C Social
Care Services
APPENDIX 1
Overview
Commissioning
Strategy
2004 – 2009
Janet Dillaway, Joint Director of Strategy
19th July 2004
2
SUFFOLK SOCIAL CARE SERVICES
OVERVIEW COMMISSIONING STRATEGY
2004 – 2009
____________________________________________
INDEX
Chapter
Title
Page
SUMMARY
1
1.
INTRODUCTION
2
2.
WHAT WILL OUR COMMISSIONING
STRATEGIES DELIVER?
3
3.
WHAT IS COMMISSIONING?
4
4.
HOW WE COMMISSION IN SUFFOLK
6
5.
NEEDS ANALYSIS: PROFILE OF SUFFOLK
8
6.
CURRENT SERVICES
13
7.
COMMISSIONING INTENTIONS
18
8.
AN OVERVIEW OF RESOURCES
22
9.
CONTRACTING ARRANGEMENTS
25
SUFFOLK SOCIAL CARE SERVICES
OVERVIEW COMMISSIONING STRATEGY
2004 – 2009
____________________________________________
SUMMARY
WHERE ARE WE NOW?
We have re-looked at our approach to Commissioning within the County Council
and established a Social Care and Health Partnership Board, supported by senior
management, which will support commissioning. We have agreed an integration
agenda with health and education colleagues and looked at commissioning in this
context.
WHERE WE NEED TO BE
We need to make key strategic shifts in the mix of directly provided services, and
within our countywide resource allocation we need renewed locality commissioning
to deliver the specific changes outlined in the individual commissioning strategies.
BROAD OUTCOMES
Integrated and locality services with the local NHS and with Education Services. A
reduction in looked after children and more local capacity in fostering systems.
Minimal delays in transfers from hospital for customers and an expansion of support
at home. Prevention of inappropriate admission to all hospital and care settings.
More inclusive services that promote both independence and interdependence.
COMMISSIONING INTENTIONS
We have outlined these in more detail in Section 8 of the strategy.
RESOURCES NEEDED
Suffolk County Council has invested an additional £8.8m in 2004 –05 to address
demand pressures and to invest in service developments and changes. In addition,
a further £3m of existing spending will be re-directed in line with the priorities set out
in this document. The Government has already indicated that public spending
cannot be allowed to grow as quickly in the early years of the next Parliament as it
has done since 1999. Public spending will rise by an average of 2.7% in real terms
in 2006/2007 and 2007/2008, which is very much less than the average annual
4.1% increase between 1999 and 2005/2006.
1
1.
INTRODUCTION
Social Care Services in Suffolk
Suffolk County Council provides or arranges services that offer help to
vulnerable people at all stages of life, from protecting babies at risk right
through to ensuring that people are well cared for at the end of their lives.
Changes in society, in legislation, in the National Health Service and in
aspirations generally for public services mean that social care services now
need to be organised differently. In Suffolk we have looked at the way services
are set up and the way we respond to people to so that we can make sure they
are well served to the highest standard.
Social care services have often organised themselves around service areas
such as learning disabilities, mental health or physical disabilities. People in
this arrangement tend to be referred to and described in terms of their
disability. That can lead to some unhelpful barriers between services and it
can be difficult for people who use services and family carers to navigate their
way through to get all the services they need. When services are organised in
this way people can fall between service areas if they do not quite fit the labels
we have given them. In order to move away from this way of thinking, Suffolk
social care services are now arranged around the life stages that we all go
through. This means that they are organised into three parts:

Children and families

Working Age Adults

Older People
Working in this way means that we will still have specialists and still use their
valuable expertise. This way of thinking about services gives us the
opportunity to share expertise and work together on things that are common for
everyone who needs services.
Services are arranged into localities to make sure that they are responsive to
local needs and aspirations. The three main localities are:
The West of the County: to link with Suffolk West Primary Care Trust
The East of the County: to link with the three Eastern Primary Care Trusts
(Ipswich, Central Suffolk and Suffolk Coastal)
Waveney: to link with Waveney Primary Care Trust
2
2.
WHAT WILL OUR COMMISSIONING STRATEGIES DELIVER?
The purpose of a commissioning strategy is to set out what services are
available, what is needed and what we intend to buy in the future.
The aim of services is to:

Improve the health, well being and life chances of the citizens of Suffolk

Enhance people’s independence, protection and inclusion, and

Acknowledge people as equal partners in their care
There are four commissioning strategy documents that fit together:
i)
An Overview Commissioning Strategy that describes our overall approach
(this document)
ii)
A Commissioning Strategy for Children and Family Services
iii)
A Commissioning Strategy for Working Age Services
iv)
A Commissioning Strategy for Older People
These documents set out the commissioning intentions of the County Council
and partners where relevant. They are the products of the first stage of the
development of more fully worked up commissioning strategies. As such they
should still be regarded as works in progress, with some details and areas still
to be worked on, rather than as completed documents.
If you would like to see the other documents you will find them on Suffolk
County Council’s website and our internal intranet, accessible for Social Care
staff. Or you can contact the Social Care Joint Director of Strategy, Janet
Dillaway, on 01473 264420 for more information.
3
3.
WHAT IS COMMISSIONING?
Commissioning is about enhancing people’s quality of life by:

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



Having the vision and commitment to improve services
Connecting with people’s needs and aspirations
Making the best use of all available resources
Understanding demand and supply
Linking financial planning and service planning
Making relationships and working in partnership
Good commissioning means:

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
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
A common set of values that respect and encompass the full diversity of
individual’s differences
Working together with people who use services, family carers, service
providers and all partners
Understanding people’s needs and preferences both now and in the
future
Having a comprehensive map of existing services
Having a vision of how local needs may be better met
Having a strategic framework for procuring services
Bringing together all relevant data on finance, activity and outcomes
Having systems for making change happen
Evaluating services to achieve better outcomes
The main stages of commissioning are:







finding out what people’s needs and preferences are (needs analysis)
developing a vision and broad plans for how services should be:
(strategic planning)
turning those broad plans into details and action about how they will be
achieved (operational planning)
agreeing with providers what the service is that is needed and drawing up
legal contracts and agreements with them (purchasing and contract
setting)
making sure the right services are there in the right quantity now and in
the future (market management)
checking regularly to make sure that what has been agreed is happening
and whether or not services are still needed or need to stop or be
changed. (contract monitoring, review and evaluation)
4
Commissioning Principles
In Suffolk all commissioning is based on the following principles:

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





We will provide the right care in the right place, at the right time
People who use services will be directly involved in the commissioning
process
Commissioning will be developed in response to the needs of the diverse
population of Suffolk, and will focus on the best outcomes for people
Feedback from people who use services will positively influence current
and future commissioning.
Needs will be identified in collaboration with partners and where this will
produce the best outcomes, resources will be shared to meet individual
needs.
Services will be provided to promote independence, interdependence and
social inclusion.
Robustness, value for money, standards and monitoring will be applied
equally to in-house services and those purchased in the independent
sector.
All services purchased will have detailed service specifications setting out
the requirements for the service.
Wherever possible, services will be provided locally and in accordance
with Best Value principles, working in partnership with NHS Services,
partners in the independent sector and community groups.
5
4.
HOW WE COMMISSION IN SUFFOLK
Services and localities in Suffolk are in different stages of development with
partners, in response to consultations and local needs. It is therefore not
possible to impose a standardised structure and model that would fit all
situations. Instead, we have designed a commissioning model that brings the
different roles and responsibilities for commissioning together into a network.
This gives coherence to commissioning activities, whilst enabling local and
service flexibility and variations in line accountability.
There are different kinds of commissioning role in the network:




All Locality Managers have a dual responsibility for operational
commissioning and provision on their localities. Some Locality Managers
also have a commissioning lead role to co-ordinate commissioning across
the county
Locality Commissioners have a strategic commissioning role in their
localities. These posts are in development and not all localities yet have
their own commissioners. Cover arrangements are in place to ensure that
local commissioning is taken account of during the development phase.
Some commissioning roles have been designed to keep a strategic and
county wide overview and to co-ordinate commissioning.
There are some specialist commissioning roles (e.g. for housing)
The network works together to carry out the full range of commissioning tasks,
to ensure that commissioning is properly co-ordinated and to draw up
commissioning strategies.
The County Council’s social care commissioning strategy has four parts:
i)
An Overview Commissioning Strategy that brings together
summarises the different strands of commissioning in the County
ii)
A Commissioning Strategy for Children
iii)
A Commissioning Strategy for Working Age Adults
iv)
A Commissioning Strategy for Older People
and
These strategies indicate where services are commissioned jointly or in
collaboration with the NHS and other partners.
A Care Procurement Service supports purchasing and contracting activities
across all services and across the County.
6
The Commissioning Network is accountable to:

A Joint Programme Board that has a joint strategic health and social care
commissioning overview. The Board consists of Chief Executives of the 5
Primary Care Trusts, the Joint Director of Strategy and the Director of
Health and Social Care.

A Procurement Board that regulates the procurement and purchasing
processes in the social care market.

Service commissioning and planning forums, such as the Learning
Disability Partnership Board, Mental Health Partnership Board, Children’s
Services Partnership Board, Physical Disabilities Partnership Board, and
Joint Accountability Boards. All Partnership Boards have representatives
of people who use services and family carers as members.
7
5.
NEEDS ANALYSIS: PROFILE OF SUFFOLK
Population
There are currently 668,553 people living in Suffolk. The population pyramid
below highlights the unusual age structure vs the national average:


there is a shortfall of people aged 15-29
there is an unusually large proportion of people aged 50+
Population projections for the region estimate an overall growth of 8% over the
next 20 years. However, within this:

the population of children and young adults is expected to stay fairly
stable until 2006 with a slight reduction thereafter with figures declining to
159,800 by 2011 and 154,700 by 2021.

the older population is predicted to increase by a massive 42% by 2021
when almost a quarter of all Suffolk residents will be aged 65+
Ethnicity
The ethnic profile of Suffolk is very different to the national picture.
Only 2.76% of the population of Suffolk comes from a non-white ethnic
background, compared to 9.07% for England. Ipswich has the largest ethnic
minority population.
8
Furthermore the relative rankings of the ethnic population is very different in
Suffolk where the largest ethnic minority group are of mixed ethnicity, whereas
nationally the largest ethnic minority group are Asian/Asian British.
0.89%
0.48%
0.64%
0.59%
2.30%
1.05%
4.57%
97.24%
1.31%
Any Chinese/Other
Any Black
Any Asian
Any Mixed
Any White
90.92%
England
Suffolk
The age profile of the ethnic minority populations in Suffolk contrasts
significantly with the white population, and appears to be skewed towards
families and young people.
2.86%
5.38%
9.42%
3.48%
18.73%
27.40%
12.08%
58.47%
56.26%
58.91%
65+
52.41%
25-64
18-24
0-17
11.24%
57.66%
27.12%
21.86%
Any white
Any mixed
12.25%
9.81%
7%
Any asian
9
21.85%
Any black
25.80%
Any
chinese/other
Deprivation
The Index of Multiple Deprivation 2000 measures a number of socio-economic
factors and combines them to create an overall index score for deprivation.
A PCT level analysis shows that all Suffolk PCT areas (with the exception of
Waveney) score lower on deprivation than the national average.
28.8
Waveney
PCT
14.9
Ipswich PCT
12.7
Suffolk
West PCT
12.1
Suffolk
Coastal PCT
23.8
Central
Suffolk PCT
England
25.2
* the higher the IMD score the more deprived the area is.
(Data Source: Norfolk, Suffolk and Cambridgeshire Strategic Health Authority,
Health Atlas, November 2003))
This however hides the fact that there are pockets of severe deprivation within the
county. The map below identifies these areas by highlighting them in red and
orange.
10
NB:
A new IMD 2004 is due to be published in the Spring of 2004 and will include a new
supplementary measure of Income Deprivation Affecting Older People. Data in this
section will be updated once this is available.
Health
Life expectancy is a key indicator of the health of an area and in Suffolk both
male and female life expectancy is higher than the UK as a whole.
11
84
Males
Females
All
80
82.5
77.7
77.5
78.9
79.7
80.1
81.7
80.9
76.6
76.7
78.8
78.6
76
74
75.6
78.1
76
80.9
81.2
78
80.5
Expectancy of Life
82
72
England
Waveney PCT Suffolk West
PCT
Ipswich PCT
Suffolk
Coastal PCT
Central
Suffolk PCT
(Data Source: ERPHO Website, Life Expectancy from Birth (Based on all cause mortality by PCT) 1999-2001)
Self assessments of health from the 2001 Census show that only 8% of the
population of Suffolk regard their health as not good, with the majority of these
being people aged 65+.
All
people
Aged
0-19
Aged
20-44
Aged
45-64
Aged
65-74
Aged
75+
668,553
163,120
214,670
168,092
62,728
59,943
%
%
%
%
%
%
Good
69
90
77
62
45
30
Fairly good
23
8
19
28
40
45
Not good
8
1
4
10
14
25
Furthermore, 17% of the total population have a limiting long term illness,
increasing to 59% amongst the over 75’s.
59%
35%
19%
17%
8%
4%
All
0-19
20-44
45-64
12
65-74
75+
6.
CURRENT SERVICES
Existing services and their use in the current market
This section gives a broad overview of existing services and their use.
Care Homes
1998 to 2001 saw a marked decline in the overall number of places registered
with CSCI. However, the rate of decline did reduce substantially from 2002
onwards. The graph below shows how the total number of registered places
has changed over time. The totals in this graph include LA homes:
Places Registered With the CSCI
7,000
6,000
All
5,000
OP
4,000
PLD
3,000
MH
2,000
Phys
Dis
1,000
0
1998
1999
2000
2001
2002
2003
Graph: Total number of registered places in each category including LA homes, care homes
and care homes with nursing
The number of places for people with physical disabilities has increased in both
care homes and care homes with nursing.
Deregistration between 2002 and 2003 affected the number of registered
mental health places.

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

In Suffolk the average care home with nursing has 40 registered places
and the average care home without nursing has 18.
In total 39 percent of all care homes without have 10 or less places
(accounting for 12 percent of all registered places) but
There are no care homes with nursing with 10 or less registered places.
41 percent of care homes with nursing have 40 or more registered places
(accounting for 62 percent of all places) compared with 11 percent of all
care homes without.
13

23 percent of all registered homes are in the voluntary sector and 67
percent are privately owned. There are substantial differences in this
between different customer groups.
The charts below show the difference between the percentage of registered
places in care homes and care homes in nursing when grouped by the total
number of registered places. They include all registration categories:
% of Registered Places in Each Size of Home - No Nursing
Under 5 Places
61+ Places
6 to 10 Places
41 to 60 Places
11 to 20 Places
21 to 40 Places
% of Registered Places in Each Size of Home - With Nursing
6 to 10 Places
Under 5 Places
11 to 20 Places
61+ Places
21 to 40 Places
41 to 60 Places
14
Domiciliary Care
The amount of domiciliary care purchased by the County Council is continuing
to increase. The graph below plots this increase over an 18-month period:
Total Dom Care Hours
26,000
24,000
22,000
20,000
External
18,000
Internal
16,000
Apr-04
12,000
Feb-04
14,000
Dec-03

Oct-03

Aug-03

Jun-03

Apr-03

Feb-03

Dec-02

Between January 03 and April 04 the total amount of external provision
increased by 19 percent
The in-house service currently provides 40% of all domiciliary care, this is
expected to decrease significantly in the coming 24 months.
The Council has 7 block contract providers and 3 preferred providers (one
preferred provider also has block contracts).
In total there are over 40 accredited domiciliary care providers across the
County.
In April 2004 there were 5 providers providing over 1,400 hours each
week and 4 providers supplying over 1,000 hours.
Most domiciliary care providers have increased the total number of hours
they supply for the County Council in the past 15 months
The 10 largest providers provided some 68 percent of all external
domiciliary care in April 2004.
The department is aware of the closure of 2 domiciliary care businesses
in the past 12 months, both in the Waveney area. Another is planning to
close mid 2004.
Oct-02

G
Graph: Total Planned Hours on Customer Database over Time
15
Day Care
The total number of weekly visits recorded on the Councils customer database
as at April 2004 is:
Internal/External
Mental
Health
Older
People
Physical
Disabilities
People with
Learning
Disabilities
External Supplier
140
1257
485
271
Internal Supplier
0
992
24
2657
Whilst 91 percent of recorded day care for people with learning disabilities is
with a County Council provider there is no internal provision for people with
mental health problems. Reviews of day care for people with learning
disabilities and older people have recently been completed and a
modernisation manager appointed for internal day care for people aged over
65.
Respite Care
In 2003, on average, the County Council made over 250 respite placements in
care homes each month. Well over 2/3rds of these places, both for older
people and people with learning disabilities, were made in the Council’s own
homes.
Respite care can be difficult and time consuming to arrange and currently very
few places in privately owned homes are secured by block contract.
Supported Housing
The County Council recognises the importance of access to sufficient housing
with appropriate levels of care and support to meet varying needs. Supported
housing services are crucial to people’s capacity to retain and/or develop their
independence, recover from periods of ill-health and to live in a noninstitutional environment. The County Council has developed and revenuesupports a large range of supported housing services for Care Leavers,
Children with Disabilities, those of Working Age and Older People.
Suffolk Social Care and Supporting People Team work in partnership with
District/Borough Housing Authorities, PCT’s and Health Provider Trusts,
service users and carers and the voluntary sector to commission and provide:



Accommodation based services that are built specifically to be supported
housing projects, providing a range of levels of care and support.
Very Sheltered Housing.
Extra Care Housing both for those with dementia and functional mental
health.
16





Sheltered housing
Almshouses, which are accommodation based services, very similar to
sheltered housing.
Leasehold Services for those people who receive a service but own their
own properties by leasehold
Floating Support are schemes that are delivered into peoples own homes,
rather than at an accommodation based service.
Community Alarm Services, usually in sheltered or almshouses, but could
be in private tenure too.
A 3 Year Rolling Programme for the development of new supported housing
services is updated on an annual basis in collaboration with Suffolk Social Care and
Supporting People Team work in partnership with District/Borough Housing
Authorities, and PCT’s. A countywide Home Improvement Agency is being
developed to join the gaps in the existing services throughout Suffolk.
17
7.
OVERALL COMMISSIONING INTENTIONS
What do we intend to do to meet people’s needs and aspirations and to
meet national and local targets?
Meeting national and local priorities and targets
The government has set out in its document Improvement, expansion and
reform : The next 3 years (www.dh.gov.uk) priorities for health and social care
services, with associated national targets. National Service Frameworks are in
place for Mental Health Services, Older People’s Services, Long-Term Limiting
Illnesses, and there are strong national modernising programmes for Learning
Disabilities services (Valuing People) and Children, where a National Service
Framework is expected following the publication of Every Child Matters and the
Next Steps publication.
The main themes for a modernised service that come from these drivers and
from our local aspirations are:

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
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
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Improved performance to make sure people are getting the highest quality
services
Involvement of people who use services and family carers in all service
development, planning and decision making
People who use services having more control over what happens (e.g.
Direct Payments)
Working collaboratively, in partnership with people who use services,
family carers and, for example, education and employment services, the
NHS, partners in the independent sector, community groups
Working corporately in the County Council so that the well being of
vulnerable people is not seen solely as the responsibility of social care
services but more in the context of community development
Helping people to have maximum personal independence
Working towards a better balance of service provision and prevention
Children and Families
The Government has published a Green Paper Every Child Matters which sets
out a vision that local government and the NHS will work together to improve
the life chances of children by:




Making sure children are safe and well cared for
Ensuring that looked after children have the best chances in life from
education, health, social care and other services
Working across agencies to support families in the care of their children
and to ensure stability
Bringing health, education and social care closer together to establish a
single accountability for children’s issues within the locality and a
Children’s Trust by 2008.
18
Suffolk County Council wants to reduce the reliance on external
purchased placements and redirect resources into preventative services.
We want to reduce the looked after children population by 10%.
Main commissioning intentions for children and families:
The commissioning priorities 2004 – 2007 are:





Reduce reliance on external purchased placements and redirect funding
into local and preventive services.
Reduce the looked after children population (by a further 10% by 2008).
Increase our in-house provision (standard foster carers, contract carers,
salaried carers) and re-provision our in-house residential children’s
home service. This should reduce costs overall within the looked after
children system.
Reinvest money into early intervention and preventive services (Tiers 1
and 2).
Develop family support services at Tier 3 level, including services for
children with additional needs.
Working Age Services
The National Service Framework sets targets for the development of Assertive
Outreach, Early Intervention, and Crisis Resolution teams by 2005. Specific
needs analyses have been undertaken, and corresponding targets for levels of
provision have been agreed between the Primary Care Trusts and the
Strategic Health Authority. Services are being developed across the County, as
resources allow, towork alongside the existing Community Mental Health
Teams.
Valuing People, A strategy for learning disability services for the 21st Century,
sets out a vision and requirements for learning disability services to modernise
day services, improve employment opportunities, work in partnership to
improve people’s health and access to health services, and develop advocacy.
The National Service Framework for long-term limiting illnesses will give a
framework and direction for how services for people with physical and sensory
disabilities will be commissioned.
Substance misuse services are commissioned through The Suffolk Drug Action
Team.
19
Main commissioning intentions for Mental Health Services:
The main commissioning intentions 2004 – 2007 are:
 Investment in up to 4 new social worker and support worker posts to
meet new NSF models of service delivery such as Crisis Resolution
 Development of 2 new supported housing projects to meet both low
and more intensive needs
 Recruitment to Diversity and Equality post within one Mental Health
Partnership Trust to promote ethnically sensitive services, cultural
competence and anti discriminatory practice. Secure funding for two
further posts in West and Waveney localities in 2005/6
 Begin review of current day service provision to ensure it encourages
access to mainstream opportunities, provides women only activities
and is sensitive to the needs of black and minority ethnic communities
 Refocus existing services to promote principles of recovery and
independent living via e.g the deregistration of care homes (North
Lowestoft Housing Project)
 Promote social inclusion and real work opportunities through
development of 2 social firms
 Develop an Expenditure Approval process to ensure more targeted use
of micro commissioning with an emphasis on through put , ‘move on’
and independent living as an outcome
Older People
The National Service Framework for Older People requires us to deliver:




Person centred care and promotion of choice
Promotion of independent living, good health and an active life
Services that people value and that are of a high quality, available when
they need them
A partnership with carers to meet their needs
Suffolk County Council and its partners want to support more older
people to live at home. We will commission services that prevent people
remaining in hospital longer than they need to. We want to integrate our
services with the NHS so that it’s easier for people to get they services
they need quickly.
20

Main commissioning intentions for services for older people:

The County Council will alter the mix of commissioned services
between 2004-2009 to become an enabling authority (of services in the
independent and voluntary sectors), rather than a major provider of
direct services. We a single process underway to achieve specific
decommissioning, reprovision and modernisation process for directly
provided County Council Residential Homes, Domiciliary Care and Day
Services.

We will develop additional community based rehab services with
Primary Care Trusts Partners to prevent hospital admission and
facilitate hospital discharge

PSS expenditure on intermediate care will increase from £2.7m to
£3.3m.

We will fund an additional 10 intermediate care beds (from 30 to 40) in
2004-2005 assisting an additional 132 people.

We will assist an additional 231 people with non-residential care based
intermediate care services.

We will expand the Domiciliary Care market by at least 5 % each year
in the independent Sector, increasing the total number of week care
hours (including very sheltered housing) from 40,200 hours to 49,500
hours between 2004-2007.

We seek to maintain the overall number of residential care placements
that we make between 2004-2007 at 1650 per year and we seek to
reduce the numbers of nursing care placements that we make between
2004-2007 from 780 to 580. Against a backdrop of growing population
this represents a shifting care patter but not a reduction in market
capacity during that time.

We will work with independent sector providers to shift the pattern of
provision in residential care towards specialist care for those people
with mental infirmity.

We will increase respite care hours from 33,000 per year to 34,000 per
year between 2004 and 2007, and will increase the number of monthly
respite bed places from 24 to 29 over the same period.
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8.
AN OVERVIEW OF RESOURCES
Suffolk County Council has invested an additional £8.8m in 2004 –05 to
address demand pressures and to invest in service developments and
changes. In addition, a further £3m of existing spending will be re-directed in
line with the priorities set out in this document.
The County Council is also continuing its policy of providing a realistic level of
investment to meet the cost of price increases. For Social Care, this means an
additional sum of £7.6m for care purchasing.
The graphs below are based on actual spend in 2003/04 and show how money
is invested in services at the moment.
Purchased Services for Children & Families
Family Centres
£0.274m
Accommodation
£0.168m
Home Care
£0.203m
Adoption £0.290m
CAMHS £0.294m
Directly Provided Services for Children & Families
Family Placements
£0.015m
Early Years
£0.086m
Other £0.156m
Residence Orders
£0.189m
Direct Payments
£0.063m
Legal Costs
£0.334m
Other £0.733m
Adoption £0.437m
Family Centres
£0.947m
Residential Care
£4.549m
Fostering £4.155m
Respite Care
£0.544m
Residential Care
£2.877m
Leaving Care
£1.397m
Fostering £1.908m
55.3% (£10.843m) of gross spend on services to children &
44.7% (£8.776m) of gross spend on services for children & families
Purchased Services for People With Physical or Sensory
Disabilities
Directly Provided Services for People With Physical Or Sensory
Disabilities
Other £0.064m
Transport £0.438m
Supported Housing
£1.112m
Direct Payments
£0.530m
Day Care £1.509m
Home Care
£0.504m
Equipment £1.581m
Residential Homes
£2.556m
Equipment £0.438m
Nursing Homes
£1.993m
Day Care £1.359m
Home Care
£1.713m
16.8% (£2.301m) of gross spend on people with physical or sensory disabilities
83.2% (£11.420m) of gross spend on people with physical or sensory disabilities
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Directly Provided Services for People With Learning Disabilities
Purchased Services for People With Learning Disabilities
Direct Payments
£0.144m
Supported Housing
£2.409m
Home Care
£0.636m
Transport £0.098m
Supported Housing
£2.185m
Home Care
£0.072m
Day Services
£1.698m
Residential Homes
£3.250m
Nursing Homes
£1.114m
Residential Homes
£13.342m
Day Services
£7.225m
39.6% (£12.733m) of gross spend on people with learning disabilities
60.4% (£19.440m) of gross spend on people with learning disabilities
Purchased Services for People with Mental Health Problems
Directly Provided Services for People with Mental Health
Problems
Supported Housing
£0.309m
Other £0.944m
Residential Homes
£2.673m
Supported Housing
£1.187m
Employment
Services £0.338m
Carers £0.109m
Day Services
£0.209m
Day Services
£0.841m
Residential Homes
£0.861m
Advocacy £0.157m
Transport £0.038m
18% (£1.38m) of gross spend on people with mental health
82% (£6.286m) of gross spend on people with mental health problems
Purchased Services for Older People
Directly Provided Services for Older People
Day Care £1.735m
Very Sheltered
Housing £3.404m
Other £0.773m
Direct Payments
£0.251m
Equipment £0.117m
Home Care
£9.363m
Transport £0.954m
Day Care £1.536m
Community Meals
£1.342m
Residential Homes
£24.413m
Residential Homes
£15.201m
Nursing Homes
£15.393m
Home Care
£12.256m
33.4% (£28.992m) of gross spend on older people
66.6% (£57.746m) of gross spend on older people
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The prospects for investment from 2004 for the medium term are difficult to
predict.
The Government has already indicated that public spending cannot be allowed
to grow as quickly in the early years of the next Parliament as it has done since
1999. Public spending will rise by an average of 2.7% in real terms in
2006/2007 and 2007/2008, which is very much less than the average annual
4.1% increase between 1999 and 2005/2006.
In addition, there is strong pressure nationally, not least from the Government
with its new capping regime, to keep down the rate of increase in Council Tax.
This will require us to constantly review our existing levels of investment to
ensure that they are targeted effectively and represent the best value for the
people of Suffolk.
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9.
CONTRACTING ARRANGEMENTS
This section outlines the approach of the Care Procurement Service and how it
will support the commissioning arrangements.
The objectives for care contracting are:

To make sure that services purchased and provided, on behalf of the
people of Suffolk, will be fit for purpose, lawful and meet quality and
performance standards of the council.

To assist in the development services throughout Suffolk that meet
localised needs respond to diversity.

To modernise care purchasing processes for Suffolk in line with the current
social care modernisation programme.

Support the take up of Direct Payments across services.
The principles that underpin contracting care services in Suffolk are:
Safety for and of the customer (Fair to the Provider)
The contracting process assists the provider to deliver a service that meets
agreed services standards, and addresses individual need.
Fairness and consistency (Fair to the Customer and Fair to the Provider)
The contracting process will be open and transparent, and will provide
information to customers and providers, that improves understanding and
service delivery.
Financial responsibility (Fair to the taxpayer and Fair to the Provider)
When awarding a contract the provider will be measured against the principles
of “best value”, securing effective and efficient services within the limits of
available resources. Fairness and understanding with regard to the price of
care will be applied.
Planning (Fair to the Council and Commissioners)
All contracted services will take account of local, countywide and national
trends assisting providers to meet the current and future needs of people who
live in Suffolk in an equitable way that takes account of county wide fair
access.
Quality and veracity (fair to the Customer)
Contracted services will have clearly stated and measurable performance
indicators to assist the provider towards continual improvement and maintain
the integrity of purchased services.
Legal and commercial implications complied with (fair to the council, to
commissioners and to providers)
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All legal, commercial and planning aspects of providing services are
safeguarded.
Our contracting strategy is to:










Reduce dependency on spot purchasing where this adds value to the
service and meets contract principles.
Maintain flexibility to support the uptake of Direct Payments.
Introduce different types of contracts as appropriate, including block
contracts, volume/cost contracts and preferred provider, amongst others.
Apply an improved accreditation process to all services, to ensure any
services used meet basic requirements of law, safety and quality.
Incentivise providers appropriately making sure capacity is maintained at an
acceptable level.
Collate and maintain information that leads to an understanding of the
quality of the service being provided. Use this information to assist
providers to improve the quality of services.
Move to Service Level agreements with all in-house services.
Increase the understanding of providers of tendering and use the tendering
process where this is a legal obligation and adds value to the outcome of
the service required.
Establish agreements with voluntary and not for profit providers that are
consistent with independent sector contracts.
Encourage partnership arrangements with medium and large providers.
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