Report of the Lead Commissioner Community Care Market and the Assistant Director Primary Care.

Jacqueline Evans, Assistant Director – Integrated Commissioning Programme and Iain Stuart, Assistant Director, Primary Care introduced a report that set out plans related to improving the sustainability of the care market in Wirral via a joint commission for care at home services led by Wirral Health and Care Commissioning (WHCC).

Appended to the report were the following appendices:

It was proposed to jointly commission and enable existing providers to keep their existing caseload post-award. Successful providers would be able to keep existing caseload and take up new cases going forward and Members were told that this would ensure minimum disruption for people who used services and would also reduce the impact of a review of the 1,400 cases.

Members were informed that this approach aimed to ensure that services were delivered in the right place and at the right time and that individual personal outcomes could be improved for vulnerable people that required personal care and support.

It was noted that the commission would support the continuation of the downward trend in long term residential and nursing placements by growing the community offer to the increasing population of older people, allowing them to receive care whilst at home.

Domiciliary Care Services provided personal care for people living in their own homes and were currently independently regulated by the Care Quality Commission (CQC) under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (Registration) Regulations 2009. All of the current service provisions were commissions provided through the independent sector.

Members noted that the service would go out to open tender in September 2018 and would be open for all providers to formally tender and apply for the work, with an intention for the new service to commence in April 2019.  The commission would include:

·  Reablement

·  Domiciliary Care Services

·  Complex/Continuing Health Care

·  End of Life Care

Members also noted that these services would form part of a newly designed integrated pathway for care at home with ‘home first’ also included. There would be an enhanced focus on hospital admission avoidance, an improved hospital discharge offer, behaviour change and self-care. The service specification outlined the vision for the delivery of these services, the key features of the service and the outcomes it was expected to achieve.

The new model would incorporate:

·  An Outcomes focused approach

·  A ‘top to bottom’ service (complex to community involvement)

·  Electronic care monitoring

·  Electronic care planning

·  Social Value (the evaluation criteria will be based on 20%)

·  Wirral based – providers to demonstrate a previous history of working in Wirral using a locally sourced workforce and keeping the Wirral £ in Wirral

·  Trusted Assessor model

·  Open Book Accounting – better value for money and a clearer understanding of Provider costs to enable us to have a dynamic financial approach

·  Payment delivery against ‘actuals’

·  Community / Third sector engagement

·  Deliver a balanced and equitable care market

·  A match to the Wirral ‘50,9,4,1’ model for placed base care, supporting the Healthy Wirral Outcomes

·  Tele monitoring

Members noted that the Wirral 2020 Plan objectives supported by this approach included Older People Live Well and People with Disabilities Live Independently.

In addition there was a specific work programme under Healthy Wirral to improve care market sustainability; this approach was part of the programme plan for improvement.

The Wirral 2020 Plan also included a target to support local businesses to thrive and do well. Therefore, the commission would commit to partly evaluate on Social Value 20% as per the Council’s new social value policy, with the aim of supporting and attracting business to remain on Wirral to support the local economy and deliver a sustainable local offer.

Other options considered included:

·  Not to go out to tender. However, Contract and Procurement Regulations required a tender process be undertaken.

·  Undertake independent commissions for Continuing Health Care, End of Life, Reablement and Domiciliary Care. However, this did not fit in with the WHCC joint plan and current procurement timelines for both areas.

·  Jointly commission and transfer all clients from existing, to successful providers. However, this could potentially disrupt clients and impact as follows:

Ø  TUPE issue

Ø  Market sustainability, unsettling clients and providers.

Ø  Wirral Community Foundation Trust – reviews undertaken as a result of a transfer to new provider.

Members considered the documentation in detail making comments and asking questions on the following:

·  It was important to grow the offer in the local community in order to keep people at home as long as possible. It was imperative to integrate into the nine neighbourhoods. The commission would include an integrated pathway, agencies would be all joined up so that patients and clients could access care and this would assist the hospital discharge process.

·  Workshops had been held with domiciliary care providers. Costs of providing care had been explored.  Issues that had arisen included the length of contracts, sustainability and open book accounting. Providing contracts for five years or more would help with the staffing element and demonstrate that this was the right approach.

·  This was about keeping people safe, providing continuity of cover, working with a Wirral wide system, inviting carer options, offering roles beyond domiciliary care and providing jobs and the economic benefits they bring to the local community.

·  The Council’s 20/20 Plan enforced the social value component.

·  Wirral had a positive and independent workforce.

·  Providers had worked to show value for money, how they would keep people safe and they aspired to a minimum waiting list with an integrated pooled budget in place.

·  There were a number of pilot exercises in operation currently and since last summer the waiting list for domiciliary care had decreased from 86 to 36. It was hoped to reduce it further by the autumn to below 25. Creative ideas were being sought to assist this aspiration.

·  Officers were confident that the procurement process would ensure that everything would be in place by April 2019 as there had been ongoing consultations and engagement for months.

·  Between now and February 2018 it was important that checks and balances were included in the process as a safeguarding measure and updates would be provided for Members of both Committees via email.

The NHS Wirral CCG Members RECOMMENDED (to the CCG): That

(1)  it allocates and sanction the use of WHCC pooled budget resources to fund the joint commissioning of this service;

(2)  it agrees to the development and deployment of a centralised system for commissioning, to enable the recording of Service delivery and the paying of Providers (subject to the contractual arrangements with the recording and payment system providers’ (ContrOCC and ADAM) being able to accommodate such an arrangement;

(3)  it approves  the proposed Care and Support at Home commission for the forward commissioning plan, and integrated governance arrangements; and

(4)  it approves the award post tender and a further report be brought back to Joint Strategic Commissioning Board for consideration at its meeting on5 February 2019.

Wirral Borough Council’s three Cabinet Members, sitting as a Committee of the Cabinet

RESOLVED:  To

(1)  allocate and sanction the use of WHCC pooled budget resources to fund the joint commissioning of this service;

(2)  agree to the development and deployment of a centralised system for commissioning, to enable the recording of Service delivery and the paying of Providers (subject to the contractual arrangements with the recording and payment system providers’ (ContrOCC and ADAM) being able to accommodate such an arrangement;

(3)  approve  the proposed Care and Support at Home commission for the forward commissioning plan, and integrated governance arrangements; and

(4)  approve the award post tender and a further report be brought back to Joint Strategic Commissioning Board for consideration at its meeting on5 February 2019.