1. Continuing Care Update 27 th January 2010 By Christopher Spark Assistant Director of Procurement

2. 2 Regional Strategy Phase 1 - Tactical activity conducting in depth examination of costs for our most expensive continuing care users. This activity has already delivered cash releasing savings for only 33 patients Phase 2 - Introduce business service modelling by deploying lean supply principles to drive out wastage and better manage demand Phase 3 – Commercial restructuring including market testing for all care groups, one of the primary aims is to adopt consistent commercial structures and commissioning arrangements for the region

3. 3 Phase 1 - Original Aim Financial pressures on PCTs continuing to grow Increasing demand to provide nursing and residential care more cost effectively while retaining a level of service appropriate to each individuals need Purchased Healthcare CMG agreed Continuing Care was a priority for procurement intervention Following a meeting last year with re:source and representatives from a number of East Midlands PCTs, it was agreed that OLM would review 65 patients as part of a pilot

4. 4 Stakeholders Namely PCT CHC leads: Anne Andrews NHS Bassetlaw PCT Linda Elliott NHS Derby City Anita Gulliat NHS Derbyshire County Shirlee Woolman NHS Leic City / NHS Leicestershire County Ruth Johnson NHS Leic City / NHS Leicestershire County Karen Stagg NHS Northamptonshire (BI, PD, Palliative) Kevin Greaves NHS Northamptonshire (MH, LD) Jane Godden NHS Nottingham City Jill Young NHS Nottinghamshire County Daphne BarnettNHS Lincolnshire Marcus Callaghanrepresenting NHS Leic City (LD) Surinder Peberdyrepresenting NHS Leicestershire County (LD) * Also have representation from Finance, Procurement and LAs

5. 5 Process – OLM Phase A Intelligent costing data information service The deliverable of this phase: A full cost breakdown separately identifying the care, management and support and non staffing costs A comparison of the true cost of care to the current fee levels incurred by the PCT and assess the cost effectiveness of those placements. Report on the outcomes of the review and make recommendations as to the scope for cost and efficiency savings Provision of the outputs from the investigations in an agreed electronic format and breakdown so that the PCT can use the data in the future

6. 6 Process – OLM Phase B Negotiation The OLM service then moves onto negotiation where most value can be added. The intention is to: Undertake supplier negotiations for agreed identified cases which lead to new agreed prices for the provision of services This takes into consideration the needs of individuals Step 1: Work Outline – Negotiation of revised rates or future uplift rates with Providers. RationaleDelivery method Negotiation of revised rates based on the true cost of care of each placement Negotiation meeting with providers jointly attended by OLM, re:source and the PCTs Step 2: Work Outline – Agree new fee rates /arrangements for future uplifts RationaleDelivery method Following the negotiation meeting agree new contracts/variations to contracts Meeting with providers jointly attended by OLM, re:source and the PCTs

7. 7 Initial Results £197,000 confirmed cash releasing savings for 33 patients. Patients whom pose a risk or require further risk assessment have been identified Certain patients have been identified whom are in residential homes or independent hospitals may be ready to step down into more independent environments such as supported living A number of service users have been identified as needing to have their care plans reviewed as the needs have either increased or potentially decreased There is often a duplication of use of the multidisciplinary teams. Sometimes this is provided but not actually used by the individual service user yet is included in the service charge to the PCT ……Next tranche of cases, 294 high cost placements (annual spend of £30m) has the potential to deliver savings of £1.4m by 2010/11.

8. 8 Key Challenges Data –Costing of care packages –Activity trends IT–No automated processes Processes –Variations in recording care delivery, activity, goals of treatment and outcomes Interaction –Patient User Groups –Local Authorities

9. 9 Observations Due to the lack of collaboration and high level of spot buying, this had led to inconsistencies across the region, a huge variation in rates, and has resulted in a highly driven provider market Quality of provision varies considerably and is not proportional to the size of the organisation There are examples of positive practice within the region Increased PCT involvement has helped negotiations and relationship building Venture capitalist backed providers are making up to 40% profit on individual placements

10. 10 Next Steps - Plan B and Plan A Plan A – Individual contributions model Not currently legal – but pilot studies exist Probably legal by 2013 Long term plan to support patient choice agenda Plan B – Approved provider list model Legal Good intermediate position Anticipated implementation 2010/11

11. 11 PCT Clinical Need Assessment City Council Social Need Assessment Home selection Suppliers Payment £ contribution ? Funding Decision Yes / No PCT User Provider Other agencies Patients select from a list of approved suppliers Approved List Negotiation Plan B

12. 12 Services / Pricing model AWP Process Older person Older person/mental health Physical Disability Mental Health End of Life Learning Disability Brain injury Physiotherapist Psychiatrist Medication Continence ??? £x £y Can you provide the service shown at the stated rate? Core servicesBolt ons Answers will be formatted Yes / No

13. 13 2.Set scope and participants 3.Sign off service specs & QMT 7. Advertise services; 8.Open AWP on BRAVO AugSept OctNovDecJan 2010 FebMay Apr Go Live 4.Construct questions & framework of rates for AWP questionnaire 5.Design commissioners input process / support web pages 10. Evaluate questionnaires 11. Summarise findings 12.Inform Market who successful providers are 1.Evaluate provider market MarJunJul Aug SepOctNov DecJan 2011 6.Agree actual participants 9.Run AWP provider forums High Level – Project Plan

14. 14 Thank you for listening. Any Questions?