirements for recording

Proof of Concept: Care Management Arrangements Jacqui McGoldrick & Chris Melling, Service Managers Glasgow City Health & Social Care Partnership 07 April 2017

Context Financial pressures Workforce pressures Need to develop a more flexible approach to meet service user needs Lean & efficient processes

Current Arrangements Support plan currently based on hours & minutes, pounds and pence Shift in focus to outcomes and not inputs Little scope for flexibility in resource planning by providers Limited opportunities for innovation

Current Arrangements Disparity between block funded and personalisation assessment processes Disparity on how support packages are reviewed Requirement for more emphasis on risk & risk management

Proposals Proportionate assessment process, dependant on risk and budget Fair and flexible assessment and care management approach Assessments will focus on specific assessed needs and wellbeing Social Work will continue to have the responsibility for management of risk and safeguarding

Proposals Focus on three key areas of risk within Support Needs Assessment (SNA) Personal care needs staying safe risk to others

Proposals Six wellbeing areas social relationships and community activities employability and volunteering personal development parent/carer running/maintaining household social support

Proposals Care planning to be co-produced by providers alongside Care Managers Prescribed levels of support regarding the three key areas of risk More flexibility around the six wellbeing areas Provider accountability for delivery of outcomes. Outcomes monitored and evaluated through service user reviews and service outcomes framework

Future Plans Guidance to be developed for staff and providers Further transformation project on low level interventions

Coffee Break

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Provider Solutions and Participation in the POC Ann Marie Docherty, Chief Executive Officer, Fair Deal, on behalf of POC Providers 07 April 2017

Agenda

Agenda Provide an overview of the Proof of Concept what does it hope to achieve, what is the opportunity of being involved, who are the providers taking part? What has the process been? Identify shared learning for the wider social care sector What have we actually achieved? What are the future developments from Proof of Concept To boldly go where no provider has gone before “If you want something new, you have to stop doing something old.”

Proof of Concept - Overview Providers – Organisations from voluntary/third sector and independent sector, a range of client groups and service models, local and national organisations Opportunity – explore innovative social care service development and delivery, service redesign, technology, ‘back office’ structures and systems, potential of additional funding Challenge – identify 5% cost savings while paying all staff 2020 minimum wage of £9 p/h Sharing learning - within the wider social care sector “Long-range planning does not deal with the future decisions, but with the future of present decisions.”

Business as usual - Challenges Retendering of existing services Implementation of the Scottish Living Wage Transition to Social Care Framework Rates Negotiated/Commissioner Pathways Sleepover rates Co-production processes Contract management Involvement in POC

Proof of Concept - Process Feed into GCHSCP project structure through collective provider meetings and 1:1 meetings Process lead rather than creative / innovative Missed opportunities for collaboration between providers Each provider had their own governance arrangements, workstreams and approaches to engagement to inform their proposals Effective engagement and co-production approaches crucial to success “Results are gained by exploiting opportunities, not by solving problems.”

Achievements     We have been evolving our use of the Better Futures Outcomes-based framework to aid analyses of achieved outcomes at Individual, single Service and aggregated Services levels. This is providing positive confirmation that this personalised, empowering, approach to services-delivery is able to provide tangible evidence of the relationship between services-provision inputs and the degree to which desired results/outcomes are actually achieved at multiple levels within and across our services.

Achievements “Doing the right thing is more important Through Service redesign, and in collaboration with our Supported Employment department, employment has been identified as a desired outcome by individuals participating in the POC. In particular, a participant has already managed to secure  voluntary position as a drivers assistant, and consequently this has the potential to transform his life in many ways, resulting in greater integration within his community, meeting new people, assisting others-achieving multiple outcomes for the participant- all in line with  the POC ethos.   As he will be working 1-to-1 with the driver, this will also potentially reduce the amount of paid support in his life and hence  allow us the opportunity to potentially reduce his overall budget.   “Doing the right thing is more important than doing the thing right.”

“If you want something new, you have to stop doing something old.” Achievements     Creation of a very active service user forum which in the period of the POC has taken ownership of a number of areas of development for the organisation - most specifically a wider range of group opportunities for the people we support to participate in. “If you want something new, you have to stop doing something old.”

Achievements As part of implementing the Scottish Living Wage and progressing towards the objectives of Proof of Concept we implemented a nationwide review of our pay and grading structures. Along with provider partners we participated in the review and testing of contract monitoring arrangements which resulted in a more streamlined version of the PQR. “Long-range planning does not deal with the future decisions, but with the future of present decisions.”

Achievements We are still here! Along with provider partners we participated in the review and testing of contract management arrangements which resulted in more streamlined version of the PQR & Service Outcomes Creation of very active Stakeholder Group to examine/ pilot use of new technology to assist in moving from traditional Sleepover cover towards more flexible Night Support Development of a transport project to address taxi issues     “There is nothing quite so useless as doing with great efficiency something that should not be done at all.”

Achievements    

Future Developments We shall continue to explore Partnership working with Providers to further grow social networks for all people with learning disabilities across Glasgow, with a strong focus on peer led initiatives and less reliance on paid support potentially creating efficiencies in existing budgets With POC Providers, we aim to explore funding options which will allow us to robustly test the impact of proposed initiatives and implement proposals in order to increase efficiencies We would like to begin conversations concerning the exploration of ‘opportunities for collaboration’ around utilising our common resources.

Future Developments We are exploring ways in which our services can be transformed to provide greater flexibility of services-provision and be more dynamically attuned to the changing needs – and aspirations – of those individuals who receive those services. This approach would aim to make better use of available resources to increase both effectiveness and cost-efficiency. Importantly, it would include escalating the harnessing of expertise and experience of current/previous Supported Individuals.

Future Developments While the shape of our service provision in Glasgow has continued to change and evolve as a result of retendering during our involvement in POC we are continuing to work with GHSCP to explore opportunities to create efficiencies while embedding services within a flexible care pathway which meets the needs of vulnerable people in Glasgow

Future Developments We continue to work on changing the way we offer night support and reduced 1:1 staff support for the people we support, including the individual, their family members and our staff in the process using the local authority Just Checking system to give us information about the possible areas to concentrate on to keep people safe when staff are not with them.

Future Developments From (Reduced) Traditional Sleepover to (Increased) Flexible Night Support To pay NMW for traditional Sleepover cover requires an increase in hourly rates from £4.33 to £7.50 (73.2%) For Fair Deal this would cost an additional £121,656 in 2017/18 for 736 hours per week of traditional Sleepover cover across 22 service users (NB NMW not SLW) Under POC, Fair Deal working with all stakeholders to pilot possible IT-based alternatives recognising strengths and limitations of current Sleepover cover Requires consideration of transitional funding solutions if spirit of SLW to be met Torbrae Nursing Home local providers collaborating  around a potential local resource   “Results are gained by exploiting opportunities, not by solving problems.”

Shared learning Proof of Concept is a resource intensive process for all involved Particular demands on smaller organisations while larger organisations benefited from an infrastructure to support involvement The world won’t stand still Commissioning processes, service user reviews, introduction of Scottish Living Wage etc Addressing the challenges of 2020 The national living wage of £9 p/h and the target of 5% savings Overall a positive and beneficial process to be part of the Proof of Concept

Next Steps… Continued meetings of GHSCP and POC Providers to update and review progress POC Providers to engage with wider provider groups

“We are on a journey of transformational change and the Proof of Concept project is not the final destination.”

Table Discussion What are your thoughts on the proposals put forward by the Glasgow City Health and Social Care Partnership? (20 minutes) What are your thoughts on the proposals for provider solutions? (20 minutes)

Question and Answer Session