John Bolton

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Transforming Social Carethe implications for
Commissioning

• John Bolton
• Director of Strategic Finance

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Putting People First
UNIVERSAL SERVICES
PREVENTION
CHOICE CONTROL
SOCIAL CAPITAL
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Putting People First

• Universal Services
• Housing, Adult Education, Employment
• Strategic Needs Assessment
• Leading to Strategic Vision and Commissioning
  Strategies
• Information and Support
• Signposting (Library Services) and non care
• Prevention / Early Intervention
• Enablement and limiting need for long-term care
  to support efficiency agenda
• Personalisation Choice and Control
• Using money better for outcomes commissioning
  key
• User/ Carer Empowerment
• User Led organisations and engagement with
  users/carers
• Empowering citizens to be part of communities

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Commissioning activities

• Having a clear vision
• Assessing Needs
• Engaging with services users macro and micro
• Working with PCTs
• Evolving with local markets
• Working with Providers
• Specifying services
• Procuring services
• Contract monitoring

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Strategic vision and needs assessment

• Vision Vision.. Vision
• Requirement of Strategic Needs Assessment
• Evaluate current demands and identify gaps in
  provision
• Debate issues with service users/ carers etc
• Leads to a Commissioning Plan
• Role of Scrutiny
• Role of Links
• Role of Partnership Boards Joint with PCT

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Commissioning for Universal Services

• Role of DASS to champion issues for Older People,
  People with Disabilities or Mental Ill Health
• Commissioning Housing services that
• will meet needs of people with disabilities
• Will meet the needs of older people
• Will ensure that people with mental ill health
  have the necessary housing related support
• Employment opportunities
• Social and Leisure Opportunities
• Shopping
• Transport
• Health Care

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Commissioning Information Services

• All Citizens have rights to information and
  advocacy
• Role of third sector
• User-Led Organisations
• Brokerage
• Advocacy
• Making choices
• Self-funders and Direct Payments
• Flexibility and creativity in solutions

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Rethinking the Approach Managing for
Independence a New Framework for Models of
Support Prevention and Upstreaming
(Low Level) Preventative Services Services that
reduce the probability of a trigger event
Trigger Event Occurrence that changes an
individuals circumstances and prompts an
intervention
Response to Trigger Event Actions to improve
support pathway and avoid unnecessary actions and
cost escalation

• At Home
• Day Services
• Institutional

Time-limited Intervention (Short term)
Reablement Focus
Presumption of Cessation and Prevention

• At Home
• Day Services
• Institutional

Extended Intervention (medium / longterm)
Reablement Focus
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People choose less dependent optionsThis is
typically more cost effective
TRANSFORMING SOCIAL CARE
Transformation through Information
(ACM) Internal Processes
Crisis Response
Re-ablement
TCEWS
Support Related Housing AT
SYSTEM OPTIMISATION PROGRAMMES
Commissioning and Brokerage
Transforming Social Care
Models of Support Planning
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Prevention planned interventions

• Who might have an acute admission to hospital?
• Who is at risk of admission to residential/nursing
  care?
• Who is at risk of having critical social care
  needs?
• Whose costs of social care are likely to
  increase?
• Whose combined health and social care costs are
  likely to increase?
• Oxford Brookes Study
• Stroke/ Podiatry/ Dehydration/ Teeth/ Continence

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Commissioning for Personalisation

• Local Authorities have role in
• Understanding Local Needs
• Place shaping
• Contracting for outcomes with rewards
• Ensuring supply
• Ensuring quality
• Clarity on what services money can buy
• Consulting with service users and carers at every
  stage
• Support capacity in User-Led Organisations and
  Social Enterprises

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Commissioning for Personalisation

• Service Users have role in
• Agree outcomes that are to be achieved from their
  budget
• Choosing who might provide their service and how
  they might provide it?
• Constructing the care package (from within the
  resources available) which might include wider
  options
• Working alongside commissioners on place shaping/
  contracting/ specifying services
• Develop user-led organisations and social
  enterprises to develop service models

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3 Key Messages

• Personalisation has 4 dimensions commissioning
  needs to face all 4
• Commissioning must focus on outcomes
• Service users are as much part of commissioning
  as any other key stakeholders and at every stage
  macro and micro