1. Social Care Commissioning
Mr David Petticrew Social Care Commissioning Lead Northern Ireland Health and Social Care Board

2. Some Principles Strategic regional overview
Longer term considered approach to the needs of the population
Information
Continuous cycle of review and improvement
Local variations
Market analysis and developing a provider base
Pilot projects before regional roll-out
Outcomes

3. A Formal Process Joint HSCB and PHA ‘Annual Commissioning Plan’
A response to Minister’s ‘Commissioning Plan Direction’ and targets
Translation of Minister’s Regional Priorities into Performance Areas
Trust response via Trust Delivery Plans

4. Commissioning Drivers
Legislative and policy context
Regional Strategies – Dementia, Disability
Demographics
Inspections
Public Interest
Stakeholders

5. Drivers Ongoing Process: 3 and 5 year strategies
Procurement (efficiency, quality, VFM)
New learning
Iterative process – speed of change and forward planning
Financial Context

6. Issue of Scale
HSC Residential, Nursing and Care home expenditure is circa £500m pa
Predictive and responsive process
25,000 people receive domiciliary care
13,000 HSC care home residents
465 homes with 16,000 registered places

7. Regional Review of Domiciliary Care ‘A Managed Change An Agenda for Creating a Sustainable Basis for Domiciliary Care in Northern Ireland’

8. Focus Domiciliary Care = ‘Home Help’?
‘The range of services put in place to support an individual in their own home. Services may involve routine household tasks within or outside the home, personal care of the client and other domestic services necessary to maintain an individual in an acceptable level of health, hygiene, dignity, safety and ease in their home’ DHSSPSNI
Project May 2014 – November 2015
Review of Trust and Independent sector provision
Excluded ‘private arrangements’ and family /informal carers

9. £206,000,000 p.a.
250,000 hrs p.w.
Complexity ++
25,000 Clients+

10. Aims
Identify a more coordinated regional model for the development and procurement of domiciliary care
Analyse & compare existing Trust arrangements for delivering domiciliary care and identify best practice
Examine service interfaces with domiciliary care
Consult with stakeholders with regard to experience of domiciliary care services
Undertake an analysis of the market
Improve information relating to domiciliary care

11. Context Information - Community Indicators Project
Market - Evidence of increasing pressures
Stakeholders - Trade Unions, Independent Sector, COPNI, Age NI, Patient Client Council, Age Sector Platform, Users/Carers
Interfaces - Reablement, Self Directed Support, Direct Payments, Telecare
Trust arrangements - Procurement, Rates

12. What People Told us
Broad consensus of views across a range of stakeholders – users, carers, providers, Trade Unions
Highly valued service
Plays a vital role in effective delivery of community care services (including impact on hospital services, carers etc)
Significant challenges (1) future procurement of the service (2) availability and development of the workforce (staff retention)
Drivers for Reform – Gill Smith

13. A highly valued service
Users and carers tell us the service impacts positively on the quality of their lives
Supports carers to keep their loved ones at home
Patient Client Council research found that 80% + of respondents rated the quality of care as “good” or “very good”
Through the PHA and HSCB jointly commissioned ‘10,000 Voices’ initiative 1330 client stories were captured in relation to domiciliary care and 78% of respondents reported a positive experience of the service and 82% stated that domiciliary support in their own home had impacted positively on their lives
Trust feedback highlighted the compassionate care and help received

14. User Views - Overview
Users would like to see better communication and information between carers
More continuity of staff
Improved timing of calls and allocation of time
Ensuring the privacy and dignity of users is respected by staff
Ensuring staff are adequately trained to care for people with dementia
Maximising opportunities for client choice

15. The challenges to us from users/carers
A service ‘fit for the future’
Addressing workforce related issues will be key to sustainability – current recruitment/retention
Partnership working – Independent Sector and Trusts
A model for the future that promotes independence and choice

16. Current Trust Arrangements
Good degree of similarity in underlying management and organisation of the service
User/ Carer satisfaction/ quality
Limited Inter-Trust liaison
Limited evidence of a ‘best practice’ approach
Individualised procurement/ rates
Workforce – recruitment, retention & training

17. Differences/Anomalies
Number of Providers
NHSCT -17
BHSCT- 23
SHSCT – 23
SEHSCT- 36
WHSCT– 12
Sector Split (S v IS)
NHSCT 50:50
BHSCT 25:75
SHSCT 40:60
SEHSCT 15:85
WHSCT 35:65

18. Pressures Tendering exercises Workforce ‘National Living Wage’
Rates paid/ variations
Squeeze on smaller providers (procurement ‘Lots’)

19. Procurement as a future service model driver
Reduction in the number of providers
Testing the market price for care
Market share
Provides a basis for moving from ‘time and task’ to an ‘outcomes’ based approach

20. Review Recommendations
Structure – A ‘Task Force’ approach to future Domiciliary/Community Care development
Funding – Coordinated approach to funding domiciliary care services to address cost pressures
Procurement – Management of tendering processes to co-ordinate and monitor change
Financial Modelling – Assessment of the impact of the living wage and the hourly cost of care provided by the statutory/independent sectors
Workforce – Consistent, Trained, Valued, Rewarded

21. Service Model – No ‘perfect’ model identified
Information - Develop improved domiciliary care information
Finance – Make the case for investment in domiciliary care
Communication – all stakeholders

22. Future of Commissioning:
Change
Closure of the Board in March 2017
Trusts will take responsibility for planning and meeting the future needs of their populations
DHSSPS adopt a more proactive role with Trusts ie performance management
DHSSPS will assume budgetary control

23. Opportunity
New model for HSC – shift away from hospital to community based care
Shift from statutory to private sector provision?
Out-workings of DHSSPS ‘Who Cares’ consultation?
Risk and opportunity