Agenda Item No. 10
THE VALE OF GLAMORGAN COUNCIL
HEALTHY LIVING AND SOCIAL CARE SCRUTINY COMMITTEE: 4 DECEMBER 2017
REFERENCE FROM CABINET: 20 NOVEMBER 2017
C148 NATIONAL COLLABORATIVE COMMISSIONING: INTEGRATED HEALTH AND SOCIAL CARE PROGRAMME - ANNUAL REPORT (SCHL) (SCRUTINY COMMITTEE – HEALTHY LIVING AND SOCIAL CARE) -
Cabinet was updated on the ongoing development of the National Collaborative Commissioning Integrated Health and Social Care Programme.
The report described the Integrated Health and Social Care Commissioning Programme, which had been awarded Welsh Government "Invest to Save" funding. This was intended to support improved efficiency in both cost and quality of residential placements for younger adults with either Learning Disabilities or Mental Health problems.
The Care Assurance and Performance System (CAPS) was developed by NHS Wales Commissioning Collaborative for Mental Health and Learning Disability Services to manage the external provision of secure hospital and rehabilitation services across Wales. The issues faced by the NHS in Wales that led to the development of CAPS had been mirrored within Social Care:
Insufficient quality and safety of placement choices;
Increasing demand and complexity of presenting individuals; and
Increasing costs within a largely independent sector market driven economy.
The South East Wales Adults Brokerage Service had also found:
Service users' needs were becoming much more complex;
Service providers were not adequately skilled or equipped to meet complex needs;
There was an over-provision of 'general' needs supported accommodation;
Specialist services were not local enough and this was a primary factor for individuals / family members when needing to access a placement;
Service providers' business models did not support recovery and progression;
New ways of commissioning social care services were required; and
Social care services needed to be procured based on supporting independence and moving on.
Working with NHS Wales Informatics Service (NWIS), NHS Wales and the South East Wales Improvement Collaborative (SEWIC) were awarded a grant from the Welsh Government Health Technology and Telehealth Fund (HTTF) in April 2014. This funding had facilitated the enhancement of the CAPS system from a 'database' of patient and provider information into CCAPS (Commissioning Care Assurance and Performance System); a tool to support the ongoing care, treatment and support of those within non NHS Wales or local authority care settings.
Cabinet was informed of the CCAPS programme in April 2016, with a view that once the Vale of Glamorgan Council could establish clear advantages to the use of the Framework, the Council would seek permission to commission all future placements using this mechanism.
All 22 Welsh local authorities confirmed approval to be named on the Official Journal of the European Union (OJEU) notice with all 7 health boards, early in 2016. Therefore, the Council could utilise the CCAPS Framework should it choose to do so, but as a local authority the Council was not mandated to do so. To date, the Vale of Glamorgan had not placed anyone via the Framework, and this was echoed across all Welsh Local Authorities with no placements being made via CCAPS by any Local authority.
The original plan was that once CCAPS was launched 1 October, 2016 all new placements would be made utilising the Framework and then on review, existing placements would be entered onto the Framework. The vision was to equalise the market and improve quality of placements.
The Council was advised that a number of providers in the Region did apply to enter onto the National Framework, but latest information had shown that there was no increase in the volume of placements through the Framework and providers noted that Local Authorities were not using the framework to commission. A desktop exercise completed over the Summer months of 2016 evidenced that utilising the Framework would not provide any savings on our costs of placement. The national team had repeatedly advised that through their robust audit and monitoring the Council would see an improvement in quality and that should not focus solely on cost.
When an individual's assessed needs indicated that a placement was required, the Vale of Glamorgan Council was able to access the CCAPS database to check availability and to establish costs if the Council utilised the Framework versus the fee rate the Council would have been able to negotiate. To date, the Council had not found a placement to be less costly through the Framework. In one case the cost was similar however in all of the others it would have been more expensive to place through the Framework.
Without clear evidence that there were efficiencies in terms of cost of placement, officers would not be seeking Cabinet approval to solely commission this type of placement via this Framework. The team supporting the CCAPS programme in relation to quality monitoring was well resourced in comparison with the Council’s own contract monitoring teams. Therefore, the improved capacity to monitor providers would be a welcome addition. However, there were concerns that with this robust auditing of providers in this specialist area there were inequities introduced when the same level of quality monitoring was not available to other high volume, lower cost placements for other client groups.
This was a matter for Executive decision
Cabinet, having considered the report and all the issues and implications contained therein
(1) T H A T the work that had been completed to date be noted.
(2) T H A T the ongoing concerns regarding the overall value (cost and quality) of the Vale of Glamorgan Council utilising the Framework outlined in the Programme be noted.
(3) T H A T the ongoing involvement of the Vale of Glamorgan Council to contribute to the regional response regarding any potential future use of this Framework be supported.
(4) T H A T the report be referred to the Healthy Living and Social Care Scrutiny Committee for its consideration.
Reasons for decisions
(1) To exercise effective oversight of important programmes that the Social Services Directorate were involved with.
(2) To ensure knowledge around the planned programme of work within the National Collaborative Commissioning Integrated Health and Social Care Programme and associated concerns when considering best value in relation to both cost and quality for the residents of the Vale of Glamorgan.
(3) To enable the Council to continue to explore options for cost effective, high quality placements for vulnerable adults with mental health issues or learning disabilities.
(4) To ensure Healthy Living and Social Care Scrutiny Committee scrutiny members were aware of and could consider the developments in this key area.
Attached as Appendix – Report to Cabinet – 20 NOVEMBER 2017