Improving market capacity for Domiciliary Care | adam HTT

What is the challenge?
Domiciliary Care commissioners are now tasked with delivering more services, to more people, with needs that are more complex. However, many commissioners have been restricting themselves because they are using a fixed number of providers to deliver these services. Which mean brokerage teams are becoming increasingly stretched because they have to work around the existing commissioning process to fulfil requirements.

At the same time, budgets continue to dramatically deteriorate out of balance with rising costs.

How has this impacted the market?
The output of this landscape is bleak. The market has become unstable because commissioners are unable to make the most of all available capacity, in a sustainable way. Which makes promoting independence and delivering outcomes, by commissioning from the best matched provider, continuously unachievable.

The latest report by the CQC also states that some 400 providers are deregistering with the CQC before they even have the chance to provide a service. Which suggests that issues with restrictive framework agreements is locking out capacity and choice.

This is leaving many commissioners asking for more funding to plug the gap, but increased funding will, at best, only ease the symptoms in the short-term.

What symptoms will you recognise?
Often local authorities recognise three symptoms to begin with:

Commissioners are working around their existing framework model to fulfil requirements. Usually via email or telephone. Commissioners will naturally call the provider they know and have a relationship with, instead of identifying the provider best able to meet the needs of the individual. This approach doesn’t create a collaborative relationship with the market and can frustrate others who aren’t engaged in the process.

The approach also means it’s likely that providers aren’t fully informed about the service criteria required to successfully meet the needs of the individual requiring care.

At times, providers simply have no choice but to hand back contracts because they can’t plan effectively. Others can’t deliver the service for the price agreed in a framework agreement from years gone by either.

What is the typical reaction?
This leaves commissioning teams blaming market factors such as uplifts to National Minimum Wage for provider capacity waning. Some have also lost control and visibility of the market and are pushing more service users towards Direct Payments to alleviate pressures.

The combination of these indicators lead to an overspent budget.

The key distinction to make is that these symptoms, feelings and reactions aren’t causes. In order to alleviate these, local authorities need to uncover and resolve the underlying causes.

So, what are the underlying causes?

There are two main causes impacting market capacity:

  • Frequently legacy commissioning processes (Closed Framework Agreements, Block Contracts, Spot Purchases) haven’t kept up with demand, reduced resources or funding cuts.
  • Restricting supply and manual processing throughout the commissioning lifecycle has compounded over time, creating a broken system.
  • Commissioning and brokerage teams are then left firefighting to fulfil more care packages, meaning they don’t have the time they need to build relationships with existing providers.
  • Creating a disengaged market, not a collaborative one.
  • Making it even more difficult to meet requirements of the Care Act and support individuals receiving the service.

The second cause is that commissioners don’t have oversight over all the available providers in the area that can support the community.

  • This means commissioners are also missing out on all the available capacity.
  • So, it’s completely understandable for teams to then believe that change is just too hard to deliver.
  • Many resort to telling themselves that they have done everything they can with the resources they have. Results show however, that there is an alternative which is sustainable and does tackle these causes.

How can you tackle the cause?
A number of councils across the country are now coming away from closed frameworks and other legacy approaches so they can manage the end-to-end commissioning process in one place. They are using a complete digital commissioning technology that enables provider engagement, development and management.

The approach gives all providers an equal chance to win business. This means a fair and transparent relationship with the entire market, enabling commissioning teams to unlock existing capacity as well as develop new capacity.

In turn, this approach improves the quality of providers delivering services and develops a sustainable market for everyone.

The technology then automates manual tasks (such as processing invoices) giving commissioners more time to build relationships with current and new providers.

The results:
On average, Digital Commissioning technology is delivering:

A 120% increase in capacity

Better quality services commissioned between 2-18%

9% provider payment accuracy

For The City of Cardiff Council in particular, they are now fostering a collaborative culture with their market across three areas:

Increased choice
Cardiff began 3 monthly Provider Forum sessions to create a strong relationship with the market. The benefits of which are starting to show, as they are currently seeing an average of 3 offers per requirement.

Making the placement process more efficient
Thanks to regular engagement sessions with providers, 4 out of 5 placements are awarded to a provider after the first offer period.

Creating value for money
In the last six months alone, Cardiff have seen 4 new providers awarded care packages. This added competition and quality has helped to drive down their blended hourly rate by 5% compared to this time last year.

A bi-product of the sustainable market being created is the value they are seeing. Now, the council is seeing10% savings overall. This is not only down to competitive pricing, but efficiencies being made through-out the commissioning process.



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