Continuing Health Care

 

Fully Funded Continuing Health Care in the North-West
February 2012
 
 
To All Providers of CHC in Lancashire
 
You will have received a letter, recently, beginning "Dear Provider, North West procurement for the provision of social, personal & nursing care services for adults in a residential setting..." on behalf of NW NHS Commissioners, from the Procurement & Commercial Lead, Continuing Healthcare NW Programme. You will have tendered and either put in at the threshold fee for your area or you will have put yourselves forward as being willing to continue to provide at the rate you think economic for your business and, if above the threshold, you will he on a 'reserve' list rather than a 'preferred' list.
 
LCA wishes to reiterate its considered position. LCA's position is as it was before we took the matter to the Cooperation and Competition Panel in 2011. LCA's aim is to help you to take control of your business and not have its viability determined for you. Think about your legal obligations to deliver the care assessed, your obligations as a business to operate viably and the fiduciary duty as a director. You should be aware of your costs, make reference to some established benchmark (we think that it is possible to set a baseline for CHC with reference to Laing and Buisson's Fair Price for nursing care). Understand that the courts recognise that you need to receive a fair return (on capital and your business operations) and there are references to this in the Fair Price model. All businesses (private and charitable) need to make a profit on their operation else they cannot develop.
 
These are our key points for providers to be aware of........Click here to read more.

 

 

JUNE 2011

Continuing Health Care procurement in the North-West. June update.
 
 
We received replies from the North West Continuing Care Agency (as was) and the North West PCTs on our Brunswicks LLP letter challenging the process and costings in relation to the CHC tender. We felt it would take the matter forward if we opened up discussions on key issues through an appeal to the NHS North-West. They gave us leave to appeal to the Cooperation and Competition Panel which we duly did. On 3rd June they 'accepted' our submission and are now looking into the matter in detail. Our submission can be found on their webite: www.ccpanel.org.uk  and follow the 'cases' tab to see our report. This is a completely open process and any provider can write in to the CCP with their views and we would encourage you to do so, whatever your view: info@ccpanel.gsi.gov.uk with the heading "North Lancashire Conduct Complaint"
 
LCA's view remains thus: that CHC rates (as indicated in the North-West CHC fees 'map', ranging from £446.70 to £590 across the region) are below rates judged as adequate for nursing care, using independent costings models (e.g., Laing and Buisson 'Fair Price' model), and are unviable given the extra levels of care and staff input needed by patients in need of fully funded continuing health care. The hidden nature of the process whereby 'threshold' rates have been set, the explicit rejection of 'actual cost' concerns from taking account of information from established costings models, the absence of any apparent impact assessment (on services users or providers or the provider market) are each, we argue, critical flaws in this fundamentally flawed process.
 
LCA, with colleague associations across the North-West, are keen to initiate a real and meaningful dialogue with the NWCCA. Discussions with NW associations about the best way of organising a constructive and effective provider voice continue. We'll keep you in touch if progress is made with this and through the Cooperation and Competition Panel's scrutiny.
 
We also think CQC should have a view on this sort or process and will follow this line of enquiry through.
 
Those who commission care and providers who deliver it in the context of a highly-regulated sector in a diverse marketplace should be able to work together. The shared aim is to ensure best use of public resources on the one hand and the best care possible for vulnerable adults on the other. There are better ways to establish an effective approach to this common task than what's happening now.
 
Provider note: 
It is not LCA's position to tell businesses what to do. It is in our remit to advise that tendering at an unviable rate (by using the published rates as a benchmark) is inadvisable and potentially damaging to your business, the viability of the provider market and to the care of the vulnerable adults you look after. We suggest you submit what you think is a genuine and true cost level for what you deliver. Reference may be made to the work by Laing and Buisson which in 2008 suggested a £589-665 range for nursing (+ inflation 2008-2011), to which would need to be added the additional fees associated with additional CHC costs. One of the NW PCTs, mid 2010, suggested a FFCHC floor price of £650 for 80% of 'cases', £850 for 10%, and £1500 for 10%). Costs can exceed this top level in specific circumstances. The 'banding' process was by needs assessment. This approach seems to involve some sensible principles which could inform the current process.
 
The general direction, though, in the age of personalised care, is towards personalised, bespoke, costings. It is as possible to produce an individual 'fair price' as a general one for a service area. The detail should and could be worked on with the NWCCA/ PCTs and provider associations individually or in a North-West consortium. 
 
Let common sense prevail: an informed approach with real commitment to partnership and a shared endeavour.
 
Queries: paul.simic@lancashirecare.org.uk

 

 

 

 

Updated: 16th February 2012