9th april- berkshire west data study final v1_0

Berkshire West Feasibility Study

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Berkshire West Realising the Benefits of a Care Data Hub

Affinity Works Feasibility Study: Evaluation Report

Affinity Works

8th April 2015


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Affinity Works and Berkshire West

About Us

In response to increasing pressure from rising demand and reduced funding, we believe that the public

sector can deliver better services as well as greater efficiency by realising the immense potential of

collaboration.

Affinity Works provide a combination of specialist services and powerful software solutions that can

help public sector organisations work more effectively together to achieve tangible, quantifiable

benefits.

Our Data Hub supports the pooling of care purchasing data, sharing vital information that helps drive

performance up and costs down. It allows clusters of Local Authorities and their partners to create a

powerful engine for change enabling

Increased internal efficiency

Reduced costs

Direct cashable savings

The Data Hub harvests care purchasing transactions from across a cluster of engaged organisations,

harmonising Service Categorisations, Service Provider and Client Group descriptions to create

standardised, easily accessible information that can be shared, analysed and leveraged. The solution

facilitatates price comparisons, highlights anomalies and supports future negotiation, purchasing and

the policing of pricing frameworks.

Our Data Hub and Directory solutions are the same as those that underpin the highly successful WLA

CarePlace implementation, which supports the largest Local Authority cluster in the UK, handling social

care spend across 19 London boroughs and through collaboration releasing year on year procurement

savings of over £10m.


In March 2015 Affinity Works were commissioned by Wokingham to deliver a ‘Feasibility Study’ that

would examine the potential benefits of a Care data hub for partners across Berkshire West. The study

would be based on an analysis of real care purchasing transaction data drawn from the Case

Management Systems of three participating Local Authorities (Wokingham, Reading and the Royal

Borough of Windsor and Maidenhead) and loaded into the Affinity Works Data Hub.

This ‘Evaluation Report’ summarises our findings and will provide input into our formal presentation

back to Berkshire West.


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Contents

Key facts ........................................................................................................................................................ 4

1. Benefits of Information Pooling ............................................................................................................ 5

2. Characteristics of the Berkshire West sample data set ........................................................................ 7

2.1 Data enhancement........................................................................................................................ 7

2.2 Client Groups, Placements and Net Cost ...................................................................................... 7

2.3 Analysing Placement pricing ....................................................................................................... 10

2.4 Service and Service Provider - Crossover .................................................................................... 13

2.5 Service and Service Provider - Variance & Benchmarking .......................................................... 15

2.6 Potential Efficiency – Calculating a cashable savings ‘envelope’ ................................................ 16

3. Exploiting Information Pooling ........................................................................................................... 18

3.1 Direct cashable savings ............................................................................................................... 18

3.2 Real time price comparison ........................................................................................................ 18

3.3 Implement and police agreed pricing frameworks ..................................................................... 19

3.4 Leveraging collaborative purchasing and supplier management ............................................... 19

3.5 Quality management .................................................................................................................. 20

3.6 Strategic decision support .......................................................................................................... 20

Appendix 1 – Example Placement anomalies ............................................................................................. 22

Appendix 2 – Risks, Benefits and Planning ................................................................................................. 27

Appendix 3 – Glossary of names ................................................................................................................. 29


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Key facts

DATA SET

1,410 purchasing transactions representing Placements across 3 local authorities

£61m of projected annual spend with 234 different Service Providers

44% of Placements are for Services or with Providers used by more than one authority

25 Providers with over £0.5m per annum shared commitment across the authorities

ANALYSIS

£2.9m annual Potential Efficiency savings ‘envelope’, equating to 4.75% of the total spend

£293k of potential savings detailed in 5 worked through examples

329 Placements with Services graded ‘Non Compliant’ by CQC. 44 of those Placements were made after the ‘Non Compliant’ rating


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1. Benefits of Information Pooling Operating a data sharing hub that enables analysis of pooled Care purchasing data drawn from across a

cluster of collaborating Local Authorities and Health organisations can provide the sharing partners with

a wide variety of short term and strategic benefits. For example:

Direct cashable savings

Evaluate the prices already being paid for services and re-align against the optimum price achieved

for equivalent services across the cluster

Real time price comparison

Ability to compare, during the purchasing process, the price on offer from a Provider with prices

being paid for the same or equivalent services across the cluster

Policing agreed pricing frameworks

Access to tools that will support the enforcement of an agreed pricing framework including

identifying and responding to anomalies as they emerge. Enabling, if required, the creation and

management of a fair pricing regime across the Berkshire West cluster

Leveraging collaborative purchasing and supplier management

Identify opportunities for cluster wide price negotiation, for example with large scale shared

Providers. Utilise the Data Hub as a platform for shared exploitation of broker expertise and more

efficient Supplier Management

Quality management

Track and analyse quality related aspects of Care service purchasing, for example, to identify and

review Placements being made with Services deemed non compliant by CQC or to compare the price

paid for Services with the quality rating of Service that is provided

Strategic decision support

Analyse detailed metrics and identify trends that can inform strategic management decision making.

Provision of key data to facilitate intelligent and joint commissioning, effective benchmarking and

help to establish clarity around ‘fair’ and ‘average’ pricing.

Information pooling and an effective Data Hub will support local authorities in carrying out their

strategic market management and commissioning functions. Including:

Market mapping and knowing what is being commissioned and at what cost

Identifying current and future population needs and how these will influences the strategic

direction for service development (for example in the joint strategic needs assessment

and/or various commissioning strategies)

Identifying gaps in services and support and working to develop the marketplace

accordingly


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Ensuring that prices paid for Services are ‘fair’ and reflect the quality of service provided

and other relevant local circumstances

Developing these message through the Market Position Statements, tracking success in

compliance with the statement and managing anomalies as they emerge


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2. Characteristics of the Berkshire West sample data set Wokingham, Reading and the Royal Borough of Windsor and Maidenhead (RBWM) provided Affinity

Works with snapshots of their Care purchasing transactions to facilitate an evaluation of how a

Berkshire West partnership might realise some of the benefits of sharing care purchasing data and

collaborative procurement discussed above. Between them the partners supplied data for 1,410

Placements as at March 2015 representing a total weekly net cost of £1.18m, i.e. an estimated £61m per

annum.

2.1 Data enhancement

Data was supplied by each Local Authority in a common input format but using location specific service

categorisations and Service Provider descriptions. In order to work effectively across the sample data set

a variety of harmonisation processes were carried out;

- Categorisation of Placements: Each transaction was mapped to one of a standard set of Client

Groups (Older People, Mental Health, Learning Disability, Physical Disability) and to one of a set of

standard Service Levels (Residential Care, Residential Care with dementia, Nursing Care, Nursing

Care with Dementia). This allows like for like comparison of transactions according to the category

of service they represent1

- Service and Provider Harmonisation: A number of matching algorithms were utilised to align

Service and Provider details across the data set and then to correlate those details against a CQC

‘master’ set. This allows cross partner transactions associated with the same Service to be aligned

and multiple Services associated with the same Provider to be identified.

Once the data set has been harmonised it can be cross-tabulated and subjected to static analysis using

appropriate tools and subsequently added to the Affinity Works Data Hub for real-time interactive

interrogation and reporting.

2.2 Client Groups, Placements and Net Cost

A breakdown of the data set as presented in Table 1 demonstrates the similarity of partner submissions

in terms of overall volume of transactions but also in how those transactions are distributed across

Client Groups.

1 The standard data set for Wokingham did not distinguish between Placements with and without dementia. Wokingham have extracted further information about their clients and linked it into the Placement data to try and differentiate between dementia / non-dementia Placements so that more of them could be compared on a like for like basis


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Overall the data shows a heavy skew toward Older People in terms of number of Placements and to

Older People and Learning Disabilities in terms of net cost. Mental Health and Physical Disability were

similar in scale to one another, both in terms of number of Placements and net cost, but form a much

smaller component of the data. This aspect of the transaction data is summarised in the Figure 1 and

Table 2.

Figure 1

LEARNING

DISABILITY (LD) MENTAL HEALTH

(MH) OLDER PEOPLE

(OP) PHYSICAL

DISABILITY (PD) TOTAL

PLACEMENT COUNTS

RBWM 109 21 313 18 461

Reading 103 29 325 29 486

Wokingham 132 7 304 20 463

TOTAL 344 57 942 67 1410

Table 1

CATEGORY PLACEMENTS NET SPEND (PER ANNUM)

Mental Health (MH) 57 (4.0%) £2,451,176 (4%)

Physical Disability (PD) 67 (4.8%) £3,154,112 (5.2%)

Learning Disability (LD) 344 (24.4%) £25,187,032 (41.2%)

Older People (OP) 942 (66.8%) £30,303,573 (49.6%)

Table 2


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Evaluating the Client Groups by Service Level allows the data to be considered in a more detailed form,

as shown in Table 3:

Table 3

Figure 2 and Table 4 compare the variation in distribution of the number of Placements and the annual

net costs of Placements by Client Group across the partner Local Authorities.

Figure 2

CATEGORY AND SERVICE LEVEL PLACEMENTS PLACEMENT % NET COST (PER ANNUM) NET COST %

LD - Nursing Care 4 0.3% 199,276£ 0.3%

LD - Residential Care 336 23.8% 24,894,560£ 40.7%

LD - Residential Respite 3 0.2% 66,955£ 0.1%

LD - Residential With Dementia 1 0.1% 26,290£ 0.0%

MH - Nursing Care 9 0.6% 399,047£ 0.7%

MH - Residential Care 46 3.3% 1,966,374£ 3.2%

MH - Residential Respite 1 0.1% 46,800£ 0.1%

MH - Residential With Dementia 1 0.1% 39,000£ 0.1%

OP - Nursing Care 351 24.9% 11,270,549£ 18.4%

OP - Nursing Respite 2 0.1% 82,535£ 0.1%

OP - Nursing with Dementia 101 7.2% 3,524,774£ 5.8%

OP - Residential Care 345 24.5% 10,967,152£ 18.0%

OP - Residential Respite 7 0.5% 409,662£ 0.7%

OP - Residential Respite with Dementia 1 0.1% 33,592£ 0.1%

OP - Residential with Dementia 135 9.6% 4,015,344£ 6.6%

PD - Nursing Care 35 2.5% 1,702,516£ 2.8%

PD - Nursing Respite 2 0.1% 174,148£ 0.3%

PD - Nursing With Dementia 1 0.1% 41,034£ 0.1%

PD - Residential Care 26 1.8% 1,131,979£ 1.9%

PD - Residential With Dementia 3 0.2% 104,476£ 0.2%

Total 1410 100% 61,096,063£ 100%


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2.3 Analysing Placement pricing

By assigning all Placements to standard Client Groups and Service Levels during the harmonisation

process the Data Hub is able to calculate average costs for each Local Authority, or across the whole

cluster, for those Client Groups and for particular Service Levels

For example Figure 3 shows the average cost of placements across the Berkshire West cluster for each

Client Group and Service Level.

Figure 3 Note that the scale of the Average Placement Cost changes between these two charts

An enhanced understanding of Placement costs can be derived from reviewing the variation within each

Client Group – Service Level combination, again at individual partner level or cluster wide. This analysis

will start to flag up variations that can indicate the scope for savings and for improved price

management. Indicating for example:

a) variation in prices paid for equivalent services by different partners

b) variation in prices paid for equivalent services by the same partner

LEARNING

DISABILITY (LD) MENTAL

HEALTH (MH) OLDER PEOPLE

(OP) PHYSICAL

DISABILITY (PD) TOTAL

PL £ PA PL £ PA PL £ PA PL £ PA PL £ PA

RBWM 109 £7,301,831 21 £828,579 313 £7,937,808 18 £738,936 461 £16,807,155

Reading 103 £7,987,360 29 £1,204,157 325 £11,155,491 29 £1,469,800 486 £21,816,807

Wokingham 132 £9,897,891 7 £418,485 304 £11,210,309 20 £945,417 463 £22,472,101

TOTAL 344 £25,187,081 57 £2,451,221 942 £30,303,608 67 £3,154,153 1410 £61,096,063

Table 4 Key: PL =Placement count. £ PA = Commitment per annum


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So for example Figure 4 provides an overview of prices paid across the cluster and across all Client

Groups and Service Levels. It provides only very general guidance, indicating for example that the largest

cohort of RBWM Placements fall in the £350-£399 per week price band, whereas for Reading and

Wokingham that becomes the £600 to £699 and the £700 to £799 bands respectively.

Figure 4

The drill down and interactive reporting capabilities of the Data Hub will allow this general overview

data to be rendered down to specific Service Levels, allowing partners to assess the variability in their

own pricing and to benchmark their pricing with other partners. As an example Figure 5 presents the

Berkshire West price band data for ‘Older People – Residential’ placements across the partners.

The data suggests that for this particular Service Level Reading have the widest variation in prices paid,

ranging from the £350-£399 per week band right through to placements over £2000 per week, but that

the large majority of their placements are grouped between £600 and £799. The Wokingham data

shows a very similar trend while RBWM appears to have most of its placements at £599 or below and

have a narrower overall range of pricing than the other partners.


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Figure 5

Specific values for the minimum, maximum and average cost of each Client Group / Service Level

combination can also be derived per partner and across the cluster as a whole. The data provided in

Table 5 provides this break down for all Service Levels across the full data set.

This kind of analysis can be undermined by a small number of isolated boundary case prices that relate

to a Placement with very particular characteristics. Ongoing access to the interactive tools within the

Data Hub provide significant value over and above static one off data analysis exercises, allowing users

to exclude ‘false drops’ and isolate those Placements that are truly out of line with the norm and / or

with pricing frameworks.


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Table 5

2.4 Service and Service Provider - Crossover

Correlating Services and Service Providers across the data set allows Placements to be reviewed and

analysed in terms of:

a) Which Service Providers and which of their Services are attracting the greatest aggregate

spend from each partner and across the partnership cluster

b) Where are there significant variations in the prices being paid by each partner and across

the partnership cluster for the same or an equivalent Service from the same Service

Provider

In this analysis we have captured two categories of crossover. The first, ‘Service Crossover’, provides the

most direct basis for price comparison and occurs where at least 2 partners have Placement transactions

in the same Service (for example within the same Care Home).

We have also identified ‘Organisational Crossover’ which identifies Service Providers who are candidates

for collaborative purchasing and / or collaborative supplier management. Organisational crossover is

defined as occurring where at least one other partner has the same type of placement with the provider

(or parent company) but within different Services.

By this analysis a total of 44% of all Berkshire West Placements (625 of 1,410) in the sample data set

were for Services or with Service Providers used by more than one of the Local Authorities. The

breakdown by partners is provided In Figure 6 and shown in more detail in Table 6.

MIN MAX AVG

PD - Nursing Respite £983 £2,366 £1,675

LD - Residential Care £340 £4,619 £1,425

OP - Residential Respite £576 £2,030 £1,125

LD - Nursing Care £797 £1,149 £958

PD - Nursing Care £639 £1,260 £935

MH - Residential Respite £900 £900 £900

MH - Nursing Care £370 £1,565 £853

PD - Residential Care £380 £1,960 £837

MH - Residential Care £311 £2,717 £822

OP - Nursing Respite £687 £900 £794

PD - Nursing With Dementia £789 £789 £789

MH - Residential With Dementia £750 £750 £750

OP - Nursing with Dementia £314 £2,208 £671

PD - Residential With Dementia £491 £950 £670

OP - Residential Respite with Dementia £646 £646 £646

OP - Nursing Care £345 £1,390 £617

OP - Residential Care £334 £2,160 £611

OP - Residential with Dementia £375 £950 £572

LD - Residential With Dementia £506 £506 £506

LD - Residential Respite £300 £575 £429

NET COSTCATEGORY AND SERVICE LEVEL


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Figure 6

Table 6

There is a strong correlation between crossover and the successful linkage of Placement records to a

Service Providers CQC identity during data harmonisation. There is very little identifiable crossover when

the linking process fails because the data can’t be positively matched across the cluster using the CQC

identity as a shared key. For Reading the data harmonisation process linked over 99% of Placements

with the CQC dataset, Wokingham 80% but RBWM only 52%. With more time (and assistance from the

TYPE PLACEMENTS % OF TOTAL

Service 128 26%

READING Organisation 141 29%

None 217 45%

Total 486 100%

Service 122 26%

WOKINGHAM Organisation 99 21%

None 242 52%

Total 463 100%

Service 77 17%

RBWM Organisation 58 13%

None 326 71%

Total 461 100%

PARTNERCROSSOVER


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authority) the amount of RBWM services that can be linked to the CQC dataset would increase

substantially and as a consequence so would the level of crossover.

Extrapolating the weekly spends to an annual figure the 3 Local Authorities in the sample have a

combined annual commitment of more than £0.5m a year with 25 Service Providers (see Table 7). The

largest commitment, to Voyage 1 represents an estimated combined spend of over £4.5m per annum.

Table 7 Key: PL =Placement count. £ PA = Commitment per annum

2.5 Service and Service Provider - Variance & Benchmarking

Having established average Service Level pricing for each Client Group, it is then possible to review

individual Service Provider pricing to establish variances from the average. Where variances are

identified individual circumstances can be assessed and where there is no acceptable rationalisation for

the differential pricing the partner(s) may choose to negotiate an adjustment.

The average (‘mean’) is used as an example for setting a comparison benchmark, but other mechanisms

(e.g. the ‘median’, the ‘mode’ and ‘standard deviation’) could be used to carry out a similar exercise. The

results of using multiple approaches can be cross tabulated to help identify priority candidates for price

review.

PL £ PA PL £ PA PL £ PA PL £ PA

Voyage 1 Limited 30 2,069,372£ 27 1,778,744£ 9 731,338£ 66 4,579,455£

Barchester Healthcare Homes Limited 5 229,037£ 69 2,854,490£ 4 206,301£ 78 3,289,827£

Bupa 61 2,369,139£ 8 387,655£ 18 485,438£ 87 3,242,232£

Dimensions 2 132,132£ 32 2,525,717£ 34 2,657,849£

Life Style Care 49 1,519,544£ 2 58,886£ 38 1,053,024£ 89 2,631,454£

Optalis Limited 41 2,495,292£ 41 2,495,292£

Care UK 8 322,949£ 3 127,613£ 64 1,497,762£ 75 1,948,324£

Affinity Trust 1 61,880£ 28 1,712,230£ 29 1,774,110£

Community Homes of Intensive Care

and Education Limited 18 1,598,768£ 1 113,694£ 19 1,712,462£

Colleycare Limited 37 1,228,760£ 3 100,230£ 40 1,328,990£

Four Seasons 2 82,618£ 38 1,187,135£ 2 47,061£ 42 1,316,814£

Jasmine Care Holdings Limited 23 747,725£ 10 334,058£ 33 1,081,783£

Mulberry Care Limited 32 1,040,769£ 32 1,040,769£

Purley Park Trust Limited 12 706,663£ 2 149,040£ 2 141,309£ 16 997,013£

Reading Borough Council 21 868,140£ 21 868,140£

Central and Cecil Housing Trust 41 863,125£ 41 863,125£

European Care (West) Limited 3 102,914£ 23 730,341£ 26 833,255£

Majesticare Limited 3 129,491£ 17 683,557£ 20 813,048£

Norwood 2 193,128£ 8 610,761£ 10 803,889£

Choice Ltd 1 108,556£ 7 691,582£ 8 800,138£

Mr & Mrs V Juggurnauth 18 608,773£ 2 71,241£ 20 680,014£

Residential Community Care Limited 3 477,526£ 2 182,166£ 5 659,692£

Life Care Corporation Limited 20 649,766£ 20 649,766£

Bridge House Nursing Home 13 521,765£ 13 521,765£

Anthony Toby Homes Trust 9 438,685£ 1 77,860£ 10 516,545£

PROVIDERREADING WOKINGHAM RBWM TOTAL


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The Data Hub contains a set of interactive tools that will carry out real time benchmarking of a user

provided ‘test price’ against the current Placement data for a given Client Group / Service Level. The

data set can be restricted to a particular partner or include Placements from across the entire cluster.

The input price might be the average price, an agreed ‘fair price’ or even a price quoted by a Service

Provider during negotiation.

The benchmarking tools can used to summarise all relevant Placements above and below the ‘test price’

allowing the user to ‘drill down’ and analyse all Placements that represent anomalies and which could

therefore release potential savings if they are renegotiated.

2.6 Potential Efficiency – Calculating a cashable savings ‘envelope’

Analysing variability of Service Provider pricing for instances of the same Service and for instances of

equivalent Services allows an ‘envelope’ to be calculated projecting the overall scope of the cashable

savings benefit across the Berkshire West group.

The parameters of such a calculation can be adjusted to make it more or less aggressive, for the

purposes of this report we have used a guarded approach as follows;

Service Crossover

Only include services from service providers with 3 or more current placements of the same

type with a value of over £350 per week

Disregard the two lowest placement costs charged for that service and calculate potential saving

on each placement by subtracting the 3rd lowest cost from the cost of each placement charged

above that threshold when it is for the same service from the same provider

Service Crossover Efficiency = Placement Cost – 3 Lowest Placement Cost

Organisation Crossover

Again only include Services from Organisations with 3 or more current services and placements

with a value of over £350 per week

Only include Services where there is no Service crossover to avoid double counting

Calculate potential saving on each placement by subtracting the AVERAGE cost charged for the

service from the cost of each placement charged above that average when it is for the

equivalent service from the same provider

Organisation Crossover Efficiency = Placement Cost – Average

Placement Cost

Berkshire West Potential Efficiency saving ‘envelope’

Running these calculations across the Berkshire West data set establishes a total savings ‘envelope’ of £2.9m per annum, or 4.75% of the committed annual spend of £61m.


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The potential savings are most significant across LD Residential Care, OP Nursing Care and OP

Residential care which make up £2.47m of the £2.9m total as summarised in Table 8.

Benchmarking the Berkshire West Potential Efficiency saving

For the purposes of comparison with the Berkshire West Potential Efficiency savings ‘envelope figures of

4.75% and £2.9m, the West London Alliance estimate they have realised a 3% (> £10m) cashable savings

from exploitation of an instance of the Data Hub for the CarePlace cluster, while Affinity Works most

recent equivalent data study for a cluster of Local Authorities in the North East of England generated a

Potential Efficiency envelope figure of 2.5% (£2.6m).

CLIENT GROUP SERVICE LEVEL POTENTIAL EFFICIENCY SAVING (PER ANNUM)

Learning Disability Residential Care £1,097, 463

Older People Nursing Care £817,009

Older People Residential Care £560,441

Table 8


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3. Exploiting Information Pooling The target benefits of pooling Social Care procurement data were discussed earlier in this document,

and having overviewed the sample data set, practical examples of the benefits can be recognised.

3.1 Direct cashable savings Evaluate the prices already being paid for services and re-align against the optimum price achieved for

equivalent services across the cluster

The Potential Efficiency ‘envelope’ for the Berkshire West data set has been calculated at £2.9m per

annum. Transformation of that figure into cashable savings would require use of the Data Hub reporting

toolkit to drill down into the procurement data and pinpoint specific anomalies and then negotiation

between the Berkshire West brokers and selected Service Providers backed up by extracted benchmark

data.

If Berkshire West were only able to realise 10% of the efficiency ‘envelope’ in Year 1 of using the Data

Hub and then made no further progress, that would still equate to a saving of £290k per annum going

forward, or in excess of £1m over 4 years.

An initial analysis of the sample data set has generated a series of examples of potential anomalies

worthy of further investigation. This is a small selection of use cases but does provide a useful set of

examples as to the kind of analysis and response activities that can be carried out once information is

being pooled and analysed. It demonstrates the kind of drill down work that will be required to attack

the £2.9m potential savings ‘envelope’ and shows how optimum pricing can be enforced once the data

pool is available online and interactively at the point of placement decision making.

3.2 Real time price comparison

Ability to compare, during the purchasing process, the price on offer from a Provider with prices being

paid for the same or ‘equivalent’ services across the cluster

Evaluation of a periodic data snapshot can provide feedback on Placement pricing but that capability can

be substantially enhanced by real time access to pricing benchmarks via the Data Hub. Tactical or

strategic analysis can be carried out ‘on demand’ and data is always live, up to date and critically,

existing price paid data is available to brokers when new Placement pricing decisions are being made

Example 4 in Appendix 1 draws out an example of where availability of existing pricing data from 2

partners with active Placements with a particular Service Provider may have resulted in a Placement

from the 3rd partner being at an improved price.

Example 5 in Appendix 1 discusses how the Data Hub can be exploited to provide real time guidance for

managing the pricing even of complex and relatively specialised packages of care. The benefits of which

can then also be shared across the partners.


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3.3 Implement and police agreed pricing frameworks

Access to tools that will support the enforcement of an agreed pricing framework including identifying

and responding to anomalies as they emerge. Enabling, if required, the creation and management of a

fair pricing regime across the Berkshire West cluster

The sample data exhibits a degree of price normalisation has already achieved. The Data Hub will

provide a comprehensive management reporting environment that can demonstrate the levels of

compliance delivered to date and continue to monitor and report progress in the future. The

identification of potential anomalies discussed above shows how non-compliance can be checked for

and addressed to maintain and improve alignment with standard pricing, while interactive

benchmarking at point of purchase should minimise occurrence of rogue pricing in the first place.

3.4 Leveraging collaborative purchasing and supplier management

Identify opportunities for cluster wide price negotiation, for example with large scale shared Providers.

Utilise the Data Hub as a platform for shared exploitation of broker expertise and more efficient Supplier

Management

It is clearly for the partners themselves to decide how far they wish to create the structures and

processes to work collaboratively in purchasing and Supplier Management. There are clear potential

efficiencies in sharing and pooling brokerage expertise and Suppliers can also benefit from partner

collaboration, for example arranging a single shared inspection process with the cluster.

Identification of Suppliers who are receiving substantial revenues from across the partners creates the

opportunity for combined price negotiation. Voyager 1 for example work with all 3 partners with an

estimated annual commitment of nearly £4.6m (£2m from Reading, £1.8m from Wokingham and

£0.75m from RBWM).

Using the Data Hub and Directory can be a good starting point for negotiation with Providers because it can realise

efficiencies for them as well as for the partners. The system has proven to reduce void times if Providers enter their

vacancies and the Directory provides them with a good marketing platform. In addition, Provider overheads can be

reduced through partners working collaboratively (e.g. carrying out shared inspections). Benefits can be “traded” for

price reductions.

Higher volume services like Residential or Nursing Care tend to be fairly standardised and are therefore easy to compare

on a like for like basis. Complex Learning Disability or Mental Health placements rarely fall neatly into these categories

but fortunately tend to be lower in volume. You can use a secure document repository to augment the Placement data

with anonymised ‘placement profiles’, which give an insight into model examples of client needs/conditions and the

associated pricing. This can provide brokers with key information to help them ascertain whether a price for a similar new

Placement is fair, compared with similar purchases across other authorities.

TIP

TIP


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3.5 Quality management

Track and analyse quality related aspects of Care service purchasing, for example, to identify and review

Placements being made with Services deemed non compliant by CQC or to compare the price paid for

Services with the quality rating of Service that is provided

Quality Management can cover many aspects of the Placement process and as more structured quality

data becomes available on Service Providers it can be fed into the Data Hub to inform pricing and

whether to place with a particular Service at all.

As a practical example of quality control, the correlation of the Berkshire West Supplier data against a

CQC ‘master’ has allowed the mapping of the CQCs Compliant / Non-Compliant status in each case along

with the relevant date of inspection. By comparing this with the combined data set we have identified

329 Placements with ‘Non Compliant’ Services, 44 of them made after a ‘Non-Compliant’ designation.

This data can be gleaned after the fact from a static analysis of the data set but can be prevented at

source by the Data Hub and Directory systems that flag CQC Non-Compliance Status and / or Local

Authority blocks.

3.6 Strategic decision support

Analyse detailed metrics and identify trends that can inform strategic management decision making.

Provision of key data to facilitate intelligent and joint commissioning, effective benchmarking and help

establish clarity around ‘fair’ and ‘average’ pricing.

With Social Care budgets under intense pressure the effective management of Service Providers and

close price control of Placements will clearly remain central to senior management focus for the

foreseeable future.

Collating real time Placement data across a cluster of partners provides decision makers with confidence

that brokers have the necessary tools to apply pricing policies, make correct day to day purchasing

decisions and identify and address anomalies using the wider groups Placement data to optimise price

points. It also offers the option of initiatives around shared procurement

In addition the pooled data set remains up to date and is available as required to inform strategic

decision making, enabling detailed analysis of what has been achieved and offering an objective basis

for future options evaluation. As the data set evolves over time it can be analysed to identify trends and

support senior staff in planning the future shape of services accordingly.

The Data Hub and the Directory contain functionality for raising alerts against Service Providers or Services. These can be

at varying levels and can be published to practitioners only or also to the public. When combined with documents that

have very granular access rights, the system can be used to manage incidents in real-time across multiple LAs /

Departments. Placement embargoes can be raised, and action plans delivered securely to the Providers. Review dates

and dictionary defined terminology for the alerts protect the issuing authority against claims for restraint of trade.

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Once operational, a Data Hub will support the use of pilot schemes to test out procurement strategies, allowing any

resulting impact to be quickly analysed. For example to evaluate whether an individually negotiated or blanket pricing

strategy will produce higher savings - both can be piloted and tested against the real-world results

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Appendix 1 – Example Placement anomalies

The following are examples of the potential anomalies identified within the sample data set that may be

worth investigating further in themselves, but primarily are provided to show the kind of analysis and

response that a information pooling via the Data Hub will enable.

Example 1

Organisation: Colleycare Limited

Service: Lakeside Residential Home (1-249715904)

LA Category Start Date Net Cost Potential Efficiency

READING OP - Residential Care 06/12/2013 £650 (1st Disregard)

READING OP - Residential Care 06/12/2013 £650 (2nd Disregard)

READING OP - Residential Care 09/12/2013 £650 (pE Threshold)

WOKINGHAM OP - Residential Care 22/10/2014 £650 £0

WOKINGHAM OP - Residential Care 01/04/2012 £700 £50

READING OP - Residential Care 17/02/2015 £800 £150

WOKINGHAM OP - Residential With Dementia 06/11/2014 £578 (1st Disregard)

READING OP - Residential with Dementia 06/12/2013 £600 (2nd Disregard)

READING OP - Residential with Dementia 06/12/2013 £650 (pE Threshold)

READING OP - Residential with Dementia 01/03/2014 £650 £0





Potential Efficiency (week) £800

Potential Efficiency (Full Year Effect) £41,600

Analysis: A fairly small service containing both residential and residential with dementia placements.

Where similar examples have been seen in London, brokers have been able to exploit the transparency

and ensure that future prices move towards the lowest common denominator.

The higher rate (£800) paid by Reading could be as a direct result of an additional need such as

incontinence. As long as this is recorded in the case management system, we would be able to identify

these placements so that comparisons are always drawn on a like-for-like basis.


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Example 2

Organisation: Jasmine Care Holdings Limited

Service: Jasmine House Nursing Home (1-159721778)

LA Category Contract Start Date Net Cost Potential Efficiency

WOKINGHAM OP - Nursing Care Spot 01/07/2014 £410.00 (1st Disregard)

READING OP - Nursing Care Block 01/04/2014 £548.01 (2nd Disregard)

READING OP - Nursing Care Block 01/04/2014 £548.01 (pE Threshold)

READING OP - Nursing Care Block 01/04/2014 £548.01 £0.00





READING OP - Nursing Care Spot 06/12/2013 £591.30 £43.29





WOKINGHAM OP - Nursing Care Spot 19/03/2013 £639.11 £91.10










Potential Efficiency (week) £1,799

Potential Efficiency (full year effect) £93,554

Analysis: Reading has negotiated a block contract price of £548.01 (highlighted) which significantly

improves on the spot purchase prices in both Reading or Wokingham. Bulk purchasing can be significantly

improved by leveraging the collective power of the cluster. For example block beds run the inherent risk of

remaining empty which may be why Reading only appear to have purchased 7 beds at the improved rate.

With this information Reading and Wokingham could leverage collective purchasing by increasing the

volume of a block contract and collectively mitigating the risk of voids.

Purchasing collaboratively in the West London Alliance has led to spot prices for the cluster that were similar to block

prices that had been achieved when Local Authorities purchased individually. This is due to the increase in placement

volumes that could be demonstrated across the cluster. In most cases, fee ceilings have been preferred to block contracts

enabling tight control over pricing whilst retaining the freedom of choice afforded by spot purchasing.

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Example 3

Organisation: Barchester Healthcare Homes Limited

Service: West Oaks (1-125862984)


WOKINGHAM OP - Nursing Care 29/04/2013 £399.06 (1st Disregard)

WOKINGHAM OP - Nursing Care 01/08/2013 £502.93 (2nd Disregard)

WOKINGHAM OP - Nursing Care 07/02/2014 £789.11 (pE Threshold)

WOKINGHAM OP - Nursing Care 27/07/2014 £789.11 £0.00























Potential Efficiency (week) £182

Potential Efficiency (full year effect) £9,495

Analysis: Initially these price variations look like inflationary increases but then two

placements have been obtained in 2014 at a lower rate (highlighted). The price variance may

not seem like much individually but collectively, even if these small amounts could be

rationalised to the optimum it would save Wokingham nearly £10k per annum.

The West London Alliance achieved -2% inflation in 12/13, 0% in 13/14 and 0% again in 14/15 by using data across the

cluster to demonstrate a fair price for care. Preventing inflationary increases can result in significant efficiencies in the

form of cost avoidance.

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Example 4

Organisation: Phoenix Healthcare Limited

Service: Warren Lodge Care Centre (1-108630838)


WOKINGHAM MH - Residential Care 26/06/2014 £850.00 (1st Disregard)

RBWM OP - Residential Care 05/10/2012 £447.43 (1st Disregard)

WOKINGHAM OP - Residential Care 01/03/2013 £523.56 (2nd Disregard)

WOKINGHAM OP - Residential Care 01/03/2013 £548.49 (pE Threshold)

WOKINGHAM OP - Residential Care 19/03/2014 £698.08 £149.59




WOKINGHAM OP - Residential With Dementia 01/03/2013 £446.20 (1st Disregard)

WOKINGHAM OP - Residential With Dementia 24/05/2013 £648.22 (2nd Disregard)

WOKINGHAM OP - Residential With Dementia 01/04/2012 £728.00 (pE Threshold)

WOKINGHAM OP - Residential With Dementia 05/07/2014 £850.00 £122.00

READING OP - Residential With Dementia 15/01/2015 £950.00 £222.00



Analysis: An example of a high degree of variation in prices across authorities and categories. Reading

has a single placement in the home which represents the highest weekly cost. This could be due to a

lack of visibility of the rates that other partners have achieved. Using the Data Hub, brokers would be

able to view the placement prices and establish the current market rate across the cluster before

contacting them about the placement.

Service Providers can enter key information about themselves, for example vacancies, language capabilities of their staff,

support for particular religious or dietary requirements. This information contributes to the Data Hub becoming a

valuable tool to assist brokers in finding suitable services. Once they have found a potential service provider, this financial

data is at their fingertips.

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Example 5:

Organisation: Anthony Toby Homes Trust

Service: Staverton (1-117125612)


WOKINGHAM LD - Residential Care 01/04/2012 £686.86 (1st Disregard)

WOKINGHAM LD - Residential Care 01/04/2012 £686.86 (2nd Disregard)

WOKINGHAM LD - Residential Care 17/08/2012 £868.00 (pE Threshold)

WOKINGHAM LD - Residential Care 20/06/2013 £890.00 £22.00





RBWM LD - Residential Care 01/04/2000 £1,497.30 £629.30

WOKINGHAM LD - Residential Care 23/10/2013 £1,555.53 £687.53



Analysis: Staverton provides a small number of placements at the higher end of the cost spectrum and

the cost discrepancies shown are quite likely to be due to the clients having differing needs. Trying to

negotiate these costs sometimes places brokers in a difficult position because there is very little that

can be compared on a like for like basis. One way this can be addressed in the Data Hub is to upload an

anonymous client profile for each placement and attach it to the organisation/service. This can serve as

a very useful reference of needs v costs for anyone else who subsequently needed to make a placement

in the same organisation/service. The fact that these placements tend to be fairly irregular means that

uploading the profile shouldn’t consume a huge amount of resources and should provide a valuable

asset for similar placements by other authorities.


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Appendix 2 – Risks, Benefits and Planning There are a variety of areas where adoption of a shared Care Data Hub may encounter some level of

‘Risk’ and where good planning will be necessary to facilitate a successful deployment and then

realisation of target benefits. The table below summarises candidate items that should be taken into

consideration by the partners seeking to proceed with adoption of the solution.

At the outset of an adoption project Affinity Works will support the partners in assessing the items

below (and any additional items raised in a Berkshire West context), in order to help with construction

of a suitable Deployment Plan, Risk Register and Benefit Realisation Plan.

AREA CATEGORY & CURRENT RATING

MITIGATION / ACTION

Agreed procurement mechanism not in place

PROCUREMENT The partners will need to agree the appropriate mechanism for actioning procurement of the software and services

Agreed contracting and contract management structures not in place

PROCUREMENT The partners will need to agree how to manage the contracting relationship with Affinity Works, for example by appointment of a designated lead authority as per the Feasibility Study

Project Management resources and reporting structures not in place

DEPLOYMENT The partners will need to agree how to structure the deployment project, how the project is resourced and how and to who progress is reported

Branding across Berkshire West not agreed

DEPLOYMENT The partners will need to agree a shared branding for the solution if it is going to operate across the cluster

Operational resources and reporting structures not assigned

OPERATION The partners will need to agree how to resource regular data extraction from their source systems and how to resource a reporting structure that monitors quality of provision and engages in Account Management with Affinity Works

Design and implementation of data extraction processes, ensure data quality and timeliness not in place

OPERATION The quality of the Data Hub is a function of the quality of data that feeds it. During deployment and then in live operation it will be necessary to ensure processes are implemented to deliver high quality data in a regular and timely fashion to the Data Hub

Data anonymisation / Information governance not in place

OPERATION The Data Hub makes no use of Service User specific personal data. It is critical that the rolling processes for feeding data to the hub incorporate appropriate steps to ensure any such data is anonymised before delivery. Information governance arrangements made for the Feasibility Study will need to be extended to cover a rolling provision of data


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AREA CATEGORY & CURRENT RATING

MITIGATION / ACTION

Service exploitation and Benefit Management plan not in place

BENEFIT REALISATION

The Data Hub provides powerful tools for understanding and leveraging care purchasing data, but it is the partners who need to exploit that capability in order to release the envisaged benefits. Appropriate resourcing, tracking of outcomes and embedding of the new capabilities into current processes and/or the development of new (perhaps shared)processes will be required to optimise the value of the new service

Service development and cluster expansion plan not in place

BENEFIT REALISATION

The Feasibility Study has been based on data from 3 partners covering selected aspects of care provision. The service can significantly extend the benefits released through ongoing development. Key development aspects would be:

a) A wider group of contributing partners, i.e. additional Local Authorities and the introduction of health partners

b) Extension of the service categories where data is being pooled and exploited, for example to cover Homecare and Children’s care

c) Incorporation of additional data elements that expand the opportunity for data analysis, for example bed provision, service user age information, service quality measurement

d) Consideration of collaboration of an associated public facing information service and Directory


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Appendix 3 – Glossary of names

ORGANISATIONS, PRODUCTS AND SERVICES

Affinity Works Provide software and services to public sector organisations interested in improving efficiency and service quality through collaborative working and information sharing.

Data Hub Managed software solution and supporting services offered by Affinity Works that enables clusters of organisations to pool and analyse their data. Underlying software is developed by OCC and forms part of their MarketPlace suite.

Directory Managed software solution and supporting services offered by Affinity Works that enables clusters of organisations to deliver a unified public information resource. Underlying software is developed by OCC and forms part of their MarketPlace suite.

Oxford Computing Consultants (OCC)

Software house with particular expertise in the public sector and social care. Developers of the MarketPlace software suite. Partner with Affinity Works to offer their products with associated services to groups of collaborating organisations.

MarketPlace OCC software suite that includes both the Data Hub and the Directory

West London Alliance (WLA) The WLA is partnership of 6 West London councils who aim to achieve better value for money and better quality of services by close collaboration across a range of service areas, including Adult and Children’s social care

CarePlace CarePlace is the adopted brand name of the WLA’s public facing care services directory and care purchasing data sharing hub. The portal is available to all London boroughs and currently has 19 members. CarePlace uses the Data Hub and Directory components from the OCC MarketPlace suite.

9th april- berkshire west data study final v1_0

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