Challenges of Social Spending Control in Paris Personal and Household Services Sector

1. Public Private Partnership CESU/Remote management Governance and Control Modalities Of Social Spending Personal and Household Services Sector PARIS experience ESN Lisbon Tuesday 7th of July 2015 Department of social action, childhood and health Sous-department of autonomy

2. Challenges of social spending control for the department of Paris personal and household services sector • Two tools: CESU, Remote management • An original public private partnership ESN Lisbon– Tuesday 7th of July 2015

3. Challenges of social spending control for the department of Paris personal and household services sector ESN Lisbon– Tuesday 7th of July 2015

4. APA social allowance for dependent elderly people • PCH for disabled people in need for human assistance in France : 66 million people 60-74 years: ……………………….....15% 75 years and more:…………………..9% 718 000 benefit from APA: 3,24 bn € 231 000 benefit from PCH: 1,620 bn € Paris: 2 273 305 Parisians 60-75 years: 299 000 Parisians……….13% More than 75 years: 171 000…………..8% 11 000 live in establishment……….…6,4% 160 000 live at home ………93% 18 000 APA at home….11% Annual cost 86 million € Disabled Parisians receiving a PCH allowance of human assistance 4 700 beneficiaries: adult and children Annual cost 49 million € ESN Lisbon– Tuesday 7th of July 2015

5. State of the art and challenges for the department of Paris • Challenges • 1- Provide department of Paris with management and control tools of social allowances APA/PCH • 2- Improve monitoring of the care of the elderly and disabled people • 3- Control social spending without reducing the quality of care for people • 4- Reduce the management costs related to social spending • 5- Favour modernisation of household services • 6- Promote simplified payment systems for private employers • State of the art • 1- Social spending APA and PCH have fallen under the responsibility of the finances of the French departments since 2002 and are constantly increasing • 2- Difficult control of effectiveness of expenses considering the number of beneficiaries (25 000) • 3- Numerous actors in the personal and household services sector • 4- Expensive use of third-party payer for APA and lack of real control and management tools for social spending • 5- Growing budget constraint for local governments ESN Lisbon– Tuesday 7th of July 2015

6. Two tools: • Prefinanced CESU • Remote management ESN Lisbon– Tuesday 7th of July 2015

7. REMOTE MANAGEMENT 1- Timestamp system on arrival and departure of carers 2- Compatible with various business software for personal and household services 3- Modernised management of personal and household services 4- Automatized billing system 5- Several competitors on the market • CESU • 1- Prefinanced Chèque Emploi Service Universel : voucher easy to use to purchase services • 2- Simplified working contract • 3- Voucher on paper support and/or possibility to use dematerialised CESU (e-CESU) • 4- Voucher allowing simple process of wages payment, approved and controlled by the State encouraging declared work • 5- 6 issuers of CESU on the market • 6- CRCESU GIE between 6 issuers of CESU to ensure vouchers’ reimbursement presented while purchasing the services ESN Lisbon– Tuesday 7th of July 2015

8. Implementation of an original public private partnership ESN Lisbon– Tuesday 7th of July 2015

9. Original Public Private Partnership • 1/ Public partners • Department of Paris signatory of the market and payer of allowances and management costs • CNCESU (State): collector of social charges and promoter of CESU (agreement with department of Paris) • 2/ Private partners • Private operator: Edenred contractor of department of Paris: designer and programme manager of CESU/Remote management, issuer of CESU • Department services responsible for personal and household services in contractual relationship with Edenred in regards of management of remote management tool • CRCESU:reimbursement centre of CESU that manages affiliation of services’ providers – companies and individuals, verifies that a person who submits CESU for reimbursement is authorised to do it and afterwards proceeds to reimbursement ESN Lisbon– Tuesday 7th of July 2015

10. Choice of Paris on the basis of tender • Single private operator • Integrated information system shared by all actors Remote management CESU -35 personal assistance services for the registration and monitoring of interventions (timestamp) of their carers in Domiphone system - For hours paid by the person , by the department or by any other agency - Automatized, secured and quick billing system • PARIS AUTONOMIE • Information and management platform run by private operator Edenred for • Beneficiaries of allowances APA/PCH or their families • Carers • Services responsible for personal and household services • City of Paris departments • Purchasing of non-integrated household services in remote management system • Payment of contracted carers of elderly and disabled people • - Payment of social charges directly to CNCESU by department of Paris • - Reimbursement of vouchers by CRCESU ESN Lisbon– Tuesday 7th of July 2015

11. 3 main stages of implementation of PARIS AUTONOMIE • Stage 1/ Remote management: 1 year (April 2012/April 2013) for: • Conceptualisation ( IT interfaces between business software SAD and timestamp system), • Training of staff from personal and household services, • Training of City of Paris employees, • Implementation of billing system. • No impact on beneficiaries of social allowances • Stage 2/ CESU: 6 months (May to October 2013) for: • - Conceptualisation, training, communication • Strong impact on beneficiaries of social allowances • Stage 3/: third-party paying social charges CESU (December 2014) • Impact on CESU beneficiaries ESN Lisbon– Tuesday 7th of July 2015

12. Key success factors • 1/ A project team dedicated to City of Paris and able to coordinate all the actors • 2/ A clear communication plan towards the beneficiaries (reference file) • 3/ An assistance plan for change for field actors (SAD, department services) by the operator and the project team of the city (training, explanation kit) • 4/ A financial incentive from City of Paris to make personal household services join the remote management system (equipment and managing costs of the device) (partial aid from the State) • 5/ Political support to the project ESN Lisbon– Tuesday 7th of July 2015

13. Project complexity and risks • 1/ Important number of actors : • Aid beneficiaries (25 000) fragile population (elderly people / disabled people) • Personal household services (20 during generalization, 30 - 1 ½ year later) with different status : private, public, non for profit • Numerous self-employed people hired by individuals who benefit from allowances • CNCESU; CRCESU; CNAV • More than 300 administrative officers in City of Paris • Software companies (SAD business /timestamp/Salsa) • 2/ Financial amounts at stake: 130 millions € (wages) • 3/ 2 new systems at the same time : CESU/Remote management • 4/ No longer need to CNAV for APA allowance simultaneously for 18 000 people • 5/ Tight deadlines (elections constraints) ESN Lisbon– Tuesday 7th of July 2015

14. Public/private partnership assessment • Project CESU/Remote management for City of Paris • 1/ For City of Paris • Monitoring tools for beneficiaries (consumption follow-up of allowances planning, data base update, indicators) • Control of social spending thanks to an automatic control of the effectiveness of the good use of allowances with remote management, non-used CESU and the third party payer of social charges • Decrease of managing costs in regards to social spending (end of CNAV) • A global saving estimated at 8% of the social spending (household allowance for disabled/elderly people) • 2/ For personal and household services with remote management • A modernization of the managing system not only for clients department but also for the others • A faster invoice payment • 3/ For the State CNCESU • - A guarantee of social charges payments and available control tools • 4/ For allowances beneficiaries and their families • New secured tools (CESU) and possibility of digitalized payment (e-CESU) • In perspective a monitoring of carers intervention available on the extranet to beneficiaries and/or their family • A few difficulties met with the delay in the implementation of the third party payer of social charges ESN Lisbon– Tuesday 7th of July 2015

15. VOUCHERS OF PARIS AUTONOMIE Presentation of Paris Autonomie vouchers

16. THANK YOU FOR YOUR ATTENTION