BOROUGH OF POOLE
HEALTH AND SOCIAL CARE OVERVIEW AND SCRUTINY COMMITTEE
9TH MARCH 2010
DIRECT PAYMENTS AND CHOICE OF SERVICE PROVIDER
1. PURPOSE OF REPORT
1.1 The report is to inform the Committee’s members of the actions taken to implement a framework for ensuring best value in the provision of community support for people with a learning disability. The report will specifically comment on the question of how choice operates through direct payments and personal budgets.
2. DECISIONS REQUIRED
The Health and Social Care Overview and Scrutiny Committee are requested to:
2.1 Consider the measures taken to implement the framework for community support.
2.2 Identify any further issues arising from the report where the Committee would wish to comment or receive further information.
3. BACKGROUND
3.1 A tendering process was instigated by a previous Head of Service to establish framework for domiciliary, day opportunities and community support services for people with a learning disability. This started in 2008, 28 tenders were received and evaluated against a price and quality matrix. For community support four providers were awarded preferred provider status.
3.2 The intention was for new service users to receive better value and quality from their community support by using the framework and for existing service users to also use the framework at the point of review. The local authority does not have an obligation for sole use of the providers on the framework, but it was regarded as preferable to do so to ensure best value which includes both quality of service and value for money.
4. DIRECT PAYMENT AND PERSONAL BUDGETS
4.1 One of the key principles with the establishment of direct payments and the operation of personal budgets is that service users and carers can choose who provides the support they receive. This does have an impact on the historical generation of block contracts and preferred provider frameworks. Once a service user or carer has had an assessment of their needs and they are regarded as having met the Fair Access to Care Eligibility criteria, support can be arranged to meet these eligible needs. When this is through a direct payment a cash amount is allocated which will enable them to purchase directly the support they need. The cash amount needs to be sufficient for the service user or carer to be able to have their needs met by service providers. For personal budgets a resource allocation system is used to allocate equitable and realistic funds to enable service users to arrange a care provider. This could be in-house or independent. Poole are currently rolling-out Personal Budgets as part of a national programme called Putting People First.
5. IMPLEMENTING THE FRAMEWORK
5.1 The intention of the community support framework is to provide best value in terms of quality and cost for the provision of services to people with a learning disability. It is recognised however that changing who provides a service to service users and their carers can have a significant impact. Changes to the support plan should only occur following a review with service users and carers. Discussions have taken place with a range of providers to adjust their rates in-line with those set with four providers who agreed to be part of the community support framework. Some providers have adjusted their rates others have not. A direct payment option is available to service users or carers who would like to purchase support from a provider whose charges are above market rates and this would involve an additional personal contribution or top up.
5.2 When considering the implementation of both the community support framework or the establishment of personal budgets, a degree of discretion has been used to accommodate service users who wish to retain an existing provider who charges above the framework rates. A transitional approach is suggested to enable the provider to adjust their business model where there is no basis for the additional premium for existing service users. This would form part of the review process and specific time frames agreed with service users and carers. To continue this arrangement permanently would open the local authority to challenge in terms of equity and ensuring best value.
5.3 There may be circumstances where service users needs require specialist skills from providers. This would be recognised as part of the review and can be reflected in the resource allocation system for the future. The intention of the new arrangements is to maximise choice and control but operate a best value principle through the application of a resource allocation system which is fair and equitable across service user and care groups.
Report of:
Harry Capron, Interim Deputy Director Adult Social Services
Jan Thurgood, Strategic Director Adult Social Services
9th March 2010
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