PCT Grant Making Powers to Commission Long Term Conditions Self Care Support from Third Sector Organisations 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 (www.nao.org.uk/ 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. outcomes. 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 community; 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 health. 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 www.nhs.uk/yourhealth. reported increased social contacts and questionnaire responses showed reduced depression scores at follow-up. Examples of individual ‘stories’ from the 3-year grant funding programme: 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.