Block booked beds
Contracts for block booked provision (including respite) can be procured through the dynamic purchasing system agreement. The Council then makes individual placements under the call off contracts with the successful contracted providers.
The Council currently has 353 (October 22) block booked beds active across Staffordshire with care homes.
Although care homes that have a Care Quality Commission rating of “inadequate” may apply and join the DPS they are contractually suspended from accepting new placements until such time that they improve this rating. We will work with care homes to improve provision and quality of care through support from the Care Market Development and Quality Assurance teams. Contractual suspensions are reviewed on a case by case basis accounting for improvements.
Dynamic Purchasing System
Since December 2017, Staffordshire County Council has used a Dynamic Purchasing System (DPS) for the supply of residential and nursing care services. The DPS is an electronic sourcing process through which a wide range of providers can respond to requests for placements.
Services under the arrangement are split into lots. The lots are divided by either residential care or nursing care, each of which is sub-divided into the five care categories. Call off contracts for individual placements are awarded through the DPS as a result of specific invitations to tender being issued and call off process undertaken in line with the terms and conditions of the arrangement.
NHS CHC DPS (ADAM)
The ICB utilizes a dynamic purchasing system for all NHS Continuing Healthcare (CHC) placements for individuals placed in a care home with nursing. The ADAM system was implemented as a brokerage tool in February 2016 for the previously 6 Staffordshire and Stoke-on-Trent CCGs.
The aims and objectives of a DPS enable the following:
- Improved measurement of quality
- Improve personalisation of care and delivery
- Improve speed of placement and discharge times
- Increase supply capacity and competition
- Robust contractual management of the supply chain
- Open framework approach leading to a fair marketplace
CHC Placement Tiered Pricing for Care Homes with nursing
The tiered pricing structure for CHC eligible individual within a Care Home with nursing was implemented on 1st April 2021. The pricing structure is based on three tiers and is supported by a clinical criterion based on the domains within the Decision Support Tool (DST), with a lower and upper limit to enable providers to offer care and maintain competition in the market. Tier allocated is based on an individual’s highest level of need, assessed, and determined by CHC. Placements continue to be brokered via the DPS on an individual basis.
Net to Gross Payments
The Council has implemented a change to all placements to pay providers gross rather than net of client contributions. This change became effective during August 2022 and resulted in providers having greater certainty of income and reduced bureaucracy associated with invoicing residents.
Quality
The County Council’s quality assurance and quality improvement approaches include:
• Support from The Quality Assurance Team, which monitors and supports contracted adult social care services
• Support from the Provider Improvement and Response Team (PIRT), which is a jointly funded team with the County Council and the Clinical Commissioning Groups in Staffordshire. This nurses and officers who work with care homes who require more intensive support to help them to improve
• The Care Market Development Team, which assists adult social care services in Staffordshire with issues such as staff recruitment, training and retention, as well as sharing good practice and examples of innovation, and supports the sector in developing its workforce
The NHS has also provided additional support, including the PIRT team, and also a Care Homes Intensive Support Team (CHIST) provided by Midlands Partnership Foundation Support. The Quality Assurance Team, PIRT and CHIST are all above to facilitate access to other advice and support from within the NHS, such as Infection Prevention and Control, SALT, and other specialisms. Primary and community care services are also linked to every care home in the county.
Although there has been a significant improvement in the quality of care homes in Staffordshire over the last five years, quality remains below the England average, with nursing care homes being the category of care with the greatest percentage of care homes requiring improvement.
Market price
The County Council funds nearly 3,000 care home placements, just over 1,800 in residential homes and over 1,100 in nursing homes. The proportion of beds purchased by the Council does vary by locality and type of care home.
The Office of National Statistics (2021) estimates that in Staffordshire 35% of care home residents are self-funders. The Council commissions around 28% and around 20% of the capacity is vacant. The remaining 17% of placements being placed by Health colleagues or by other Local Authorities.
The price that the Council pays for care home places is set through the purchase of block booked beds and the DPS. Reference rates provide an indication of the price the Council expects to pay. However, there is substantial variation in prices in all lots across the county. The spread of varying fees remains a challenge to the Council with its aim to deliver Staffordshire with a fair and sustainable market.
Since April 2020 there was an increase in the average bed price for older people by 9.3% for Residential and 8.2% for nursing more than the annual inflation award made by the Council. During 2020/21 this increase reduced to 3.7% for residential and 3.9% for nursing.
The average cost of new commissioned placements for older people did drop during 2020/21 for Nursing but in Residential this increase has been gradual since before the pandemic.
Setting the Contracted price
The Council forms the contract price based on the cost submitted by a provider that has been calculated based on the care needs of the resident which is stated in a document known as a Pen Portrait and the residents full social care assessment. A provider should develop this weekly cost based on the support and staffing required to safely meet the individuals care needs. The delivery of the care should be based on the individual care needs and should be staffed as required to safely meet those needs. The delivery of any assessed 1:1 care for ongoing care needs should be considered and costed into the contracted care price and not requested outside of the agreement. The expectation is that most daily tasks on a 1:1 ratio would be managed through core staffing with an expectation additional 1:1 may be required to manage a crisis or a short-term period. Once the contract is agreed, there should be no additional agreement costs outside of the contracted price set for a placement for needs that were stated in the initial assessment and Pen Portrait.