Ensuring Choice, Commissioning Quality and Evidencing Value in Residential Care Commissioning | adam HTT

What is the challenge?

The introduction of the Care Act in 2014 means commissioners need to ensure service users are placed in homes that cater for their specific needs. They also need to evidence that they have provided service users and families choice over where they go.

This change comes at a time when unprecedented pressure is facing Health & Social Care.

These pressures include funding and resources stripped back; whilst the latest research into projected demand increases show the challenge is only going to become greater.

And although we should not make direct correlations between a growing, aging population with the number of extra Care Homes needed across the country (as David Brindle highlights), it’s an indicator that cannot be ignored.

Currently, 421,000+ people find themselves in a Care Home and 59% of those placements come through a Public Sector Organisation. As figures stand, occupancy levels within Care Homes sit at 91%.

The prediction is that existing Care Home places will run out in less than 3 years.

What’s happening now?
Worryingly, commissioners of Care Home placements are already struggling to feed choice into the sourcing and placement process. Inherently these commissioners believed that due to reduced resources, the only way to counter the challenge was to use limited suppliers because it was easier to manage.
Sadly, this approach cannot be sustained because the same commissioning teams are over-stretched, unable to keep up with demand. Providers are also at full stretch according to the latest CQC report. Which indicates that some providers are struggling to improve and some that were previously delivering a good standard of care have slipped backwards.

Ultimately the current outlook is leaving Public Sector Organisations requesting more funding, more people and more resource to plug the gap.

However, the appetite for more is a direct result of the symptoms these organisations are suffering from.

What symptoms will you recognise?
Commissioning teams struggling to feed choice into the process of placing service users, usually suffer from a variety of symptoms. As they’re working with a limited number of providers, commissioners spend most of their time firefighting to manually fulfil requirements around their current framework agreement. This often means a broker picking up the phone to see if another provider can take on the requirement.

An approach which is not only potentially non-complaint, but often results in higher costs of care.

The individual is also at risk of not receiving the personalised service they so desperately need. According to Age UK, they estimate that 1.2m older people have unmet care needs up from 1m in 2016. Nursing home bed numbers also stopped rising in 2015, with 4,000 fewer beds available since that time.
Of course, feeding choice into requirements is a tough task. Frequently, commissioning teams believe they have already tried everything to resolve the issue.

This is especially true when Public Sector Organisations only focus on resolving symptoms with more instead of uncovering the underlying cause.

What is the underlying cause?
A number of causes are reducing the ability of Public Sector Organisations to embed choice, quality and value into the commissioning process. Part of the problem is an inconsistent process. There is also a major lack of market control with around 80% of Local Authorities having no dedicated commissioning model for Residential Care placements.

Local Authorities instead use a rolling yearly contract, block contract or pre-placement contract with a fixed number of providers. These approaches don’t effectively enable the management of quality or choice as demand continues to rise. The same goes for spot purchasing around these contracts, as there is little control over the market and compliance.

The result is a disengaged provider market, who have had their needs continuously neglected.

This approach is repeated over time, compounding the problem.

However, evidence suggests that there is an alternative approach that is instilling choice, enabling quality and evidencing value throughout the commissioning process.

So how can you solve it?
Micro-commissioning from a diverse pool of providers through Digital Commissioning Technology, has eased these pressures for several organisations.
It’s an approach which is equipping commissioners with the tools they need to shape quality into the commissioning and selection process.

This means commissioners can highlight individual criteria that needs to be met on each requirement. Providers are then able to see that criteria before they submit an offer.

Using a single technology with a micro-commissioning model also enables these councils to pin-point where specific capacity issues reside in the area.

Overtime the approach fosters a collaborative relationship with the provider market.

The available time gained back from firefighting, also means commissioners have more time to quality check providers. These checks include financial viability, CQC compliance data and safeguarding.

This helps commissioners manage a diverse pool of providers, increasing choice. They can then target the most suitable, quality provider to support and meet the needs of the individual requiring a Care Home.

Commissioners are then able to share this information with families, to better inform their decision-making process for their loved ones.

The result?                                                                                                                                                                                                                   

It enables commissioners to buy better quality services between 2-18% greater than with previous approaches to commissioning.

Haringey Borough Council have developed a Collaborative relationship with their providers

A number of CCGs across the Midlands and Lancashire have transformed their approach to commissioning Care Home placements.

Averaging 5 offers per requirement

Averaging savings between 7%-8%

Consolidating invoices into one weekly document

Residential Care commissioning will only become more challenging as we approach 2020 and beyond. The good news is, technology is already reducing the complexities in commissioning Care Home placements.

It’s also fostering a sustainable market with collaboration at its heart.

Which allows commissioners to identify value, reward quality and evidence choice.


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