National Commissioning & Contracting Conference Short Breaks & the Three C’s: Commissioning, Contracting & Costs Clare Gent Strategic Development Manager, Disability Action for Children Samantha McDermid Research Associate Centre for Child & Family Research Loughborough University

Workshop Overview Presentation on the research and findings Questions and Answers Group Work and Feedback

Why we commissioned the Research The primary aim of this research is to compare the unit costs of a range of Action for Children short break services with those provided in house by Local Authorities It also aims to: Demonstrate the relationship between levels of children's needs, costs and outcomes Introduce transparency in to cost calculations to ensure like is compared with like and why differences occur Explore the contracting & commissioning process

Action for Children’s Starting Point Largest provider of short breaks in UK The need to deliver high quality services whilst delivering value for money Desire to effectively benchmark costs and quality against in house delivery Desire to optimise business retention and growth

The Context of Short Break Services Substantial growth in range of short break opportunities under AHDC - led to more mixed economy of providers Shift from high cost low volume to low cost high volume Loss of ring fencing for funding and competing priorities within Early Intervention Grant 2011 statutory short break duty Climate of budget constraints and efficiency savings Commissioners developing specifications with families and providers

The Context of Short Break Services Commissioners need efficiencies & economies of scale plus flexibility to support innovation and responsiveness High cost of supporting children with severe and complex needs Personal budgets may reshape what needs commissioned and decommissioned

Changes in Commissioning Fewer Local Authority are providing short breaks in house Variation in outcomes focus of commissioning New models of support Increase in Framework Agreements Grant procurement Budgetary uncertainty & spending review cycles continue to impact on strategic planning

Selecting Short Break Providers

Contract Monitoring

The commissioning environment External providers offer: –Knowledge and expertise –Value for money ‘Success’ measured by: –Outcomes –Value for money Different models of commissioning –Tendering model –Grant model Move towards shorter contracts

The costs and outcomes programme at the Centre for Child and Family Research Understanding the links between costs, needs and outcomes –Bottom up costing methodology –Introducing transparency –Comparing like with like Comprehensive costs –Combines costs of different types of services with the costs of worker ‘activity’ –Understanding overheads Stream of work exploring the costs and outcomes of short break services for disabled children and their families –DfE funded study: bottom up costs of short breaks –Exploring the outcomes of Action for Children short break services –Comparing the costs of short break services

Previous research: Why do variations in costs occur Service related variations Child related variations –The provider –The type of service –The type and number of staff required –The length of the activity –The number of children attending –The needs of the children attending –The locality of the service –The time the service was delivered –The type of social care activity associated with the service

Cost Comparisons of short breaks Aim to identify where and why variations in costs occur between different types of short break services: –Overnight residential and foster family based –Community based –After school clubs –Domiciliary care Worked with Action for Children and three local authorities Survey distributed to network of local authorities Gathered services data and finance data Categorised the finance data using the overheads framework

Costs of short breaks Service typeAverage costRange Residential overnight£ per night£ £ per night Foster family based£ per night£ £ per night Community: Groups£40.15 per hour£ £71.59 per hour Community Activities£15.82 per hour£ £44.13 per hour Community: Access to Leisure £23.42 per hour£ £60.59 per hour After school clubs£20.55 per hour£ £11.60 per hour Domiciliary£26.42 per hour£ £32.83 per hour

Drivers for costs The needs of the children –Staffing ratios –Equipment and training of staff –Can be highly variable Service type –Activity costs Staffing –Actual and relative costs Management costs The costs of commissioning Linking costs to Value

The costs of commissioning Inclusion of commissioning in cost calculations –Selwyn et al (2009) Different models of commissioning –Tendering model –Grant model Changes to commissioning environment –Impact on the costs of providing short breaks –Impact on the delivery of short breaks.

Shared learning: key factors in comparing costs Data –Consistency in the data provided –Understanding full cost recovery –Foster Family overnight short breaks –Personal budgets Comparing like with like –Understanding the services –Understanding the children The costs of commissioning Cost and value

Any Questions?

Group Activity Rapid audit of importance of factors when selecting short break providers Identify 3 aspects of value for money that you look for in tenders and discuss how these differentiate from cost Each group to agree 1 key point about what differentiates value for money from cost in when commissioning and feed this back to large group

Thank You /policy-research/research /policy-research/research

Clare Gent Strategic Development Manager, Disability Action for Children Sam McDermid Senior Research Associate Centre for Child and Family Research, Loughborough University