Council-managed Personal Budgets: Developments in the home care market and the role of brokers

1. 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 22nd May 2014

2. Most older people prefer managed PBs Most managed PBs used for home care Context • Mechanisms for managing personal budgets (PBs) • Cash direct payments (DPs) • Council-managed PBs • Provider-managed PBs (known as ISFs)

3. The original study 2011-2012 • 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

4. 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

5. 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

6. DEVELOPMENTS IN THE HOME CARE MARKET

7. Framework agreements • Limited numbers of providers to choose from • ‘Closed’ agreements • Changed obligations • Zero hours contracts • Neighbourhood/locality working

8. Engaging the market • E-market websites • Provider forums • Market Position Statements

9. £300 ‘one off’ personal budgets Community Catalysts social enterprise Initiatives to increase diversity • Learning events • Innovation grants of up to £9000 • £500 for providers to encourage older people to get out

10. Conclusion • Shift in balance of power • Provider choice & flexibility • Less certainty for councils • Locality-based approaches to commissioning • Collaborative approach to market development

11. The role of brokers in matching of older people’s needs and preferences with home care providers

12. 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

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

14. Brokers’ routine practice The procedure varied across the three study sites: • Daily ‘mini-tender’ requests emailed to ALL providers • ‘Mini-tender’ requests but search restricted to providers within geographical limits • Brokers contacted each provider they worked with previously

15. 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

16. 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

17. 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

18. 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

19. 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

20. Contacts and acknowledgements Contact details: Parvaneh.Rabiee@york.ac.uk Kate.Baxter@york.ac.uk For further information see: http://php.york.ac.uk/inst/spru/research/summs/managedPB.php 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.