Contract Monitoring Framework Updated 2011

Contract Monitoring Framework – Updated 2011

Contract Monitoring Framework

Contents Page

1. Introduction and background

1. Contract monitoring – definitions
2. Development of a contracts monitoring framework

1. Context

1. What is contracting?
2. Changing context and social care market
3. Who monitors contracts?
4. Contract monitoring responsibilities
5. Service user involvement

1. The framework

1. Foundations
2. Objectives
3. Stakeholders’ perspectives
4. Priorities – resources available to monitor & risks

1. Contract monitoring plan – key elements

1. Reactive monitoring
2. Proactive monitoring

i)monitoring methods

ii)monitoring methods linked to risk assessments

1. Collation of information
2. Categorising of risk and performance
3. Managing poor performance

i)seriousness of problem

ii)risk, particularly to service user

iii)breach of contract

1. Conclusion

1. Appendices

1.Introduction and Background

Stirling Council commission a wide range of care services both from internal and external providers

Current data (Jan 2009) indicates:

• 738 older people received Care at Home services from internal/external services providers
• 240 service users with learning disability living in supported accommodation or receive support in their homes.
• 210 service users receiving specialist mental health support services
• 239 living in residential or nursing care homes in local area
• approx. 8000 contacts through voluntary sector services

Currently Community Services have contracts locally with:

• 9 Care at Home/Support providers
• 20 Learning disability providers (5 local providers)
• 10 Mental health providers (4 local provides)
• 16 private Residential and Nursing Care Homes in local area
• 33 Voluntary sector organisations providing a wide range of services

In addition Stirling Council contracts with Providers outwith the area, predominantly for older people and learning disability service users.

Considering the wide range of service user needs’ and the volume of providers Stirling Council are involved with it is essential a Contract Management Framework is in place with contract monitoring being a vital component of the framework.

The following diagram illustrates an overview of Contract Management process. All of these contracting activities need to be undertaken within the overall commissioning framework if they are to contribute to the achievement of efficient and effective services.

Figure 1. Contract Management Process

1.1Contract Monitoring

Contract monitoring will ensure that services purchased from providers are effectively meeting the needs of service users, complying with contract requirements and providing value for money. Furthermore, the Contract Monitoring Framework has the potential to provide a critical contribution to the current Commissioning Strategy and influence and change future commissioning and procurement decisions.

It is important to provide a definition of contract monitoring1 as this will define the development of the Contract Monitoring framework:

• the collection of consistent and measurable information about the services’:
• quantity and efficiency (performance management information)
• quality
• effectiveness (achievement of outcomes)
• the collation of information from a variety of sources
• analysis, consideration and making judgements about such collated information
• the use of such information and judgements in order to:
• Identify and resolve any shortcomings in the service provided, at individual, provider and whole service levels.
• Review and raise contractual standards.
• Support service-purchasing decisions, including those involving suspension or termination of contracts because of continuing unsatisfactory performance.
• Achieve optimum efficiency of the operational arrangements that enable the service to be set up, delivered and reviewed.
• Support and stimulate wider market management and strategic commissioning.

The contract monitoring definition explains why it is done, what is done and how its products/outputs are used.

1.2Development of a Contract Monitoring Framework (CMF)

The framework has to provide a straightforward yet comprehensive description of the essential elements of effective contract monitoring of social care contracts.

The objectives of Contract Monitoring need to be clear. Underpinning these objectives are the aims of Care Management Services (CMS) “to provide high quality, responsive services” by:

• Working to assist and support older people and people with disabilities, along with their families and carers, to discover and move towards a desirable personal future as part of ordinary community life
• Provision of services, which aim to protect and support valued experiences for people
• Working in a way which promotes continuous improvement with a focus on outcomes for the individual.

In meeting these aims CMS have laid out ‘guiding principles’ that assessment and care management staff must follow in all activities related to services to all service users and informal carers. These principles focus and guide the Service in its day to day work.

These guiding principles will be used as the foundations in the development of a framework. The effectiveness of the framework can be assessed if it is able to evidence these principles are being achieved by service providers and benefits/outcomes are achieved by service users and informal carers.

2.Context

2.1What is contracting?

It is important to understand the meaning of contracting and the key role it has in the strategic commissioning process. Contracting can be defined as:

“The process of securing or buying services and contracting the means by which that process is made legally binding“ 2

Contracting covers a wide range of activities from agreeing a contract with a provider to deliver a certain service through to monitoring the success of that contract. All contracting activities need to be undertaken within the context of an overall commissioning strategy if they are to contribute to the achievement of efficient and effective services that meet the needs of service users.

A framework for commissioning and contracting is shown below : it emphasises the relationship between the commissioning and the purchasing/contracting ‘cycles’. Contract monitoring is a key activity within this framework, the results of which should always be fed back into the strategic commissioning cycle.

Figure 2. Commissioning and Contracting Framework 3

2.2The changing context and market

The context within in which social care services and contracting operate is constantly changing and evolving. The most obvious changes are the direction and speed of social care policy developments, however other factors such as position of social market, financial stability, local needs and employment/skill levels all need to be considered in the development of a Contract Monitoring framework.

2.3Who monitors contracts?

Currently various organisations and Stirling Council have formal responsibilities for monitoring social care services:

• Each service provider is responsible for monitoring the quality of its service
• SCSWIS has a legal regulatory responsibility for ensuring services met national minimum standards
• Care Management services and the Contracts team have ongoing monitoring function to ensure providers deliver the service, whether it meets contractual quality and effectiveness standards i.e. contract compliance.
• Other services feed into the monitoring process through their specific roles (e.g. Fire service, Police authority).

It is important considering the range of people involved in contract monitoring that roles and boundaries are clear and agreed mechanisms for sharing and ‘joining up’ information from different sources is established.

2.4Contract Monitoring responsibility

The Contract’s team have a management and monitoring role, with the core function to enable assessment and commissioning staff to be able to fulfil their responsibilities. There will be overlap in the monitoring process as information is shared between both parties. Another link to be developed is with the Social Work Complaints Officer and a protocol developed for the sharing of information. Again, specific role boundaries need to be agreed with all involved in the Contract monitoring process.

The Contract’s team will implement the Contract Monitoring Framework through a positive partnership approach with all involved in the process. The monitoring function will remain distinct from operational teams. This position gives the Contracts team an overview of the service/provider.

2.5Service user involvement

Currently there is no direct mechanism between Contract monitoring and service users/carers to share information regarding services/providers. The best way to do this, needs to be considered in the development of the Contract Monitoring Framework.

Possibly, the introduction of the User Defined Service Evaluation Tool (UDSET) by Care Management Services will enable service users’ views to be fed into the monitoring process.

The Framework

The diagram below is a visual summary of the framework which has been developed as a good practice model for contract monitoring.4 There are four ‘layers’ in the framework:

1. The Foundations
2. Documents
3. Monitoring
4. The results

The framework relies on each layer to be in place to allow the next layer to be effective and meet the overall objectives of contract monitoring. It is important the results link back to the objectives and aligning to the guiding principles.

3.1The Foundations

The best practice model framework identifies 3 areas within the foundation layer;

• The principles upon which contract monitoring is based
• The objectives of contract monitoring
• The priorities for contract monitoring

The aims and the guiding principles developed by Care Management services establish the value base on which the contract monitoring framework needs to be developed. The processes involved within the framework must evidence that the provider reflects this value base in the planning, provision and review/evaluation of their services.

The best practice framework suggests a basic approach needs to be developed. How we approach any form of contract monitoring must be consistent. The following are agreed principles that must be followed or applied within any monitoring process:

• Developmental approach - To work with providers to achieve maximum potential.
• Encourage continuous self-improvement.

• Ensure transparency and equity in process
• Include services user feedback into process
• Opportunity for two-way feedback
• Use key criteria for defining poor performance & increase of monitoring.
• Apply procedures on managing continuing unsatisfactory performance.
• Understand the outcomes that need to be achieved.

Code of Conduct

The framework will set out for Contract monitoring staff and Providers a code of conduct that will clarify how the monitoring duties will be carried out:

• Contract monitoring staff will behave in a courteous, professional and straightforward manner.
• Contract monitors will share concerns about service quality with all relevant parties at appropriate time.
• Provide guidance on how any notifications anonymous or vexations will be treated.

• Contract monitoring will be clear in communicating decisions taken by the Council which affects how it does business with the Provider

3.2 Objectives

It is important everyone involved in the Contract monitoring process has a clear understanding of why we are doing it and what we hope to achieve.

The following have been agreed as the main reasons for monitoring contracts:

• To ensure or improve quantity and efficiency
• To ensure or improve quality
• To ensure or improve effectiveness
• To ensure smooth operation of the contract

Effective Contract monitoring should be able to answer the following questions:

- is provider delivering agreed service?

- Is service efficient? If not, why not?

- Is service of an acceptable standard?

-If an outcome focus service- what extent are outcomes achieved?

-Is there any difficulty with day-to-day working relationships affect operation of contract?

-Strategic Fit -does the service fit with commissioning strategy

Each stakeholder will have different expectations from Contract monitoring and it is important that these are understood and can be met by the monitoring framework.

Stakeholders

There are stakeholders who have an interest in, but who are not usually involved in, contract monitoring. These include elected members, senior managers, legal, audit, finance and advice services within Stirling Council. Service users and their relatives, friends and advocates are important stakeholders, who can contribute to contract monitoring in various ways.

As part of the consultation exercise it is intended to discuss the framework with stakeholders and identify what their key expectations of contract monitoring are. The critical issues identified through the consultation process will be summarised in Appendix A.

Priorities

In establishing the priorities of contract monitoring two elements need to be considered: the resources available and the assessment of risk of current providers.

Resources – the main functions of monitoring will be done by the Contracts Team. Currently there are four posts in the team one which is primarily a monitoring role, however all other posts contribute to the process. It is important with the limited resources that monitoring needs to become ‘smarter’. Therefore it is important to link available resources against the risk assessments of providers.

Risk

The Contracts team will use the Risk Assessment Tool (based on the ADSW model5 Appendix 1) to assign levels of risks to each Provider. Based on the scoring the provider will be assigned a level of monitoring (low-medium-high). The basic principle is that the monitoring that a particular provider or service receives should be proportional to the assessed risk.

Risk assessments are not static and need to be reviewed regularly as the risks may change over time and initial assessment may now have changed.

4.Contract Monitoring Plan

Now that the foundations to the Contract Monitoring framework have been established the next stage is how we monitor the wide range of services being delivered. This is not only about monitoring methods but also about how the whole process operates and is managed.

Contract monitoring includes two different approaches - reactive and proactive.

• Reactive methods are where another person notifies there is a problem or concern or unsatisfactory service.
• Proactive methods involve planned collection and collation of information and visits on a routine and regular basis.

Reactive Approach

Reactive monitoring mostly deals with circumstances where things go wrong, or appear to go wrong. It can produce three important types of outcomes:

• Issues are resolved and customer is satisfied with the service.
• Provider performance improves/changes in relation to issues/complaint.
• Provides overview of the service.

The information/outcome from this reactive monitoring must be linked back into the overall contract monitoring framework and considered in the risk assessment processes.

Raising a Complaint/Concern to Contracts team (Reactive)

The Complaints and Concerns Feedback form and Guidance note (Appendix 2 & 2a) is the method to be used to notify the Contracts team of any problems/issues with a provider/service.

The Contracts team will consider the issues raised and seek further clarification from the notifier, if necessary. Throughout the process a log (Appendix 3) will be maintained to record and provide an audit trail of actions:

• Summary of Complaint/Concern
• Priority assigned to concern/complaint by notifier
• What the agreed action(s) will be
• Who is responsible for the action(s)
• Outcome of the action(s)
• Final resolution agreed
• Closure date of Complaint/Concern

The following flow chart represents the pathway that will be followed in dealing with the complaint/concerns raised.

Proactive Approach

The proactive approach by the Contracts Team involves a much wider range of monitoring methods. A variety of different types of information from many sources can be collected and used for monitoring purposes. Collection of this information will provide a comprehensive review of the Provider/service.

Table 1 summarises the different methods that the Contracts team have available to monitor Providers/services. This defines how we will monitor, who provides the information, and what the information tells us.

Table 1. Monitoring Methods

Proactive monitoring will be a structured cyclical process that involves all members of the Contracts team. The diagram in Appendix 4 represents the cycle of monitoring processes and identifies who is involved in the processes. At any point reactive monitoring information can trigger increased levels of monitoring activity within the cycle.