Individual Budgets, new opportunities for the VCS?

Over a decade ago the government introduced a system called Direct Payments which provided the option of means tested cash payments to service users for the purchase of services to meet their care needs. A new system named Individual Budgets, currently being piloted across 12 sites (The findings will be published towards the end of 2008), will be a development of the benefits currently on offer through the Direct Payments scheme. Individual Budgets will give users the option of taking their budget as a direct payment, let the council commission services on their behalf, or as a combination of the two.

The new system of Individual Budgets is influenced by health care reform. Key messages from government policy that inform the developments:
• Independent living
• Staying healthy
• Choice
• Sustaining families and children not inappropriately undertaking caring responsibilities
• Improving quality of life
• Dignity, respect and free from discrimination

To achieve this Individual Budgets will place the user at the centre of decisions over their care package, supporting them to choose from a greater range of services, from a greater range of providers (including friends and relatives) that is most appropriate to their needs. It represents a more holistic approach to health that also includes preventative rather than crisis led solutions. For example, a user who needs support with their shopping may opt for a package that includes meeting with a befriender, going to the shops with them and having a coffee and a chat afterwards.

As Individual Budgets are currently still in development and the model differs in each locality it is impossible to outline here exactly how the system will work. The assessment will include a multiple choice self-assessment questionnaire, generating a score that will determine level of financial support and the type of support required to meet the identified priorities. There will be a menu of services for the user to choose from, though they can identify services outside of this. A plan will then be agreed between the service user and social worker. Some pilots have commissioned a third party organisation as a broker service to manage the relationship between service user and provider, including taking the employer responsibility on behalf of the service user.

VCS organisations can and do provide services under the existing Direct Payments scheme. Clearly the development of choice and of ‘whole person’ care plans, the inclusion of preventative services and the addition of existing funding streams to the Individual Budgets scheme presents the VCS with new opportunities. As the VCS looks to diversify and develop the range of income it generate Individual Budgets could be a real opportunity to sell its services. As the scheme is not yet developed locally we cannot specify how VCS organisations might engage with Individual Budgets. The information currently available indicates that little or no additional requirements would be placed on VCS organisations (those currently delivering funded services). The organisation would have to position its services to meet the needs of Individual Payment service users. A unit cost would need to be calculated, a practice not commonly used or required of the VCS at the moment. The organisation would need to consider if there was a conflict if they were in a position where the provision of ‘paid for’ services were the same as services already provided through a grant or contract.

HealthNet will keep you updated on developments as they happen and provide direct support to VCS organisations once Individual Payments are sufficiently developed locally.

Any questions, comments or information requests contact Rachel or Razwanah @ HealthNet (Bradford CVS) t: 01274 722772 or e: health@bradfordcvs.org.uk

New Supply 2 Health Site Launched

The new NHS supply portal has been launched. You can now register at Supply to Health to receive email notifications of advertisements that are placed on NHS Supply2Health. You will also be able to find details on this site of contracts that have been awarded.
The Website is intended to assist NHS commissioning bodies to advertise Part B clinical services. Click on the link to visit the site www.supply2health.nhs.uk/default.aspx
AWP opportunities will be advertised on NHS Supply2Health from January 2009.

Healthy Ambitions Directory

Social Enterprise Support Centre (SESC) are putting together a directory of social enterprise service providers who provide services/products in line with the Healthy Ambitions Pathways. This information will then be shared with NHS Yorkshire and the Humber to assist with commissioning. The eight care pathways are:
Staying Healthy
Reducing alcohol abuse, tackling rising obesity and helping people quit smoking.

Maternity and Newborn Care
Encourage breastfeeding, reducing mothers smoking during pregnancy. Improve information for pregnant women and increase levels of consultancy and prioritise midwifery time. Improve the experience for women throughout pregnancy and delivery and improve the health and wellbeing of babies.

Long Term Conditions
Annual personal care plans, with more support for people to manage their own conditions. Better coordination of care and also better use of new technology to help self-care. There is to be a prevention of problems. There will be a reduction in unnecessary hospital admissions and will help to keep people healthier for longer.

Children’s Services
Improve children’s health and well being. Halt the rise in obese children and young people. Provide access to GP’s who are trained in the needs of children. Reduce asthma suffers admitted to hospital. Improve support for diabetics to control their condition. Improve services in the community and provide parents with better information and support and help with parenting skills

Planned Care
Improve access to diagnostic services. Better communications between GP’s and hospital doctors. Reduce time patients spend in hospital. Have appropriate cover for intensive care and specialist care in non-hospital setting and home monitoring.

Acute Care
Providing a wider range of services including pharmacies, urgent care centres. Develop self-care manuals; provide a single telephone number of local urgent care and out of hours care. Provide guidance for ambulance services to take people immediately to best location. To improve patient satisfaction and provide a better service. Make best use of staff and facilities. Save lives and reduce disability, strokes and heart attacks.

Mental Health
Modernise dementia services, link mental health teams to GP practises, invest in community mental health services. Provide quicker access to the right services and reduce waiting. Improve services for people of all ages, reduce inequalities and provide better outcomes.

End of Life Care
Provide clinical teams caring for patients, their families and carers. Establish single care co-ordinators. Skill professionals to deal with patients.

If you provide services that fit into any of the theses categories please download the application form http://www.sesc.info/healthsocialcare.php and return it to rachel.oddie@sesc.info

Health - Opportunities for Social Enterprise

Description
A chance to explore the opportunities currently available delivering services in the area of health and social care. At the end of this half day session, delegates should have a clearer understanding of what they need to do to win business through the structured and informative workshop.

Aimed At
Any social enterprise currently delivering or planning to deliver health and social care based services.
Main Points
• Policy background • Procurement & commissioning • NHS, non NHS and local authority opportunities • Barriers to success • Some real life examples • Sources of information and support

Event Type: Startup Workshop
When: 8/12/2008 9:30 to 12:30
Register: 9:30
Venue: The Lighthouse Group
Cost: £0.00 (VAT Included)

Places are currently available, please click the link below to book on the event.
https://yandh.regionalknowledgesystem.com/EDMSPortalWebsite/ClientApps/Silverbear.Web.EDMS/public/default.aspx?tabid=36&id=2290&p=&orgId=1&guid=a17418a9-76dc-4777-bf33-c70cce1716b0

Practice Based Commissioning (PbC) CityCare Alliance Update

Back in June when Practice Based Commissioning (PbC) was just starting to take shape in the district HealthNet brought you a conference aimed at the VCS. The conference aimed to inform the sector about PbC and explore its involvement as both an influencer and provider. HealthNet will keep members informed of the work of the PbC alliances and any relevant opportunities. This is an update on the CityCare Alliance.

Firstly, to recap on PbC in the district as a whole…

Practice Based Commissioning in the Bradford District
PbC engages practices in decisions about the design and investment in health
services, harnessing clinical and system knowledge that exists in primary care.

Alliances
In the Bradford District, four PbC alliances (partnerships of GP practices) have been established:
• Airedale and Wharfedale PBC Alliance
10 practices + 2 independents. Population 93,000 + 11,000
• Yorkshire Primary Care Alliance
15 practices. Population 118,000
• Citycare Alliance
35 practices. Population 146,000
• South and West Commissioning Alliance
23 practices. Population 167,000

each has an alliance manager.

Budgets
The alliances are delegated indicative budgets, Bradford & Airedale tPCT retains overall responsibility and accountability for commissioning. PbC is intended to respond to the identified needs of local people, not to provide extra services that suit providers. The priorities of each alliance differ according to local need. Alliances identify health needs through a range of mechanisms including working with thematic PCT-wide leads for commissioning (e.g. Children’s Health, Substance Misuse and Mental Health).

FURs
As a result of commissioning, Freed up Resources (FURs) are reinvested to target areas of greatest need. VCS partners may be able to provide services and influence priorities through the appropriate mechanisms.

CityCare Alliance

The CityCare Alliance encompasses 35 practices covering a population 146,000.

PbC although by no means concerned only with public health, is the area of interest to the VCS. The CityCare Alliance Health and Wellbeing agenda has prioritised obesity, cardiovascular disease, alcohol, smoking as key issues. Alcohol services will plug the gap in existing services focusing on brief intervention and detox. Breastfeeding support and buddying services will contribute towards infant mortality targets. The obesity care pathway has been developed. Services will include cook and eat, exercise and walking groups. The Alliance recently funded a scheme that will see patients of 14 GP practices within the CityCare area offered vouchers for 12 free sessions at a local Weight Watchers or Slimming World. To be entitled to the vouchers patients must be on a low income and have a body mass index over 30 or high blood pressure For a full article see; http://www.thetelegraphandargus.co.uk/news/news_behind/3743851.A_weighty_matter_exercising_minds/

In the design of local health and wellbeing services front line clinicians, mainly GPs at this stage, identify local priorities and present a business case to the PCT for the services needed to meet those priorities. The tPCT can then decide to commission them. To support this process information will be gathered on what resident’s want, where they want it and at what times. Mapping of existing services and identifying gaps also contributes to the planning process. There is a move towards placing services such as screening, health advice and access to Community Development Workers and Health Trainers within community settings e.g. community clinics and pharmacists.

Bradford and Airedale tPCT new structure

Bradford and Airedale tPCT has now divided its structure into two parts; the provider (approximately 2000 staff) and commissioner (approximately 500 staff). For the sector this signifies a further move towards the VCS competing directly with statutory sector partners along with other VCS organisations.

New NHS Community Contract

The Department of Health (DH) is currently developing a new standard contract for community and mental health services including those delivered by the Voluntary and Community Sector (VCS).

The requirement to develop a standard contract forms part of the Health Reform in England, featuring first in the Commissioning Framework (July 2006) and then again in the Commissioning Framework for Health and Well-being (March 2007) and will be in place for April 2009. The contract will replace all existing contract/s between the VCS and the PCT.

Benefits of the Standard Contract

The Department of Health cites the following benefits to the standard NHS contract:

• A focus on keeping it as simple as possible, using plain English and accompanying guidance to ensure that both commissioner and provider fully understand the contract
• Flexibility; can be amended to account for service and organizational contexts
• A standardized contract will reduce the monitoring and administrative burden on third sector organisations holding more than one contract across different funding streams and different PCTs
• Built in measures to support organisations not meeting their contractual agreements as opposed to an automatic funding cuts
• Opening up commissioning opportunities where the standard contract wasn’t appropriate for VCS organisations e.g. GP commissioning
• Create a ‘level playing field’ across sectors
• Three year contract length default

The overarching aims of the contract being to improve patient experience through quality, joined-up services that represent value for money (VFM).

Local Impact on VCS Organisations
The standard contract will be of interest for any organisation wishing to contract with the NHS in the future and those currently holding contracts that run beyond April 2009. Locally this will affect those organisations with existing contracts through funding streams (namely Bradford and Airedale tPCT commissioning and Healthier Communities Fund), and individual contracts e.g. Practice Based Commissioning. For the districts 86 VCS organisations currently in contract with Bradford and Airedale tPCT this will mean a new contract less than a year after their initial contract has been signed. This is a requirement placed by the DH nationally and therefore out of the hands of the PCTs locally. In reality this should only mean a format adjustment of the contract rather than any major content changes. Our understanding is that the standard contract will also apply to Healthier Communities Fund but we are currently seeking confirmation on this. We will keep you updated! For Healthier Communities Fund schemes this would also signify a move from Service Level Agreements (SLAs) to a legally binding contract.
Organisations should wait to be contacted by their commissioning contact officer.

VCS Planning for NHS Contracts
Though the disruption to existing providers should be minimal the new standard contract serves to further reinforce some of the changes we expect to see as key to future commissioning arrangements.

Take into account these changes through your organisations planning for future funding bids.

Features of the contract:

• Evidence base
• Expected outcomes
• Service delivery model
• Referral routes
• Quality and performance indicators
• Care pathways

Services will be based on proven delivery models and community need. The contracted service will be identified as fitting into the relevant care pathway considering referral routes from and to other services within the pathway. Organisations could identify where their organisations services fit, or may want to position themselves into the relevant care pathway e.g. mental health, smoking cessation. An article outlining how to map your organisations activities to care pathways will follow.

As is now the case with many, but not all existing contracts, performance will be measured by achieving agreed health outcomes rather than outputs.

If you have any questions or comments relating to this article contact either Rachel or Razwanah @ Bradford CVS t: 01274 722772 e: health@bradfordcvs.org.uk . Keep checking the blog for updates!