School for Social Care Research Improving the evidence base for adult social care practice Council-managed Personal Budgets: Developments in the home care market and the role of brokers Parvaneh Rabiee, Kate Baxter SPRU, University of York Making Research Count - York 22 nd May 2014

School for Social Care Research Context  Mechanisms for managing personal budgets (PBs)  Cash direct payments (DPs)  Council-managed PBs  Provider-managed PBs (known as ISFs)  Most older people prefer managed PBs  Most managed PBs used for home care

School for Social Care Research The original study  Factors affecting personalised support for older people using managed PBs in three councils  Changes in commissioning and market development  Support planners’ roles in enabling increased choice & personalisation  Providers & older people’s experiences

School for Social Care Research Findings from original study  Transition to new framework agreements  Balancing act – competition v. financial stability  Communication issues – broker roles  Early days for market development/shaping activities

School for Social Care Research The follow-up study  Interviews with three service development managers  Framework agreements, engagement with providers, market development, information management  Interviews with three council brokers  Brokerage system, knowledge of the market, information exchange

School for Social Care Research DEVELOPMENTS IN THE HOME CARE MARKET

School for Social Care Research Framework agreements  Limited numbers of providers to choose from  ‘Closed’ agreements  Changed obligations  Zero hours contracts  Neighbourhood/locality working

School for Social Care Research Engaging the market  E-market websites  Provider forums  Market Position Statements

School for Social Care Research Initiatives to increase diversity  Learning events  Innovation grants of up to £9000  £500 for providers to encourage older people to get out  £300 ‘one off’ personal budgets  Community Catalysts social enterprise

School for Social Care Research Conclusion  Shift in balance of power  Provider choice & flexibility  Less certainty for councils  Locality-based approaches to commissioning  Collaborative approach to market development

School for Social Care Research The role of brokers in matching of older people’s needs and preferences with home care providers

School for Social Care Research The brokerage system  The original study suggested :  Potential for greater market efficiency  New communication barriers and delays  The follow-up study - brokers’ perspectives on:  Negotiating role  Knowledge of the market  Information exchange  Challenges experienced

School for Social Care Research Support planners’ and brokers’ roles and responsibilities Brokers: match individual clients with the most appropriate provider/s on the Framework LA support planners: draw up basic plan based on identified needs Agency staff - draw up more detailed support plan with service user

School for Social Care Research Brokers’ routine practice The procedure varied across the three study sites:  Daily ‘mini-tender’ requests ed to ALL providers  ‘Mini-tender’ requests but search restricted to providers within geographical limits  Brokers contacted each provider they worked with previously

School for Social Care Research Experiences of matching service users’ needs with available care  Brokers aware of shortfalls in provision, in particular  In rural areas  Provision for non-English speaking clients  In providers’ capacity to provide two care workers at each visit  Brokers responded by:  Using financial incentives  Setting up spot contracts  Arranging for relatives to act as second worker  Purchasing care from more than one provider

School for Social Care Research Experiences of matching service users’ needs with available care – continued  Insufficient information provided by LA support planners about service users’ needs, leading to…  Inappropriate packages being set up & additional work for brokers to find alternative providers  Delays - Support planners bypassing brokers

School for Social Care Research Information exchange Effective matching relies on information flow  Sufficient Knowledge of service users’ needs  Providers want to have more information  Brokers can only provide the information they are given  Up-to-date information on capacity to take on new clients  All 3 sites relied on regular contacts with local providers

School for Social Care Research Information exchange – continued  Feedback from support planners  Feedback mostly received only when problems arose  Positive feedback on providers considered helpful too  Feeding information back to commissioning teams (e.g. data on gaps in services and delays in arranging care for difficult to place clients)  Brokers in a unique position to spot gaps  Mechanisms in two LAs for brokers to routinely feedback to commissioning teams - brokers not clear about the impact of any feedback

School for Social Care Research Conclusion  Brokers can improve market functioning by matching supply and demand and spotting gaps, BUT communication remains a big issue  Information flows are essential to effective brokerage  Full details from support planners about client’s needs  Feedback from support planners on home care providers that work more or less well  Feedback from brokers to the commissioners on gaps in service capacity

School for Social Care Research Contact details: For further information see: Acknowledgements These slides present independent research commissioned/funded by the NIHR School for Social Care Research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS. Contacts and acknowledgements