NHS Wales Shared Services Partnership (NWSSP) in collaboration with the National Collaborative Commissioning Unit (NCCU) work together on a number of National Mental Health and Learning Disabilities Framework Agreements, in both hospital and care homes settings, and includes the provision of services for adults and children.
As part of the procurement process, implementation and contract management of these agreements, further collaborative working is carried out by the two organsiations in conjunction with the Health Boards and Local Authorities within Wales. Partnership working is also extedned to the service providers to assist in building long-term professional relationships with all parties concerned.
NHS Wales Shared Services Partnership (NWSSP) and the National Collaborative Commissioning Unit (NCCU) have been working in a collaborative partnership since 2011 on several mental health and learning disability framework agreements in both hospital and care homes settings for adults and children.
This working relationship between the two organisations has seen collaborative working extended to wider stakeholders such as Health Boards and Local Authorities in Wales, Care Inspectorate Wales, Welsh Government and a forum for care providers – Care Forum Wales. This has been most evident in the development of the National Collaborative Framework Agreement for Care Homes and Nursing Homes for Adults (18+) with Mental Health and Learning Disability conditions.
This Framework Agreement commenced 1 October 2016 and delivered a collaborative project across the 7 Local Health Boards and 22 Local Authorities in Wales who commission services in care and nursing homes for residents with mental health and learning disabilities. The residents of these homes are receiving publicly funded care from non-public sector organisations.
The project received funding via the Welsh Government “Invest to Save” scheme. A key driving force to securing this funding, is the collaborative working relationships between NWSSP Procurement Services and the NCCU as well as the adoption of key policy drivers when delivering this project.
Since the inception of the Framework Agreement, project team members have continued to engage with stakeholders to ensure their ongoing support and commitment to using the agreement. In 2018, following consultation with the market, it became evident that some modifications to the Framework Agreement were necessary. As such, an application to Welsh Government was successful to secure additional funding to assist in hosting provider and commissioner event across Wales, legal advice and additional resource for the project team. NWSSP Procurement Services continued to provide Procurement support, clinical input was maintained by the NCCU and additional resource was brought in by way of financial support to assist in the development of the Framework. The data base through which placements are made – The Commissioning Care Assurance and Performance System (CCAPS) – was also developed.
Engagement events were carried out throughout Wales in which members of the project team invited new and existing framework providers, along with the local commissioners, to attend venues to understand the changes that were being made following their feedback and to give them further opportunity to engage with the project team. This was also a time for providers and commissioners to seek advice on support as to the procurement process involved and to the operational side of the Framework.
The Framework Agreement adopted several modifications by way of a Variation Agreement in October 2019 and NWSSP and NCCU continue to work in collaboration with each other and their stakeholders.
The Framework Agreement is contractually managed by NWSSP Procurement Services and performance managed by colleagues within the NCCU. Whilst Procurement ensure the Framework remains compliant and in line with procurement regulations, clinical colleagues within the Commissioning Unit, carry out site audits within the care homes and monitor reports from care homes providers that are submitted via CCAPS. Throughout the lifetime of the Framework, both organisations continue to work collaboratively with each other and wider stakeholders to maximise the efficiency of the Framework and ensure the benefits are realised. Some examples of this extended collaborative working have been described below.
Local Care Mapping
Local Care Mapping is the review of residents settings using a bespoke ‘Individual Progress Review’ tool designed by the Quality Assurance Improvement Service of the National Collaborative Commissioning Unit.
The NCCU undertook a Local Care Mapping programme to provide assurances to commissioners that the residents they had placed within a residential setting were receiving;
- Care in the right environment to meet their needs
- Care which empowers, enables and involves
- Right level of support to reduce risk, promote independence & improve quality of life
- Safe, effective & high-quality care, with minimal use of restrictive processes
- Outcome focussed interventions by skilled and experienced staff
The production of a ‘local care map’ provides a comprehensive depiction of specific care which has been commissioned by the health board to inform local strategic planning, benchmark against other areas and highlight areas of care requiring action.
The outcome of the care mapping review was that each resident was provided with a recommendation on further action. 90% of placements were able to meet residents needs but half of these were recommended for urgent review to ensure the packages of care as currently commissioned were suitable. This information was fed back to the appropriate health board who would then decide if they were to take up the appropriate recommendations. Each health board received a presentation with their bespoke findings.
Transition of placements
Local commissioners are able to make placements via CCAPS for new residents; however, there is also support available for them to transition off-framework placements over on to the Framework terms and conditions so they can be in receipt of the quality and value adding benefits that come with the Framework Agreement.
Procurement and members of the NCCU have been working with Pembrokeshire County Council for almost 18 months to assist them in their efforts to transition historic care homes placements over on to the Framework terms and conditions. This has involved face to face meetings with both commissioners and provider in order to establish their needs as well as analysing data to understand the financial impact to the local authority as a result of this transition. Due to historical cultural differences between health and social care, this has not been an easy feat; however, through collaborative working and building relationships with the Local Authority this has seen circa 50 residents transferred over the Framework terms.
In addition, similar meetings were held with Monmouthshire County Council and more recently City and County of Swansea Council. A transition team is being set up by the NCCU, which will be supported by procurement when needed, to offer this service to all Health Boards and Local Authorities as and when required.
Care Forum Wales / provider engagement
Over the last 2 years work has been undertaken in collaboration with Care Forum Wales to gain a greater understanding of the care home industry within Wales. This partnership working has been instrumental in developing the framework agreement and gaining more traction from the placing authorities. Since October 2019, members of Care Forum Wales and local commissioners, have sat on a Future Pricing Support Network, chaired by NCCU to establish the future pricing structure for this market within Wales and to further identify ways in which the Framework can be developed to obtain maximum coverage.
Work of this nature is ongoing and further demonstrates the cross functional collaboration element of this project team.
Framework Advisory Board
Members of the project team meet periodically with stakeholders within the Local Health Board Boards and Local Authorities to update them on progress in terms of placements made, new providers joining the Framework, engagement with the market and any price alterations that will have an impact on placements made via the Framework.
The Framework Agreement is reasonably flexible in terms of when it is open to the market to allow for new providers / care homes to be added or if providers wish to reduce their prices to make them more competitive. In terms of price increases, providers will be eligible to apply to increase their prices in April 2021, and annually thereafter. During this process, NWSSP Procurement Services and NCCU colleagues, will undertake an initial pricing analysis to identified where the financial impact lies in order to invite those providers to meet with members of the project team – and those commissioners who are responsible for the placements – to discuss the submission with the provider and see if there is any way of reducing this impact whilst also ensuring they are still sustainable.
This collaborative Framework Agreement is focussed on a joined up, compliant and collaborative approach to ensure the Framework offers high quality care providers at reasonable pricing without compromising the level of care that is received by the residents. NWSSP and NCCU strive to work with their stakeholders to continue to bring out the following benefits of the Framework Agreement;
- Care closer to home by offering more choice of care providers enabling commissioners to match care settings with the residents needs
- Quality is measured and maintained through a Quality Assurance Rating System; commissioners are kept updated should any of the ratings change
- The Framework has provided assurance that the contracting arrangements between commissioners and providers complies with best legal, contractual and procurement requirements
- Financial sustainability – the Framework has provided assurance, using financial viability tests (that each provider is sustainable and a provides a form of financial guarantee when deemed required
- Providers are required to monitor and report on specific outcomes for residents through CCAPS
- Incidents and complaints – there is a direct reporting system that requires each provider to report on safeguarding concerns and serious incidents within 24 hours. This is information is also disclosed to the placing commissioning authority
Finalist : 2020 HCSA Cross Functional Collaboration Award and Highly Commended: 2020 HCSA Cross Functional Collaboration Award
Name: Julia Goddard
Job Title: Senior Category Manager
Organisation: NHS Wales Shared Services Partnership
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