care act seminar provider failure, market oversight & market reshaping correct as at march 2015
TRANSCRIPT
CARE ACT SEMINAR
Provider Failure, Market Oversight & Market Reshaping
Correct as at March 2015
• There was the Local Authority, and the Local Authority provided services
• Then came the Compulsory Completive Tendering Policy of the ‘80s and ‘90s…..
• …..and the Best Value policy of the ‘00s• Throughout the ‘00s there was a growing emphasis
on engaging with stakeholders to identify need…….• ….which extended into new duties to consult,
involve and co-design services with users – to “recast the service user as the service shaper”
In the beginning….
• “Increasingly, the role of local authorities will no longer centre on the purchasing and provision of care and support. Instead, authorities will be expected to take a leadership role: identifying the needs of the local population, supporting the informal and community networks that can help people stay independent, and ensuring that people have a diverse and responsive choice of options” (Caring for our Future)
• ….so the role of the local authority has changed primarily to a facilitative one, and the role of the service user to active participant or even micro-commissioner
And the Department of Health said….
• In 2012-13 the total net expenditure on adult social care by local authorities in England was nearly £15 billion (an average of around a £100 million per authority) of which the vast majority was spent in the private and voluntary sector
• Around half of all care home places taken up by older people are self-funded – so the total size of the care market in both regulated and unregulated care will be considerably larger
• Social care has a substantial workforce, estimated at around 1.85 million in 2011
http://ipc.brookes.ac.uk/services/documents/The_Basics_of_market_facilitation.pdf
The Market: National Context
• In 2007, NELC delegated adult social care commissioning to the CCG (then CTP) via a s75 agreement
• In 2011, mental health functions were transferred to Navigo, and provision of community services to Care Plus
• In 2013, delivery of adult social care functions was transferred to focus independent adult social work
• 5 lead home care providers, and other approved providers• 47 homes run by 35 different companies in NEL; inc:
residential and nursing home providers Specialist learning disability residential and nursing homes Specialist mental health residential and nursing homes
• There are a range of third sector and voluntary providers
The Market: NEL’s Approach
• What’s the Problem?
• What solution does the CA seek to provide?
• What are we doing about it locally?
Market Oversight and Provider Failure
• We have an increasingly diverse provider market
• As in any market, some business fail, businesses change hands & some are bought out and amalgamated
• Some business change is planned and managed, some provider failures are sudden and disorderly
Market Oversight and Provider Failure: the Problem
• There is currently no formal system in place for checking how well a care provider is managing its own finances – no early warning
• This can lead to sudden and/or unexpected collapse and leads to breakages in the continuation of care, anxiety, cost, disruption, harm etc
Market Oversight and Provider Failure: the Problem
Market Oversight and Provider Failure: the Problem
• Southern Cross Healthcare (Group plc) was the largest provider of care homes and long term care beds in the United Kingdom, operating over 750 care homes, 37,000+ beds and employing around 41,000 staff
• Following rapid expansion financed by the sale of leases of its homes, its shares fell 98% from early 2008 to early 2011, reducing its market value from £1.1bn to around £12m
• In early 2011 the company was in crisis, as it increasingly found its annual rent bill (over £240m on its 750 properties) unaffordable
• With public spending cuts leading to fewer referrals (and a drop in occupancy rates from 92% to 84%), it was forced into negotiations with its landlords for rent reductions and appealed to the government for support
• By July 2011, attempts to rescue the company had failed, and all care homes were being taken over by Southern Cross’ landlords
• Late in 2011, two staff at the company's Orchid View care home in Copthorne, W Sussex, were arrested on suspicion of ill-treatment and neglect of residents. A coroner's ruling in 2013 found that 19 deaths at Orchid View were unexplained, but stated that under Southern Cross' former management the home was "mismanaged & understaffed" & rife with "institutionalised abuse”
Case Study : Southern Cross
• CQC’s role is to ensure that hospitals, care homes, dental and general practices and care at home services provide safe, effective and high-quality care – to monitor, inspect, regulate and encourage improvements
• CQC given new role to assess financial ‘health’ of “hard-to-replace” care providers from April 15
• Applies to only the largest providers, i.e. Dom Care providers of more than 30,000 hours pw, OR more than
2,000 people receive care, OR more than 800 people receive care and they each receive more than 30 hours each
Resi Care providers of more than 2,000 beds, OR providers of between 1 - 2,000 beds and either they have beds in more than 16 LA areas, or the capacity in each of three or more LAs areas exceeds 10%
Market Oversight: the Solution
• CQC can take action where satisfied of ‘significant risk’ to financial sustainability
• New power to request information and intel • New power to ask provider to develop a
sustainability plan• Can now arrange an independent business review• CQC will notify LA if failure likely so LA can prepare• CQC will share info with the LA to assist them in
preparing for and responding to failure
Market Oversight: the Solution
• CQC’s new operating model:Duty of candour – acting in an open and transparent way
re the care provided; when things go wrong, give a truthful account, offer support and an apology
CQC use standards to help them make judgements on whether regulations have been breached; their Essential Standards will be replaced by Fundamental Standards in April 2015 – must deliver on these in carrying out regulated activity
More stringent fit and proper persons test; applies slightly differently depending on whether the provider is an individual, partnership or company – and to employees
Market Oversight: the Solution
• The CA imposes clear statutory duties on LA’s where a care provider fails; extends existing duties of care
• Duties apply whether or not failed provider within CQC regime • We now have a temporary duty to ensure that the needs of
people are met if their provider fails, irrespective of: eligibility, funding, who made the arrangements for care, type of care, and whether the provider is one with which we contact
• People should not experience a gap in their care• We may discharge our duty by:
providing I&A or signposting case manage the process and facilitate physical moves
Provider Failure: the Solution
• Business failure will usually involve the appointment of an Administrator who represents the interests of creditors
• Building a relationship with the Administrator is key. There is mutual benefit to doing so. Understanding each player’s intentions is key
• In some situations the interest of the creditors will be best suited to business continuation
• In that situation we are required to co-operate where possible. insofar as it does not adversely affects people’s wellbeing
Provider Failure: the Solution
• Local authorities may still chose to meet need, even where no duties to do so arise
• This is likely to be where urgent needs arise due to service interruption – as opposed to business failure
• Not all situations where a service has been interrupted or closed will merit local authority involvement, because not all cases result in service users having urgent need
• Whether to act on this power is a judgement for the local authority
• If the provider has not failed, it is primarily the provider's responsibility to meet need as per their contractual obligations
Provider Failure: the Solution
• Colleagues have successfully managed the failure, decline, exit, remodelling of a number of providers in recent years, via:Market Intelligence and Failing ServicesTriangulation of intelligence – Portal, PALS,
Complaints, SI, Contract Monitoring, RelationshipsPolicy and Checklist (covers the advice and learning
points in the CA’s Statutory Guidance e.g. re managing media messages and communication)
CCC and Delivery & Assurance committee
Provider Failure: NEL’s Approach
• What is it?• What are it’s aims?• How are these aims achieved?• What’s our approach in NEL?
Market Shaping
• The Care Act imposes new duties on LAs to facilitate and shape the market
• Market shaping is the process by which LAs ensure that services:Meet the needs of all in their area – both those whose
needs are met by them and those who are self-funded Promote wellbeing of service users and carers
• Could include active intervention or more ‘passive’ support such as provision of intelligence
Market Shaping: what is it?
Market shaping aims to secure:1. An appropriate choice of different types of
service and providers 2. High quality, personalised and outcome-
focused services 3. A supply of such services sufficient to meet
the demand for them 4. A stable and sustainable market
Market Shaping: its aims
Effective shaping of the market to achieve these aims is likely to involve such activities as:
1. Engaging with stakeholders (users, providers and professionals)
2. Assessing and sharing knowledge of the demand and supply of services and the way that needs and aspirations are changing
3. Encouraging innovation, investment and work on improvement where necessary in order to meet this demand
Market Shaping: achieving aims
• The Act introduces a new emphasis on:1. Supporting those who purchase their own
services, to a) empower them to be effective consumers, b) ensure they have adequate information to use this power
2. Co-production, to ensure that the market reflects the needs of services and carers, providers and the wider community
3. Building Community Capacity, to support the more formal provider market
Market Shaping: achieving aims
Market Shaping: PSMDB• Aims to support the delivery of
health and social care services by charities, voluntary organisations and social enterprises
• and to develop new organisations that can increase the market supply of third sector providers
• Gives the participants the skills and confidence to set up and deliver interventions in their area.
• More info: [email protected]
• Start-up investment
• Access to business advice and guidance
• Help to put a bid together
• On-going support including SROI
• Training and development for Managers and Staff
• Sign-posting and support to access other sources of funding
Market Shaping: RCC
• Free support to help communities and organisations provide community based solutions with own solutions
• Promoting practical actions that will deliver improvement and change
• Introduction to well-being: an overview to raise awareness
• Bespoke support to organisations developing new initiatives
• Targeted skills development –detailed starter courses with focus on an individual issue
• Change Champions:
• A three day over three month intensive and practical course
• in depth knowledge and skills development – focus on action not awareness – intensive, project support
• Gives the participants the skills and confidence to set up and deliver interventions in their area
• More info: [email protected] or [email protected]
• Central to the process of market shaping is developing a market position statement
• The Market Position Statement(s) for NEL are intended to give information and analysis which describes what people
and services look like now flag the changes to the sort of care and support we think
that people will want to increase independence, choice and control
set out how we plan to purchase services, to work with the market to promote best practice
help businesses understand the future environment for their work and decide how to grow in future
Market Position Statement: NEL
• NEL’s market position statement is intended to enhance the understanding of all parties and can be found at:
http://www.northeastlincolnshireccg.nhs.uk/market-position-statement-mps/
Market Position Statement: NEL
Market Shaping, Market Position Statement
Market Shaping, Market Position Statement
Summary: contributing to the Act’s vision
Caring for our Future
The transformation envisaged by the Care Act “will come about only if it is a genuinely
collaborative endeavour. We need to dissolve the traditional boundaries that lie
between the third sector, private organisations, local authorities and individuals. And we need to listen”
(Caring for our Future 2012)
Comments, suggestions, questions?
Presented by:Jake Rollin
Assistant Director, Care & Independence (NELCCG)
For further comments / queries:[email protected]