Adult Social Care A consultation event 6 th February 2013

1. Adult Social Care A consultation event 6th February 2013 Karen Murphy and Simon BartonBusiness Transformation Directorate

2. Agenda - 6 February 2013 Start at 2pm Introductions and Purpose Karen Murphy Consultation on ILEX: Presentation Simon Barton Consultation on Fees: Presentation Simon Barton Questions and discussion All Summing up and next steps Karen Murphy Finish by 4pm

3. Independent Living and Extra Care (ILEX) Housing StrategySimon BartonStrategic Commissioning Manager for Older People

4. Why is ILEX important? Bring together Planning, Housing and Social Care for the first time Join up with the new approach to health Promote independence, provide support Identify needs Reduce reliance on residential care Set out clear, joint priorities Commission services and developments ….currently consulting

5. What do we want ILEX to achieve? enable vulnerable people to continue to live independently in their own homes through provision of support services encourage provision of a wider range of suitable and affordable independent accommodation for people who need or choose to move

6. What is influencing ILEX?

7. How is the population changing?2012 to 2030 Larger and older population in Solihull (DH est.) Total pop’n: 208,400 to 236,100 (+13%) Over 65: 40,800 to 55,900 (19.6% to 23.7%*) Over 85: 5,880 to 10,800 (2.8% to 4.8%*) * as a proportion of total population

8. How is the population changing? People with dementia (Solihull Living Well with Dementia Commissioning Strategy 2010-2013) 1 in 20 people aged over 65 yrs 1 in 5 people aged over 80 yrs (approaching) 1 in 3 at 90 yrs

9. How is the population changing?2012 to 2030 Trend to continue Falling numbers of children and younger adults More people in middle age

10. Helping people to stay at home Advice services Housing options, debt, benefits, heating, safety Rapid response to problems Repairs, heating, homelessness, ASB, harassment, security Housing related support (Supporting People) Floating support and accommodation based services

11. Helping people to stay at home Reablement Hospital avoidance/discharge, intensive care and support Home adaptations e.g. grab rails…to ground-floor extensions Telecare 24 hour response ~ range of technology ~ promote awareness of benefits

12. Helping people to find a new home More housing suitable for older people and people with disabilities, with care and support A wider choice of affordable homes e.g. rent, buy, part-buy/shared ownership Single properties ~ grouped accommodation

13. Helping people to find a new home Designed or adapted ~ new build and conversion Extra care ~ as an alternative to residential care

14. Risks and Issues Promote: independence ~ self-determination Prevent: isolation and loneliness ~ abuse Maximise: affordability ~ value for money Workforce: recruit, retain and train

16. ILEX: the next steps Continuing engagement and consultation in 2013 Cabinet, April 2013 with revised draft for approval

17. Your views about ILEX Are the objectives the right ones ? Have we identified the appropriate range of services do people need to stay in their own home? For people who have/choose to move home, have we highlighted the right range of housing options ?

18. Adult Social Care Consultation on Fees 6th February 2013 Karen Murphy and Simon Barton

19. Purpose • To begin consultation on arrangements by which to determine fee rates to be set by SMBC for: • registered residential and nursing care • non-registered support services • No decision has yet been made for 2013/14 and beyond

20. Purpose • Domiciliary/home care support: current rates apply until outcome of tender process • Supporting People: outcome of service review determines contract value ~ 20% reduction in programme expenditure by March 2015

21. Putting Solihull People First • Our ObjectivesPeople in Solihull: • Are able to get high quality information and advice from a variety of sources so that they understand how care and support works and they can get the support they need. • Are enabled to maintain their maximum degree of independence. • Can be confident that their care and support will be of high quality and that they will be safe and treated with dignity and respect • Feel in control of their care and support

22. Strategic Context • Objectives supported by a range of strategies…both SMBC and joint with NHS • Market position statement: picture of supply and demand ~ what it might look like in future ~ how commissioners will support and intervene to deliver this future vision • Development of new contract and specification

23. Services ContextRegistered Care Home beds in Solihull @ Feb ‘12

24. Services ContextRegistered Care Home providers in Solihull @ Feb ‘12 plus…175 homes out of borough with 300 service users

25. Financial Context Solihull MBC Adult Social Care – 2011/12 to 2014/15

26. Challenges • Demographic: increasing demand • Funding: constrained resources • Quality: increasing aspirations • Legal: due regard to actual costs of care • Market: oversight to ensure quality, safety and financial viability • Scope: significant area of investment

27. Proposal: Principles • Partnership and co-development of fee structure and quality framework: SMBC and Providers ~ dialogue ~ improved transparency ~ ‘greater awareness of how much things cost’ • Contribution from service users and carers • Supported by independent 3rd party • Consultation throughout process

28. Proposal: Principles • Sustainable longer term settlement… • fair price that is affordable… • neither a cost that SMBC cannot afford… • nor a price that would put homes out of business • Incentivises quality improvements and delivery of positive outcomes

29. Proposal: Principles • Fulfil Equalities obligations ~ promote equality of opportunity, good relations, positive attitudes ~ eliminate harassment and unlawful discrimination ~ anticipate consequences of proposals and minimise/eliminate negative impacts • Residential and nursing care homes for older people …potential wider application at later date

30. Proposal: Step 1 - Framework • Providers to declare actual costs: direct, indirect, capital • Costs of local (not regional/national) services • Analysis of returns forms basis of fee structure • Methodology…to be fully defined

31. Proposal: Step 1 - Framework • Set a fee for each of: residential ~ nursing ~ older people ~ dementia • Fee for meeting ‘core standards’ plus higher ‘enhanced’ rate if additional quality standards met • Subsequent inflationary award aligned to demonstrable increases in direct/in-direct costs only

32. Proposal: Step 1 - Framework • Quality framework ~ cross refer to development of contract/specification • Simple, clear, attainable standards with incentives

33. Proposal: Step 2 - Procurement • Procurement to create a framework agreement • Local Solihull based services • Tender to assess whether meet ‘core standards’ • If not achieve ‘core standards’ and a place on framework = lower fee

34. Proposal: Step 3 - Validation • Validation of quality and associated fee • On-going monitoring of quality • Feedback from residents and family members ~ 3Cs • Continuing joint work with NHS and CQC

35. Proposal: Benefits • Future sustainability ~ stability ~ value • Assurance ~ safeguarding residents and interests of families • Improved quality ~ care tailored to deliver person centred outcomes for residents • Co-development of quality framework, standards and fee structure • Develop and retain workforce

36. Proposal: Benefits • Reduces threat of legal challenge • Better understanding of market ~ improved decision making ~ anticipate demand pressures • Improved relationships • Politically…greater oversight, improved understanding and accountability…better able to represent constituents

37. Proposal: Process • Governance and infrastructure • Co-development and consultation ~ contributions from… • provider staff: front line staff ~ managers ~ trustees/directors • residents and family members • commissioners and partners

38. Proposal: SMBC Current Offer • 0% for all registered residential and nursing care services and non-registered support services for 2013/14 • Undertake the ‘fees project’ for residential and nursing care for older people, including dementia, (Step 1/Framework) for conclusion and recommendations to DASS and Cabinet Member by September 2013 • Decision on fee settlement wef 1 October 2013 for 4 ½ year period (until 31 March 2018) • Backdating under consideration

39. Proposal: SMBC Current Offer • Registered residential and nursing care home services for adult mental health, learning and physical/sensory disabilities…0% will apply except where the outcome of a care funding calculator exercise and/or review of high cost placements determines otherwise • ‘Fees project’ Steps 2 and 3 to conclude by March 2014 for implementation in 2014/15…including further consideration of wider application.

40. Next Steps • Confirm this offer in writing • Deadline for responses to consultation by 5pm Thursday 7 March 2013 (30 days) to simon.barton@solihull.gov.uk • Consideration and analysis of responses • Decision announced w/c 18 March 2013

41. Next Steps • If proceed with ‘fees project’…commence immediately • Step 1/Framework for conclusion and recommendations to DASS and Cabinet Member by September 2013, and decision wef 1 October 2013 • Step 2/Procurement and Step 3/Validation to conclude by March 2014