Cumbria County Council has developed a capacity planning tool to help implement the commissioning strategy for older people. The capacity plan outlines how the Adult Services Directorate will take forward service capacity developments over the next 5 years and the shifts in patterns of care needed to achieve the commissioning intentions.
The tool is a simple spreadsheet which applies demographic trend data to model the pattern of care provided to older people across age groups and service-type over a ten year period i.e. home care, extra care housing, nursing and residential care, and direct payments. It provides a snapshot of which people are receiving which services and applies commissioning intentions to demonstrate what the market should look like in five or ten years’ time. It also allows calculations to be made, such as the number of residential care beds required or the extra number of home care hours needed to achieve the required shift.
The plan provides information to the authority and providers as to the changes in patterns of care needed in order for the commissioning strategy to be successful: Cumbria County Council Commissioning Plan Update 2005/06.
What prompted the organisation to develop this approach?
Work began in 2001, with the aim of informing providers and partners about the authority’s plans to take forward its commissioning strategy for older people. The decision to develop this approach was in direct response to the following:
- Best Value Review of commissioning strategy for services for older people. The outcome of this review was an agreed strategic intention to promote independence for older people and to meet the challenges of demographic growth by changing the nature of services commissioned in the future. At the core of this strategy was the intention to grow home and nursing home care in line with demographic growth, whilst maintaining residential care at current levels and accommodating demographic growth that would have occurred for people going into residential care by extra care housing or home care.
- The launch, in October 2001, of the government initiative ‘Building Capacity and Partnerships in Care’, which required councils to build partnerships with health care organisations, housing providers, the independent sector and voluntary groups in order to deliver better services to older people. Cumbria used the requirements outlined in this initiative to signal to providers how their commissioning strategy was to be taken forward.
What has the work involved?
- A county-wide task group representing providers from the health, voluntary, social care and housing sectors was established to get the project off the ground. Two managers were seconded for 3 months to work on the project and external consultants helped develop the spreadsheet modelling tool.
- Once the project was established, a network of joint management teams was set up for each of the county’s six districts to develop local capacity plans, allowing each locality to consider appropriate service development and corresponding action plans.
- A county-wide capacity plan was developed as well as six locality capacity plans. An example of the capacity plan for one locality is Furness Community Capacity Plan.
- Locality provider forums were also developed to enable full engagement with social care providers.
- All plans are updated every six months to plot the changing pattern of care and explore the progress made towards desired provision. This way, the question as to whether the market was changing and commissioning intentions were being achieved could be answered.
How have things changed for the better?
- Capacity planning has provided an effective market management tool and helped the authority to have a better understanding of the market and ability to model financial impacts.
- It has increased confidence in the authority’s knowledge of the market by County Council members and providers.
- Improved ability to share understanding and intelligence about the market with providers and colleagues in each locality and across the county. By engaging providers in the planning process, they are more prepared for the challenges which lie ahead in terms of their current pattern of provision and, as such, have time to make appropriate changes.
- Improved ability to monitor the way in which the market is responding to the authority.
- Better understanding of those areas which haven’t shifted as intended, which then feeds back into, and informs, the commissioning strategy.
- Improved ability to shape and influence the market both at county and local level. For example, the local Furness Community Capacity Plan, together with analysis of ‘delayed transfers of care’, indicated the need to build a new nursing home to meet demand. The capacity plan, which illustrated commissioners’ understanding of the current shortfall in provision and foresight into growing demand, was used by the nursing home provider to obtain capital funding for a new home.
What have been the major challenges/drawbacks?
- Weak linkages with housing in terms of the overall strategy.
- The struggle to maintain the model once it was devolved to local teams/managers. As a result, plans were not being updated every six months as intended. In response to this problem, the authority is in the process of updating the tool/process which is to be managed at county level to make sure the six monthly update becomes a routine activity at all levels. In addition, a county-wide manager has been given overall responsibility for service development.
- The modelling tool is just one means of managing and shaping the market and does not in itself improve performance. People still need to focus their attention on improving performance. It’s what people decide to do with the information that makes the difference.
What lessons have been learnt?
- The need for a county-wide approach and monitoring arrangements.
- The importance of complementing the tool with robust action plans. The tool doesn’t replace the real work needed to influence the market.
- The importance of understanding workforce implications in implementing commissioning intentions. To support more people at home, for example, introduces clear workforce capacity issues. Capacity planning highlights such workforce implications.
How might the work affect commissioning in the longer-term?
- The same approach is now being developed to model lower level provision for the prevention/promoting health and wellbeing agenda.
- The model will be developed to respond to ‘Total Transformation’ challenges as increasing numbers of older people are offered individual budgets.
- It will help us to engage with the Primary Care Trust at a strategic level and emerging Practice-based Commissioners at a locality level – so that people can have informed, evidence-based discussions.
Contact
For more information about this case study please contact Nick Smith, County Manager (Older Adults Service Development), Cumbria County Council This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
May 2007
