NHS Fully Funded Continuing Healthcare (CHC) in the East Midlands – Any Willing Provider (AWP)

It remains our contention that CHC commissioning in this area is fundamentally flawed if takes account only of price and not 'actual cost' issues and if it gives no account of impact (on service users and on the provider market) which may be subject to scrutiny. 'Evidence-based' commissioning requires peer review and public scrutiny processes which we think are absent here. The current model of commissioning is going in the opposite direction to policy on care, which is towards personalised and 'bespoke' care. We are also very concerned as to the role played by a monopsony (dominant purchaser) in relation to competition policy, market development and quality.

We also think there is a better way of engaging in dialogue with the provider sector to ensure best use of a limited public purse and to deliver a fair price, a viable care market, and quality personal care for society's most vulnerable than has so far been shown.

Mandate

At the joint Association meeting in February the Nottingham, Derbyshire and Lincolnshire . Associations were mandated by the meeting: This was reconfirmed at the NCA`s AGM on 10th May:

Members consider the AWP process not to be fair and equitable in meeting resident needs and providing a realistic and justifiable fee.  They recommend all homes not to take up the AWP offer but to continue to offer their normal quality service under existing contracts.  They further mandate the executives of the Nottingham, Derbyshire and Lincolnshire Care Associations to negotiate with the PCTs on their behalf to engage with the PCTs to develop a structure that fairly meets the needs of residents, staff and businesses.

The key features of any future arrangements must  take into account

—  D o H contract

—  The new Service specifications

—  Laing & Buisson report fees as basis, plus additional cost

—  A professional costing tool, e.g. the ARC model to assess and cost resident needs on a case by case basis.

—  If contracts are more than 1 year an inflation linking mechanism.

If you have signed up and wish to reconsider - it is still possible to withdraw by writing to the PCT.  The more homes that reject the offer the stronger the message. The PCTs will still need to place new residents even if no agrees. We stress that ultimately each company needs to make its own decision.

 

Independent Report on Fair Pricing

 The Laing & Buisson  “East Midlands Fair Price for Care” report we commissioned in October 2010, indicated that a fair price was around £528.00 per week for residential care and £688.00 per week for nursing care for the most efficient of providers in large corporate 50 bedded homes, not necessarily the typifying the homes in the East Midlands that tend to be smaller and provide more care hours per resident. The additional costing involved in Continuing Healthcare such as additional staff time, equipment and lower occupancy will increase these figures. The costs were also based on a 50 bedded corporate home and not the typical smaller home found in the East Midlands. The PCT have not adequately explained how it can justify imposing fees below these levels.

Copies of the L & B report and correspondence between the PCTs and our solicitors are available from the secretary, contact details are below or on our web site

 

Latest news - July 2011

 Sadly the implementation of AWP/AQP in Derbyshire has given rise to a number of distressing cases where prospective residents being refused a reasonable choice of nursing home.  

The NHS Co-operation and Competition Panel (CCP) has agreed to look at the complaint from all care homes in Nottinghamshire, Lincolnshire and Derbyshire regarding the implementation of AWP/AQP in the East Midlands.  This is good news. 

·         In light of this, and the complaints from individuals, our solicitor has asked the PCTs through the EMPACT,  SHA and CCP to put the current implementation on hold.

Care providers have said that “we cannot offer a care package on the basis of cost alone.  The risks to the client and to the sustainability and reputation of our company will not allow us to make such a decision.”

A letter  has been sent to all Nottinghamshire and Derbyshire MPs and Councillors.