Department of Health. Developing Care Markets for Quality and Choice Programme. What is Market Facilitation?

Transcription

1 Department of Health Developing Care Markets for Quality and Choice Programme What is Market Facilitation? September 2012

2 Department of Health Developing Care Markets for Quality and Choice Programme What is Market Facilitation? 1 Introduction As part of the Draft Care and Support Bill, 1 the Government proposes, for the first time, a duty on the local authority (LA) towards care markets. The Bill states: 1) A local authority must promote the efficient and effective operation in its area of a market in services for meeting care and support needs with a view to ensuring that any person wishing to access services in the market: (a) has a variety of providers to choose from; (b) has a variety of high quality services to choose from; (c) has sufficient information to make an informed decision about how to meet the needs in question. (2) In exercising that duty, a local authority must have regard to the following matters in particular (a) the need to ensure that the authority has, and makes available, information about the providers of services for meeting care and support needs and the types of services they provide; (b) the need to ensure that it is aware of current and likely future demand for such services and to consider how providers might meet that demand; (c) the importance of ensuring the sustainability of the market (in circumstances where it is operating effectively as well as in circumstances where it is not); (d) the importance of fostering continuous improvement in the quality of such services and the efficiency and effectiveness with which such services are provided and of encouraging innovation in their provision. One of the ways an LA can be supported to meet this duty is through the Developing Care Markets for Quality and Choice programme. The programme aims to develop the market facilitation capability of all LA s with social care responsibilities, building on their current skills and expertise. 1 IPC Market Analysis Centre, Department of Health, ADASS dcmqc@brookes.ac.uk

3 This paper is one in a series of briefing papers that will be produced during the programme to help in developing the above activities. 2 What is market facilitation? Market facilitation can briefly be defined as follows 2 : Based on a good understanding of need and demand, market facilitation is the process by which strategic commissioners ensure there is diverse, appropriate and affordable provision available to meet needs and deliver effective outcomes both now and in the future. Within the above definition a number of phrases need unpicking in order to understand what is meant by market facilitation. Definitional task Understanding of need and demand Strategic commissioners Diverse, appropriate and affordable Application Local Authorities and their partners will already have access to Joint Strategic Needs Assessments. They may also have a number of other documents that can be pulled together to give a view of demand. More advanced public care bodies will have good quality consumer research identifying consumer preferences. However, the task is more than a simple matching of demographics to existing populations. Understanding demand is also about understanding what approaches work best, with whom and when? Where might interventions best be targeted? What situations might deteriorate leading to poor outcomes for the individual and high, potentially avoidable, costs for public care? How does strategic commissioners understanding of demand tie in with that of actual and potential users of care services? In the past this would probably have meant the commissioning and contracting functions in social care. This now needs to be seen somewhat wider and should involve health commissioners as well as encompassing those involved in housing, planning and community development. There is clearly a balance to be struck here: Diverse may mean a choice of providers or a choice of different services from one provider. It certainly 2 Some of the concepts explored in this and other DCMQC papers have been derived from earlier work with the National Market Development Forum (NMDF). The NMDF is a work stream of the Think Local, Think Personal Partnership, IPC Market Analysis Centre, Department of Health, ADASS dcmqc@brookes.ac.uk

4 Definitional task provision Deliver effective outcomes Now and in the future Application does not mean a market where there are many providers all offering the same service. Appropriate may have a wide range of interpretations, eg, a predominately older person s rehabilitation service may not be appropriate for a young physically disabled adult, a meals service that fails to offer a choice of menus may not be acceptable on the grounds of an individual s faith. Obviously, affordable is not at any price but equally does not always mean the lowest price, whether the purchaser is a local authority or an individual buying independently, or through a direct payment. The word outcomes is increasingly entering the lexicon of public care from both central and local government. However, there is a difference between simply stating a set of outcomes that are desired, as compared to paying for that service by the achievement of those outcomes. An example may be where the purchase of home care moves from purchasing by cost and volume to one where the purchase is based around a set of rehabilitative or reablement goals. Market facilitation needs to combine both short and long term strategic approaches. Of immediate concern will be day to day issues over supply and demand. However, as most providers state, the key to a successful market is about consistency of demand and price. Investment requires predictability about how the market will behave and longevity if new ideas are to mature and develop. Therefore, in order to ensure that there is diverse, appropriate and affordable provision available to meet needs and deliver effective outcomes both now and in the future, means the local authority should develop a strategic approach to their understanding of their local market. The activities in which a local authority engages, in order to achieve this can broadly be described under three headings, as Fig 1 illustrates. IPC Market Analysis Centre, Department of Health, ADASS dcmqc@brookes.ac.uk

5 Fig 1 Three dimensions of facilitating the social care market Market intelligence involves ensuring that the LA is well informed about the market, understands the factors that influence demand and supply and has a clear vision of what good quality care looks like and the outcomes that it will achieve. For example, in understanding the learning disability market you would want to look across all purchasers at who provides what, where, to whom and at what price? However, you might also need to answer some of the following questions: What does quality look like? How sustainable are the care businesses that serve the local area? Is there sufficient diversity and flexibility of services to meet local need or is the market dependent on very few providers, where the service is delivered at the provider s convenience rather than that of the consumer? What are the deficiencies in current provision? What do consumer surveys tell us about the future shape of provision? The social care market has close interaction and interdependencies with the markets for health, housing, transport and leisure and can have a significant impact on local economies. Therefore, a full understanding of the market should involve working with other public care commissioners. It may also include consideration of out of area commissioning and emergency commissioning approaches. There also needs to be strong elements of co-production in market intelligence. The information available should be of benefit to the market, which means knowing what the market needs (that is why a Market Position Statement is a market facing document), plus the sector also holds data which may be of benefit when shared with others. Strategic commissioners also need to give thought to which elements of market intelligence they have captured, might be of benefit to actual, or potential, consumers of care as well as helping to improve transparency. IPC Market Analysis Centre, Department of Health, ADASS dcmqc@brookes.ac.uk

6 Finally, the LA then needs to use the intelligence it has gained to be able to portray where the market in social care is now, what it should look like at a fixed point in the future and how the LA might influence the market through the structures it begins to put in place. Market structuring means making explicit to the sector how the LA intends to perform and behave in influencing the market. For example, an activity that works with providers to change the shape of purchasing from cost and volume to outcomes, would be market structuring activity. The actual contract would be a market intervention. As for market intelligence this may involve work with other key stakeholders such as health, housing and planning. Other examples of market structuring could involve working with planning to produce guidance that reflects long term demand for care homes and supported housing in the context of older people or learning disability. It may mean; identifying and removing barriers to market entry faced by specific providers, developing channels to pull in ideas from providers of new models of care, or piloting innovative approaches. Strategic commissioners also need to understand, and take into account the impact their decisions may have on the overall market. From the LA s perspective market structuring may also entail considering how staff skills need to change, eg, the skills that former contracting officers required may not be the same skill set as those needed to be effective in capturing and using market intelligence. If market intelligence is the thinking and planning stage then market structuring is when the LA works with the market to put the relevant pieces into place to deliver the kind of market that is required. Finally Market intervention brings the results of the intelligence activity and the market structuring together into a potential number of intervention activities. As the title suggests the plans and structures are in place, this where sometimes intervention from the LA may be required in order to deliver the kind of market that consumers of care need and want. For example; this may include; stimulating particular parts of the market with financial incentives, offering specialist training, support to providers with business planning, working with providers and consumers in order to deliver good quality information, creating vehicles for consumer feedback on service provision setting up not for profit ventures. Institute of Public Care Market Analysis Centre IPC Market Analysis Centre, Department of Health, ADASS dcmqc@brookes.ac.uk