Wiltshire Council - Consistency Sourcing Care Placements

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The Challenge

  • Develop a consistent approach to Wiltshire Council’s process and pricing for sourcing individual placements for people with specialist care needs
  • Increase visibility of placement price calculations (both care and accommodation costs)
  • Consistent and accurate benchmarking
  • Reduce cost variation and bring equity across the market
  • Stabilise the Learning Disability Residential Care Wiltshire market

The Solution

  • Use of the new online CareCubed tool to manage learning disability and autism placements
  • Use of CareCubed to identify inconsistencies in the assessment of needs – a key factor in the variation in prices
  • Training for assessment staff with clarification of guidance
  • The opportunity to separate the care costs from the hotel costs both on an individual and provider-by-provider basis
  • An asset-based approach to assessment and use of three conversations model
  • A project to manage the work flow
  • Evidence based approach to risk sharing and negotiations

Results

  • Consistent approach that is fully embedded into Wiltshire Council’s care costing processes, using CareCubed as the fundamental pricing mechanism for their LD and autism placement contracts
  • Clarity of benchmark costs for placements, informing current prices and as a baseline for discussion of changes to needs and/or costs
  • Negotiation meetings with providers resulting in some costs decreasing, some costs increasing and other costs staying the same
  • Alongside the increase in costs, a cost avoidance of approx. £605kpa has been achieved
  • Positive and open engagement with care providers
  • Improved working relationships both internally and externally
  • Clarity of split between care needs and hotel costs
  • A more robust quality assurance process

Wiltshire Council pride themselves on their person-centred approach to sourcing individual placements for people with specialist care needs. But due to the sheer volume of cases (more than 350 residential placements for adults with a learning disability and/or autism) they knew that their processes were not as consistent as they’d like, with a variation in costs across apparently similar needs and a lack of visibility as to how a placement price was determined. So, back in 2016, considering this inconsistency and expected budget pressures from increases in cost of care, they launched a project to overhaul their approach to the assessment process and the purchasing of specialist residential care placements.

Previously, the costing tools used by Wiltshire Council were out of date and not widely accepted outside of Wiltshire so didn’t have credibility with providers; moreover, they didn’t lend themselves to convenient sharing of information and partnership working.

The Council reviewed the market and selected CareCubed (then Care Funding Calculator) as their key tool to support them in their commissioning work. A secure online tool, CareCubed supports sharing of cases across multiple users within the Council. It’s updated annually to cover market and legislative changes, using authoritative data sources including the National Minimum Data Set for Social Care (NMDS-SC).

“We’ve never had anything as transparent, equitable, and user friendly as CareCubed”

Victoria Bayley, Lead Commissioner, Specialist Commissioning Team, Wiltshire Council.

Consistency of approach

The project started with a pilot, using CareCubed to support them in managing their learning disability and autism residential placements, involving staff from the Council’s Specialist Commissioning and Community Team for People with Learning Disabilities (CTPLD) care management team, as well as one of the larger, national care providers in Wiltshire. CareCubed’s structured approach to documenting individuals needs soon helped the Council identify a key source of the variation in prices – inconsistencies in the assessment of needs. This was remedied by training for assessment staff, clarification of guidance, and appropriate QA.

Working with providers

Wiltshire Council are now rolling out the approach across all their specialist providers. Given the volume of placements, this is ongoing, but the approach is now fully embedded as “business as usual”, with CareCubed built into the specialist placement contracts as the pricing mechanism. A clearer definition of the needs of individuals, captured in CareCubed, has enabled the Council to work with providers to “rightsize” the care packages and renegotiate prices accordingly. Some providers have really embraced the opportunity to work in partnership with the Council, substantially remodelling their provision to better match individuals’ needs.

Critical to the success of the project has been the Council’s ongoing communication and openness with providers, with regular presentations to the Wiltshire Provider Forum and sharing of key data on price changes with them. While there is clearly a financial driver to this work, sustainability of the Wiltshire care market is also important and in some cases the Council have unilaterally proposed increases in rates to certain providers who were significantly below the CareCubed benchmark price, to ensure future sustainability.

“Using CareCubed has helped us to stabilise our market in a fair and equitable way. It has provided us with robust benchmarking data across our market, which gives us clear evidence to be able to enter into a robust and business-based discussion with our providers on a fair price. This has changed our conversations and enabled us to move our relationships to a more positive and focused place”

Hazel Matthews, Assistant Head of Service Specialist Commissioning at Wiltshire Council.

Wiltshire Council’s methodical approach has paid off. The tool has brought clarity of benchmark costs for placements, informing current prices and giving a baseline for discussion of changes to needs and/or costs. This has led to a massive un-necessary cost avoidance of approximately £605kpa. However this also identified where the council was underpaying in some cases historically which caused an additional cost pressure.

The journey is not over, and next steps under consideration by Wiltshire Council include the potential roll out of CareCubed to support commissioning of mental health and transitions placements. They’ll also be making more use of the newer features of CareCubed to support their strengths-based approach to assessment, including improvement outcomes, and automatic flags for review.

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