These notes can be downloaded as a pdf document HERE
Cornwall Council & KCCG Question and Answer Session re Home Care & Supportive Lifestyle ITT
Held at Crossroads House Care Home on the 6th March 2018 11:00 to 12:30
The meeting consisted of a panel of representatives from Cornwall Council and NHS Kernow and was chaired by Sarah Foster (Deputy Chief Finance Officer at NHS Kernow).
It was noted at the start of the meeting that all Clarification questions would be responded to within 48 hours of this meeting.
Jonathan Price outlined the agenda for the meeting of addressing the themes raised through clarification questions rather than each question individually.
It was also noted that there have been more than double the number of clarification questions than last time (with the Framework), which was seen as a positive.
Karen Hooper highlighted that the ITT was for a Dynamic Purchasing System (DPS) with the option for Providers to join and leave as they please as this is what was requested by Providers. Providers will be able to join the DPS without any commitment to bidding on any packages.
roviders expressed their concerns of having their clients removed that when leaving the DPS system and that this fear is holding Providers to ransom.
Karen stressed that both Council and KCCG want to work with the sector.
The performance is set out in the ITT documents and the commissioners will go into more detail once everything is live.
Karen informed the meeting that the National Minimum Data Set (NMDS) is a requirement for joining the DPS and must be submitted before the contract goes live in June (not necessarily before ITT deadline).
The deadline for submitted the ITT has been extended to 13:00 on Friday 16th March.
Karen also informed the meeting that the Council had signed up to the Ethical Care Charter (ECC) and the Living Wage Foundation (LWF), the latter of which applies to all hours worked, including travel time.
It was noted that the ceiling rates may be different where there is a clinical or financial justification. This would be applied on a case by case basis.
It was also noted that the DPS system is only for new business. For existing business, as assessment will be carried out before that package is added to the DPS. The Council expects to have conversations with Providers regarding their existing business during the 3 week period after the close of the ITT (although there was an acknowledgement later in the meeting that all assessments are unlikely to be completed by the June start date).
Questions were raised regarding how Providers are to be expected to create their business plans without knowing what fees Providers will receive for their existing business. Kieran Topping suggested that Providers use their best assessment of their situation when creating their business plans.
Some providers indicated that they have been entering the fees that they need (in order to remain financially sustainable), rather than fees related to the ceiling rate.
A number of Providers made the point that there had not been any real engagement with the sector on the actual ITT before the ITT was issued. The first time any documents were seen by Providers was when the ITT opened, which left no opportunity for any co-production.
It was also noted that many of the Providers recommendations were ignored;
- Many Providers did not want ECM
- Providers that would still use ECM did not want minute by minute invoicing
- Providers wanted a light touch approach
Sarah Indicated that as the ITT process is currently underway, it would not be possible to comment on the above directly.
A few Providers were not aware of the ITT process until very recently. Kieran confirmed that the Council and KCCG had broadcast the details as widely as possible to ensure that everyone was aware of the ITT.
A question on the purpose of the Business Plan was raised. Gareth Rees outlined that the Council are looking to gather a lot of information so that they can best understand the pressures of Providers and so that financial viability and sustainability can be assessed.
Karen confirmed that not submitting any Business Plan equates to a fail, but that submitting a Business Plan with errors would be acceptable and the Council would subsequently have a discussion with Providers.
Karen also reminded the meeting that Providers who are unsuccessful in joining the DPS will be able to reapply.
It was indicated that some Providers simply could not sign the ITT in its current form and there was a call for the Council to adopt no system for 12 months to trust Providers to run their own businesses properly and service the needs of the clients.
Concerns were raised by some Providers that they were being asked to submit without knowing what they are signing up to. This was not recognised as an issue.
The question was raised whether it would be preferable for Business Plans should show a loss and keep within the proposed ceiling rates and ITT budget constraints or whether real data should be used to show financial viability and sustainability even if this means using rates higher than the proposed ceiling. Kieran reiterated that Providers should use their best assumptions when submitting their Business Plan and that discussions with Providers would take with Providers individually during the 3 week period.
One Provider indicated that they might submit two Business Plans, one using the proposed ceiling rate and one using real data to show the difference and the likely loss some Providers face if the ceiling rate is adhered to. Kieran indicated that he did not think the system would support uploading two Business Plans.
It was questioned by Providers whether the reason for the Business Plan was to gather market intelligence so that rates could be lowered to the absolute minimum.
The night rate was raised as an issue as Providers are being encouraged to increase wages to the LWF rate, yet the night rate is considerably lower. One Provider indicated that this would equate to a loss of £1.75 per hour per member of staff for every night shift worked (or around £5000 per month).
It was questioned whether the night rate could possibly vary depending on clinical need and KCCG confirmed that it could and would be assessed case by case as it is currently.
Karen indicated that an ECM system would allow for greater flexibility for Providers to deliver their packages.
Karen reported that some Providers find ECM very useful, producing valuable information, and that the ECM report will be used to validate Providers invoices and Key Performance Indicators (KPI). Invoices will cover a 4 week period so ECM will capture time over as well as under.
Karen also confirmed that there is not requirement to continue using CM2000, Providers are able to choose their own ECM packages and Karens research suggests that there are some cheap or even free options available. Karen offered to see if she will be able to share her research. Providers research indicates several thousands of pounds of initial layout with ongoing monthly fees of several hundreds of pounds.
The question was asked whether any financial support is available to assist Providers with the costs. There was some confusion over the answer as Jonathan seemed to indicate that there might be before Kieran indicated that there isnt.
One Provider spoke very positively about their experience of using ECM, however they stated that minute by minute invoicing is not wanted. They lost staff when they originally introduced an ECM system and they expect to lose staff again this time.
The issue around Direct Payments not being included in the ITT was raised as some Providers have a significant percentage of their clients using Direct Payments. All staff will need to be paid the LWF rate yet the rates for Direct Payment will not increase to reflect this.
Kieran highlighted that the Price as Usual Policy is currently open for consultation and Providers are urged to provide their feedback. Kieran also suggested that Providers could use the revised rate in the draft Price as Usual Policy, however it was pointed out that this is lower than the current Direct Payment rate.
One Provider reported that some of their Direct Payment clients have recently been reassessed and had their rates reduced.
A question was raised as to whether Community Outreach provision is considered a regulated activity. Vicki Allan indicated that it might not be a CQC regulated activity but that a CQC registration is required for this contract.
The question was asked if there is a minimum number of bidders required to make this contract viable. Kieran confirmed that there was no minimum number and reiterated that they genuinely want to work with Providers.
Some Providers raised concerns about the levels of liability and insurance risks, which are too high for some Providers to accept, on handbacks for example. Karen indicated that the Council would always be reasonable, however Providers were still concerned that the in the eyes of the law, Providers will be at risk once they have signed the contract and offers such as we have a conversation later or we will be reasonable will carry little weight. It is the owners who are legally responsible for their businesses and who have to ensure that their business is not put at unnecessary risk.
Karen reiterated that the process is to apply via the ITT, have a conversation during the 3 week period and then sign the contract.
It was questioned whether the night rate was calculated using the UKHCA model, as many Providers already pay night staff higher than the proposed rate. Gareth indicated that it was expected that back office costs should be recoverable through the day rate. Providers indicated that back office costs such as ECM, training, pensions, holiday, etc is spread across 24 hours and applies to all staff.
One Provider indicated that in order for the Council to gather accurate market intelligence Providers will have to use real data in their Business Plan, ignoring the ceiling rate. Using the ceiling rate and showing a loss will not serve any purpose. Expanding on his earlier comments for Providers to use their best assessment, Kieran conceded that if the only way Providers can make a Business Plan work is to use rates higher than the ceiling rate, they should do so and submit that data.
The question was asked if the DPS terms are negotiable. Karen stated that they were currently not negotiable, but that she hoped that they want an ongoing process.
The point was raised that some Providers have both Home Care services as well as Residential or Nursing homes. This contract will either require Providers to pay staff different wages depending on which areas they work or force Providers to raise wages for Care Home staff without any direct increase in Care Home fees. Kieran directed Providers to the Price as Usual Policy consultation and encouraged people to give their feedback.
Sarah closed the meeting