Service users in Peterborough are now choosing their own
care providers. Maria Ahmed looks at how the independent living
support service works
Abandoning block contracts and allowing service users to choose
and change their own care providers is seen as one way for
commissioners to personalise services in line with the government's
Putting People First agenda.
But implementation of such schemes on the ground can seem risky
- particularly for providers who may fear their business can no
longer be guaranteed.
Primary care trust Peterborough NHS, which is responsible for
commissioning adult social care and health in the city, has bitten
the bullet by ending block contracts for domiciliary care, care and
housing support, low-level health, rapid response and
re-enablement.
Under the
independent
living support service (ILSS), users can choose from 41
approved providers who have been assessed for their quality,
competence, training and safeguarding. They can also change
providers or choose one not on the approved list.
Biggest obstacle
Although the new service is just over a month old, hopes for
success are high.
Paul Raymond, senior contracts manager for NHS Peterborough,
admits the biggest obstacle to making the change was to manage the
commercial risks involved in abandoning block contracts for
commissioners and providers.
"[There were] risks that the marketplace would not fully respond
to the re-engineering of the services," he says. Commissioners also
had to ensure they could gather the resources to ensure effective
procurement and monitoring.
Raymond also points to additional concerns that care and support
providers would find it "difficult to offer competitive
services".
For Raymond, the risks are outweighed by the ultimate benefit to
service users. "Because the service user holds the final decision,
he or she is at liberty to swap a poor quality provider for a
better performing one," he says. This type of outcome has already
been achieved for one Peterborough service user, Lorraine Cherry
(see Case Study, below).
Commercial framework
The development of Peterborough's new service was driven by
several factors. Existing arrangements for the provision of
domiciliary care and supporting people services expired at the end
of September this year.
Meanwhile, the PCT's commissioning strategy for 2007-8,
influenced by guidance from In Control, set out plans to develop a
commercial framework for care services driven by individual
budgets, putting the user in control.
To help bring about the changes needed, the PCT enlisted the
support of K Consulting, an organisation specialising in
procurement and operations in areas including social care.
The PCT also held a series of consultation events with
providers, users and user-led organisations. Providers were then
invited to a workshop by the PCT and K Consulting to finalise the
structure of the commercial framework.
"This step was added to ensure that providers were fully
bought-in and risk thereby reduced," says Raymond.
Pricing strategy
Providers were able to give their views on the activities
required to deliver outcomes, as well as address issues of
geography, service user needs and the days and times care was to be
delivered.
Working alongside K Consulting, providers developed a pricing
strategy that aimed to reflect the "complexities of delivering
services to individuals with health, housing and social care
needs," Raymond says.
"The approach was particularly helpful in instilling confidence
in the provider market in moving away from conventional block
contracts."
Raymond admits any procurement process carries the risk that
providers will "submit pricing that is unsustainable, simply to
'win the business" and recover losses by reducing quality.
He says NHS Peterborough tried to manage this risk by only
allowing providers to bid between a higher and lower limit and
making 60% of the assessment of providers based on quality, rather
than price.
Brokerage teams
Providers' positions on the lists are ranked and can change
according to the quality of outcomes they deliver and the prices
they offer, based on current market factors and other providers'
revenue models.
After an assessment, a care and support plan is developed for
users, defining outcomes and how they can be met.
Brokerage teams then give users information on providers that
can meet these needs in ranked order, giving providers placed
higher on the list a greater chance of being selected, Raymond
says.
Service users can access the ILSS through schemes including an
advocacy pilot run by Age Concern Peterborough, which is just a few
weeks old. Under the scheme, run in partnership with the PCT and
community health provider Peterborough Community Services, an
advocacy worker is available four days a week to help older people
complete self-assessment questionnaires and contact the independent
living support service.
Extend provider list
David Bache, head of services and development for Age Concern
Peterborough, says the advocacy scheme is likely to be "busy and
add real value to the needs of older people". He expects the ILSS
to make "a tremendous difference in giving older people a choice of
services and a say in their lifestyle outcomes".
Bache is also keen to ensure that service users' complaints
about the ILSS are fed back through the appropriate channels.
This is just the beginning for Peterborough, as it plans to
extend the provider list to other types of services over the next
two years, including night sitting and respite care.
The initial prognosis for the independent living support service
is clearly optimistic, particularly from the service user
viewpoint. But the outcomes for providers remain to be seen. One
Peterborough care provider contacted by Community Care felt unable
to comment for this article, saying it was "still early days".
This leaves unanswered important questions. Now they are no
longer awarded contracts, what level of business will providers get
as the service matures? And in the broader push for
personalisation, how can providers adapt to ensure their survival?
No doubt the emerging answers will be keenly watched in
Peterborough, and elsewhere.
PETERBOROUGH IN NUMBERS
● The budget for ILSS services is about £9m
● This is 30% of the budget for externally purchased adult
social care services.
● About 1,300 clients will access and arrange services through
the ILSS Framework this financial year.
POLICY BACKGROUND
Under Putting People First, councils and other care
commissioners must transform adult care services between 2008 and
2011 by giving service users choice and control over their support,
including through personal budgets. As part of this, they are
expected to help create a strong, varied and flexible social care
market.
➔ More on
Putting People
First
CASE STUDY
LORRAINE CHERRY Domiciliary care service user
Lorraine Cherry, 40, has been receiving domiciliary care from
Peterborough since she started living independently in 2002.
Cherry, who has spina bifida and uses a wheelchair, has morning
carers, who bathe, dress and do the laundry, and evening
carers.
She recently changed her morning care provider after the
introduction of Peterborough's independent living support service
and is pleased with the outcome.
"I wasn't getting on with one of the morning carers and they
didn't give me a particular service I needed, so I rang social
services," she says.
Cherry asked for her evening care provider to take over her
whole care package, and this was achieved within a week.
She believes ILSS has offered her more choice and a speedier
response than before. "Before, I wasn't aware I could change
providers when I wanted to, and it happened quickly," she says.
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guide to personalisation
This article is published in the 19 November 2009 edition of
Community Care under the headline "Peterborough offers clients a
choice"