Working with the independent sector

Good practice examples

The Challenges

Good practice examples

Hertfordshire - procurement initiative for home care

Newham - regenerating the social care market

Flintshire - Homecare brokerage

Social Services have a series of complex relationships with their providers.(Exhibit 9) They purchase services from a range of different providers as well as providing a range of services themselves. But Social Services are not the only purchasers of service, many individuals purchase care and equipment from the same providers independently.

A commissioning strategy which is able to respond to identified need is only possible when there are a range of potential providers willing to meet developing needs. It is therefore in every authority's interest to develop and nurture its independent sector.

The Challenges

• The existence of large numbers of people within a particular area who are purchasing their own services can be a benefit as more providers may to enter the local market.
• Self funders can also create challenges, particularly when those in residential or nursing care have spent all their capital and come to their local social services for help to fund their remaining years. Where individuals have chosen to live in expensive care settings this is a real dilemma, leave the user there and pay high rates, or ask them to move with all the risks this entails.
• Providers are in theory in competition with each other and may not feel comfortable in working in forums that include other providers
• Private and not for profit providers of service are often suspicious of each other as the former feels the latter has a competitive advantage
• In house providers are often viewed with even more suspicion
• Encouraging new providers, or asking current ones to change what they provide often takes a long time
• Providers sometimes threaten evictions of long term residents if fee levels are not raised significantly
• Providers go out of business or refuse to take social services placements because fee levels do not cover costs, leaving a sudden gap in available services.

Formalise your relationships with your providers through proper procurement. See Good Practice: Hertfordshire for an example of how they have done this for their home care services

Develop your local Social Care market through cooperation. For one example of a successful initiative see Good Practice: Newham

If your independent sector is underdeveloped you may need to take steps to make changes in the market. For ideas on this look at the scenario in the Commissioning module "You have an underdeveloped independent sector, which does not require the in house services to have a competitive edge"

 

GOOD PRACTICE

Developing effective partnerships with the independent sector As a group: Develop provider forums and put an effort into making them work involving managers of a sufficient status to reflect the importance of the provider role Use these to develop protocols/concordats that will contribute to resolving regular difficulties like fee levels and annual increases, standardised contracts, monitoring arrangements etc Become more sophisticated in setting fee levels to reflect the multiplicity of levels of need Recognise the differences between the private and not for profit sectors Develop "local compacts" for working with Voluntary Organisations (This is discussed further in the Partnership Module and additional information is available on the internet) Involve current providers in discussions about future needs and how they might be met But recognise that you may need to encourage other providers into your area if appropriate skills are not there Individually Provide block contracts that last long enough to give providers some stability, but which don't lock you into services you do not need. Consider carefully the use of block/spot contracts. The former can reduce costs and guarantee a service but the latter increases your flexibility. Flintshire have developed a successful brokerage scheme which arranges all the spot contracts for domiciliary care. Start discussions about renewal of contracts/fee increases early so you don't have a last minute rush or regular short term extensions Address concerns as soon as they arise through regular contract reviews, don't wait until the contract is about to expire Identify self funders who may run out of resources as early as possible and get talking to them, their carers and their service provider well before decisions about future placement need to be taken