Briefing paper 3: Developing the service provider market to best meet the needs of holders of personal budgets

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1 Briefing paper 3: Developing the service provider market to best meet the needs of holders of Findings from the second round of a three-year longitudinal study in Essex ecdp May 2011 OPM 252B Gray s Inn Road, London WC1X 8XG tel: fax: office@opm.co.uk web:

2 Introduction In 2008 Essex County Council (ECC) commissioned OPM and ecdp to do a longitudinal study of people receiving cash payments for adult social care within Essex. The study provides a unique opportunity to fully understand the experiences of people living with a personal budget over a three-year period, and also to engage with stakeholders from the council and the wider service market who are working to facilitate self-directed support within the local area. The study has two main objectives: 1. To capture the impact of self-managed cash payments on the lives of people who use them, including evidence of how and why impact is being achieved over time 2. To assess the effectiveness of practices and processes being used by ECC and its partners to support the delivery of cash payments, including evidence of how the market is evolving over the study period This is one of a series of briefing papers containing findings from the second annual round of research with service users, frontline practitioners and providers in Essex. These brief papers have been produced to share key findings with audiences involved in personalising social care, including practitioners, managers, commissioners, service providers and policy makers. Other papers in this series include: Briefing paper 1: Positive impacts of cash payments, for service users and their families Briefing paper 2: Understanding demand Briefing paper 4: Attitudes to risk in spending Briefing paper 5: In our own words the impact of cash payments on service users and their families For copies of any of the above or for a copy of the full report, which contains details of our findings, please Sarah Holloway at OPM (sholloway@opm.co.uk) OPM page 1

3 Key points The local market can support positive outcomes for service users by offering tailored, flexible and high quality services. Similarly, there is evidence to suggest that when providers offer service innovations they can actively improve the choice and control available to service users. Some providers are preparing themselves to act in a broader capacity as advisers and brokers to service users, supporting them with ideas, advice and connections to new support and services. The lack of market options can significantly restrict people s ability to exercise choice and control. There is a particular limitation within the market in rural areas. Cash payments and micro commissioners are not sufficient to develop the market on its own. Commissioners can support market development by supporting new entrants into the market, providing some business support services and sustaining the effort in continuing open channels of communication with providers. This should include reassuring them over the future of cash payments. At present, service users tend to rely more on word of mouth to find and spend their cash payments with the best-suited provider. Service user networks and peer support, often supported by innovative online platforms, may help improve the quality of the market more generally, as well as support ongoing market development, by facilitating usergenerated information on provider quality. OPM page 2

4 Overview This briefing paper sets out evidence from our second annual round of research that demonstrates the fundamental importance of the local market in either supporting or limiting positive outcomes for services users who receive. 1 It also sets out some recommended next steps in terms of local market development. It aims to answer the following questions: As a provider: What is my role in supporting positive outcomes for service users on cash payments? What are the ways in which I need to develop my service offer to ensure service users can make the most out of cash payments? As a commissioner: Why is market development an important priority in terms of improving outcomes for service users on cash payments? Where should I focus my efforts in terms of collaborative market development with service providers? How can the local market support positive outcomes for service users? By offering tailored, flexible and high quality services Many service users told us that through their cash payments they were able to access more tailored services from the local provider market, compared with either their previous or imagined experience of council managed services. With cash payments service users have been able to specify to their providers both the timing and routine of their care package and in some cases the individual they wish to receive care from. An example of a highly tailored care service offered by the market is that of the personal assistant (PA). The quotation below shows the value in the local market s offer of one-to-one PA support tailored to an individual s needs and personality. he's still got that independence thanks to the time with the PA. He can talk about his worries with them. They're there for him and he likes that. He enjoys it because they are his own special friends, as it were. (Mother of LD service user) Service users also told us that the flexibility offered by providers is extremely valuable, especially for those who face fluctuating health circumstances. Service users recounted examples of providers going above and beyond what was previously expected of care services, providing additional care at short notice or changing the timetable to accommodate a specific event. For example, when one older service user had to go for a stay in hospital, the carer offered to drive her husband to see her. This offer of ad-hoc support was highly valuable as not only did it remove a great deal of pressure from the daughter who would otherwise have had to drive the father, but it also meant a lot to the service user who was able to keep up her relationship with the carer, whom she both trusted and liked a great deal. 1 The local market is one of a range of factors which are important in supporting positive outcomes. These factors are outlined in the conceptual framework that underpins the study Please see main report. OPM page 3

5 By innovating There is some evidence, although at this stage still limited, that the local market within Essex is innovating to provide new services, ways of delivering services and ways for customers to access services. Crucially, innovations are actively improving the choice and control available to service users. One service user we spoke to gave an example of how providers have got together to make it easy for budget holders to access PAs. Accessing services is not easy, as information on the full range of services and providers, how they differ and whether they will be able to meet a specific person's requirements is often not available. But there is now an innovative new online service, though which subscribers can pay to get access to profiles of a large number of PAs, and a message service through which to contact them. The interviewee remarked that this had made the task of finding PA support an absolute breeze. Providers themselves told us of their intentions to innovate in terms of service specifications. One spoke of plans to offer more niche services that wouldn t normally be included in a care package delivered on behalf of the council, for example, nail cutting and dog-walking. By acting as advisers and brokers Our research suggests that some providers are also preparing themselves to act in a broader capacity as advisers and brokers, supporting their clients with ideas, advice and connections to new support and services, as outlined below. As a provider we can play a role in encouraging greater independence of service users helping to them to lever in the range of resources and support sources that could be available in their communities. It s about adding value to our clients in a more creative way. (Voluntary and community sector (VCS) provider) In the few cases highlighted in our study where this is already happening, for example, where a carer may suggest an additional service, or an adaption that they think would benefit a service user, it is highly valued by service users. This input is particularly useful for service users who have increasingly limited contact with their social care practitioners, traditionally seen as the source of this kind of expertise. How does the market currently limit positive outcomes for service users? As noted above, there is evidence that the market is showing greater awareness of the use of and is beginning to respond to the new requirements of budget holders as opposed to council delivered service users. But there is still much more market development required to enable full choice and control for cash payment recipients. Evidence from our research points to ways in which the current state of the market can act as a barrier to positive outcomes for service users. By offering a limited choice of providers A number of service users explained that they were experiencing problems with their providers (for example, where a carer does not keep to their schedule, or where they offer a rushed or disinterested service) but they have been unable to change provider since there OPM page 4

6 are no others in the area. In such cases, the lack of market options is significantly restricting people s ability to exercise choice and control with their cash payments. This point is well illustrated by the case of a mother of a young service user with learning disabilities. She felt as though providers in her area were now able to turn around to service users and say sorry we can t come today, knowing that families would not be able to respond by taking their custom elsewhere. In her words: So you re almost scared to upset whoever it is you ve got because you know it s going to be difficult finding somebody else. There s not enough agencies around at the moment that really take on board cash payments. (Mother of LD service user) especially in certain areas Service users complained of under-developed market in specific areas, saying that they struggle to find particular services, and as such could not spend their cash payments in the way that they wanted to. Namely, there appears to be unmet demand for: Specialist PA services for young people with autism Cheap handyman services Specialist health care including chiropody and lymphomatic massage Further, there are limitations within the market in rural areas, which limit the choice and control available to some. Recommended next steps for market development So that service users and their families can be confident that they can secure positive outcomes with a cash payment, there is a need for a market that offers a wider choice of providers, types of services and can tailor the services on offer to meet individual requirements. Personalisation does not necessarily mean wholesale replacement of existing services by completely new types of service, although some services may disappear altogether. Rather it will be a mix of personalising existing services (which may still require big cultural and organisational changes for providers) as well as developing new types of tailored services. Our research with providers suggests that many are taking steps to adapt their services and their organisations more broadly to cash payments, with a strong appetite for improvement and innovation among VCS providers in particular. In this final section we outline some of the ways in which market development and improvement can be supported by both providers and commissioners. Although budget holders have a degree of market shaping power through their budget spend choices, this is not sufficient to develop the market on its own. Commissioners and providers need to work together to grow and shape the market in a way that will better meet the needs of the broad population of services users, including the following. Easy access to information on service quality Service users require easily accessible information on the quality of the market s offer to enable them to spend their cash payments with the best-suited provider. OPM page 5

7 At present, service users in Essex tend to rely on word of mouth or trial and error. Within other authorities there are innovative online platforms that help service user networks and peer support to provide user-generated information on provider quality. This may help to improve the quality of the market more generally, and support on-going market development. Supporting new entrants to the market There is a need for new entrants into the market, particularly in the more rural areas and also within the sphere of LD support services. Greater numbers of providers are required to ensure service users can choose a service that gives them good quality at a price that is in line with their support budget. Reassurances over the future of cash payments from the local authority will provide the certainty and security needed to encourage new entrants into these under-developed market areas. Similarly, business support services and easy access to start-up finance are also key to ensuring new entrants are given the chance to join the market. This has been especially successful in enabling the development of micro social enterprises. Payroll services to take the pain out of being self-employed, (as currently in development in Essex) will help individual carers to enter the market, boosting the local market s offer of independent PAs or carers. Ongoing engagement and communication between local authority and market Some providers engaged in this study were keen to emphasise the effort the local authority had put into communication with providers on cash payments. This effort needs to be sustained, since there are still providers who will be either unaware of or else unsure of the changes in the shape of the market. Further, as the local authority continues to learn what works best in terms of managing cash payments, and makes amendments to its systems and processes, open channels of ongoing communication to providers are very important. OPM page 6