Agenda item

(1)       The Chairman welcomed Mr Adams, Ms Gibb, Ms Taylor and Ms Swan to the meeting and asked them to introduce themselves before answering questions from Members of the Committee.

(2)       Mr Adams said elaborated on some of the points made in the briefing paper received by the Committee.  In particular he said the care homes sector considered there was a “disconnect” within KCC between commissioning, operations and procurement as well as a “disconnect” between the commissioning officers and service providers.  He said that when tenders were published they tended to be more prescriptive about methods and outcomes than anticipated during discussions. Frequently there were no references to social value or to the possibility of providing services in different or innovative ways in the tender documents.  

(3)       Ms Gibb said there was a need to consider long term outputs.  For example her organisation had been very successful getting adults with learning difficulties into supported living arrangements but that it could take a very long time to do this.  As a charity they could add extra value by looking at work and volunteering opportunities.

(4)       Ms Gibb applauded the KCC Stakeholder Board but thought it was too bureaucratic and took too long to make decisions.  She said collaboration was important and that she would like to see better quality outputs and recognition that commissioning services imposed a cost on charities. 

(5)       Ms Swan said that she represented the KCHA on the KCC quality board and worked as a provider of residential and nursing care with large and small providers.  The creative and innovative work done by smaller providers could be overlooked and many such organisations had concluded they were not able to work with the local authority.  She agreed that the KCC Stakeholder Board took a long time to reach decisions.  She also thought that many of the commissioners of services were out of touch with reality particularly about the cost associated with providing services and expressed concern that no additional funding or “top-up” funding was available for support that would enhance an individual’s life.

Question – How could whole life care be achieved within the system?

(6)       Usually care packages would be reviewed annually with the care manager, the provider, the individual and his/her family and usually more support was required initially.  

Question – Does the care manager hold the budget?

(7)       No. Care managers usually have to persuade the Care Committee that an individual needs a particular type of support and the process is bureaucratic and “clunky”.

(8)       In the case of older people such decisions are taken by a panel and it is especially difficult when the support required is funded from health care budgets.

Question – Is the health and wellbeing architecture helping?

(9)       The flexi-care contract gave care managers to re-act immediately to meet needs and it worked well as it built trust. 

Question – In the written submission you talk about prime integration providers coming to dominate the market.  What do you mean by that?

(10)     This is terminology used by Newtons, the consultants employed by KCC. The big providers frequently undertake to provide services as a loss leader which makes it impossible for smaller providers to come together to develop an alternative offer.  However once the big providers are in place the prices tend to increase.   

Question – Is the market moderated by the continued existence of in-house services?

(11)     There is only limited in-house provision.  The sector is trying to talk to the local authority with a view to enabling small and medium organisations to come together as networks of supply that are able to respond to needs rather than relying on one big provider for all the services 

Question – Is the structure Age Concern UK has adopted a suitable model?

(12)     Yes.  The sector is interested in establishing consortia to bid  for services but commissioners could  say “no” as such consortia do not have a track record of delivery as a group.

Question – How can you measure residents’ enjoyment or peace of mind in a qualitative way?  How can it be monitored?  How can it be included in a contract?

(13)     There are tools, often produced by universities, to qualitatively evaluate the quality of life.  If there was a better “connect” between the service provider and KCC, ways of measuring and monitoring performance and outcomes could be discussed and then written into contracts.

(14)     It is important to talk to clients, their families and advocates and make sure they are involved in any proposed changes.  Case studies of experiences of whole life care could be provided

Question – How could these qualitative measures be written into contracts?

(15)     By asking providers for evidence of what is being claimed as well as Care Quality Commission reports and reports of activities relating to adult protection and health.

Question – We have heard from commissioners who think they engage with service providers and from service providers who say commissioners do not engage with them.  How could they be brought together?

(16)     It is a process and is primarily about trust.  Some KCC officers are very committed to consultation but others are less so.  It is important to work with service providers rather than just consult with them at times that are convenient to KCC.  Issues about the attitude of some KCC staff have been raised with the Director for Strategic Commissioning.  In some consultations it feels as if the decisions have already been made and the consultation is only about ticking a box.  KCC also needs a better database of organisations as the organisations in the sector frequently need to advise each other of meetings coming up 

Question – If members are to drive forward change it would be useful to have case studies of the impact of the “disconnect”.  Could they be provided?

(17)     Yes. 

Question – How do you feel about negotiated contracts?

(18)     We prefer negotiations as they build trust.  We took legal advice about a contract for services for people with learning disabilities and when our concerns were raised with KCC we were told to “sign it or not get the contract”. 

Question – How will the move to direct payments affect you?

(19)     We already work with direct payments for community-based services and they will not apply for residential services.

Question – How can elected members help?

(20)     By bringing common-sense to the table and by helping to develop trust between KCC and service providers.  The sector is in “receive” mode and the emphasis must be on people and not process.