Care Act implementation support – care markets and commissioningSlide 1

University of Wolverhampton MSc Commissioningin Health and Social Care

Tuesday 23rd June 2015

Glen Mason Director of People, Communities and Local GovernmentDepartment of Health

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Overview• Context

• The Care Act

• Wellbeing, prevention and the whole population

• Market shaping

• Commissioning for Better Outcomes

• Care Act implementation support materials

• How do we make the most of our assets?

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Care and Support affect a large number of peopleMany people need some extra care and support during their adult years to lead an active and independent life. Three-quarters of people aged 65 will need care and support in their later years…

48 per cent of men and 51 per cent of women will need domiciliary care only

33 per cent of men and 15 per cent of women will never need formal care

19 per cent of men and 34 per cent of women will need residential care

Who needs care? At age 65, what are your chances of needing different types of care within your lifetime?

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Drivers for Change in the English Care System

• Demographic pressure

• Unprecedented financial challenges

• Raising expectations

• Technological Change

• Systems failure eg: Mid Staffs Hospital and Winterbourne View

• A drive to integrate services

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A shift in the care and support system

From To

RepairFocusing only on response after a crisis

PreventionActing earlier to prevent or delay needs

FragmentationIsolated services focused internally

IntegrationJoined-up services working as partners

PaternalState knows best

PersonalPerson knows best

Exclusive“Doing to”

Inclusive“Doing with”

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National Assistance Act 1948: established the welfare state and abolished the Poor Laws

1948 1960… 1970…

Chronically Sick and Disabled Persons Act 1970: reforms to key entitlements to community services

A brief history of care and support

NHS and Community Care Act 1990: first major set of reforms, including first right to assessments and start of commissioner/ provider split.

1980… 1990… 2000… 2010…

Carers (Recognition and Services) Act 1995: the first Act to recognise carers

Community Care (Direct Payments) Act 1996: new powers to make direct payments

Carers and Disabled Children Act 2000: extending direct payments to carers

Health and Social Care Act 2001: updates on direct payments

Social care law and policy has evolved over more than 65 years, incorporating around 30 Acts of Parliament, but reform has usually been piecemeal.

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• Promote people’s wellbeing

• Enable people to prevent and postpone the need for care and support

• Put people in control of their lives so they can pursue opportunities to realise their potential

The care and support White Paper was published in July 2012 and set out the Government’s vision for the future system.

If adult care and support in England is going to respond to challenges it must help people to stay well and independent:

Caring for our Future

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• The Care Act represents the most significant reform of care and support for a generation

• Puts well-being at heart of every decision

• puts carers on the same footing as those they care for;

• Prevents and delays need for care and support

•embeds rights to choice, personalised care plans and personal budgets, and ensuring a range of high quality services are available locally

•Introduces a cap on care costs and provides for a new universal deferred payments scheme;

•provides for a single national threshold for eligibility;

•supports people with information, advice and advocacy;

•ensures continuity of care when people move between areas;

•ensures that no one goes without care if their provider fails;

•Sets out duties on local authorities to facilitate a diverse, sustainable high quality market for their area.

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ALL LOCAL PEOPLE

Market shaping and commissioning

Duty on local authorities to promote a sustainable, diverse and vibrant market for care and support that delivers high quality services for all local people.

Wellbeing

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Commissioning for Better Outcomes

•A framework of standards•Designed for self-assessment& peer challenge•Prototype available now: http://www.adass.org.uk/policy-documents-commissioning-for-better-outcomes/ •Designed for self-assessment& peer challenge

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Commissioning for Better Outcomes Good commissioning….

•Promotes health and wellbeing for all• “This covers… maximising people’s

capabilities and support within their communities, commissioning services to promote health, wellbeing, preventing, delaying or reducing the need for services…”

•Is coproduced with people, their carers and their communities.

•Demonstrates a whole system approach • “ensure[s] the best use of all resources

in a local area through joint approaches between the public, voluntary and private sectors”

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The Standards

1. Person-centred and focuses on outcomes

2. Promotes health and wellbeing

3. Delivers social value

4. Coproduced with local people, their carers and communities

5. Positive engagement with providers

6. Promotes equality

7. Well led

8. A whole system approach

9. Uses evidence about what works

10. A diverse and sustainable market

11. Provides value for money

12. Develops the workforce

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Outcomes-based commissioning

• Fifteen-minutes visits vs “time & task”• Reablement• Prevention • Personalisation

• System transformation

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Market Shaping Toolkit (MaST)

• Supporting SME providers and LAs to work together

• Market Position Statements

• Micro-providers

• Promoting innovation

• Case studies, and practical tools

• Meeting local need, procurement, workforce, sustainability, technology…

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Think Local Act Personal

• Top tips for commissioning for diversity

Asset based approaches Unpicking ‘diversity’

• Co-production in commissioning Personal outcomes

Care Act implementation support – care markets and commissioningSlide 17

Thoughts and questions?