Main Areas of Commissioning Activity
Care Home Placements
Wakefield Council’s strategic intent is to target resources to enable people to live independently at home for as long as possible, including investment in Extra Care Housing.
However it is recognised that there is still a need to provide reasonable levels of stability and sustainability within the local care home market given the local demographics indicating that the number of older people (in particular) in Wakefield will continue to grow. Despite a strategic intent to support and enable people to live at home for longer there will still come a time when people may require residential or nursing care; however the anticipation is that people will enter residential or nursing care with higher care needs and remain in residential or nursing care for less time. This can be seen to be happening already in the data set out below concerning the number of residents supported in permanent residential and nursing placements together with the number of supported permanent admissions to residential and nursing care during the year.
Between 2008/09 and 2013/14 the number of permanent residents aged over 65, financially supported by the council in care homes has reduced by approximately 14.5% in line with the council’s strategic objective to support individuals in their own homes as far as practicable. This, together with a 14% increase in bed provision locally over the past 4 years through a combination of new care homes and significant expansion of existing stock, has contributed to an increase in vacancies across the sector within the Council district which is currently in the order of 17% compared to the current national average of 10%. The continued vacancy level within the district illustrates over provision.
Whilst the table below illustrates a continuing decline in the number of individuals aged 65+ supported in care homes, the admissions to care homes for that cohort as evidenced over the page is marginally increasing and mirrors the national average evidencing that people are entering care homes at a later stage of their care journey than in the past and consequently residing for shorter periods with a subsequent effect of increasing turnover in care homes.
Learning disability care home provision for individuals with challenging behaviour and complex health needs represent a significant cost pressure within the overall care home provision expenditure. In line with the House of Commons Communities and Local Government Committee report on local government procurement published in March 2014 Wakefield council has developed approaches to implement an open book accounting approach to improve procurement transparency.
The position regarding over 65s residential care home placements contrasts with that of 18- 64 provision as illustrated below.
Whilst the number of residents supported in permanent residential and nursing placements aged 18-64 has effectively plateaued in the last 3 years, the admissions to care homes for those aged 18-64 is significantly lower in the Wakefield District than the national average. (During 2013- 14 the number of adults aged 18-64 admitted permanently to care homes equated to 10.9 per 100,000 population compared to an England average of 14.4 and Yorkshire and Humber average of 11.0)
This has been achieved through more community based provision including the development of a range of tenancy based supported living options, extra care for those of working age and framework agreements for providers of community based services.
Analysis of Care Homes Surveys undertaken in 2013 – 15
(All Care Homes catering for Older People over 65 in the Wakefield district)
Including both long term placements, CCG part funded placements and respite placements, as at January 2015 the local authority purchased 42.9% of the care home beds within the district for older people (a 6.1% drop from 2013).
Care homes within the district currently report that 19.8% of their placements are self-funders (a 1.3% drop from 2013), which is substantially less than the national average of 43% (Laing & Buisson “Care of Elderly People” – Market survey 2013/14)
Analysis of Care Homes Surveys: Breakdown by Bed Purchaser
Apr-‐13 Apr-‐14 Apr-‐15
WMDC Funded (including CCG part funding & respite)
Self Funded CCG Fully
Other LA Funded
Funded (including CCG part funding & respite)
Wakefield Council commissions care home provision via spot purchasing arrangements to promote user choice. Wakefield Council works in partnership with its independent sector market and has developed ‘fair rates for care’ where the Council is statutorily required to implement “usual rates” in an attempt to balance local market conditions, the strategic aim to promote and support independence, organisational pressures and to provide reasonable levels of stability and sustainability within the local care home market.
The Council has an approach of working with providers to raise standards of care through its contract monitoring and annual review processes.
Residents of care homes for the elderly, funded by the council within district have their care and support packages reviewed on an annual basis via an on-site visit to discuss their satisfaction and experience of services. All issues
and actions are taken up with the care home or referred to the community team as appropriate and plans and actions monitored. In addition, care homes are asked to provide self-funded residents with an opportunity for the council to conduct a review of their placement.
Where individuals choose a care home placement, they will continue to be commissioned on an individual and spot basis, however the continuing roll out and take up of personalisation will see even more people seeking alternative services for example, extra care housing, supported living, assistive technology, and intensive domiciliary care, supported through an increase in self-directed care including direct payments.
Over the past few years three Extra Care Housing schemes have been commissioned for older people across the district together with an Extra Care Housing scheme for people with learning disabilities. These schemes provide housing options that promote independence through the provision of on-site care and support and as such are a valuable option within the overall Social Care offer.
A fourth Extra Care Housing scheme for older people has been commissioned in the South East of the district due for completion in winter of 2015.
The Council will continue to explore opportunities for the development of additional Extra Care provisions as such opportunities arise.
Wakefield Council commission approximately 12,000 hours of domiciliary care from independent sector providers per week and support 1,200 people at any one time involving 1.3 million visits per annum.
Wakefield Council commissions domiciliary care through spot purchasing arrangements via a framework agreement to promote user choice. The current framework agreement was procured in 2013 and is in place until 2017.
Wakefield Council’s ‘whole systems’ approach to the commissioning of Domiciliary Care includes:
- An outcomes focussed specification reflecting the Adult Social Care Outcome Framework (ASCOF)
- A ‘fair hourly rate’ that seeks to balance local market conditions and organisational pressures.
- Recognises travel time and expenses and includes provision within its rates
- Contract management activities to promote high-quality and safe services including electronic call monitoring performance metrics to aid continuous improvement and develop service quality.
The council will continue to spot purchase domiciliary care in response to the increasing number of individuals undertaking self-directed support. For those who do not choose to receive a personal budget via a cash payment, the introduction of call monitoring technology with our contracted providers
is enabling us to introduce managed accounts for those individuals. Other related developments include a bilateral agreement between commissioners and contracted providers to amend packages and activities in response to individual service user’s needs, together with reviews to monitor quality. This whole systems approach is ensuring a personalised experience for all domiciliary care recipients.
The re-design of the in-house service will support the integrated “connecting care” programme by preventing unnecessary admissions to hospital and reducing delays in hospital discharges. This re-designed service will focus on reablement and early intervention in addition to supporting hospital discharges. The service will increasingly rely on
a responsive independent sector service able to pick up
the maintenance of longer term packages of care to aid throughput.
In recognition that the HMRC have been selecting domiciliary care providers for investigation into minimum wage compliance, Council commissioners have engaged with
local contracted providers to ensure that they are aware of emerging requirements. Wakefield Council specifically contributes towards travel time which enables providers to
roster and pay staff for travel. This position significantly aids providers to be National Minimum Wage compliant.
The Council commissions a range of services to support individual’s with a learning disability in their own home to maximise independence addressing their daily living skills (including personal care), housing related needs, health and well-being and assisting access to their local community.
There are two strands to our supported living commissioning activity:
- Intensive care and support provided on a 24 hour
– 7 days a week basis (where the Council typically commissions both the care and support service plus the accommodation)
- Support and enablement services for people with lower levels of need who have their own living arrangements in place (e.g. living with parents etc.).
Approximately £13 million per annum is spent on supported living and support and enablement services within the independent sector with a further £4 million on in-
house service provision. Services are commissioned via a combination of spot purchase framework agreements together with a large contract derived from a previous hospital re-provision exercise.
In keeping with the national agenda to develop alternatives to care home provision we intend to continue to commission supported living and support and enablement services. As with all commissioning activity undertaken in the financial environment that public bodies now operate in, the objective will be to secure value for money services that achieve positive outcomes for individuals. The Council will actively seek from providers the increased use of telecare technology to reduce the level of direct care input (e.g. waking night provision) to maximise use of the Council’s limited resources
both within existing and future packages of care and support.
Wakefield Council is committed to supporting all people to self-direct their care and maximise choice, independence and control.
In support of the roll out of personalisation, commissioning and contracting arrangements have been evaluated and amended with the specific purpose of encouraging and enabling providers to offer choice and flexibility not only to those individuals seeking absolute control over the support provided but to all individuals in receipt of services, including self-funders. This has been supported by a dramatic reduction in block or cost and volume contracts with a continued migration to framework and spot contracting arrangements.
The number of clients receiving self-directed support continues to increase in line with the government’s policy.
The continued drive in terms of personalisation will inevitably lead to individuals increasingly seeking a wider range of support mechanisms in preference to existing models of support. To support this approach the council has implemented an e-market place via a web-based portal “Connect to Support Wakefield” which allows individuals to identify potential services and service providers.