1. Follow us on twitter:
twitter.com/GCHSCP

2. Agenda 9:15 Registration, Tea and Coffee 9:30 Welcome and Introduction
David Williams, Chief Officer, Glasgow City Health & Social Care Partnership
9:40 Proof of Concept Overview
Allison Eccles, Head of Business Development, GCHSCP
9:50 Contracting and Contract Management
Craig Cowan, Principal Officer, Business Development, GCHSCP
10:05 Care Management
Chris Melling And Jacqui McGoldrick, Service Managers, Adult Services, GCHSCP
10.20 Coffee Break
10:35 Provider Solutions and Participation in the POC
Ann Marie Docherty (CEO), Fair Deal on behalf of POC Provider
11:05 Table Discussion: Immediate Thoughts/Reflections
Facilitators and Participants
11.45 Question and Answer Session
POC Workstream Leads, POC Providers and All Participants
12.30 Close
David Williams

3. Welcome and Introduction
David Williams
Chief Officer
Glasgow City Health & Social Care Partnership
07 April 2017

4. Proof of Concept Overview
Allison Eccles
Head of Business Development
Glasgow City Health & Social Care Partnership
07 April 2017

5. Context c£160m pa purchased community-based social care services
New National Minimum Wage 2020 – £9ph
c17% gap between current and future wage levels
Uplift in SWS budget – c£21m

6. Current Arrangements Purchasing on hourly rate basis
Need to ‘follow the public pound’
Commissioning, procurement and audit/monitoring arrangements on an ‘inputs’ and ‘outputs’ basis
Arrangements, processes and staff involved are significant

7. Proof of Concept
Approval of a ‘Proof of Concept’ with a small number of providers over an 18-month period
Proposals to assist in meeting new NWM 2020 and 5% savings
Evidence base to be extended across all providers

8. Project Arrangements and Engagement
Integration Transformation Project
Involvement from Partnership and Council staff and providers (5)
Project groups and workstreams
Co-produced proposals
Engagement with a range of stakeholders

9. Proof of Concept Proposals
Alternative and/or leaner arrangements by the Partnership
contracting
contract management (incl. service outcomes framework)
care management
finance
Individual social care provider solutions
Range of outcomes seeking to achieve
Business pressures (e.g., SLW)
Proposals developed with some testing

10. Next Steps
Share proposals with providers (Provider Event) (April 2017)
Finalise proposals (April/May 2017)
Report on outcome (June 2017)

11. Contracts & Commissioning Workstream
Craig Cowan
Principal Officer Business Development,
Glasgow City Health & Social Care Partnership
07 April 2017

12. Workstream scope
Review CMF: Provider Quarterly Return, Risk assessment and monitoring, Review, Care Manager Concerns, Performance Framework
Link commissioner model
Outcomes based contract
Service outcomes
Co-production!!
Your Support Your Way Glasgow: CMF

13. Provider Quarterly Return
Electronic survey every 3 months
Generic questions irrespective of provider
Providers have one week to return
Response mandatory
Feedback suggested:
too frequent
too many questions/resource intensive
Purpose unclear
overly complicated to complete (e.g. whole time equivalent)

14. Proposals: PQR (PSR) Reduce no’/simplify questions (42 to 12)
Reduce to 6-monthly (rename PSR)
Increase the completion window (1 to 2 weeks)
Generic questions
Progress Provider Portal for submission
Tested & implemented with POC providers

15. Risk assessment/monitoring
Current
Risk reviewed quarterly (risk matrix, PQR data and professional judgement)
Scrutiny level and frequency determined by risk
Monitoring sessions once a year minimum
Activity captured in CM1 and updated quarterly
PQR data
Risk

16. Risk & monitoring Proposal Retain risk matrix tool
Risk/monitoring expectations 6-monthly (min)
Risk rating revised when necessary
Changes to risk notified to the relevant PO
Autonomy to aggregate CM1’s

17. Reviews Current Service reviews once per contract term
Every 2 years if cross-commissioning team
Scope of review determined by staff and context
Generic sign off process
Proposal
Review timescales for review
Tiered approach to sign off

18. Concerns reporting Current Limited to concerns from care managers only
Submitted via central mailbox managed by Business Development
Action by contract manager (not always well communicated)
Generic Care Managers Concerns Form (needed updated)
Logged on team Concerns Log (limited reporting capability)
Proposal
Expand process to external agencies and stakeholders (e.g. Health, Police Scotland, Fire Service and members of the public)
Must inform concerned parties of outcome of concerns
Improve concerns form and concerns logs to improve efficiency

19. Lead Commissioner Model
Current
Commissioners organised by care group
Contract mgrs allocated to service providers
More than 1 contract mgr across/within teams
Providers can work to different NHS and Council contracting arrangements
Provider preference
1 link officer
Rationalisation of contract mgt regime

20. Lead Commissioner Model
Proposal
1 lead commissioning officer per provider
Covering all services/care groups
Focus on contract management and review
GCC procurement and contracting regime the “default”
Leaner, more efficient contract management
Reduced bureaucratic burden for providers
Consistency of approach

21. Outcomes based contract
Proposal
Contracts which require providers to have outcomes based planning tool
Part of the evaluation of tender exercises
Contracts specify outcomes obligations/autonomy & performance mgt
ITT/service spec’s/contracts to be outcomes or inputs specific

22. Service Outcomes Framework
Current
Service user outcomes not embedded in service outcomes FWork
POC sought to develop measurable service outcomes
Reviewed a range of frameworks (e.g. GIRFEC, Better Future and Carista, ROW)
No standard framework or tool used to monitor outcomes
GCHSCP compared current frameworks to develop proposed framework that:
reflects strategic priorities
safeguards service user rights and preferences
delivers improved outcomes

23. Service Outcomes Framework
Proposal
Standard but flexible service outcomes framework
Six core service outcomes
Care group specific outcomes if relevant
Common indicators for each core service outcome
Types of evidence agreed to present outcomes
Providers report at 6 monthly contract mgt meetings
Next steps
POC providers to test model
GCHSCP to explore IT requirements for recording

27. Proof of Concept: Care Management Arrangements
Jacqui McGoldrick & Chris Melling,
Service Managers
Glasgow City Health & Social Care Partnership
07 April 2017

28. Context
Financial pressures
Workforce pressures
Need to develop a more flexible approach to meet service user needs
Lean & efficient processes

29. Current Arrangements
Support plan currently based on hours & minutes, pounds and pence
Shift in focus to outcomes and not inputs
Little scope for flexibility in resource planning by providers
Limited opportunities for innovation

30. Current Arrangements
Disparity between block funded and personalisation assessment processes
Disparity on how support packages are reviewed
Requirement for more emphasis on risk & risk management

31. Proposals
Proportionate assessment process, dependant on risk and budget
Fair and flexible assessment and care management approach
Assessments will focus on specific assessed needs and wellbeing
Social Work will continue to have the responsibility for management of risk and safeguarding

32. Proposals
Focus on three key areas of risk within Support Needs Assessment (SNA)
Personal care needs
staying safe
risk to others

33. Proposals
Six wellbeing areas
social relationships and community activities
employability and volunteering
personal development
parent/carer
running/maintaining household
social support

34. Proposals
Care planning to be co-produced by providers alongside Care Managers
Prescribed levels of support regarding the three key areas of risk
More flexibility around the six wellbeing areas
Provider accountability for delivery of outcomes.
Outcomes monitored and evaluated through service user reviews and service outcomes framework

35. Future Plans
Guidance to be developed for staff and providers
Further transformation project on low level interventions

36. Coffee Break

37. Follow us on twitter:
twitter.com/GCHSCP

38. Provider Solutions and Participation in the POC
Ann Marie Docherty,
Chief Executive Officer, Fair Deal,
on behalf of POC Providers
07 April 2017

39. Agenda

40. Agenda Provide an overview of the Proof of Concept
what does it hope to achieve, what is the opportunity of being involved, who are the providers taking part?
What has the process been?
Identify shared learning for the wider social care sector
What have we actually achieved?
What are the future developments from Proof of Concept
To boldly go where no provider has gone before
“If you want something new,
you have to stop doing something old.”

41. Proof of Concept - Overview
Providers – Organisations from voluntary/third sector and independent sector, a range of client groups and service models, local and national organisations
Opportunity – explore innovative social care service development and delivery, service redesign, technology, ‘back office’ structures and systems, potential of additional funding
Challenge – identify 5% cost savings while paying all staff minimum wage of £9 p/h
Sharing learning - within the wider social care sector
“Long-range planning does not deal with the future decisions,
but with the future of present decisions.”

42. Business as usual - Challenges
Retendering of existing services
Implementation of the Scottish Living Wage
Transition to Social Care Framework Rates
Negotiated/Commissioner Pathways
Sleepover rates
Co-production processes
Contract management
Involvement in POC

43. Proof of Concept - Process
Feed into GCHSCP project structure through collective provider meetings and 1:1 meetings
Process lead rather than creative / innovative
Missed opportunities for collaboration between providers
Each provider had their own governance arrangements, workstreams and approaches to engagement to inform their proposals
Effective engagement and co-production approaches crucial to success
“Results are gained by exploiting opportunities, not by solving problems.”

44. Achievements
We have been evolving our use of the Better Futures Outcomes-based framework to aid analyses of achieved outcomes at Individual, single Service and aggregated Services levels.
This is providing positive confirmation that this personalised, empowering, approach to services-delivery is able to provide tangible evidence of the relationship between services-provision inputs and the degree to which desired results/outcomes are actually achieved at multiple levels within and across our services.

45. Achievements “Doing the right thing is more important
Through Service redesign, and in collaboration with our Supported Employment department, employment has been identified as a desired outcome by individuals participating in the POC. In particular, a participant has already managed to secure  voluntary position as a drivers assistant, and consequently this has the potential to transform his life in many ways, resulting in greater integration within his community, meeting new people, assisting others-achieving multiple outcomes for the participant- all in line with  the POC ethos.  
As he will be working 1-to-1 with the driver, this will also potentially reduce the amount of paid support in his life and hence  allow us the opportunity to potentially reduce his overall budget.
“Doing the right thing is more important
than doing the thing right.”

46. “If you want something new, you have to stop doing something old.”
Achievements
Creation of a very active service user forum which in the period of the POC has taken ownership of a number of areas of development for the organisation - most specifically a wider range of group opportunities for the people we support to participate in.
“If you want something new, you have to stop doing something old.”

47. Achievements
As part of implementing the Scottish Living Wage and progressing towards the objectives of Proof of Concept we implemented a nationwide review of our pay and grading structures.
Along with provider partners we participated in the review and testing of contract monitoring arrangements which resulted in a more streamlined version of the PQR.
“Long-range planning does not deal
with the future decisions, but
with the future of present decisions.”

48. Achievements We are still here!
Along with provider partners we participated in the review and testing of contract management arrangements which resulted in more streamlined version of the PQR & Service Outcomes
Creation of very active Stakeholder Group to examine/ pilot use of new technology to assist in moving from traditional Sleepover cover towards more flexible Night Support
Development of a transport project to address taxi issues
“There is nothing quite so useless
as doing with great efficiency something
that should not be done at all.”

49. Achievements

50. Future Developments
We shall continue to explore Partnership working with Providers to further grow social networks for all people with learning disabilities across Glasgow, with a strong focus on peer led initiatives and less reliance on paid support potentially creating efficiencies in existing budgets
With POC Providers, we aim to explore funding options which will allow us to robustly test the impact of proposed initiatives and implement proposals in order to increase efficiencies
We would like to begin conversations concerning the exploration of ‘opportunities for collaboration’ around utilising our common resources.

51. Future Developments
We are exploring ways in which our services can be transformed to provide greater flexibility of services-provision and be more dynamically attuned to the changing needs – and aspirations – of those individuals who receive those services.
This approach would aim to make better use of available resources to increase both effectiveness and cost-efficiency. Importantly, it would include escalating the harnessing of expertise and experience of current/previous Supported Individuals.

52. Future Developments
While the shape of our service provision in Glasgow has continued to change and evolve as a result of retendering during our involvement in POC we are continuing to work with GHSCP to explore opportunities to create efficiencies while embedding services within a flexible care pathway which meets the needs of vulnerable people in Glasgow

53. Future Developments
We continue to work on changing the way we offer night support and reduced 1:1 staff support for the people we support, including the individual, their family members and our staff in the process using the local authority Just Checking system to give us information about the possible areas to concentrate on to keep people safe when staff are not with them.

54. Future Developments
From (Reduced) Traditional Sleepover to (Increased) Flexible Night Support
To pay NMW for traditional Sleepover cover requires an increase in hourly rates from £4.33 to £7.50 (73.2%)
For Fair Deal this would cost an additional £121,656 in 2017/18 for 736 hours per week of traditional Sleepover cover across 22 service users (NB NMW not SLW)
Under POC, Fair Deal working with all stakeholders to pilot possible IT-based alternatives recognising strengths and limitations of current Sleepover cover
Requires consideration of transitional funding solutions if spirit of SLW to be met
Torbrae Nursing Home
local providers collaborating  around a potential local resource
“Results are gained by exploiting opportunities,
not by solving problems.”

55. Shared learning
Proof of Concept is a resource intensive process for all involved
Particular demands on smaller organisations while larger organisations benefited from an infrastructure to support involvement
The world won’t stand still
Commissioning processes, service user reviews, introduction of Scottish Living Wage etc
Addressing the challenges of 2020
The national living wage of £9 p/h and the target of 5% savings
Overall a positive and beneficial process to be part of the Proof of Concept

56. Next Steps…
Continued meetings of GHSCP and POC Providers to update and review progress
POC Providers to engage with wider provider groups

57. “We are on a journey of transformational change and the Proof of Concept project is not the final destination.”

58. Table Discussion
What are your thoughts on the proposals put forward by the Glasgow City Health and Social Care Partnership? (20 minutes)
What are your thoughts on the proposals for provider solutions? (20 minutes)

59. Question and Answer Session