Beacon Submission 2009
Strategic Commissioning
Case study - Commissioning Home Care
Background
In 1998 our corporate thinking and political direction of travel was to challenge whether our services really were ofthe right quality, providing value-for-money, and delivered what residents wanted. Additionally, the Departmentneeded to respond effectively to three service imperatives:
• future needs of older people and physically disabled people,
• rising expectations in relation to quality,
• projected demographic patterns of older people.
We had 23 different contracts (one with the Council's own Direct Service Organisation) and a range of spot purchasearrangements in place. Members and officers developed a strategy to reconfigure home care services to meetservice user needs more effectively within available resources. Our overarching aims were to use commissioningand contracting to:
• build on the existing good quality of home care services to develop a more flexible and responsive
service whilst maintaining continuity for service users,
• use current research and the commissioning process to develop the service
• develop the home care market and contribute to the development of a stable home care workforce.
To drive this reconfiguration we carried out a procurement exercise for the delivery of all our home care.
Phase One: Preparation for Tender
We developed a multi-disciplinary project team encompassing commissioning, contracting, care management,financial, legal, and HR skills. This built strong internal partnerships and ensured buy-in across Council departments.
We used geographical and demographic intelligence covering all households and individuals to complete a detailedphysical mapping exercise using OS grid references to show:
• receipt of home care by age group,
• intensity of support,
• location.
This provided clear information on the numbers of people and levels of service in geographical clusters acrossWestminster.
We explained our proposals to service users. Our aim was to produce a positive impact for service users, so wecarried out a survey of everyone receiving home care to find out what they considered important in a new service.
We placed the findings of this local survey in the context of the Nuffield Institute's report: "Listening to Users ofDomiciliary Care Services" and grounded our Specification in improved outcomes for service users.
We consulted widely with our staff and unions on the significant staffing implications. We developed a rigorousunderstanding of the TUPE implications which ensured we retained a valued workforce who would continue to bethe people working with our service users.
Members and the wider Council were fully involved. The Council's rigorous Contracts Code ensured probity andgave us the opportunity to use the Council's corporate structure to challenge our ideas and ensure the project wasallied to corporate and political objectives.
Phase Two: Procurement
We used the OJEU process to procure one or more of six separate contracts to cover the Specification covering:
Borough wide personal care for adults with physical disabilities
Borough wide personal care for older people
Personal care for older people across three separate localities
Day care centre and dementia support service
We proposed 10 years with break clauses at 5 and 8 years as the contract term.
In April 2000 the Council awarded two contracts for the service. This section focuses on the larger contract withHousing21 (H21) covering home care for older people and people with physical disabilities, carers' dementia support,specialist dementia day care, and specialist home care based on a guaranteed number of hours of service per week.
Phase Three: Monitoring and Challenges
A strong partnership at all levels, and the Council's agreement to admit H21 to our Pension Scheme, enabled thesmooth TUPE transfer of 400 of our staff to H21 ensuring continuity of carers for service users.
Proactive, monthly monitoring visits and meetings ensured that we monitored the outcomes service users which hadidentified as important. We had agreed that an element of the contract payment was based on H21's monthlyachievement against a range of service-based indicators in the Specification. Feedback from care management and service users showed high service user satisfaction.
The advent of Fair Access to Care and changes to our Charging Policy led to the hours falling below the originalguaranteed level. This could have led to H21 being unable to continue with the contract beyond 2006. Thereforewe negotiated to reduce the level of actual hours and agreed a price for hours that were not provided.
Strategically we wanted to develop BME provision and worked with H21 to support a small, local BME home-careagency deliver their service. H21 purchased the organisation, maintaining it as a separate entity, enabling them toextend the BME service to neighbouring local authorities.
Both our organisations faced further challenges in 2004. For us this was a continuing downward trend in theguaranteed hours creating a 20% difference between actual and commissioned hours. H21 were faced withsignificant, unforeseen costs:
• Increased National Insurance contributions
• Cost of Enhanced Criminal Records Bureau checks
• Above inflation pay settlements
• Increased costs for New Care Standards
• Congestion charging in Westminster
• New legislation re staff terms and conditions
• Zero VAT rating
We negotiated to maintain the contract which was working effectively for service users. We changed the terms andconditions to share risks in a new way. We agreed on new methodologies: Open Book Accounting and PriceReviews, for contract management. We reduced the guaranteed hours, and jointly developed a new Home CarePlus service for people with dementia focussing on re-ablement and outcomes within the contract price. These newdevelopments and shared accountabilities, moved the contract forward continually linking it to our strategicdirection.
Phase Four: Future Plans
We face exciting, strategic challenges ahead adapting commissioning and the structure of long-term contracts to thetransformation agenda. Building on mutual trust we have agreed with H21 to vary the contract to develop aPersonal Digital Assistant system to measure routine information and outcomes. We will work with them to ensurethat this will be relevant to our work on Individual Budgets and choice and control.
Beacon
Strategic Commissioning – Case Study
Westminster City Council