Agenda item

Cabinet Member: Adult Social Care

Forward Plan Ref: 2014/091

Contact: Benedict Leigh, Strategic Commissioner – Adults Tel: (01865) 323577

Report by Director for Adult Social Services (CA10).

Outcomes Based Contracting is an NHS priority as a way of managing spending and activity by making health care providers responsible for delivering outcomes, rather than paying them for activity. The substantial and ongoing pressures on health and social care services, and large activity pressures with acute (hospital) care mean that there needs to be action to manage costs and activity over the medium term.

The total budget going in to outcomes based contracting from Oxfordshire County Council is £11.2m. This is 4.1% of the total of the two pooled budgets (£281m). It is 10% of the total outcomes based contracting budget of £111.6m. £62m (55%) from pooled budgets, the remainder from Oxfordshire Clinical Commissioning Group.

Cabinet is recommended to:

(a)      Support the transition of the NHS to focus on outcomes rather than activities as the right direction for the benefit of the health of people in Oxfordshire; to recognise that the change is essential if the NHS in Oxfordshire is to be able to manage with the resources available and that the NHS managing within the resources is crucial to securing the resources of £8m from the Better Care Fund to protect Adult Social Care services and to secure resources to pay for the costs of the new Care Act.

(b)      delegate authority to negotiate Oxfordshire County Council’s engagement with these two OBC contracts to the Director of  Adult Social Services with certain conditions namely:

(i)       that this is limited to adult social care services for people with mental health problems and reablement and intermediate care services for older people;

(ii)      that there are specific outcome measures for both reablement and intermediate care that relate to our strategy of limiting demand for health and social care;

(iii)     that there is a genuine pooling of resources for mental health; and

(iv)     that the final negotiated position is subject to the prior agreement of the County Solicitor as to compliance with proper procurement requirements.

Cabinet considered a report on Outcomes Based Contracting which is an NHS priority as a way of managing spending and activity by making health care providers responsible for delivering outcomes, rather than paying them for activity. The substantial and ongoing pressures on health and social care services, and large activity pressures with acute (hospital) care mean that there needs to be action to manage costs and activity over the medium term.

Councillor Laura Price, Shadow Cabinet Member for Adult Social Care, recognised that the report set out attractive objectives but commented that it was clear from the report that it involved huge risks. In particular she highlighted the long contracts with providers. She sought assurance that the mix of providers did not exclude small providers. She would like to see information on those affected as soon as possible. Also she queried how dynamic long contracts could be and how easy it would be to switch out providers where necessary. An additional concern was around governance and performance indicators.

Councillor Judith Heathcoat, Cabinet Member for Adult Social Care, responded to the comments made noting that it was a challenging process. She heard the concerns and the length of contracts would be reviewed as part of the process. She added that as far as governance was concerned the meetings of the Older Peoples Joint Management Group were open to the public.

Councillor Heathcoat proposed the recommendations commenting that it was a priority for the NHS and allowed best use of pooled budgets by supporting groups of providers and focussing on outcomes for clients. She acknowledged that there were risks but noted that she and the Shadow Cabinet Member were kept fully briefed. Monitoring would be very careful with regular reports to the Older Peoples Joint Management Group. John Jackson referred to the links to the Better Care Fund report later on the agenda and commented that whilst there were risks it was important also to see the benefits.

RESOLVED:      to:

 (a)     Support the transition of the NHS to focus on outcomes rather than activities as the right direction for the benefit of the health of people in Oxfordshire; to recognise that the change is essential if the NHS in Oxfordshire is to be able to manage with the resources available and that the NHS managing within the resources is crucial to securing the resources of £8m from the Better Care Fund to protect Adult Social Care services and to secure resources to pay for the costs of the new Care Act.

(b)      Delegate authority to negotiate Oxfordshire County Council’s engagement with these two OBC contracts to the Director of Adult Social Services with certain conditions namely:

(i)       That this is limited to adult social care services for people with mental health problems and reablement and intermediate care services for older people;

(ii)      That there are specific outcome measures for both reablement and intermediate care that relate to our strategy of limiting demand for health and social care;

(iii)      That there is a genuine pooling of resources for mental health; and

(iv)     That the final negotiated position is subject to the prior agreement of the County Solicitor as to compliance with proper procurement requirements.