council-managed personal budgets: developments in the home care market and the role of brokers
DESCRIPTION
Council-managed Personal Budgets: Developments in the home care market and the role of brokers . Parvaneh Rabiee, Kate Baxter SPRU, University of York Making Research Count - York 22 nd May 2014. Most older people prefer managed PBs Most managed PBs used for home care. Context. - PowerPoint PPT PresentationTRANSCRIPT
School for Social Care Research Improving the evidence base for adult social care practice
Council-managed Personal Budgets: Developments in the home care market and the role of brokers
Parvaneh Rabiee, Kate Baxter SPRU, University of York
Making Research Count - York22nd May 2014
School for Social Care Research
Context Mechanisms for managing personal budgets (PBs)
Cash direct payments (DPs) Council-managed PBs Provider-managed PBs (known as ISFs)
Most older people prefer managed PBs
Most managed PBs used for home care
School for Social Care Research
The original study 2011-2012 Factors affecting personalised
support for older people using managed PBs in three councils Changes in commissioning and
market development Support planners’ roles in enabling
increased choice & personalisation Providers & older people’s
experiences
School for Social Care Research
Findings from original study Transition to new framework
agreements Balancing act – competition v.
financial stability Communication issues – broker
roles Early days for market
development/shaping activities
School for Social Care Research
The follow-up study Interviews with three service
development managers Framework agreements, engagement
with providers, market development, information management
Interviews with three council brokers Brokerage system, knowledge of the
market, information exchange
School for Social Care Research
DEVELOPMENTS IN THE HOME CARE MARKET
School for Social Care Research
Framework agreements
Limited numbers of providers to choose from
‘Closed’ agreements Changed obligations Zero hours contracts Neighbourhood/locality working
School for Social Care Research
Engaging the market
E-market websites Provider forums Market Position
Statements
School for Social Care Research
Initiatives to increase diversity Learning events Innovation grants of up to £9000 £500 for providers to encourage older people to get
out £300 ‘one off’ personal
budgets Community Catalysts
social enterprise
School for Social Care Research
Conclusion Shift in balance of power
Provider choice & flexibility Less certainty for councils
Locality-based approaches to commissioning
Collaborative approach to market development
School for Social Care Research
The role of brokers in matching of older people’s needs and preferences with home care providers
School for Social Care Research
The brokerage system The original study suggested:
Potential for greater market efficiency New communication barriers and delays
The follow-up study - brokers’ perspectives on: Negotiating role Knowledge of the market Information exchange Challenges experienced
School for Social Care Research
Support planners’ and brokers’ roles and responsibilities
Brokers: match individual clients with the most appropriate provider/s on the Framework
LA support planners: draw up basic plan based on identified needs
Agency staff - draw up more detailed support plan with service user
School for Social Care Research
Brokers’ routine practiceThe procedure varied across the three study sites: Daily ‘mini-tender’ requests emailed
to ALL providers ‘Mini-tender’ requests but search
restricted to providers within geographical limits Brokers contacted each provider they
worked with previously
School for Social Care Research
Experiences of matching service users’ needs with available care Brokers aware of shortfalls in provision, in particular
In rural areas Provision for non-English speaking clients In providers’ capacity to provide two care workers at each
visit Brokers responded by:
Using financial incentives Setting up spot contracts Arranging for relatives to act as second worker Purchasing care from more than one provider
School for Social Care Research
Experiences of matching service users’ needs with available care – continued
Insufficient information provided by LA support planners about service users’ needs, leading to… Inappropriate packages being set up & additional
work for brokers to find alternative providers
Delays - Support planners bypassing brokers
School for Social Care Research
Information exchangeEffective matching relies on information flow
Sufficient Knowledge of service users’ needs Providers want to have more information Brokers can only provide the information they are
given
Up-to-date information on capacity to take on new clients All 3 sites relied on regular contacts with local
providers
School for Social Care Research
Information exchange – continued Feedback from support planners
Feedback mostly received only when problems arose Positive feedback on providers considered helpful too
Feeding information back to commissioning teams (e.g. data on gaps in services and delays in arranging care for difficult to place clients) Brokers in a unique position to
spot gaps Mechanisms in two LAs for brokers to routinely feedback to
commissioning teams - brokers not clear about the impact of any feedback
School for Social Care Research
Conclusion Brokers can improve market functioning by matching
supply and demand and spotting gaps, BUT communication remains a big issue
Information flows are essential to effective brokerage
Full details from support planners about client’s needs Feedback from support planners on home care providers that
work more or less well Feedback from brokers to the commissioners on gaps in
service capacity
School for Social Care Research
Contact details:[email protected] [email protected]
For further information see:http://php.york.ac.uk/inst/spru/research/summs/managedPB.php
AcknowledgementsThese slides present independent research commissioned/funded by the NIHR School for Social Care Research. The views expressed in this publication are those of the authors and not necessarily those of the NIHR School for Social Care Research or the Department of Health, NIHR or NHS.
Contacts and acknowledgements