The potential for a brokerage role for CVS and other support organisations

1. The potential for a brokerage role for CVS and other support organisations Kathy Atkinson, RAISE Shelly Hambrecht, Empowering West Berkshire

2. Our aims • Share what “A Healthier Perspective” tells us about the potential brokerage role • Explore the possibilities for charging for this role • Highlight the dilemmas / decisions involved for you and your Board • Discuss ideas for further action / help required

3. What are we talking about.... brokerage? Conduit (it’s our role anyway so no charge) Facilitator (part of our role, but we could potentially charge for it) Manager (would need to charge for this)

4. Actions arising from the project’s research Towards brokerage: being an effective conduit

5. Position yourself as a leader/gateway for voluntary and community organisations in your area • Identify the tangible benefits that a voice for the sector within your local area can provide for you, the sector and commissioners • Test the potential of this role with both the rest of the sector and commissioners to ensure needs of all potential partners are met • Undertake a review of the skill set within your organisation to ascertain your ability to take on a role as a leader/gateway for the VCS • Get yourself invited to key meetings with commissioners – offer your support to commissioners, and demonstrate your reach and understanding in your communications • Invest the time to network – get out and about

6. Identify a way into the Health & Wellbeing Board in your local area • Get to know the Health & Wellbeing Lead within your Local Authority or the Healthwatch representative if you are not at the table • Understand the Health &Wellbeing priorities for your local area and the opportunities this brings to your organisation and the sector • Get on the circulation list for minutes of key meetings • Disseminate priorities and opportunities to the rest of the sector on a regular basis – use ebulletins, conferences, fora, networking events, etc. • Use a strategic approach to identifying which are the key forain your local area that require voluntary sector representation • You can’t go to everything and so identify appropriate colleagues across the sector to attend those key meetings or fora who can represent the sector and feed back

7. Publicise success stories to promote positive relationships with commissioners and providers • Use e-bulletins, case studies at conferences, website features, etc. and acknowledge commissioners’ good practice in all these cases • Drip feed success stories of VCS to promote positive perception by commissioners • Consider using space in commissioner newsletters/e-bulletins to highlight successes within the sector • Advocate for small grants where they make a big difference; use evidence to demonstrate this

8. Moving into the facilitator / manager role

9. Foster networking within the voluntary sector and with commissioners • Get to know your members; scope out who’s involved in health and social care (they may not define themselves as such) • Assess their expertise and needs through surveys/conferences, etc. • Are the networks/forathat you run/attend the right ones? Think about non traditional networks, perhaps around different themes (e.g. take a health and wellbeing priority outcome rather than a “sector” approach). • Think about the purpose of each forum and what it is going to achieve • Do fora need to be time limited? Make sure you have regular reviews • Get to know the commissioners; be proactive – go to your local authority or Clinical Commissioning Group and seek them out for face to face meetings • Exploit opportunities such as stakeholder meetings, other statutory led meetings to get to know commissioners better

10. Identify the potential for your role as a broker between commissioners and the VCOs in your area • Identify whether you want that brokerage, or mediating role, through discussion with your Board of Trustees • If yes, to what extent do you want that role? • Only if there is funding available to support it; or • We see the value and will fund it ourselves through a review of our services to assess what other work can stop • If yes, develop a marketing strategy • If no, who else might take on this role?

11. Develop your role as a facilitator of relationships • If you are going ahead, develop expertise in brokerage/ mediation; put together an organisational development plan for this kind of service • Signpost to, or provide, support around formal collaborations; for example around governance, consortia, legal entities, intellectual property • Identify what you can provide directly (bear in mind liability) and where to suggest organisations get specialist help. Can that be provided pro bono through specialist volunteers, through Corporate Social Responsibility programmes or does it need to be bought? Supplier “deals”? • Discuss with your Trustees how the broker role will be funded – will these services be free or will there be a charge, and if so, to whom?

12. It’s all common sense What strikes you? To what extent could you enhance your role as conduit? What is your appetite for moving further into the facilitation / manager role? What issues – barriers, opportunities, dilemmas - affect this?

13. What you and your Board might consider • What are the information flow needs in your area / for your target communities and commissioners? Who’s doing what right now? • How well are you fulfilling your key role as conduit; how could you improve upon it, and what are the resources implications of this? Any quick wins? • How well do you understand your local marketplace, from the high level strategic priorities to the specific needs of the organisations you support? • What would be the tangible benefits of travelling down the brokerage spectrum, to commissioners, providers and communities as well as to you? • What is so important to your organisation that you would do it anyway? What must generate income in order for you to do it (does it need to cover its costs)? • Could you stop doing something in order to release capacity for more facilitation / brokerage activity? What opportunities might that bring? • What additional skills and resources would you need to do more facilitation / brokerage? • Who’s your competition in this field?

14. How could we make the broker role pay? Some initial thoughts

15. Key questions 1. who would value or benefit from this service (and how, exactly)? 2. who would pay for this service? - they may not be one and the same

16. Health and Wellbeing Boards - want access to intelligence to feed in to strategic discussions This could mean charging for: • Disseminating HWB priorities to the voluntary sector and the wider public • Facilitating consultation processes; ensuring the right people are in the room / can feed in • Translating performance data, successes and information for public consumption • Facilitating information flow from the voluntary sector to inform needs assessment, service design, procurement and evaluation • Convening networks for a specific purpose (e.g. hard to reach groups; JSNA consultation, CCG commissioning plan review)

17. Adult Social Services • want to understand who does what so that they can purchase services directly and advise personal budget holders on what’s available • want access to intelligence to inform commissioning plans Is there an opportunity for support organisations as brokers in the era of personal budgets? Aim: to get more for your money / long term cost savings

18. Personal budgets: an allocation of funding given to users (after an assessment) which should be sufficient to meet their assessed needs, either by: • Direct payments: cash payments given to service users in lieu of community care services they have been assessed as needing. Intended to give users greater choice in their care. • Council managed (individual service) fund: budget is held by a care provider but the service user can choose how some or all of it is spent and potentially make better use of their funding.

19. Big feature of Caring for our future: Reforming care and support, July 2012 : • Legislating to give an entitlement to personal budgets • Strengthening ambition on direct payments • Supporting a diverse range of quality care providers • Encouraging the use of non-traditional services • New models of advice and support such as peer networks and user-led organisations … to bring different people together to purchase care and support

20. Option 1

22. Public Health • want to understand who does what so that they can purchase services directly • want access to intelligence to inform commissioning plans Clear synergies between public health objectives and much of what voluntary sector providers do How to charge?

23. Clinical Commissioning Groups - want to get through the authorisation process as painlessly as possible - want to develop effective mechanisms to meet statutory duty of patient and public engagement - want access to intelligence to inform commissioning plans - want to know who does what so they can purchase services directly and to signpost patients

24. Worth exploring whether we could charge for: • Helping CCGs develop the Communication and Engagement strategy they need for authorisation • In this and on an ongoing basis, offering advice on involving hard to reach groups in commissioning plans and in PPE • Facilitating the involvement of hard to reach or specific groups in commissioning plans and PPE activities • Providing the one stop shop service to the provider market Not a grant; this is payment for a service that gives value for money. What’s it worth? Let’s take a look at Beryl....

25. A year in the life of Beryl, 79, widowed, lives on her own, no family living locally Month 1 £25 Month 3 £25 £25 Month 5 Running total: £75

26. Month 7 £25 £249 £118 Month 9 £1,400 £25 Running total: £75 + £1,817 = £1,892

27. Month 10 £25 Month 11 £25 Month 12 £25 Running total: £1,892 + £75 = £1,967

28. = £1,967 (or let’s say £2,000) over a twelve month period Not a lot you might say, but • Over the course of a year… • In West Berkshire there are 26, 300 women over the age of 70 registered with a primary care organisation. • Let’s say 10% of these fit the Beryl mould, the total annual cost for West Berkshire would be: • 2,630 ‘Beryls’ each costing £2,000 = £5.2m Assumptions and sources: Average cost of a GP visit£ 25 (NHS Northwest Choose Well posters Average visits to a GP for an elderly woman per year 7.4 in 2004 (Uni. Oxford discussion paper, dept. economics 2011 2010-2011 reference costs in the NHS – headline figures Attribution dataset GP registered populations scaled to ONS population estimates, 2011 February 2011

29. Is there an alternative for Beryl and her GP?

30. Another year in the life of Beryl, 79, widowed, lives on her own, no family living locally Month 1 £25 £0 Month 2 Running total: £25

31. Month 3 Befriending service £x Befriending service Lunch club Month 4 £x Befriending service Lunch club Month 5 Running total: £x

32. Get the idea…?So how can this be achieved?

33. Just twice per year = £100 Potential savings to GP per head = £1,900 - cost of brokerage service per head

34. There may be other opportunities.... • Commissioning Support Units • 111 service • Foundation Trusts • NHS Commissioning Board regional team • ???

35. Costing and charging Some questions to consider

36. What are the full costs incurred by you in providing this service? • What are the costs likely to be incurred by others if this service is not provided? • Can you describe how your intervention would improve quality (e.g. better services, reducing health inequalities, improving patient experience, etc.)? How would it address the stated local priorities? • What is your ideal (full cost recovery) day rate? • What sort of additional resources might you need to incorporate in to your costings? • What flexibility / standardisation do you wish to have in day rate / project charges? • What sort of costing structure is acceptable to you (e.g. on results, payment frequency, contract length, etc.) • What are the charges to be proposed? What is your room for negotiation? • How are you going to present this “offer” so that the commissioner finds it irresistible?

37. What are your thoughts? Which of these ideas have legs? Where are the opportunities for support organisations? How can you develop these (and other) ideas further, or help us to develop them further?

38. What you could do next • Clarify your aspirations for your organisation’s role; use the key questions for you and your Board • Put together an organisational development plan to fulfil your desired role – be honest about your collective capability and capacity • Address the questions around costs and charges for each of your target customer groups • Develop a proposal aimed at your key customer groups, with tangible benefits to justify the charges you are seeking to make; then take it out there • Have contingency plans in case your proposals are not taken up (what could you adapt – costs, delivery, scale?)

39. What we will do at RAISE • Continue to advocate for your role and its value with CCGs, Local Authority HWB Leads, ADASS, SHA and new bodies such as CSUs and the NHS Commissioning Board regionally • Further develop charging models (tell us if you would like to participate in this thinking) • Share good ideas, practice and success – we will ask you but please also tell us

40. Thank you Katkinson@raise-networks.org.uk