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Changing our commissioning approach

Michelle Atkinson, commissioning manager at Leeds City Council, explains how the local authority has changed its approach to commissioning homecare services in the city.

In Leeds, a framework arrangement was in place with 32 providers registered on the Home Care framework. The contract was due to expire in October 2015. Given the complex nature of the issues to be addressed through the re-commissioning process, a further extension was sought to extend the current framework arrangement for a period of up to 12 months, thus allowing sufficient time to redesign and cost the new model of service, secure the necessary agreements and complete the procurement process. 

Whilst the framework contract and services were generally working well, the re-commissioning of these services presented a unique opportunity to radically redesign homecare services in the city to address a range of issues which included personalised ‘outcomes-based’ commissioning; consistency of staff providing services; flexibility of service providers to meet the needs of service users; the use of 15-minute visits; and the recruitment and retention of staff, including the use of zero-hour contracts.   

In addition, the new pricing model allows for progress on a range of staffing issues, including staff travelling expenses and travelling time payments, and aspirations in relation to the introduction of the living wage.   

The ethical care charter standards 

The new commissioning and contracting model has been developed and designed to lay the foundations for meeting the requirements of the ethical care charter standards, including improved terms and conditions for homecare staff. Together these will help provide a care workforce sufficient for the future needs of the city. 

Following extensive consultation and analysis of information, options were created and appraised by a broad cross-section of stakeholders, including service users, councillors, NHS partners, trade unions and providers (contracted and non-contracted). 

The initial outline proposal saw the existing framework agreement ceasing when the additional contract extension expired, and was replaced with a new contract arrangement with a small number of ‘primary providers’ who are responsible for delivering all care packages within a particular geographical zone, with a number of other ‘secondary’ providers having the ability to undertake work where the primary provider is unable to do so.  

During the consultation, there was widespread support for a model which would include an inner and outer area based price. This reflects the geography of the city, which has differing travel requirements, and contains some areas where it has been traditionally difficult to recruit and deploy care workers; consequently, individual providers could potentially submit one price for inner Leeds and one price for outer Leeds.  

Further consultation work with providers agreed that there would be six zones: three urban, two rural and one super rural, with a fixed price for each. The fixed price would differentiate between an urban zone and a rural zone. Throughout the consultation there was support from all stakeholder groups to try and move to implementation of Unison’s ethical care charter – it is worth noting that much of the charter relates to the quality of the service delivery. However, elements of the ethical care charter relate to staff terms and conditions of provider organisations. The known financial impact for the council of implementing all of the ethical care charter standard requirements is complex and the implications of this significant. Naturally, to incentivise organisations to comply with all the expectations of the charter due regard was given to our assessment of the costs in the establishment of the pricing model described previously. 

We believe the proposed fee structure and service delivery model can only be delivered if staff have appropriate terms and conditions of employment in relation to the fundamentally important work that they do. 

Locality-based services 

There was also strong support for more locality-based services, ensuring staff could assist service users to engage more in local communities and for homecare staff to have much closer links particularly to local statutory sector teams, especially the integrated NHS and social care teams and with other local third sector services.  

We divided Leeds into three areas with six ‘lots’ broadly coterminous with the zones covered by the clinical commissioning groups. Within these three larger areas, the arrangements required providers to have a locality-focus to their service delivery teams broadly associated with the 13 integrated health and social care neighbourhood teams. The model has one primary provider per lot who is responsible for delivering all services within the area it successfully tendered for. However, a framework arrangement was also put into operation in case the primary provider was unable to deliver the required service.  

An outcomes-based approach has been adopted within the adult social care (ASC) assessment and care planning methodology to ensure personalised care is offered to eligible service users. This approach also ensures compliance with the requirements of the Care Act. ASC client record systems, assessment and review processes are being amended to reflect the outcomes-based personalised approach. This approach will be extended to encompass personalised care delivery by commissioned homecare providers under the new contract. 

New processes are being developed to ensure outcomes-based commissioning and delivery can be achieved by the contract start date. This will ensure that services are commissioned on an outcomes and hours basis, and will place the onus on the service provider to identify, with the service user, how best those outcomes can be achieved.

A set of robust quality standards, focused on service user dignity, have also been co-produced with service users and service providers to which providers will be held accountable in the newly commissioned homecare services during the lifetime of the contract.

FOR MORE INFORMATION

W: www.leeds.gov.uk

Image: © CQC Press Office