The Voluntary Organisations Disability Group The DCMQC programme – Positioning the voluntary market and local authorities.

IPC and care markets The Institute has been leading on the DCMQC programme over the last fifteen months for DH and working in partnership with ADASS and the CPA. IPC is also working with CQC in developing a report on market stability as a precursor to the regulator taking on their new role with regard to market oversight. 2

Why is this happening - Section 5 of the Care Bill The LA must promote the efficient and effective operation of a market for meeting care and support needs. Make information available. Current and likely future demand and supply to meet that. Help people take part in work, training and education. Ensure the market is sustainable. Foster continuous improvement in services. Foster the workforce. The LA must have regard to ensuring sufficient services are available for meeting the needs for care and support for adults and their carers. 3

Terms and conditions The Act does not require LAs to develop an MPS but the guidance will suggest it is a good way to bring those duties together. The guidance will also define some of the terms such as sustainable, efficient etc. It is clear that the LA will have a responsibility towards the whole market whether an individual is a self funder, in receipt of a direct payment or where the LA arranges care. It is also clear that an MPS should be a precursor to wider market shaping not an end in itsefl. 4

Why is this happening - Section 56 of the Care Bill Market oversight Designed, post Southern Cross, to act as an early warning and intervention system for large, geographically significant or specialist care providers who may be in difficulties. Where there is a risk to financial sustainability CQC can require a provider to prepare a plan to mitigate that risk and conduct an independent review. If the provider cannot continue in business, the LA must be notified and continuity plans implemented. 5

Why is this happening - Section 49 of the Care Bill Provider failure Proposes a temporary duty on LAs where a provider fails, that the LA must need the needs of adults who would have received care and support from that provider. To do so regardless of whether the person is their resident or whether the authority carried out the needs assessment or whether the person passes eligibility criteria. Authority may charge for carrying out this duty (other than the supply of information). 6

The DCMQC programme A programme of support offered to every local authority and region to help kick start the development of market position statements and market facilitation. The best of times and the worst of times to do something new: Staff turnover in LAs, focus of thought elsewhere, fears over judicial review, lack of expertise. Yet a need for cooperation with the market if quality is to be protected at a time of cost restraint. Recognition that the private and voluntary sector is where care is delivered. 7

Where are we nationally… Take up quantitatively: Every English authority contacted, programme in essence delivered over one year, project managed through a programme group with ADASS and provider representation. 63 authorities have an MPS that is available 61 authorities have a draft MPS 14 in process of writing 43 authorities have clear evidence of provider involvement (6 still in progress) 8

Where are we nationally… The vast majority of IPCs involvement with local authorities fell into three categories: Getting people started either through meetings with senior management teams or commissioning teams - sometimes both. Reviewing and commenting on MPSs and acting as a critical friend. Helping to set up, participating in, or facilitating meetings with providers. 9

Where are we nationally… Minority activities consisted of: Conducting mini-questionnaires with providers. Involving public health Joint health and social care meetings Involvement of housing and supporting people. Wider meetings across the LA Help on how to identify self-funder populations Providing mini-research reviews 10

Where are we nationally… A variety of projects with regions or sub regions: Estimating self funders Training and development programmes Local consortia to review MPSs Regional Learning Disability MPS. A range of guides and support papers on the DCMQC webpages

Most authorities Readily embraced the concept of market facilitation and developing a Market Position Statement. Recognised areas where they needed to improve or where they were short of information. Wanted to change the nature of their relationship with providers. 12

Some authorities were innovative… In going to the market and constructing exercises to find out what providers would most benefit from. In extending the MPS concept to other parts of their authority such as housing, supporting people and Public Health. In recognising that even if the time was not quite yet right they need to bring their local CCGs on board with their market activities. In re-defining roles within the authority and developing a market lead person. 13

Most authorities struggled with … Writing a concise document. Being analytical about their data and information. Producing a document that was market facing. Quantitatively being able to show the value of the care market to local economies. Producing knowledge backed information of the strategic direction the LA would be encouraging through its commissioning activities. 14

Most authorities struggled with… Intelligence about self-funders and how direct payments were being spent. Any useful and qualitative consumer research. Having an understanding of where and how they could be innovative towards the market. Having a clear plan for market engagement post MPS development. Moving from being a procurer of care to being a market facilitator. An understanding of businesses work. 15

Some authorities struggled because Some authorities struggled because… Three days help was not seen as significant enough to warrant investment and because some needed more help than the time available. They were trying to deliver the programme at a time when LAs were undergoing major financial problems and staff changes meant some found it hard to get going. The development of an MPS was seen as simply a task to be got through. Consequently, it was not seen as significant and its authorship got pushed down the chain of command. 16

Some authorities struggled because Some authorities struggled because… They do still not easily embrace the concept of a market and some have difficulties accepting a facilitative role towards the market as compared to a controlling role. In facing financial problems they did not see that the market could be engaged with as part of the solution rather than being perceived as part of the problem. 17

What do providers say they would like from an MPS Future LA procurement plans (what kinds of services will the LA support and how). Current patterns of care provision (who supplies what, to whom). Demographics now and in the future. How are direct payments being spent / info about self funders? Geographical distribution of LA funded service users and distribution of care organisations (by ward) The price range of the last 50 purchases of care by the LA on behalf of service users by type of care purchased. 18

The future LA role The future LA role is as the people who influence and understand the care market to ensure sufficiency of good quality supply at an affordable price that lessens the likelihood of future demand. Who is buying what, from whom, at what cost? What impact are direct payments and self directed support having on the market? What does a balanced care market look like? To know and sell what good looks like, the outcomes it delivers,the evidence that supports that and the quantities it might be needed in. 19

The future LA role The future LA role is as the people who influence and understand the care market to ensure sufficiency of good quality supply at an affordable price that lessens the likelihood of future demand. The capacity to use both funding and negotiation to stimulate innovation. To offer training to care organisations that reflects the desired care model, delivered in a way that shows you understand both consumer and provider positions. To reflect the importance of the care market within the local economy. 20

How might providers respond Better able to chronicle data about your own organisation. To be able to demonstrate what outcomes you achieve. To understand what your consumers want, what they need to know about your services and provision and how they influence that. To be able to show what you can deliver, the evidence as to why that works and what are your costs (open book accounting). 21

Some questions The Care Bill uses the term market shaping to describe the role of the local authority. How would you want LAs to define that to benefit your organisation? What would be the three main things you would want to see in a local MPS where your organisation worked? How would you want LAs to engage with you outside the context of contract and finance discussions? 22