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 [email protected]
• 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