2.1 Twice a Year the Chief Officer of the Glasgow City Health and Social Care Partnership

Report title:Glasgow City Social Care Provider Event April 2017

Date:12 May 2017

1. Purpose

1.1The purpose of this report is to present feedback from the provider event for providers of purchased social care services held on 7 April 2017.

2.Background

2.1 Twice a year the Chief Officer of the Glasgow City Health and Social Care Partnership (GCHSCP) hosts an event for providers of purchased social care services. The event is designed to offer providers the opportunity for face-to-face dialogue with Partnership staff in an effort to foster a collaborative relationship with the private and voluntary sectors, and to promote openness and transparency. The purpose of the event is:

• to share relevant information with service providers;
• to update providers on transformation programmes or projects;
• to bring providers together from across the sector to network/share ideas;
• to consult and collaborate with providers on key pieces of work and
• to listen and respond to questions or concerns providers may have.

2.2 The Provider Event was well attended with 103 delegates representing approximately 90 provider organisations who deliver a broad range of services across Glasgow City.

2.3 The Partnership was represented by a selection of officers and Heads of Services (Social Work and Health) from Commissioning, Operations and Business Development among other areas.

2.4 The event focused on the GCHSCP Transformation Project: ‘Proof of Concept: GCHSCP and Provider Proposals to Meeting the Implementation of the National Minimum Wage 2020.’

2.5 The event started with welcome and introduction by David Williams, Chief Officer, GCHSCP. There then followed presentations by representatives of the Partnership: Allison Eccles (Head of Business Development) provided an “Overview of the Proof of Concept; Craig Cowan (Principal Officer) discussed ‘Contracting and Contract Management’ and Chris Melling and Jacqui McGoldrick (Service Managers) completed the presentations by discussing Care Management proposals.

2.6 During the second part of the event, Ann Marie Docherty (CEO, Fair Deal), representing all five provider organisations involved in the POC project, discussed ‘Provider Solutions and Participation in the POC.’ All of the presentations focused on POC project proposals and experiences, and were well received. They provided a stimulus for lively and engaging discussions during the table discussions and questions and answers that followed.

2.7 Next on the agenda were structured table discussions. These were facilitated by Partnership staff and designed to explore the points raised in the presentations and generate ideas and questions in advance of the Question and Answer session.

2.8 The event was rounded off with delegates given the opportunity to ask questions of representatives from both the GCHSCP and provider organisations participating in the Proof of Concept. Facilitated by David Williams, presenters clarified and elaborated further some specifics in relation to their presentations and also addressed the queries from the tables.

1. Presentations

3.1There were four presentations delivered during the event. This section details some of the content.

3.2Health & Social Care Update, David Williams, Chief Officer, GCHSCP

3.2.1David Williams started the event with a brief update on the latest progress in the integration of health and social care services in Glasgow. He presented and put into context some of the challenges faced by the IJB and the Glasgow City.

3.3Proof of Concept Overview, Allison Eccles, Head of Business Development, GCHSCP

3.3.1Allison placed the Proof of Concept project in the context of financial challenges and developments within social care. These included discussions of Social Work Service spend (c£160m per year) for community-based social care. Allison reiterated the need to meet the gap between current funding and that required to maintain a standstill position as result of the new National Minimum Wage.

3.3.2Allison advised the overwhelming majority of purchased community-based social care provision is undertaken on an hourly rate basis. Traditionally the processes of commissioning, procurement and monitoring/auditing have been undertaken on an ‘inputs’ and ‘outputs’ basis.

3.3.3The Proof of Concept transformation project set out to develop and test (where possible) different models of commissioning, procurement and monitoring of purchased social care services. It endeavoured with provider organisations to move away from ‘inputs’ and ‘outputs’ with more focus on service user outcomes.

3.3.4 The Proof of Concept would be the evidence base to engage in a transformational way with other Glasgow social care providers and to enable them likewise transform their services.

3.3.5The Proof of Concept project involved:

• Partnership and Council staff from commissioning/procurement, contract management, care management, finance, ICT and communications, legal, procurement and internal audit and
• five social care provider organisations – Aspire, Enable Scotland, Fair Deal, Mainstay Trust and Turning Point Scotland.

3.3.6Allison then highlighted three of the workstreams involved in the Proof of Concept, which were discussed on the day:

• Contracting & Contract Management
• Care Management and
• Provider solutions.

3.4Contracting and Contract Management, Craig Cowan, Principal Officer (Business Development), GCHSCP

3.4.1Craig outlined the Contract Management Framework and the associated policy and practice for contract management, risk assessment, level of scrutiny and provider reporting.

3.4.2The findings of GCHSCP consultation with provider organisations and our internal reviews were then shared. The feedback on current arrangements from providers included:

• PQR survey was too frequent
• there were too many questions and was resource intensive
• purpose unclear and
• overly complicated to complete (e.g., whole time equivalent).

3.4.3Several changes are being proposed:

• reduce number of questions (from 42 to 12)
• simplify questions
• reduce to 6-monthly (rename PSR)
• increase the completion window (1 to 2 weeks)
• generic questions
• progress Provider Portal for submission.

3.4.4The Service Concerns process has also been revised and it is proposed that it is expanded to external agencies and stakeholders (e.g., Health, Police Scotland, Fire Service and members of the public) who can raise service concerns. Other internal business processes have been streamlined.

3.4.5Changes to the contract management organisation was also discussed. Currently, contract managers are organised by care group. This can lead to one provider organisation having several contract managers allocated. It is proposed that the GCHSCP adopts a lead commissioning officer approach per provider organisation, by exception for business purposes. Provider organisations involved in POC welcomed this proposal.

3.4.6It was recognised that a focus on outcomes should be laid out within the planning stages of tenders and contained within the ITT and service specifications. From the collaborative work with POC providers, a standard but flexible service outcomes framework across care groups and service models is being developed. It is proposed providers report on these six-monthly (as a minimum). However, providers have discretion on the tools/methods that they use for recording and aggregating individual service user outcomes for whole-service analysis.

3.5Proof of Concept: Care Management Arrangements, Jacqui McGoldrick and Chris Melling, Service Managers GCHSCP

3.5.1Chris and Jacqui started by sharing the current care planning arrangements. They advised support plans are currently based on hours and pounds and there is a real need to shift focus from inputs to more of a focus on outcomes. This leads to the GCHSCP being overly prescriptive at times and can provide little scope for flexibility or innovation in resource planning by providers.

3.5.2They acknowledged the disparity between block funded and Personalisation assessment processes.

3.5.3Arising from the POC and discussion with providers, the proposals are that GCHSCP adopts a proportionate assessment approach, focused on specific needs and wellbeing, dependent on risk and budget. The changes will mean more flexible assessment and care planning. All the while, Social Work will continue to have the responsibility for management of risk and safeguarding.

3.5.4Further proposals include care planning to be co-produced by providers and care managers. While necessarily GCHSCP will have particular regard for the three key areas of risk, providers will have increased flexibility to design packages around the six wellbeing areas. Outcomes will be monitored and evaluated through service user reviews and service outcomes framework.

3.5.5The future plans for the implementation of the proposals, if accepted, are for guidance to be developed for staff and providers and possibly a further transformation project on low level interventions.

3.6Provider Solutions and Participation in the POC

3.6.1Ann Marie Docherty, CEO, Fair Deal, presenting on behalf of all the provider organisations, advised of the provider organisations involved in the POC: Aspire, Enable, Fair Deal, Mainstay and Turning Point Scotland. These organisations represented the voluntary/third and independent sectors, and local and national organisations who in turn support and provide services to a range of client groups.

3.6.2Delegates were informed that provider organisations were interested in participating in the POC as it provided an opportunity to explore innovative social care service solutions and be involved in the design, development and restructuring of processes and systems, all within the context of the funding challenge to identify 5% cost savings. In addition, it provided the opportunity for sharing learning within the wider social care sector. Some of the provider proposals for each provider participating in the POC were presented.

3.6.3There were particular challenges for the organisations involved in the POC. These included working collaboratively within the POC while at the same time being involved in retendering exercises, which involved some providers competing against one another, and working through issues raised by external factors such as the Scottish Living Wage and moves to consider alternatives to sleepover service models. Additionally, the Proof of Concept was a resource intensive process for all involved and it placed particular demands on smaller organisations while larger organisations benefited from an infrastructure better equipped to support involvement.

3.6.4Nevertheless, Ann Marie advised that overall being part of the process and having the opportunity to work collaboratively on the POC and share learning was useful for providers.

4 Feedback from Table Discussions

4.1The table discussions produced a number of key themes. The GCHSCP proposal of adopting the ‘lead commissioner/ contract manager’ approach was generally welcomed by providers and was viewed as complimenting the Care Inspectorate’s approach. Providers also believed the relationship with GCHSCP would be strengthened and communication improved by adopting this approach. There were queries regarding when this would be adopted.

4.2It was also acknowledged by providers that the drive to streamline services was also supported by GCHSCP’s desire to work collaboratively with providers.

4.3Providers also welcomed the changes to and streamlining of the PQR.

4.4Providers advised that given the current environment within the sector there are a lot of pressures upon them. One of the solutions proposed to help make savings and meet service user outcomes is increased use of technology. However, despite the possibilities offered through assistive technology, some providers report that it is not as widely used as it could be. The challenge facing the Partnership and providers is to consider how best to communicate and share the opportunities and benefits of technology with providers, service user, and families in order to widen its use.

4.5Given the pressures and resource implications facing care management within the Partnership, some providers queried whether there may be more desktop reviews in future and what the possible implications are for providers given resource constraints.

4.6 The change to focus on outcomes was welcomed. However, some providers thought the use of the diary can be a barrier.

5. Feedback from Anonymised Survey

5.1To inform this report and also evaluate the event, a web-based survey was sent to all providers and individuals who participated in the event to be returned anonymously. Of those who were contacted, 13 responses were received.

5.2Overall, communication and engagement with provider organisations prior to the event was viewed positively by those who submitted responses, with 85% thinking the communication was good or excellent. Almost all of the respondents, 92%, thought the topics for the agenda were interesting.

5.3All presentations were well received and all respondents thought the quality of table discussions and interaction was either good or excellent.

5.4Although respondents appreciated the surroundings, there were a number of concerns raised regarding the quality of the audio and the acoustics in the Banqueting Hall in the City Chambers.

5.5There were some concerns regarding possible changes in financial models that could be adopted by the GCHSCP. For instance, one provider asked if payments may be directly linked to delivery of outcomes, and therefore would non-delivery or poor delivery of outcomes lead to non-payment. In addition, there was some concern expressed by providers that focusing on outcomes, although welcome, could be used predominantly as a method of cutting costs.

5.6Providers expressed interest in alternative contracting arrangements such as ‘alliance contracting.’ There was a desire to consider how providers can improve working between themselves.

5.7A huge challenge facing providers is the recruitment crisis arising from competing with other businesses and organisations and the associated impact of the National Minimum Wage and Scottish Living Wage. Encouraging people to choose social care as a career in the current environment can be difficult. Furthermore, short-term contracts (e.g., of one year) are a disincentive for investment. Some provider organisations expressed the need to be open about exploring and discussing possible collaborative solutions. This was consistently raised during this provider event and also previous events.

5.8Overall, all of the respondents thought the day was useful or very useful. A similar percentage thought the level of provider engagement was good or excellent.

5.9For future events, one respondent advised that they would appreciate a discussion of security for services. As current contracts have a tendency to cover approximately 3 years, this can lead to staff turnover as staff move on through fear of being made redundant. It would be helpful to have discussions to consider how to improve this to ensure longer-term consistency for service users.

5.10A discussion to consider how best to address the recruitment crisis would also be welcomed.