1. Commissioning social care Angela Canning & Cathy MacGregor, 15 March 2012

2. Social care in Scotland 215 March 2012Commissioning social care – CCPS members meeting

3. Commissioning is… 315 March 2012Commissioning social care – CCPS members meeting

4. Key message: Strategic commissioning 415 March 2012Commissioning social care – CCPS members meeting Councils and NHS boards need to get better at commissioning social care services This is not just about procuring services from providers It includes strategic planning:  working jointly with NHS boards and other bodies  involving local communities, service users and carers  involving providers  developing services that achieve good outcomes  planning for the longer term

5. Key message: Strategic commissioning 515 March 2012Commissioning social care – CCPS members meeting Councils and NHS boards need to get better at commissioning social care services Commissioning is complex and is made more challenging due to:  reducing budgets  changing demographics  rising demands and expectations  developing policies and legislation on: integrating health and social care self-directed support

6. Key message: Strategic commissioning 615 March 2012Commissioning social care – CCPS members meeting Recommendations: Develop commissioning strategies Work collaboratively with other councils and NHS boards Have professional skills in both procurement and social care commissioning Train commissioning staff

7. Key message: Preventative services 715 March 2012Commissioning social care – CCPS members meeting There is a risk of councils not investing in low-level and preventative services Indications that councils are focussing resources on people who have the most intensive support needs:  13 councils have tightened their eligibility criteria  7 councils now charge for services previously free, or have increased charges  home care hours have increased by 74% over the last decade but home care clients receiving less than 4 hours a week have decreased by 41%

8. Key message: Preventative services 815 March 2012Commissioning social care – CCPS members meeting Councils are targeting their resources at people who need more intensive home care - number of clients (000s)

9. Key message: Provider involvement 915 March 2012Commissioning social care – CCPS members meeting There is scope to improve provider involvement Councils and NHS boards do not always involve voluntary and private providers in:  planning which services are needed in the local area  how best to provide them  developing new, more flexible services

10. Key message: Provider involvement 1015 March 2012Commissioning social care – CCPS members meeting There is scope to improve provider involvement When things are going well… Providers’ information and expertise are valued Providers are kept informed and are involved in improvements and developments When things are not going well… o Providers are seen as outwith the commissioning process o Providers are not engaged and not involved so services are not developed in line with plans

11. Key message: Provider involvement 1115 March 2012Commissioning social care – CCPS members meeting There is scope to improve provider involvement Focus groups with providers Things work well when:  Clarity and fairness  Support and feedback  Take account of evidence of quality / performance  Procure to achieve good outcomes  Reasonable timescales

12. Key message: Provider involvement 1215 March 2012Commissioning social care – CCPS members meeting There is scope to improve provider involvement Challenges for providers:  Consistency of decision-making  Procurement administration  Capacity of providers  Communication, awareness, joint working  Balancing quality and price  Equalities  Assessing long-term implications of procurement decisions

13. Key message: Provider involvement 1315 March 2012Commissioning social care – CCPS members meeting Arrangements are sporadic and patchy Theimpactsfor staffaremassive The council rarely asks service users You sometimes feel that you are going through the motions There is nocommunication orinformation fromcommissioners The commissioning processdoesn’t do anything toimprove quality

14. Key message: Provider involvement 1415 March 2012Commissioning social care – CCPS members meeting Recommendations Maintain good working relationships with providers Map out current provision - understand quality, effectiveness, costs and challenges for providers Base decisions about in-house vs external on understanding costs, quality and outcomes Develop transparent procurement processes

15. Key message: Managing risks 1515 March 2012Commissioning social care – CCPS members meeting More needs to be done to manage the risks to users when a provider closes, including having contingency plans and monitoring providers’ financial health The risks to users are high It’s hard to monitor providers’ financial health In the case of large operators, it’s inefficient for both councils and providers What would councils do if they found financial difficulties?

16. Key message: Managing risks 1615 March 2012Commissioning social care – CCPS members meeting Recommendations: Contingency plans Periodic expert assessment of the social care markets Understanding the financial and business impact of commissioning decisions on providers Monitor the impact that services have on people’s lives as well as the quality of services

17. Key message: Involving users/carers 1715 March 2012Commissioning social care – CCPS members meeting Users and carers need to be more involved in commissioning Large majority are happy with services Most issues raised relate to home care:  Carers feel under pressure to supplement home care  10 minute visits too short  Time of day of visits  Pushing and fighting to get the services they need  Inflexibility

18. Key message: Involving users & carers 1815 March 2012Commissioning social care – CCPS members meeting We were told what we could get I don’tfeel Ihavecontroloverwhat Iget It has made a great difference – I can get out now You sometimes feel that you are going through the motions Going through afinancial assessmenthas been scary andstressful They help you withanything – you name itand they’ll help you In my house, I’m the boss

19. Key message: Self-directed support 1915 March 2012Commissioning social care – CCPS members meeting Councils may need a significant amount of support to implement self-directed support effectively Users and carers need information, advice and support Implications include disinvestment in some services Councils are at very different stages in implementing SDS They may need support to do so effectively:  low use of direct payments (4,400)  need to develop commissioning skills and capacity  need to improve partnership working with providers  need to improve consultation with users and carers

20. Audit Scotland 2015 March 2012 cmacgregor@audit-scotland.gov.uk Tel: 0131 625 1865 Website: www.audit-scotland.gov.ukwww.audit-scotland.gov.uk Commissioning social care – CCPS members meeting