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.
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).
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.
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.
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.
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
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.
This article is published in the 19 November 2009 edition of Community Care under the headline “Peterborough offers clients a choice”