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reCaring for our future: shared ambitions for care and support

Emerging thinking: Markets

November 2011

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Context

• Caring for our future: shared ambitions for care and support was launched on 15th September and will run until early December.

• It is a discussion with people who use care and support services, carers, local councils, care providers and the voluntary sector about the priorities for improving care and support.

• The discussion has been jointly led by senior civil servants from the Department of Health and leaders from the care and support community and supported by small reference groups. The discussions have focused on the following six reform areas:– Quality and the workforce– Personalisation– Shaping local care services– Prevention and early intervention– Integration– The role of the financial services

• These slides represent key findings and emerging thinking from these discussions to date. They are not a statement of policy.

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Markets

• How would you define the social care market? What are the different dimensions we need to consider when assessing the market?

• How could we make the market work more effectively, including promoting

growth, better information for commissioners (local authorities and individuals), improved quality, and choice and innovation?

• Does there need to be further oversight of the care market, including measures to address provider failure? If so, what elements should this approach include, and who should do it?

• Looking to the future, what could be the impacts of wider reforms on the market? What possible effects would the following have on the market: the recommendations of the Dilnot Commission's report, the roll out of personal budgets and direct payments, and the drive to improve quality and the workforce?

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What needs to change?

The current situation

• A lack of support for people trying to make decisions about the care they want, and where to get it.

• People are not encouraged to plan or prepare for the future.

• A focus on procurement of services, rather than strategic commissioning, or support for individual purchasing.

• A lack of integration between different types of services, missing an opportunity to deliver more efficient, more effective services.

• Communities’ assets not fully utilised.• A focus on short-term pressures.

Where we need to be

• A diverse, vibrant and sustainable market.

• Quality care provision, which helps people meet their outcomes and improve their wellbeing.

• Much improved commissioning by local authorities.

• Individuals and families being encouraged to plan and prepare.

• Support for people to make good decisions through better information and advice, at the national and local level.

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Key issues for reform

• Empowering the individual: individuals need to be better supported to make decisions about care, both at the point of needing care and earlier in life. Focus should be given to facilitating early planning, and intervening at critical times with tailored advice and support.

• Joining up services around the individual: there are real opportunities to deliver better services, more efficiently, if health, housing and care services were better joined-up and more effectively commissioned at the local level.

• Understanding and facilitating an effective market: there needs to be a greater emphasis on planning and strategic commissioning, built on a better understanding of the local population, the capacity of local communities, and the services offered by the market.

• Sustainability: a more stable market needs to be encouraged, which supports innovation and investment for the longer-term. This is partly linked to the funding of the system, but also encompasses wider issues such as ensuring quality services.

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Key findings (1)

How should we define the social care market?• Need to look beyond traditional definitions – personalisation should focus on outcomes.• Should look across traditional silos and look at the impact of other, closely linked, areas

such as housing and health services. • The market should be for all, regardless of the source of funding.• Need to more carefully consider the different types of social care provision from

prevention to re-ablement and through to specialist services.

Do we understand the market well enough?• Many feel that we do not yet properly understand those using services, or have

insufficient insight into individual’s needs and how to effectively tailor information, advice and support.

• Need to promote greater understanding of providers – their needs and pressures.• Need for better market intelligence, both at national and local level.• Data and information needs to flow more effectively around the system, and there

should be greater transparency.

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Key findings (2)

What is the role of local authorities in the market?• Increasingly local authorities will be moving from the provider of care to a body

which facilitates a wider market. • To do this successfully, local authorities need to fulfil a range of functions,

starting with strategic planning and commissioning through to effective procurement of services, where this is necessary.

• Call for greater information to be available to facilitate this role – including better understanding of the needs of the local population and of the market.

What do we need to do to develop sustainable markets? • Fee levels consistently raised as a concern; acknowledgement that this was

only part of sustainability, but indicative of wider challenges.• Other issues raised included: need for innovation, requirement to attract

investment, consideration of prices paid by different types of service users, how to incentivise integration of services, and how to support quality and continuity of care.

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Key findings (3)

How can individuals be supported?

• Increasing numbers of individuals will be commissioning services either as self-funders or through personal budgets/direct payments.

• This means individuals need information and support to make decisions, especially given that people may be needing to source care under difficult circumstances.

• Need to give consideration as to what type of information is required, who should provide it and when? For example, there is a need for information when people present with needs, but also perhaps to intervene at key ‘trigger’ points.

What do we need to promote quality?

• There is a strong call for some sort of quality mark which would allow differentiation between provision on more than just essential standards.

• Support for a consistent, impartial system, which is simple and transparent.

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Key findings (4)

Are additional measures of market oversight required?

• Preliminary views are that there is a need to do something to address the risks that were highlighted by the collapse of Southern Cross, but that it is important not to overreact.

• Many said there should be better coordination between different parts of the system, and that clear plans need to be put in place in case a similar situation arises in the future.

• Agreement that the core objective must be to safeguard the quality and continuity of care for service users, but to not otherwise get involved in the activities of service providers.

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Opportunities

• Personalisation: people believe that personalisation provides a mechanism to transform the market and delivery of care. However to achieve this, there needs to be much greater understanding of what individuals need and want, and the support in place to help people negotiate their way through the system.

• Integration: people have said that there is a real opportunity to delivery better outcomes, more efficiently, through joined-up working between health, housing and care. Services should focus on wrapping around the needs of individuals and be based on the outcomes they want to achieve.

• Building community capacity: feedback suggests that there needs to be a focus on maximising the value we made of the significant community assets which are already in place. Activity in this area can complement the services offered by the market.

• Health and Wellbeing Boards: people believe that there is a real opportunity in bringing together all the commissioners of services together in a local area to coordinate strategies and action.

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Commission on funding of care and support recommendations: key findings

• Strong support for funding reform and the Dilnot model from this strand of the engagement.

• The Commission's recommendation for greater funding for current system is very much welcomed.

• Encouraging people to plan key is seen as one of the key strength of the Dilnot recommendations, and should be core to any reforms going forward.

• Widespread support for a wider range of financial products to help support people financially.

• Number of areas where people felt greater clarity was required, including: – Implications of a more universal system for self-funders and local

authorities needs to be considered. – Although greater transparency over accommodation costs welcome,

people said the implications of this need to carefully worked through.– Position on ‘top ups’ should be clarified.

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Emerging priorities for action

• A comprehensive information and advice strategy, which includes information for individuals, for providers and for local authorities.

• Greater transparency throughout the system, with clear statements on both the demand for services (JSNA) and supply, clearly explained to local people.

• Existing providers able to offer a wider range of care services, leading to closer integration with the NHS.

• Incentives for new care and extra care housing solutions, which help people make better choices earlier, and support people to live in their own homes for longer.

• Encouraging more strategic commissioning practices which better match the needs of the local population with the formal services on offer and local community capacity.

• Ensuring the sustainability of local markets, with consideration given to how to encourage investment and innovation.

• Introducing an impartial, consistent and national quality kite mark, indicating more than compliance with basic standards.