Provider Engagement Forum – Sout

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Provider Engagement Forum – Sout Powered By Docstoc
      Engagement                              MINUTES

Date:         Thursday 14 May 2009
Location:     Bickleigh Castle, Nr Tiverton
Co-chairs:    Jan Ingram and Geoffrey Cox

Open Meeting – Welcome/Apologies, Introductions and Minutes of Last Meeting
(Geoffrey Cox)

Welcome & Apologies

Review of Forums and Aspirations.
Currently at a time of change nationally in health and social care and local elections on 4th June.
The purpose of the forum is to have a working relationship between the local authority and the
provider market to allow true engagement. Recognition of the importance of social care and that
there are financial challenges and if these are to be meet a dialogue with commissioners is
required. The forum has a range of providers present but all facing common issues. The forum
will enable presentations to cover important topics and allow discussion and debate to ensure
quality social care for the people of Devon.

Mental Capacity Act Update
(Presentation on Deprivation of Liberty Safeguards, arrangements in Devon - Sharon
O’Reilly and Charlie Smith)

Presentation covered who is in the team; what is their role and how to contact them:
Tel: 01392 381676
Fax: 01392 383327

Q:     What has been happening in practice and how complex have the queries been to date?
A:     Initially have received calls come from home managers to ask about things such as use of
       cot sides / lap belts etc and how to employ the Mental Capacity Act. Also queries on
       Safeguarding Adults issues, the law of how DOLS established and enquires about locked
       doors / key pads etc. Commonly explaining and discussing the difference between
       restricting vs. deprivation of liberties.

Q:     If been assessed as not depriving of liberties then is there a need to notify?
A:     No, but please contact for advice if required. There are difference levels of assessments,
       standard vs. urgent.

Q:     How long are the forms that need to be completed?
A:     There are lots of different forms, the standard assessment form is approximately 14 pages
       but some of these are information pages and only roughly 4/5 pages which the provider
       needs to complete.

Q:     Is an assessment required for each resident?
A:     Assessment is only required if you think that the person is being deprived of their liberty. It
       is the responsibility of the provider to do the assessments, not the team.

Q:      What happens if a service user who is confused, wants to go out and wants the doors
A:      This is a difficult area, it is important that the provider has assured themselves of any
        actions. It is about proportionate restriction / restraint to prevent harm. It will be about
        questioning, for example, the original intention to live in the home; about how many times
        they want to go out and how happy they are to stay etc. It is important to consider
        proportionality, persuadable, historical choices and apply this to each individual do what is
        best for them.

Q:      What if a social worker thinks someone is deprived but the home staff disagree?
A:      The social worker, or any 3rd party, can make an application to DoLs but the home
        manager has the authority and has responsibility to deal with the matter.

Q:      Where does assessment of Mental Capacity fit?
A:      Would want to know if this has been assessed. Anyone can make a assessment of mental
        capacity. If this happened within 12 months it would still be valid but would look to re-

Q:      Where a situation is in flux i.e. a minor crisis, does the system cope / work?
A:      Team is in early stages and approximately 10 full assessments have been undertaken to
        date. As awareness increases so should the number of referrals. Government
        expectation is that 400 DoLs authorisations will be required per year in the UK.

(Geoffrey Cox & Jan Ingram)

    David Johnstone is leaving ACS to become Director at Care Quality Commission in June.
     Unsure of the interim arrangements at this stage.
    Budget position in PCT. PCT broke even at the end of the financial year but there is an
     underlying deficit. It is the Chief Executive, Kevin Snee, priority to break even and therefore
     will be looking at how much needed to make efficiencies.
    2 key areas of challenge 1) planned admission to acute hospital is bigger than expected. PCT
     set-up referral centres to look at process / assessment. 2) Unpredictable level of Continuing
     Health Care (CHC) referrals.
    Unplanned admissions – are currently looking at falls prevention. Rapid Response is being
     piloted in Eastern Devon.
    ACS also faces financial challenge. 2009/10 likely to be difficult as no growth budget requires
     effective joint working across the health and social care community

Local Update - Eastern

    Piloting Rapid Response with the business case being written for roll out across the County.
    Working with Community Hospitals (10 in Eastern Devon) to effectively transfer patients out of
     RD&E and enable GP’s to admit directly. Also looking at productivity and benchmarking with
     other areas to compare performance such as length of stays – through a nationally
     recognised ‘Productive Community Hospital’ process that frees up time for front line staff to
     spend more time on the ward with patients.
    Looking at the skills mix of the community nursing services.
    Complex Care Teams have been operational for 1 year. They have been very successful in
     supporting people to stay at home - but there remain challenges in terms of waiting times for
     assessments. Work is underway to address this across the county.

Q: Is there any flexibility in the budget?
A: There is a degree of flexibility which can be managed.

The domiciliary care group – DICPA – is already established outside this forum, however there
was no similar residential/nursing provider group and so this is being formed. It will be an
association including Plymouth & Torbay and will work in partnership with the other groups
already established, as well as similar groups in Somerset and Wales. An invitation was sent to
providers and currently this new group represent 50-55% of residential/nursing providers in
Devon. This new group will look at issues specifically effecting residential/nursing providers,
share practice and respond to issues. It will be a channel for a dialogue on fees and will have a
website with relevant links. Currently in it’s infancy with only the first meeting undertaken.

Future Commissioning of Services Including Update on Externalisation Process and
Feedback from Aging Well in Devon/Community Engagement Packs
(Paul Collinge, Joint Strategic Commissioner for Older People Services)

Need to be thinking about how services are developed in the future. Information packs have been
developed ( Presentation covered an update on the
decision regarding Shaw Healthcare and the planned next steps, background on pervious tender
process and that DCC will be a commissioner not a provider.

Engagement groups undertaken in 3 areas of Devon with mixed representation. Reference
groups have now formed and these will meet for the first time on 15th May. Feedback from focus
groups included demographic issues; need to re-profile services; cost difference between in-
house and external; some community based service decreasing need for institutional provision;
disinvest in some services; invest in community services to re-invest elsewhere.
Look at priorities / proportional areas for re-investment with an emphasis on extra care and range
of services around keeping people at home.

Tendering exercise will be undertaken and currently deciding how go to go to the market i.e.
number of lots to be offered. Provisional timetable is as follows:
June / July – OJEU advert
July / August – Expressions of Interest
Sept to Nov – prepare bids
Dec 09 – clarification and award

Key Questions posed by Paul Collinge to providers:
    What would put you off bidding for this work?
    What you look for from DCC in order to secure the development funding you might need?

Q:     What is a ‘lot’?
A:     This is a package, although still in discussion about how these are made up. In the tender
       it is expected providers can bid for one or more of these ‘lots’.

Q:     How will providers know about the tender?
A:     An OJEU notice is posted and expect that there will be adverts in journals/papers,
       however it will be run as an electronic tender through the Procurement Portal. Providers
       can register on this portal at anytime:

Q:     Which service users does this cover?
A:     Older people services, over 65. The tender will be for current services based on activity
       not units and will be outcome focused.

Q:     Why was the process not successful in the first instance?
A:     Adopted a pragmatic solution at the time but lessons learnt about how this should be re-

Q:     What is driving this, for example policy from central government, the cost between in-
       house and external provision and/or the needs of service users?
A:     All of these factors. There are significant challenges regarding demographics and we
       need different model. DCC can’t continue to directly deliver services at the current costs
       plus policy regarding imbalance between community and institutional provision.

Q:     Who makes decision on what required? How is this made?
A:     After the action plan / strategy is developed this will be authorised by DCC / PCT / DPT
       and politically by the County Council. The award of tender will be signed by Executive
       Committee, who are elected members, after having all the evidence presented.

Q:     Query whether this is a partnership with independent providers if Executive Committee
       make final decision?
A:     This has been a process of partnership from the start and engagement with providers
       about how to tender. There will be negotiations with any preferred providers about how
       the contracts can be delivered. ACS governed by scheme of delegation regarding
       approval levels following a tender.

Q:     Would a provider have to pay County Council rent for use of buildings?
A:     This one of questions that is open for debate. There are not fixed rules around this. It will
       be for the provider to consider what is needed. Tender is looking for innovation.

Group discussion on tables (see notes below)

Continuing Health Care (CHC)
(Yvonne LeBrun, Interim Assistant Director for CHC)

There has been media publicity around the review of healthcare needs following a time of change
within ACS and the PCT. The Strategic Health Authority wanted to find out what had happen so
began investigations on 6th March. This involved speaking to providers and families with an initial
report being made with suggestions for improvement about how reviews are undertaken.
Important points were about how families and providers are involved in the review process and
are communicated with about decisions that are ‘negative’. Report indicated that this
communication was not undertaken as thoughtfully as should have been and that there is the
need to improve information provided about CHC and FNC.

CHC very complex policy area – it is where free NHS services meets assessed social care
services. Strategic health authority (SHA) re-visited on 23rd April and request to look at point of
entry and whether this is robust enough. Presented 40 cases of new applications including
successful and unsuccessful applications and those which have also appealed. Not yet had
findings from this re-visit however initial feeling and verbal feedback is that the SHA would not
have changed any of the assessment decisions. The report is due next week and will be in the
public domain so providers can view SHA’s findings. Already have work-plan in place and
appeals process ready to be implemented once get the go ahead from the SHA. CHC apply to
Learning Disabilities, Physical Disabilities and Mental Health , it is not just for Older People.
Findings of report will also be discussed with the PCT provider arm to see what might need to be
put in place.

Q:     Query - 1) There are delays in assessments being done and 2) there have been a number
       of times people kept in hospital to save PCT money.
A:     1) Eastern Devon faced challenge of bringing together 3 PCT’s with huge staffing
       difference. There is not a large staff complement even though this is a big area. Aware of
       delays and have advertise for staff with a good response to date. Also offering
       opportunities for secondments. People can contact Yvonne directly if wish to discuss
       (mobile: 07796393769). FNC – also experiencing a delay in assessments. A letter last

       week was sent from Sally Slade regarding this and explaining re-introduce system that as
       soon notify someone in nursing bed this will automatically trigger FNC payment. Issue
       was around charging pay back if not nursing therefore need confidence as provider that
       person has nursing needs.
       2) Jan confirmed only 2 people were waiting in hospital until the funding could be realised.
       Now no one waiting. This was about managing resources to ensure maximum

Q:     How does the NHS adopt Social Services rates of funding and apply these to complex
A:     Commissioning decision between DCC and PCT. There is a mechanism between PCT /
       DCC that if demonstrated a higher than Nursing band level 2 and can be costed then
       follow process for additional funding. A county panel will look at this with the power to
       approve. On average 10-15 cases each week with county panel meeting every Thursday,
       every week including representatives from LD and MH and chaired by Director of PCT.

Q:     What is future for funding / availability for CHC? Is it true that there will be a funding crisis
       in the future?
A:     Devon, historically, used to be ‘tight’ regarding provision of CHC funds. New rules and re-
       organisation then had effect of Devon becoming ‘generous’. Therefore need to look back
       and question the decisions made. PCT have now moved into position of equilibrium.
       Yvonne negotiating with the PCT and identify risks about unexpected demand including
       retrospective reviews. Can ask at anytime for a retrospective review of a case – currently
       74 waiting to go through. There was a closing date for this but this was challenged.

Any Other Business and Future Agenda Items

Future agenda item – flu pandemic.

Next meeting will be on 29th September (PM). The venue is to be confirmed.

Table Discussion Groups

What would put you off from bidding?

Table 1:
    Lack of information / vagueness / detail
    Time spans
    Not having accommodation
    Difficulties in consortium bids
    Will small providers be seriously considered as tender will involve lots of work / paperwork

Table 2:
    Scale
    Depends on size of LOT
    Quality of joint partnerships
    Fixed cost? (Tender process should allow for provider to set cost, would this be this case
       as fixed cost for residential care?)
    Length of contract v amount of work to develop service

Table 3:
    Time / length of contract
    Would cheapest tender be preferred
    How would quality be assessed in more than Care Quality Commission?
    Criteria
    Where liability for staff lies if limited contract period in? TUPE
    Huge amount of extra paperwork / monitoring requirements
    Size of unit

Table 4:
    Risk of low fee with high staffing costs (TUPE) and pension commitments

What would you look form from DCC to secure funding?

Table 1:
    Meeting needed with detailed information about individual LOTS. Information may be
       need prior to meeting to consider questions.

Table 2:
    Provision of adequate information
    Appropriate timescales allowing for development of organisation to fulfil tender outcomes
       i.e. resources, fundraising, staff training etc.

Table 3:
    Understanding difference between tender contracting and block contracts?
    Whether places would be funded whether used or empty?
    Clarity about levels of dependency and attached funding availability for users

Table 4:
    Guarantees of occupation
    Fees
    Reasonable accommodation standards
    Very comprehensive description of facilities
    NB. Consider block contracts with existing providers at a proper fair fee