Good Commissioning? Wendy Fabbro Strategic Director, People Group Warwickshire County Council Commissioning and Contracting conference 11 September 2014

“ The vision for social care is clear. This is a care system which seeks through prevention to keep people as independent as possible with good advice and information, preventative approaches such as reablement and enablement before personal budgets provide as much choice and control as possible for service users and carers. There is a strong momentum for joining up commissioning, and where appropriate, provision with health and other services such as housing”

Current picture of use of resources and demand..

What do the budget surveys tell us? Impact to date Total annual savings from adult social care of £2.68bn by March 2014 – 20% of net spending Most of the savings are through “Efficiency savings” but significant pain involved: –providers squeezed on prices; –care packages reviewed; –services outsourced; –providers changed Quality maintained so far: 86 per cent of councils said that the quality of life for services users had not been lowered, while only 5 per cent thought that the quality of care had fallen

What do the budget surveys tell us? Fears about the future 19 per cent councils think quality of care will be lower 50 per cent think that fewer people will be able to access adult social care services in two years time (26% fewer OP received a public funded service in 12/13 than 5 years previously) 50 per cent fear that people will be getting smaller personal budgets 57 per cent think providers will be facing greater financial difficulty 42 per cent anticipate more legal challenges

Demographic Pressures Budget survey has consistently shown that demographic pressures are about 3% a year (and this may be understated) This is not just about an ageing population but also the increased costs of caring for younger adults as their needs become more complex and informal care arrangements breakdown There is also unmet need. A summary of national research into unmet need (Southampton University) identified –only 20% of people who report difficulties with dressing and bathing receive support from social services. –50% are supported by their family and friends; –3% pay privately for support and –32% do not receive any support. A substantial proportion of care for people is provided by informal carers whose willingness and ability to perform a caring role is reducing. Over the next 20 years the supply of care by adult children will grow by 13% (assuming unchanging propensity to care) while demand for care will increase by 55%

Position of local government Net spending on adult social care £13bn 34% of total local government spending (£39bn) Projected 1.9 million gap prior to Care Act Local government is faced with funding reductions of 33% over 4 years – approximately 8% a year. In contrast, total public spending is being reduced by 8% over 4 years Significant reductions in local government funding will impact on adult social care. There is no choice in that. And then there is the Care Act and service for self funders…

A new settlement for health and social care

what does the Care Act says about commissioning?

What the Care Act 2014 (section 5) says.. Must ensure that the wellbeing of patients and carers, and their required outcomes are central to enable people to stay independent as long as possible Must facilitate markets to continuously improve quality, innovative services including fostering a workforce Must comply with Equality Act 2010 Must develop markets for care and support Must step in to ensure continuity of care if a provider fails Must encourage a variety of providers and services Must ensure sufficiency of provision Must facilitate information and advice to support choice Must have regard to co produced guidance on integration

Market shaping and commissioning of adult social care and support Supplementing and supporting (incentivising) informal care, facilitating whole market Analysing and forecasting sustainability Market balance- sufficiency, sectors included, Co produced and integrated Local authority Market ALL LOCAL PEOPLE

how will we demonstrate excellence in commissioning?

Healthwatch, Assembly Health and wellbeing Peer reviewers Case reviews feedback Contract decision Surveys, collating reviews, reference groups

Well led commissioning: -understand needs, including self funders and forecast needs -secure sufficient supply and choice of appropriate service -Assure quality -strategies to meet need -workforce strategies( pay, t&c, training -transparency Sustainable and diverse market:- Engage with providers and facilitate/ understand the market and business plans -Financial viability and vfm -monitor quality -flexible to fluctuating care needs Person centred and outcome focused: -Promotion wellbeing/prevent /reduce/delay need for care -consider ASCOF/NICE& Outcomes are central, to payments Inclusive and co produced: -Integrate with partners where it makes sense -co produce with Sf and SU

ADASS/DH/TLAP Commissioning standards 4 domains:- –Sustainable and diverse market –Well led commissioning function, promoting quality –Person centred / outcome focused –Inclusive and co produced

Advice sources TLAP Leadership framework for empowered and healthy communities TLAP Commissioning for Provider diversity Making it Real “I” statements Guidance on outcome based commissioning-Better commissioning (Kerslake), and IPC website(ipc.brookes.ac.uk) Preventive – Leeds MPS ADASS top 10 tips for home care commissioning SCIE guide to commissioning home care for OP How to commission the ASC workforce ipc Developing care markets for quality and choice (ipc website) LGA peer review KLOE UKHCA min price for home care Laing and Buisson ADASS paying for care calculator Commissioning for provider diversity- shared lives plus Mencap- commissioing for profound and multiple disabilities Hertsdirect.org emarketplace Gov.uk/the-commissioning-academy Nao.org.uk/successful-commissioning National Skills Academy & Commissioning Now