Transforming Community Services_

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Transforming Community Services_ Powered By Docstoc
					PCT Grant Making Powers to Commission Long Term
Conditions Self Care Support from Third Sector
Gateway Ref: 12947
Introduction                                    Working with the NAO to develop the
                                                 Decision Support Tool so it‟s aimed
The purpose of this paper is to highlight        more directly at PCT/LA
the role that grants can play in                 commissioners rather than
developing and supporting low level              Government Departments;
community activity. The use of grants is
particularly pertinent to commissioning         A procurement 'roadmap' is in
self care support for people with long           production that will highlight the grant
term conditions.                                 route;

There is a common misunderstanding              Developing a 'model' grant
that in the move towards ensuring                agreement for PCTs to use alongside
service provision is properly purchased          the standard contract.
through procurement processes and
contracting, there is no longer a role for   Commissioning Self Care
grant funding. This is not the case. The     Support
guidance for the standard community
contract around the use of grants (pg 6)     Following the publication of „Your health,
states that:                                 your way – a guide to long term
                                             conditions and self care‟ it is anticipated
Commissioners should consider the use        that there is likely to be an increase in
of grants as an alternative funding          demand for self care support for people
arrangement where appropriate for third      with long term conditions. This expected
sector organisations. Contracts should       increase in demand means that
not inappropriately replace grant funding.   commissioners will need to work in
The National Audit Office decision           partnership with other local organisations
support tool ( guidance       to make sure that self care support for
/better_funding/index.htm) should be         people with long term conditions is
used to determine the basis of funding. It   commissioned to meet access and
should be noted that grant funded            responsiveness requirements.
arrangements may well incorporate
monitoring requirements.                     Procuring and contracting self care
                                             support services can be challenging
The Department of Health is carrying out     because of the depth of involvement
a number of actions to provide               needed by the individual. It is difficult to
clarification to PCTs around the use of      commission self care support from a
grants:                                      provider in the way that we would for
„conventional‟ types of care. New modes      involved in discussing the differences
of delivery, contracting routes, new types   between grants & contracts and deciding
of provider – means that the challenge is    which would be offered in the
even greater.                                commissioning process. The benefits
                                             from opting for grant-funding are:
Information for Third Sector
Organisations                                   Voluntary and community groups
                                                 have the flexibility to design activities
Third Sector organisations will have an          to achieve outcomes; they are not
increasingly important role to play in           tied to a service specification. It is a
meeting some of the expected increase            very good fit with commissioning for
in demand for self care support. Although        outcomes.
the funding route a PCT chooses to use,
either a procurement or grant process,          The concept of a „conditional grant‟
will be based on the objectives they are         links the funding to the specific
seeking to achieve, grant funding fits the       activity, but without small,
purpose of working in partnership to             unincorporated, local groups taking
achieve shared objectives and has a              on the risks associated with delivering
good fit with commissioning for                  services under contract.
                                                Capacity building: During the
It is an ongoing reality that public             process, we helped more than 40
services have to adapt to meet a variety         small groups to meet the Council‟s
of difficult changes, such as meeting the        criteria for funding (eg. around
increasing complex needs of service              governance, administration) and adult
users and communities, and balancing             safeguarding (eg. CRB checks,
competing priorities with limited                signing up to local procedures); a
resources. Given these difficulties,             contracting process would have had
commissioners need to demonstrate a              far less flexibility to work on capacity
more flexible approach to the way they           building during the process itself.
commission services.
                                             Grant funding is an ideal framework for
The following case study highlights the      putting council funding alongside other
approach Bradford Adult Social Services      resources (eg. use of buildings, other
and PCT adopted around the use of            income, and goodwill of volunteers); i.e.
grants.                                      it releases „social capital‟ and achieves
                                             good value for money.
Case study – a grant-funded
programme for older people’s                 Background
well-being                                   Bradford Metropolitan District Council
                                             invests c. £2m annually in
Reasons for selecting grant-                 commissioning voluntary and community
funding                                      sector (VCS) groups to run services and
                                             activities for older people. The people
Prior to a major commissioning process       benefitting from the activities are
for the 3-year grant funding in 2007-8,      independent with self care, but have
procurement and legal colleagues were
difficulties getting out and about and are    voluntary and community groups having
at risk of social isolation. They may be      the freedom to design and innovate, and
known to GPs and have long-term               respond to the wishes of local people.
conditions, and / or be isolated through
bereavement, and / or lacking in              For the 3-year grant funding, the
confidence, e.g. feel unsafe going out        outcomes are very broad, aligned to
independently. They may well not be           strategic health & social care priorities:
eligible for formal provision such as
home care; indeed such services might            Improved „well-being‟ and quality of
not be what they want.                            life for older people;

What is being grant-funded?                      Promoting independence and
                                                  involvement in local communities for
The £2m is invested via three funding
                                                  older people;
strands as follows:
                                                 Promoting positive attitudes and
   £1.7m committed 3 years at a time,
                                                  challenging negative attitudes to older
    currently funding 62 older people‟s
                                                  age, and to the diversity of the local
    groups to run 73 activities – eg. day
    centres, befriending, transport,
    exercise, crafts.
                                                 Reduction of health inequalities and
                                                  the promotion of informed choices for
   £100K for a network of “well-being
                                                  improving health;
    cafés”, which meet monthly and offer
    social activity, information and
                                                 The relevant Strategic Health
    support for people with dementia and
                                                  Improvement Partnership priorities for
    carers; both when people are newly-
                                                  promoting healthier communities:
    diagnosed and longer-term.
                                                  Obesity & malnutrition; Smoking &
                                                  substance abuse (including alcohol);
   £200K “well-being activity fund” –
                                                  Mental health & well-being; Sexual
    short-term grants to encourage new
    activities and innovation, with a focus
    on promoting good mental health.          For the well-being activity fund, there is a
                                              little more detail but still considerable
The approximate costs are £7 per
                                              flexibility as to what the activity could be:
attendance at an activity for the 3-year
funding programme, and £4 for the well-       The well-being cafés are a more specific
being activities and cafés. Therefore, the    service model, but providers still have
programme represents very good value          flexibility around how it is set up and
for money. This is because all the            operated.
groups make good use of volunteers,
other income, and their own resources         Evidence for outcomes:
(eg. church buildings).
                                              Providing support for older people with
Outcomes                                      mild/moderate mental health needs:
All the three strands above are
commissioned against outcomes, with
    Providing opportunities for older
     people with mental health needs to        Mrs A is an 87 year old widow. She
     stay physically active;                   has severe osteoporosis and had
                                               experienced six falls in a 12 month
    Providing opportunities for older         period resulting in hospital admission.
     people with mental health needs to        The Community Matron referred her
     make new/retrain friendship and           to her local social day centre. After
     social contacts;                          attending for 18 months, she has
                                               benefited from the mental and social
    Supporting older people with mental       stimulation but most of all from the
     health to maintain hobbies, interest or   exercise sessions during her
     occupational pursuits, including          attendance. This has increased her
     volunteering;                             confidence and general well being.
                                               She has had one fall since attending
    Supporting carers of older people         but this did not entail admission to
     with health needs, or older carers        hospital.
     who‟s own wellbeing is affected by
     their caring role.

This area is still in development with the
funded groups, but we already have both
qualitative and quantitative evidence.
The well-being cafes and well-being            People living with a health condition,
activities were part of the University of      or who just want to learn how to look
Bradford‟s evaluation of Bradford‟s            after their self better, can ask their
“Health in Mind” programme (funded by          healthcare professional for
the Dept of Health‟s Partnerships for          information on the advice and
Older People‟s Projects initiative). The       support available or visit
evaluation found that participants   
reported increased social contacts and
questionnaire responses showed
reduced depression scores at follow-up.

Examples of individual ‘stories’
from the 3-year grant funding

    A concerned neighbour referred Mrs
    B after she was widowed. Very
    happily married for 50 years but no
    other family members. Her well-being
    declined drastically, she lost 2 stone
    in weight. She was persuaded to
    attend her local social day centre by
    the co-ordinator. After attending for 9
    months she has regained her weight,
    her low mood has lifted, she has
    made new friends and actively
    participates in all activities.