­Commissioning Supported Living Care and Support for individuals in Shropshire by Michelle Davies Service Manager, Commissioning and Governance, Shropshire Council Adult Social Care.                                           

Firstly, on behalf of Shropshire Council we would like to thank you for you for continued support and contributions during these challenging times. We look forward to brighter times ahead.

At Shropshire Council we want to make sure we are providing the best possible care and support for individuals using our services. We have been carefully considering how we can best meet the increased demand for our services and changing needs of individuals we support. As a result of this review we have put some changes in place that will enable us to provide a wider range and better quality of services in future.

We have summarised the changes and the process involved in establishing our new Flexible Contracting Arrange (FCA) and how we purchase care support going forward below.

A new Provider Framework- Why?

Shropshire Council previously had a framework of care providers that they used when there were setting up new supported living services for individuals.  We used this framework to purchase the care and support for adults with a Learning Disability or Autism, who were going to be moving into supported living.

On this framework we only had 7 providers and we found that as we were offering supported living to more individuals, particularly young adults who were just turning 18, these providers where not always able to pick up new work as they did not have the capacity, or sometimes, the experience, to support some of those with more complex needs. This may include someone who may sometimes do things that are challenging and put themselves or others around them at risk, known as Behaviours of Concern. However, this might also be someone who has complex physical health needs or specific communication needs or may not be able to live with others and need constant support and supervision to keep them safe. We also did not have any providers who could support individuals who had Mental Health needs.

Last October (2020) this framework was due to expire, and Shropshire Council needed to look at how we could do things differently so that we had a larger selection of providers to address the above issues.

The key thing for us was to make sure that we have the right care and support providers to give the best possible care and support to individuals that need it and that the providers work alongside them and their support network to ensure they are always providing the right level of care. We also needed to ensure that there was more availability of care and support providers so we make sure individuals could be supported to move into their new home at the right time.

As well as the above we needed to ensure that if there are any changes in someone needs everyone involved can work together to make sure the provider can continue to support the individuals and if they and/or those in their support network (all of the people in their lives who support them, including their families, friends, health and social care workers and any advocates who may be supporting them) acting on their behalf, feel that the support provider needs to change this can be done in the best way possible.

 Doing things collaboratively

We had been working with our colleagues in Telford and Wrekin Council and the Clinical Commissioning Group (CCG) and we realised that this issue was not unique to Shropshire and that they were having the same problems. Therefore, we decided to work together to develop a new opportunity.

We reached out to our external stake holders, including service users, carers, our Parents And Carers Council, our Autism Hubs, Shropshire and Telford Asperger Carers’ Support and Taking Part (advocacy service) and started to work together to undertake a process to completely change how we commission care and support. This is specifically for people of all ages with Learning Disabilities, Mental Health needs and Autism, to improve the quality of the care that the individual will receive and the experience of moving into supported living for them and their support network.

This approach involved redesigning the application process and accreditation questions that we are asking providers when they apply to deliver this support and all those involved helped to fully coproduce a new set of accreditation questions and model answers. We made sure that the questions asked to providers would evidence how they would ensure they delivered high quality care that involve the individuals support networks in their care and support and that they had a good understanding of the variety of needs of someone may have and how to meet these. The questions also enabled us to see how providers would ensure that individuals and their support networks are always fully involved in all aspects of their care and fully supported to made decisions about all aspects of their lives.

What type of care and support can these providers offer?

It was decided that different levels of care and support needed to be determined and that some providers may be very good at supporting someone to manage their daily living tasks, support them to access the community and develop life skills and occupation, but may struggle to support individuals with more complex needs, or  those with a forensic history, so we split the accreditation into 3 levels (described in the table below). In order to be accredited for any of the below care and support, all providers MUST meet the minimum requirements set out under ‘Living Well’.

How does it work?

This new accreditation process is called ‘a flexible contracting arrangement (FCA)’ which enables us to purchase services from providers whom we have quality checked. We can open the accreditation up to new applications every 6 months to ensure we have a continued pool of different providers. The successful care and support providers accredited will be used by both Shropshire, Telford & Wrekin Local Authorities, and the Clinical Commissioning Group (CCG).

Once those who wish to live together and have been matched and the appropriate accommodation has been identified there is a new process for getting the care and support for them. We will ask all involved; the individuals receiving care (where they have capacity) their support networks and professionals, to help evaluate potential providers by writing 2 additional questions that they would like to ask them, to see if they are able to support those requiring care and meet their specific needs. The providers will need to respond to these questions if there are interested in taking on the new service for the individuals as well as provide a quote for the cost of the care. Once the applications come back in those involved in writing the questions will also come together to score the answers to ensure they are happy with the providers who have applied, they will need to mark the answers based on quality and how they feel they will work with them. If a provider passes the questions, then the service will be awarded on the costs quoted by those providers.

Where are we now?

Using the model answers produced by the group, a team of evaluators, including staff from Shropshire Council, Telford and Wrekin Council, Midlands Partner Foundation Trust and advocacy services worked together to evaluate the applications against the model answers.

We completed this piece of work throughout the month of March 2021, we received a total of 39 applications, and we have accredited 13 providers. For Shropshire this is fantastic news as it has increased our pool of providers to work with by 6. From the 1^st Aril 2021 these providers have been able to apply for any new supported living services that are tendered out, provided its fits into the level they have been accredited to.

Using an FCA means that the application process will be open again for new providers in September 2021. We have also given feedback to those providers who were not successful this time so that they can work on these areas and have the opportunity to reapply.

We plan to hold learning events with providers biannually, we welcome as many people as possible to be involved in these events so if you would like to be part of this or have any further questions about the supported living process please do get in touch with me at michelle.davies@shropshire.gov.uk. We really welcome your contributions to ensure the success of this process.

What does this mean for us and the people we support?

• Access to a wider range of providers
• More timely transitions into supported living
• More tailored services to meet individuals’ specific needs to include enabling them to:
• live good quality and meaningful lives
• build on what they can do and what they choose to do
• choose where and with whom they live
• choose their relationships
• be respected for who they are
• aspire to be creative and reach their full potential

Who are the new providers and which level are they accredited for?