Pan Wales Commissioning and Contracting Officers Conference 7th June 2007

1. Pan Wales Commissioning and Contracting Officers Conference7th June 2007 Rob Pickford Chief Inspector Care and Social Services Inspectorate Wales

2. CSSIW April 2007 A new inspectorate for a new context Improvement, assurance and protection

3. Changing context High and growing demands of assurance with increasingly complex service user needs and a mixed market of care A fear that control stifles innovation Public expectations of accessibility and flexibility control timeliness challenge -evidence to back up decisions

4. Importance of social care Social Services in Wales support 150,000 people. They account for nearly £1.1 billion in public spending and employ over 70,000 people Resources are unlikely to continue to grow at same rate

5. Circle of Care

6. A range of tools

7. Regulating and inspecting in a joined up world Real and tangible changes Frameworks not just scheduling Children’s services Programme of work now being scoped

8. CSSIW Vision Making a tangible difference- the improvement agenda Public assurance Using knowledge to determine priorities achieve change be a respected and credible source of professional advice Deploying a range of flexible tools to do the job Proportionate in what we do Being a key part of the network

9. What do we know about services? Major shift in nature of care services Predominantly private sector owned Morphing of private/public divide Significant concerns Care homes Children's homes

10. CSIW Annual Report 2006 “…our concern that the basics of care and support are not provided with sufficient consistency across Wales raises significant questions about how the further improvement that is needed will be achieved. Our concerns about a number of care homes and children’s homes make this a pressing task.” CSIW Annual Report 2006

11. SSIW Annual Report Evidence of improvement but concerning inconsistency

12. Re-balancing Roles

13. Implications for regulation “Our aim is to increasingly focus resources on those services that have most need, including those who have the greatest difficulties providing services at the standard the Welsh Assembly Government regulations require. We have moved from a model of inspection which treated all providers the same, to one that focuses our resources where service users need us most.” CSIW Annual Report 2006

14. A momentum for change Deepening the reform of regulation 80%+ inspection to new model –complete the task Complaints reformed Changes to enforcement Move on to registration Performance evaluation – bedrock of LA review Joint Reviews Thematic inspections

15. Implications for providers Building leadership and management Supporting networks Sharing services Public provider interface Supply chain management

16. Implication contract monitoring Duty of care Danger of duplication New regulations It is crucial that “commissioning focuses on the quality as well as the shape and distribution of services.” “ a better alignment between contracting by local authorities and local health boards and regulation by CSIW can contribute to building high quality services.” CSIW Annual Report 2006

17. Do we require a common framework for contracts across Wales? Common issues and challenges faced across the UK Apparent lack of consistent system or framework for making a judgement about whether or not a provider’s performance is satisfactory Complexity of contracts How contract monitoring information is collated/summarised Circulation of reports & information between partner agencies lack of quality measurement systems and risk analysis/triggers for additional monitoring: Variation in practice in investigating reactive notifications Is this the case in Wales?

18. Managing specific serious concerns What is the relationship between this work and multi-agency investigations in adult protection Need to revisit “In Safe hands” – some way behind children's services How do agencies cooperate as concerns develop? Do we need to create guidance that helps people ask questions or guidance that specify’s pathways? What is the right balance between flexible arrangements and setting up structures Agreeing home closure procedures – should there be a national framework or should this be looked at locally? Who is accountable for leading such arrangements – local authority has overall duty to meet needs of local residents What are the implications of growing numbers of self funded service users?

19. Fulfilled Lives and Supportive Communities Requires a new relationship with services users Changing pattern of expectations mean changing patterns of services Redesign services to promote the independence and control by people to support them in the community Work in partnership both locally, regionally and nationally where appropriate

20. Importance of commissioning Shaping the pattern of services to reflect need Making best use of available resources Poorly designed or outdated services waste resources and may result in under use or poor user experience of services. Recognised as a key driver in improving social services in Fulfilled Lives: Supportive Communities

22. Guidance Fulfilled Lives: Supportive Communities Commitment to: Developing a comprehensive commissioning framework for social services Working with partners Social Services Improvement Agency, NLIAH, private and voluntary sectors and you. Value Wales also has important role.

23. Services promoting control and independence New services Telecare/ telehealth, extra care housing Remodelling existing services Home care – re-ablement Community Equipment Services Preventative measures in child care

24. Commissioning involves Partnership Adults – Social Care, Housing (inc Supporting People), and Health Commissioners. Children – Social Care, Housing, Health and education commissioners Working across LA/LHB boundaries Working with Providers in the private and voluntary sector. They need to be involved at each stage of the commissioning process – needs analysis – market analysis Service Users and carers

25. Senior Management These are strategic judgements and decisions Senior managers need to lead commissioning Commissioning requires the involvement of commissioning/ contract officers, operational managers and staff, finance managers, procurement officers and HR.

26. Health Act Flexibilities Provide opportunities to formalise partnerships Provide time for reflection when things get tough May assist commissioning in that partners are more precise regarding resources, outcomes etc when they sign formal financial agreements Seminars and templates

27. Pan Wales Commissioning and Contracting Officers Conference7th June 2007 Rob Pickford Chief Inspector Care and Social Services Inspectorate Wales