Adult Social Care

A consultation event

6th February 2013

Karen Murphy and Simon BartonBusiness Transformation Directorate

Agenda - 6 February 2013

Start at 2pm

Introductions and Purpose Karen Murphy

Consultation on ILEX: Presentation Simon Barton

Consultation on Fees: Presentation Simon Barton

Questions and discussion All

Summing up and next steps Karen Murphy

Finish by 4pm

Independent Living and Extra Care (ILEX) Housing Strategy

Simon BartonStrategic Commissioning Manager

for Older People

Why is ILEX important?• Bring together Planning, Housing and Social

Care for the first time• Join up with the new approach to health• Promote independence, provide support• Identify needs • Reduce reliance on residential care• Set out clear, joint priorities• Commission services and developments

• ….currently consulting

What do we want ILEX to achieve?

• enable vulnerable people to continue to live independently in their own homes through provision of support services

• encourage provision of a wider range of suitable and affordable independent accommodation for people who need or choose to move

What is influencing ILEX?

CouncilHome Care tender

Assistive Technology & TelecareReview of housing allocations

and tenanciesScrutiny

GovernmentWelfare Reform

3rd SectorCentre for

Independent Living

Health Clinical Commissioning GroupMental Health Service redesign

ILEX

How is the population changing?2012 to 2030

Larger and older population in Solihull (DH est.)

• Total pop’n: 208,400 to 236,100 (+13%)

• Over 65: 40,800 to 55,900 (19.6% to 23.7%*)

• Over 85: 5,880 to 10,800 (2.8% to 4.8%*)

* as a proportion of total population

How is the population changing?

People with dementia (Solihull Living Well with Dementia Commissioning Strategy 2010-2013)

• 1 in 20 people aged over 65 yrs

• 1 in 5 people aged over 80 yrs

• (approaching) 1 in 3 at 90 yrs

How is the population changing?2012 to 2030

Trend to continue

• Falling numbers of children and younger adults

• More people in middle age

Helping people to stay at homeAdvice services• Housing options, debt, benefits, heating, safety

Rapid response to problems• Repairs, heating, homelessness, ASB,

harassment, security

Housing related support (Supporting People)• Floating support and accommodation based

services

Helping people to stay at homeReablement• Hospital avoidance/discharge, intensive

care and support

Home adaptations• e.g. grab rails…to ground-floor extensions

Telecare • 24 hour response ~ range of technology ~

promote awareness of benefits

Helping people to find a new home

• More housing suitable for older people and people with disabilities, with care and support

• A wider choice of affordable homes e.g. rent, buy, part-buy/shared ownership

• Single properties ~ grouped accommodation

Helping people to find a new home

• Designed or adapted ~ new build and conversion

• Extra care ~ as an alternative to residential care

Risks and Issues

• Promote: independence ~ self-determination

• Prevent: isolation and loneliness ~ abuse

• Maximise: affordability ~ value for money

• Workforce: recruit, retain and train

ILEX: the next steps

• Continuing engagement and consultation in 2013

• Cabinet, April 2013 with revised draft for approval

Your views about ILEX

• Are the objectives the right ones ?

• Have we identified the appropriate range of services do people need to stay in their own home?

• For people who have/choose to move home, have we highlighted the right range of housing options ?

Adult Social Care

Consultation on Fees

6th February 2013

Karen Murphy and Simon Barton

Purpose • To begin consultation on arrangements

by which to determine fee rates to be set by SMBC for:

– registered residential and nursing care– non-registered support services

• No decision has yet been made for 2013/14 and beyond

Purpose

• Domiciliary/home care support: current rates apply until outcome of tender process

• Supporting People: outcome of service review determines contract value ~ 20% reduction in programme expenditure by March 2015

Putting Solihull People First

Our Objectives People in Solihull:

1. Are able to get high quality information and advice from a variety of sources so that they understand how care and support works and they can get the support they need.

2. Are enabled to maintain their maximum degree of independence.

3. Can be confident that their care and support will be of high quality and that they will be safe and treated with dignity and respect

4. Feel in control of their care and support

Strategic Context • Objectives supported by a range of

strategies…both SMBC and joint with NHS

• Market position statement: picture of supply and demand ~ what it might look like in future ~ how commissioners will support and intervene to deliver this future vision

• Development of new contract and specification

Services ContextRegistered Care Home beds in Solihull @ Feb ‘12

  OP LD EMI MH -65 IC Total

Residential 608 196 175 16   995

Nursing 301   114   18 433

Respite     7     7

Transitional EMI     12     12

Total 909 196 308 16 18 1,447

Services ContextRegistered Care Home providers in Solihull @ Feb ‘12

  OP LD MH -65 Total

Residential 18 37 1 56

Nursing 8     8

Residential & Nursing   3     3

Total 29 37 1 67

plus…175 homes out of borough with 300 service users

Financial ContextSolihull MBC Adult Social Care – 2011/12 to 2014/15

2011/12 2012/13 2013/14 2014/15Actual Estimate Estimate Estimate

£m £m £m £m

Older People - Residential and Nursing 8.46 8.15 7.69 7.34% Change Year on Year   (3.7%) (5.7%) (4.6%)

Learning Disability - Residential and Nursing 13.57 13.23 12.85 12.67% Change Year on Year   (2.5%) (2.9%) (1.5%)

Other Residential and Nursing 1.55 1.67 1.66 1.66

Rest of Adult Social Care 37.06 37.63 37.19 36.16

Gross Total Adult Social Care Spend 60.64 60.68 59.39 57.83% Change Year on Year   0.1% (2.1%) (2.6%)

Challenges• Demographic: increasing demand

• Funding: constrained resources

• Quality: increasing aspirations

• Legal: due regard to actual costs of care

• Market: oversight to ensure quality, safety and financial viability

• Scope: significant area of investment

Proposal: Principles • Partnership and co-development of fee structure

and quality framework: SMBC and Providers ~ dialogue ~ improved transparency ~ ‘greater awareness of how much things cost’

• Contribution from service users and carers

• Supported by independent 3rd party

• Consultation throughout process

Proposal: Principles • Sustainable longer term settlement…

– fair price that is affordable…– neither a cost that SMBC cannot afford…– nor a price that would put homes out of

business

• Incentivises quality improvements and delivery of positive outcomes

Proposal: Principles

• Fulfil Equalities obligations ~ promote equality of opportunity, good relations, positive attitudes ~ eliminate harassment and unlawful discrimination ~ anticipate consequences of proposals and minimise/eliminate negative impacts

• Residential and nursing care homes for older people …potential wider application at later date

Proposal: Step 1 - Framework• Providers to declare actual costs: direct,

indirect, capital

• Costs of local (not regional/national) services

• Analysis of returns forms basis of fee structure

• Methodology…to be fully defined

Proposal: Step 1 - Framework• Set a fee for each of: residential ~ nursing ~

older people ~ dementia

• Fee for meeting ‘core standards’ plus higher ‘enhanced’ rate if additional quality standards met

• Subsequent inflationary award aligned to demonstrable increases in direct/in-direct costs only

Proposal: Step 1 - Framework

• Quality framework ~ cross refer to development of contract/specification

• Simple, clear, attainable standards with incentives

Proposal: Step 2 - Procurement

• Procurement to create a framework agreement

• Local Solihull based services

• Tender to assess whether meet ‘core standards’

• If not achieve ‘core standards’ and a place on framework = lower fee

Proposal: Step 3 - Validation

• Validation of quality and associated fee

• On-going monitoring of quality

• Feedback from residents and family members ~ 3Cs

• Continuing joint work with NHS and CQC

Proposal: Benefits • Future sustainability ~ stability ~ value

• Assurance ~ safeguarding residents and interests of families

• Improved quality ~ care tailored to deliver person centred outcomes for residents

• Co-development of quality framework, standards and fee structure

• Develop and retain workforce

Proposal: Benefits • Reduces threat of legal challenge

• Better understanding of market ~ improved decision making ~ anticipate demand pressures

• Improved relationships

• Politically…greater oversight, improved understanding and accountability…better able to represent constituents

Proposal: Process• Governance and infrastructure

• Co-development and consultation ~ contributions from…

– provider staff: front line staff ~ managers ~ trustees/directors

– residents and family members

– commissioners and partners

Proposal: SMBC Current Offer • 0% for all registered residential and nursing care

services and non-registered support services for 2013/14

• Undertake the ‘fees project’ for residential and nursing care for older people, including dementia, (Step 1/Framework) for conclusion and recommendations to DASS and Cabinet Member by September 2013

• Decision on fee settlement wef 1 October 2013 for 4 ½ year period (until 31 March 2018)

• Backdating under consideration

Proposal: SMBC Current Offer • Registered residential and nursing care home

services for adult mental health, learning and physical/sensory disabilities…0% will apply except where the outcome of a care funding calculator exercise and/or review of high cost placements determines otherwise

• ‘Fees project’ Steps 2 and 3 to conclude by March 2014 for implementation in 2014/15…including further consideration of wider application.

Next Steps

• Confirm this offer in writing

• Deadline for responses to consultation by 5pm Thursday 7 March 2013 (30 days) to simon.barton@solihull.gov.uk

• Consideration and analysis of responses

• Decision announced w/c 18 March 2013

Next Steps

• If proceed with ‘fees project’…commence immediately

• Step 1/Framework for conclusion and recommendations to DASS and Cabinet Member by September 2013, and decision wef 1 October 2013

• Step 2/Procurement and Step 3/Validation to conclude by March 2014