Market Position Statement Workshop

1. Market Position Statement Workshop 22 January 2015

2. Programme

3. Aim and Objectives Aim To engage local providers in order to inform our commissioning and market shaping responsibilities Objectives • Discuss Providers local development plans • Consider how the Council can support local provider market • Agree mechanisms for effective partnership working between Council and local providers

4. Update from last session Cathy Kerr – Director of ACS

5. Context • Market Position Statement (MPS) event held 12th March 2014 • MPS document published on Richmond website at http://www.richmond.gov.uk/lbrut_market_position_statement_2014.pdf • Case for change: • Council acknowledged the need to commission differently and engage with Providers and Service Users in a meaningful way in order to ensure Service Users` outcomes are met • Focus on preventative services and enable Providers to be creative • Real partnership working and co design with Providers and Service Users and their Carers

6. Financial context • Legislation largely reflects current best policy and practice but with some significant and substantial changes • Key areas of financial risk for 15/16, new rights for Carers • Forecasting demand (future behaviours) is not an exact science (managing the known unknown) • Detailed metrics and financial modelling is only a part of the jigsaw (‘soft’ evidence also required) • Need to redirect financial resources to enable people to be supported in their own homes and communities • Exploring joint working with other Boroughs

7. What Service Users/Carers said to us…

8. What Providers said to us...

9. What we did… Preventative services • Community Independent Living Service (CILS), commissioned December 2013 (mobilisation completed April 2014) • Richmond Response and Rehabilitation Service, commissioned October 2013 (mobilisation completed January 2014) • Review is in progress for the following provision: • Information and advice offer including the Council's external website • Advocacy provision • Explored opportunities to use technology more innovatively e.g. Older People Technology workshop

10. What we will do… • Explore new opportunities to address the self funders market • Commission services where Service Users/Carers take informed risks • Develop integrated services which promote choice and control • Use the Co production group (Service Users, Carers representatives) to understand people`s views and wishes • Commission Outcome Based Services (e.g. Help to Live at Home, Outcome Based Programme for community health services) • Engage more with Providers to better understand and shape the market

11. Help to Live at Home - objectives • Allow as many people as possible to remain in their home after a serious life crisis • Allow people to exert choice over what happens next for them, including: • defining their own life outcomes; and • agreeing and committing to a support plan intended to help them meet their outcomes; • Incentivise providers to help people to realise their outcomes by paying providers by results • To reduce the cost of the traditional home care service.

12. Residential Care Provision (Care UK) • Re profiling beds in Care UK PFI contract • Local need is for more intensive nursing and dementia beds rather than residential • Commission additional extra care provision locally

13. The Care Act 2014 for ProvidersGill Ford - Care Act Programme Manager

14. Context • The Care Act came into law in May 2014 • Many new duties but also put on a statutory footing existing best practice such as Personal budgets & direct payments (the latter still the preferred option for personal budgets) • Whilst the legislative base has changed totally, in practice much will remain the same for providers • Key change is that the Act encompasses the whole population • This presentation is focussing on key changes for providers and what is happening in Richmond

15. Implementation timescales

16. Promoting Wellbeing Whenever a local authority carries out any care and support functions, it must promote wellbeing described as: • Personal dignity including respect • Physical and mental health and emotional wellbeing • Protection from abuse and neglect • Control by the individual over day-to-day life (including over care and support and the way it is provided) • Participation in work, education, training or recreation • Social and economic wellbeing • Domestic, family and personal relationships • Suitability of living accommodation

17. Prevention • Applies to all adults, including people who do not have any current needs for care and support, or people with no eligible needs • Three levels of prevention: • Prevent: primary prevention – promoting wellbeing • Reduce: secondary prevention – early intervention • Delay: tertiary prevention Richmond Council is developing a prevention strategy with Richmond CCG and other local partners; one outcome of this will be a commissioning plan.

18. Information and Advice Information and advice services for all residents, to include: • How to access care and support locally • The types of care and support locally and nationally and the quality of locally provided care • The likely costs to the person of the care and support services available to them including costs that the Council pays • How to access independent financial advice on matters relating to care and support • How to raise concerns about the safety or wellbeing of an adult with care and support needs. Richmond is implementing a local resource directory using Careplace.

19. Carers Same rights for carers as those they care for example: • Wellbeing principle • Preventing needs for support • Right to assessment • Eligibility: national minimum threshold for carers • Planning: rights to personal budgets, direct payment, support plan • Market shaping - ensure appropriate services for carers Richmond is developing a local carer’s offer

20. Market Shaping and commissioning Duty on councils to facilitate diverse, sustainable, high quality services in their area to provide people with meaningful choice regardless of who pays for care – it covers the whole market. Underpinned by these principles: • Focusing on outcomes and wellbeing • Promoting quality services, including workforce development and remuneration and ensuring appropriately resourced care and support • Supporting sustainability • Ensuring choice • Co-production with partners Richmond is reshaping its Market Position Statement

21. Managing provider failure & market oversight • Provider Failure: Triggered “when the service can no longer be provided” Council has temporary duties to meet people`s needs. This already happens (think of Southern Cross) • Market oversight applies to largest and difficult to replace providers i.e. domiciliary care providers delivering 30,000 hrs or 2.000+ people a week, care home providers 2.000+ beds • Providers have a duty to provide information to CQC who assess sustainability and inform local authorities as early warning when they consider a provider is likely to be unable to continue. Richmond is waiting for CQC to issue guidance on market oversight in January 2015 to understand Council responsibilities

22. Financial sustainability of other providers (not in the CQC oversight regime) • Will affect vast majority of small and medium providers. • LAs must ensure continuity of care in respect of business failure of all providers and so need to have contingency plans and an understanding of the likelihood of failure of providers in their area • Authorities need to have an understanding of current trading conditions and the sustainability of their pool of providers in order to focus their contingency planning • Strengthens the need for contingency planning on all parties Richmond is waiting for the LA toolkit for Contingency planning for care provider failure to be issued April 2015

23. Advocacy • New duty: Where the local authority considers that a person has substantial difficulty in being involved with their care and support then they must consider whether there is anyone appropriate who can help the person to be fully involved, e.g. family member or friend. • If there is no one appropriate, then an independent advocate must provide support and represent the person in the assessment, support planning and review. In Richmond we are reviewing current provision and will be going out to tender for a new services in 2015.

24. Funding changes for 2015 • Deferred payments: People do not have to sell their homes in their lifetime to pay for residential care • Self-funders with care at home may ask their local authority (LA) to arrange their care; the person cannot be charged more than the cost the LA is able to secure, plus an admin charge. • Rules on ‘top-up fees’ are re-enforced to make clear that all arrangements must be through the LA. A provider must not seek a ‘top-up fee’ directly with the person receiving LA funded care. In Richmond we are consulting on our charging policy for deferred payments and for arranging care for self funders

25. Funding changes for 2016 • Self-funders in a care home may ask their LA to arrange their care; the person cannot be charged more than the cost the LA is able to secure, plus an administration charge. • Extension to the point at which means tested support becomes available. This means more people eligible for Council funded care. • Introduction of the cap on care costs (care accounts). In Richmond work has not yet started. Waiting draft guidance from DH and also results of national work on the impact of self funders accessing care home beds at LA rates

26. Safeguarding • Safeguarding now on statutory footing • Providers have a duty to co-operate during a Safeguarding Adult Review • Providers must have a Designated Adult Safeguarding Manager • All providers must have safeguarding policies and procedures Richmond: Implementing Making Safeguarding Personal to ensure service user is at the centre of the safeguarding process

27. Integration, cooperation & partnerships Local authorities must: • Carry out their care and support responsibilities with the aim of promoting greater integration with NHS and other health-related services • Duties also apply from NHS bodies to LA In Richmond; JCC set up to deliver joint commissioning and working with CCG in delivering OBC through community provision

28. Summary for providers 2015 • Market Shaping interaction with local authorities • CQC Market Oversight & Business Failure regime • Duty to arrange care for self funders at home using Council rates • Statutory Safeguarding • Information & Advice and Resource Directory • Services aimed at prevention • Independent advocacy • New & different services as a result of integration • More demand for carer services/support • National communication campaign starting February 2015

29. Summary for providers 2016 • Duty to arrange care for self–funders in care homes at Council rates • Capital limits raised so more people eligible for Council funded care • Care account commences April 2016 • Assessments of existing self funders in care homes to start autumn 2016 • More people known and potentially supported by the Council • National communications campaign starting post general election

30. Outcome Based CommissioningDavid Sykes – Interim Head of Joint Commissioning Collaborative

31. Commissioning for Better Outcomes “Effective commissioning plays a central role in driving up quality, enabling people to meaningfully direct their own care, facilitating integrated service delivery, and making the most effective use of the available resources.” Commissioning for Better Outcomes : A route map

32. What matters.. “What matters most to people? • The person at the centre, rather than fitting them into services • People who use services and carers treated as individuals • Empowering choice and control for people who use services, and carers • Setting goals for care and support with people who use services and carers • Having up to date accessible information about services • Emphasising the importance of the relationship between people who use services and providers and staff • Listening to people who use services and acting upon what they say • A positive approach, which highlights what people who use services can do and might be able to do with appropriate support, not what they cannot do ClentonFarquharson MBE, Co Chair Thin Local Act Personal”

33. Standards for good commissioning.. • Are designed to ensure that everyone shapes and shares the vision of excellent • Support the development of a common focus and purpose across the system, driven by shared values and behaviours care and support • Seen as a route map for that journey rather than the final destination

34. What good commissioning means (1)

35. What good commissioning means (2)

36. Outcome Based Commissioning (OBC) Programme • OBC means thinking more about what the services we commission achieve (outcomes for people) instead of how they operate • Under OBC contracts, service providers are paid for delivering a set of outcomes for people rather than for the amount of activities undertaken In Richmond, the OBC programme will run across five phases.

37. OBC Phases

38. Outcomes framework - generic outcomes (1)

39. Outcomes framework - generic outcomes (2)

40. Engagement process on OBC • Engagement process with Service Users/Patients and their Carers undertaken from July to September 2014 • Development of an outcomes framework • OBC contract not yet finalised, more important is to work with providers about how to focus on outcomes

41. What does this mean for Providers • Different ways of working • OBC moves back towards partnership relationship and co design • Moves the focus back to what Providers deliver for the people they support • Reduces admin tasks and monitoring • Incentivises performance

42. Procurement exercises – 2015/2016

43. Next stepsDavid Sykes – Interim Head of Joint Commissioning Collaborative

44. Next steps • This is just the first event in a series • Engagement plan will be circulated by end March 2015 • Providers will be co-opted to help the Council co-design future services and contribute to shaping future MPS (Provider Reference Group). We will take into account Providers who volunteered in the past

45. Evaluation