The Challenge
- Understanding the true cost of care for adults aged 18-64. • Gathering information on providers operating costs and unique services.
- Paying higher rates than the rest of the region and didn’t know why. • Engaging with providers and having open, transparent negotiations.
- Deciding whether to agree to social care uplift requests and cost of living changes.
- Understanding which placements are under and overfunded.
The Solution
- Using CareCubed to benchmark new and reviewed cases for adult social care.
- Using the CareCubed place-based licence to allow providers to submit service and placement information directly to the council.
- Using the place-based licence in negotiations for joint funded health and social care placements.
- Accessing the wider CareCubed Community of over 300 commissioning colleagues from other authorities.
Results
- Significant cost avoidance achieved with several providers on new placements, reviews and uplift requests.
- Improved the day-to-day commissioning process by giving a structured basis and evidence for an open, transparent conversation with providers.
- Greater local market understanding and development of ongoing market shaping strategies. • CareCubed is a key system giving a consistent, place based approach to support all age commissioning across the council, health partners and care providers.
- Levelling up the market to bring all providers in line with fair care costs.
- Gaps in provision have been identified and the council is now looking to work with strategic partners to design and implement new services.
- Wider rollout of CareCubed to support all age commissioning.
- Rich intelligence to guide future fee setting for working age adults with complex needs.
Bristol City Council (BCC) were early adopters of the place-based licence of iESE’s social care benchmarking tool CareCubed. The aim was to bring consistency and governance around day-to-day commissioning processes, improve engagement with providers by using a single solution to collaborate and have the tools in place to prepare and implement the reform agenda.
The council can now allow providers to submit information relating to specific person-centred placements (new/reviews/uplift requests) or whole services directly to them via the CareCubed platform. The council can then review this information, add comments, work through with the provider all within a single system. This removes the need for duplication of data entry, but also cuts down on the subsequent checking of what different amounts relate to or include because the provider enters the information themselves in an already structured format. It also means that the council can compare services because the data is in a consistent format, and they can agree cost templates for services once instead of having the same conversation about a provider’s specific costs each time a placement is made.
“To not be using CareCubed, means you are missing a crucial tool in your armoury for both tactical, day-to-day commissioning, and for those wider strategic projects. It is robust, nationally recognised, impartial and pays for itself from just one or two uses. These challenges aren’t going away, and more are coming as a result of the reform agenda, and we would be at a loss without CareCubed.”
Hugh Evans, Executive Director of People, Bristol City Council
“With the place-based licence we ping them a link and when dealing with organisations with large volumes of placements that is a godsend because they are entering the data and we are reviewing it for consistency,” explains Jonathan Wright, Strategic Commissioning Manager at Bristol City Council, “It makes the negotiations a lot less fraught and complex because they enter the data and we review it – there is no quibbling because they enter it themselves. It takes me about 20 minutes to review a case in CareCubed which is significantly less time in comparison to our previous approach. And the data is saved in a digital system that can be used as part of our day-to-day commissioning processes.”
BCC started using CareCubed in 2020 when they realised the tool could replace the manual and labour-intensive way it had been gathering provider data in Excel spreadsheets to form guide prices for the Learning Disability (LD) market. BCC first bought the council licence, Bristol City Council but quickly switched to the place-based licence as an early adopter and their efforts have been instrumental in helping iESE to develop and shape the place-based offering.
“When our new Director of Adult Services came in, he took one look and asked why we weren’t using CareCubed,” said Wright, “That’s when iESE came in and I realised that CareCubed could do what we had been doing on an Excel spreadsheet manually. It ticked so many boxes in terms of the issues we have on a daily basis, but also for the important strategic, market shaping projects that we are working on now and in the future.” Wright immediately felt confident that CareCubed gave accurate information. “The benchmarking was very close to what we had arrived at, which gave me a great deal of faith. We were within a percentage of CareCubed on most key items, but CareCubed benchmarked a lot more of the operating costs, and by using an independent, nationally recognised tool it has opened up new and better dialog with our market,” he explained.
“CareCubed Place-Based has been a god-send for us in Bristol! It has provided us with an intuitive solution that can be accessed by providers to submit the costings of each of their services. This has made the process quick and easy and reduced the resource required for both the council and care providers. CareCubed and our new approach has been very well received by providers.”
Jonathan Wright, Strategic Commissioning Manager, Bristol City Council
Whilst CareCubed has been brought in to deliver a wide range of strategic benefits, it has also made an immediate impact, with lots of examples of cost avoidance on new and existing placements. One provider, for example, with three placements in the same service had approached the council saying that they were underfunded. However, using CareCubed, they found there was less resource required which resulted in saving the council around £40,000 per year and reduced some of the recruitment pressures this particular provider was facing. Another provider wrote to the Chief Executive stating they were underfunded and should be being paid £3,700 a week for their service user. “We CareCubed it and it came out at about £2,600 at the top end. We asked to talk through the differences and they said ‘capital costs’ without any detail or explanation, so we said no to the request. It is about having a conversation and giving providers the opportunity to help us understand the unique services they offer, whilst paying for what is being delivered,” said Wright.
Another benefit of CareCubed has been the connection to other councils through the online CareCubed user community. “The CareCubed Forum has been a saviour because you can go in and say I am having issues with X – has anyone else got similar,” said Wright. In one dispute which went on for nine months, Bristol City Council linked with other local authorities and found that the provider was giving each commissioner different operating costs. “We worked out that between the three local authorities we had a third of the provider’s business. So, when we banded together it was easier for us to defend,” he explained.
The council now has a tool to support with day-to-day conversations and have much better governance and control on costs. Working in an open and transparent way with providers is improving relationships and opening up new opportunities to work in partnership to develop new services. BCC is also well placed to prepare and implement changes as part of the Adult Social Care Reform Agenda knowing that CareCubed can be used to model changes to the future delivery of health & social care services.
