This is the second in our series about the Care Act and in this case is based on Chapter 5, which places substantial responsibility on Local Authorities (LA) to ensure a vibrant and responsive care provider market for the direct benefit of local people and communities. The principles which are expected to underpin this are based around focusing on outcomes and wellbeing, promoting quality services (including remuneration for the workforce), supporting sustainability and what is described as co-production with partners. So let’s take a closer look at what this means in practice.
Firstly, it is vital to get this right if LAs are to meet their responsibilities in meeting the needs of their residents. And to get it right they will need to design strategies that meet peoples’ needs based on a thorough understanding of what they are. This will necessitate engaging with communities and providers – easier said than done if an LA does not have strong links with providers and service users. Needs must be translated into definable demand and from that, an understanding of the current supply network and then shaping that towards a careful balance between the two that is both secured and sustainable.
Sustainability will mean different things to each side of the equation – to the provider, this will mean the ability to sustain their businesses and this will rely in varying degrees on state funded care which should recognise the actual cost of care, including adequate remuneration for staff, occupancy levels and finding ways to attract personal budget holders in an open market, possibly based more on a predominance of spot placements rather than block contracts than has been experienced in the past. For the LA, sustainability will mean maintaining and improving quality whilst providing value for money to the tax payer. This is a difficult equation for LAs to deliver on considering their dwindling purse in a period of increasing demand.
If we take a look at these principles more closely we see that as far as outcomes are considered, LAs must ensure that promotion of the wellbeing of those needing care and their carers is central to their considerations and this should include keeping people at home for longer. Not necessarily good for the residential care market, which will need to adapt and diversify its provision to be sustainable, but good for the domiciliary care market which will need to upskill its workforce to deal with increasingly frail people. Again, LAs must ensure that appropriate training is facilitated and that there is appropriate recognition of cost in establishing sustainable fee rates. An emphasis on outcome based commissioning also features in this mix and will entail a very carefully structured move away from process driven care towards payment for outcome systems – both commissioners and providers will need to tread very carefully but concentrate in bite sized chunks on such activities as prevention, enablement, independence, avoiding social isolation and maintaining choice.
Success in promoting quality underpins the development of the wellbeing of individuals and the communities in which they live. The Act requires LAs to develop markets that offer continuously improving high quality, appropriate and innovative services that are cost effective and offer value for money. The care workforce is central to this and their skills, capability and willingness to respond will be heavily influenced by their remuneration, self-confidence and recognition. Commissioners will need to evidence that contract terms, conditions and fee levels are appropriate to the quality outcome that is expected.
LAs must support sustainability in the breadth and depth of the market if they are to meet the requirements placed upon them in the Care Act. They will need to demonstrate an understanding of the market and the business environment in which it sits and seek to help and support providers who are facing challenges through their Quality Policy processes and Market Position Statements, the latter of which will need to signal potential changes to the distribution of providers across their areas of interest, reduction or increases in need, shortages of specialist provision and the uptake of direct payments over time. Of course, the key factor in sustainability is to avoid setting fees that would undermine it!
LAs should also pursue the principle that market shaping and commissioning should be in full and open partnership with providers and service users and other stakeholders including the public to find shared and agreed solutions. This effort should be in line with the agreement set out by the Department of Health as long ago as 2001 entitled Building Capacity and Partnership in Care Agreement. This is a sensible and practical document that has been rejuvenated by the Care Act and certainly worthy of re-reading.