1. HOME CARE & MONITORING A County Story – 5 Years On… Ian Benson
May 2016

2. STAFFORDSHIRE IN 2010 Over 1,000 square miles
Population approaching 1 million
Approximately 800,000 hours of home care per year
30 block contracts and 40 spot purchase arrangements
Annual spend approximately £33m per annum
Call cramming – manual timesheets, in-house service filling 3x cost
Increasing complaints/challenges relating to charging vs actual services delivered
No quality control
No oversight of delivery
No MI / ability to plan effectively

3. WHAT DID WE DO? 2011 – all contracts retendered
16 block contracts, 2 per district, with variable guarantees for generic provision
8 Framework arrangements for specialist provision and also generic backup
Mandated Electronic Monitoring of all services
Annual spend reduced to approximately £27m per annum
No call cramming, manual timesheets or in-house service
Real time oversight of actual delivery
Payments made on actuals
Introduced commissioning based on MI

4. HOW DID WE DO IT? Contract requirement to accept all referrals
Framework arrangements to encourage phased reduction in block arrangements over term
Contract requirement to have electronic rostering system compatible with ‘QA partner’
Contract requirement to use Electronic Monitoring
KPI’s for compliance
Brokerage module

5. HOW DID WE DO IT (procurement route)?
Eastern Shires Purchasing Organisation (ESPO)
Internal regulations required use of PPO
Service Specification vs Technical Specification
(i.e. monitoring solutions was a SC service, not IT)
Only one supplier that met all requirements
ESPO ‘Draw Down’ route utilised
Process externally audited

6. IMMEDIATE BENEFITS (cashable)
Reduced contracted spend by £9m per annum (mix of DP take up (£3m) and payment on actuals (£6m))
Reduced back office processes (£500k)
On-going efficiencies approx. £55k per week on block contracts
QA productivity increased by 100% (double amount of reviews and monitoring of provides)

7. LONGER TERM BENEFITS Proportionally increased delivery by 15%
Real time alerts for time critical calls
Suite of MI to interrogate and support quality/safeguarding investigations
Commissioning decisions structured around real time MI and ability to focus alternative provision based on risk stratification
Improved cash flow for providers
Case studies show increased choice and control for users – 91% of users ‘very’ or ‘extremely’ satisfied

8. CHALLENGES
Marketplace responded by passing reduction in income on to workforce
Limited ability to recruit and retain suitable workers
Capacity issues as a result of sporadic coverage
Increased pressure from acute hospital settings to discharge people sooner
Increased complexity of needs at home
Traditional models of delivery still adopted by providers

9. LESSONS LEARNT
Monitoring can be just monitoring, or it can be the driver for market practice change
Balance required between efficiency drivers and desire to maintain market stability
New monitoring/payment practice needs to accompany new recruitment/retention practice
Market requires support to adjust
Fine line between outcomes based commissioning and task & time based commissioning

10. QUESTIONS?
Ian Benson