FAQs for providers

What is Devon County Council’s understanding of and plan for supported living?

At the heart of our vision is the belief that people should be supported to maximise their independence and remain in their own homes for as long as they choose and are able and that people are cared for in the place they want to be with their family & networks around them. But for people for whom that is not possible (apart for those people who need intensive and integrated nursing support as part of their requirements), people with even the most intensive and complex health and social care needs still should have a range of choices open to them and be supported into service models which continue to maximise their independence and support their continued involvement in existing social networks.

The diagram below illustrates how in pursuing that vision, the County Council is working with social care clients who are living across a whole range of different housing settings. At one end- actually the vast majority of social care clients today – people are living in their own home, and receiving care that ‘comes in through their front door’. At the other end of the spectrum, people that have complex health and social care needs are being offered packages of care that involve ‘on site’ care & support staff, and where managed accommodation has to be part of that offer.

Illustration 1 (above): Devon County Council has a responsibility to use its resources in a way that is fair for all of the people in Devon who require adult social care, and to ensure that best value for Devon County Council is achieved.

In developing the above vision into practical offers of care and support, the County Council is working with a broad range of partners including housing associations, District Borough and City Council housing authorities, independent sector accommodation with care providers, private ‘landlords’, DCC, Devon Partnership Trust, the two NHS Clinical Commissioning Groups and the voluntary  and community sector.

What is the process leading to a Supported Living Contract?

Providers of Supported Living should all be aware of the principles that the Council intends to apply following engagement events started in 2015 and followed by individual contact as well as regular updates via the PEN.

The timetable of planned work by the Supported Living Review was then published in early 2016 via the PEN and updates have been provided bi monthly.

There are a number of steps to these reviews commencing and decisions being made about whether a Supported Living contact will be offered to a provider.

  • The Council will arrange a ‘Launch’ meeting with a provider before any review of clients is due to commence.
  • The ‘launch’ meeting will seek to confirm which buildings are to be reviewed, the priority order in which reviews will occur, consider the level of shared hours likely in each building and identify any need to arrange independent advocacy for individual clients.
  • During the period that the client reviews are taking place, the Council will work closely with the provider to discuss the initial outcomes of the reviews, cost structure that the Council will use, and how to take forward any changes that are going to be needed.
  • After the client reviews are completed, the clients and carers/families will be informed of the outcome and where appropriate a shared hour offer contract signed.

  • There is a follow up of the new arrangements completed 6 – 8 weeks after the completion of client reviews, to monitor the progress for each client under the new arrangement.
  • Should any longer term development plan or other arrangement need to be followed through then this will be completed by your local Social Care Community Team.

What happens if the shared hours financial settlement being offered to a Supported Living provider is felt to be insufficient?

The Council is currently offering what it believes are viable and sustainable interim financial settlements.  These are being negotiated with providers on an individual basis, because they involve detailed confidential financial information about each provider’s cost structure and staffing arrangements.

Should agreement not be reached there is an appeals process the can be followed

A written appeal should be lodged within 7 calendar days of receipt of the draft Property Schedule, sent to supportedliving-mailbox@devon.gov.uk, to include

  • on what grounds the appeal is being made
  • confirming an open book financial check can be conducted
  • any counter proposal

Devon County Council will then consider the appeal within 14 calendar days, further detailed discussions with the Provider are likely to support this process, and then dependant on the outcome a course of action will be taken –

  1. the Schedule may be implemented with any variance in financial settlement to accrue pending agreement dates for completion of agreed actions e.g. open book accounting check.
  2. or the Schedule will be revised to reflect the agreed counter proposal and will then be backdated

 

So what is Devon’s definition of Supported Living?

In Devon Supported Living is where the Council has assessed a group of people living together, as all in need of the shared hours of care and support being provided to everyone there.

Why are you doing this now?

We have not previously established a specific commissioning arrangement for Supported Living, and need to do so now to secure quality and value for money across this area of business.

This has become increasingly relevant as Supported Living alternatives to residential care have become more widespread, and the duties towards safeguarding and Fair and Affordable Care Policies remain key priorities for us.

We propose to establish this commissioning arrangement for Supported Living across all care groups, wherever social care assessments validate the option of a shared on-site service as the best way of meeting needs.

Work will start with learning disability building-based services, because this is where the evidence of need for shared service is already strongest and where the model is most typically used.

When will new Supported Living Contracts start?

Supported Living contracts have already started for provider properties which have been reviewed and a shared hours service is identified as appropriate.

Once engaged and your properties have had all clients reviewed a meeting is held with you to discuss, if appropriate, the shared hours offer at the property.  As agreement is reached on the first property the contract will be sent out, then as each properties reviews progress the relevant contract schedules will be agreed and added as addendums.

How will we know when our organisation is due to be reviewed?

The process begins with Providers supporting people with Learning Disabilities as this is the largest group of clients utilising shared support in Supported Living properties.  Engagement began in 2015 with a resulting programme published early in 2016.

The programme is flexible and can be changed to suit operational needs or issues arising.  Updates to the programme are advised to all Providers through the PEN Newsletter and those directly impacted are contacted directly.

The latest version of the Learning Disability phase of the Supported Living Review programme is provided below:

 

 

How and where is provider engagement happening?

  • Since the summer of 2015 there has been a series of engagements with providers and the PEN regarding the vision and commissioning plan for Supported Living.
  • The Supported Living review process was launched at the end of 2015 and progress reports and updates have been regularly provided through the PEN.
  • As work begins with each provider one to one meetings are held to lay out the strategy for their review with regular progress meetings arranged.
  • The ‘Supported Living’ website. This site includes ‘frequently asked questions’, and other material or links. https://new.devon.gov.uk/providerengagementnetwork/
  • The Supported Living mailbox – can be used to improve the council’s awareness of vacancies, or advise us of changes. Supportedliving-mailbox@devon.gov.uk

Will there be an opportunity to discuss how the new arrangement is working?

There is an existing process that enables you or your staff to raise any issues you see developing and this can be copied to supportedliving-mailbox@devon.gov.uk.

Beyond this there will also be an early review scheduled, within the first 6-8 weeks to assess how the arrangement is working for everyone and is an opportunity for you to raise any concerns.

What are the process steps for carrying out a supported living review on a building?

An initial business meeting with you will determine appropriate properties for review and client arrangements.  Clients will be re-assessed following information gathering and discussion will take place at a progress meeting around a month later to determine whether/the most appropriate Shared Hours offer at a property.

At this time the arrangements to manage the introduction of the Shared Hours offer into the property will also be discussed with the reviewing officer.  At the end of this process you will be given the Interim Supported Living contract to sign.

What happens if there is no shared hours offer in my building?

Where the discussion with the potential Supported Living provider does not identify a shared hours offer, but is simply a shared housing solution, then the Supported Living specification will not be progressed. Payment will then be through the most appropriate contractual arrangement for providing care at home.

What is an Advocates role?

An Advocates role is to support the client with understanding and engaging with the assessment conducted by the Care Manager.  An Advocate will not have a role in negotiation regarding the DCC contract with the Provider.

How do Shared Hours Offer agreements affect clients with Direct Payments?

If all the people at a Supported Living building were in receipt of Direct Payments, the Council would not be commissioning the service, and there would not be the need for any Supported Living contract for the shared hours being delivered there.

However, the provider may still wish to structure their service delivery and costs around the same principles of ‘shared hours’ and ‘one to one hours’ used for commissioned Supported Living. The advantage of them doing that is that they would become better able to avoid situations in which tenancies were offered to people who didn’t have enough money in their personal budget to pay their share of the care and support delivered at the property.

Providers should bear in mind that the client’s choice to take their personal budget as a direct payment, does not mean that the Council becomes able to base a client’s personal budget on the costs of where the client would like to live. A personal budget is based on what the Council believes it to be possible to meet the client’s need with; not the provider’s price for a service that a client might ideally prefer.

If only some of the people at a Supported Living building were in receipt of Direct Payments, the Council would be commissioning a shared hour service for the people that didn’t have direct payments.  The Supported Living contract for the shared hours being delivered there would be based on the assumption that the shared hours were equally split between everyone living there – in exactly the same way as a fully commissioned service. The provider would need to make its own arrangements with clients in receipt of direct payments, with regards to getting paid for each client’s share of the shared hours.

Why do clients with a Direct Payment have to have their funding streams split?

They don’t, and in fact the opposite is true. For clients in Supported Living that are not taking their personal budget as a direct payment, the Council splits their personal budget into two separate client agreements – one for their shared hours, and another for their ‘one to one’ hours.  This is to make the service we are commissioning for that client clearer in terms of what is being purchased.

What happens in a house with out of county clients, and/or private (self funding) clients?

If Devon offers an interim Supported Living contract to a provider, it will always and only be on the basis of the tenant in each lettable room paying an equal share of the shared hours offer our assessments/ reviews have determined are needed by the Devon clients.

Devon may share the details of the SHP agreement with other Local Authorities.

What happens if the shared hours financial settlement being offered to a supported living provider is felt to be insufficient?

The Council is currently offering what it believes are viable and sustainable interim financial settlements. These are being negotiated with providers on an individual basis, because they involve detailed confidential financial information about each provider’s cost structure and staffing arrangements.

Does the Shared Hours Offer cover unregulated as well as CQC regulated support provided?

Yes

Do Shared Hours have to be delivered by CQC registered staff?

It depends upon the needs of the people.  If nobody within the house needs personal care or prompting for personal care then the SHO can be delivered by non CQC regulated companies.  If somebody does need personal care the provider (if unregulated) has to prove that they are able to meet the CQC regulations.

What happens if the client with tenancy does not occupy the room 24/7?

The shared hours offer remains for as long as the tenancy is retained, with no individual hours being paid.

How do I negotiate a Supported Living contract?

We have been conducting workshops and individual discussions since early 2015, and we’ve also written out to providers that have multiple DCC-funded clients in a single building to request basic details to inform us of the potential of any provider as a Supported Living provider. If you have not already been contacted email us at supportedliving-mailbox@devon.gov.uk and we will send you the submission form to complete and return. You will not be able to negotiate SHO outside of this process.

Will inflationary uplift be applied to my Supported Living contract?

Each year the Council makes a statement about how any inflationary uplift it intends to apply to social care contracts will be implemented.  In reaching a decision about inflation, the Council considers a wide range of factors, including any circumstances that may be unique to the different sectors operating across the Social Care market.

What notice will be given to the providers and the clients of changes to service under the interim Supported Living contract

We are running Care Act compliant reviews with advocates (either family or independent) to support clients through this process.  Each individual’s assessment is sent out in drat to clients and advocated (either family or independent) in preparation for Care Planning.

The provider progress meeting [held around 3 – 5 weeks from the initial client review at the property] will use this information to discuss the Shared Hours Service proposal, where appropriate, normally implementation is around 8 weeks from the start of reviews at the property but this may be flexed in some circumstances.

 

 

How do we advise you of vacancies?

To provide DCC with information on vacancies please use supportedliving-mailbox@devon.gov.uk

How will vacancies be advertised?

There has been work completed with our systems that enable staff commissioning Supported Living placements access to this information. The properties where Void payments apply will also be flagged to these staff.

It is important that you continue to advise DCC of vacancies at a property whilst there is no interim Supported Living contract in place using supportedliving-mailbox@devon.gov.uk [Many send in updates monthly].

Can a vacant room that we are invoicing for a Void payment under the Agreement be used for other purposes e.g. Respite?

No.

What if the Provider decides to use a room for other purposes?

You may raise a request to reduce the number of places commissioned under the Shared Hours contract and DCC will enter into discussion with you. Email the supportedliving-mailbox@devon.gov.uk.

Will Brokerage continue to contact us in the normal way for placements? How do we respond.

For new placements, in the interim whilst a low number of properties are under contract, Brokerage will refer to the Vacancy register for Supported Living properties and if appropriate ensure inclusion in the tender whilst also meeting client choice directive.

This inevitably means that in this interim period you may be contacted for both properties already under contract, and those not.  The preference in this roll out period is to continue to use the existing process and forms. This process will be kept under review with the Brokers and any changes made will be advised to Providers.

So currently should you choose to respond to a tendered service need then the response should identify that you are a Supported Living Provider under the new arrangements.  The outcomes should identify which will be met by the Shared Hours offer [SHO] and which will require additional individual hours [1:1].  The costs should show the cost of Shared Hours Offer and then the cost of individual hours based on the agreed rate under your Contract Schedule.

As someone moves into a property with a Supported Living contract will they be reviewed and changes made to their package?

Any clients seeking Supported Living Accommodation are likely to have already been through a review, should a placement be made then the Care Plan will be updated to reflect the outcomes met by Shared Hours and those met by Individual Hours, to finalise their package and enable agreements to be entered onto our systems.

What happens if the Shared Hours Offer provider does not wish to deliver the one to one regulated hours?

This would be discussed when setting up the Agreement for the property and specific impacts could then be considered.

If I have a property and there is a medical emergency outside of the Shared Hours agreed, or during the individual hours activity, who is responsible?

This is no different to normal situations, if a medical emergency occurs while the 1:1 member of staff is there or the Shared hour’s staff then they are responsible for supporting the person to access medical help.  Otherwise the contingency arrangement made for each individual applies; this can differ person to person, and often includes training for the client by one of the providers in how best to respond.

We have vacancies that have persisted beyond the 90 day period and the Council is therefore no longer paying the shared element hours of these. What is the Council’s response to our concerns that these costs are no longer being covered for us?

The Council is unable to pay the shared hour element on a vacancy beyond the 90 day period. Where a vacancy persist beyond that period, the Council would want to work with the provider to establish why, and would try and help either in finding a new referral, or helping the provider structure their service configuration for sustainability and to best meet local demand.

What if I haven’t already been contacted but I run Supported Living services or I am considering setting up a service?

Email supportedliving-mailbox@devon.gov.uk to tell us and we will contact you to discuss the process. This will be influenced by your position in the implementation schedule and whether you are an existing Supported Living provider.

Can outcome based commissioning be developed as part of this shared hours offer? How does the Council’s Supported Living model fit with Independent Service Funds?

These are approaches being developed under the ‘Living Well at Home’ contracts.  Supported Living providers that are interested will have opportunities to participate in shaping these developments. However, the Supported Living commissioning plan and interim contract is not currently configured as an outcome based commissioning or ISF arrangement, and cannot yet be used in that way.

What happens when the individual hours under the Shared Hours schedule are offered to LW@H prime providers?

Currently LW@H providers are focussed on mobilising non LD services, the further development of the contract for LD services for existing clients will include engagement with all LD service providers. Further information will be updated through the PEN newsletter but currently this is anticipated this us unlikely to be ahead of the next financial year i.e. [2018/19].

If you have made changes to my support do you come and see how I am doing?

There will be a review scheduled within the first 3 months to follow up on the new arrangement with you.

Why are 2015/16 Framework rates (2015/16 spot rates if not on the Framework) being used for the Shared Hours element of the new Supported Living Contracts?

The nature of Shared Hours is that people are sharing the support provided in the property, unlike other support services involving travel.  It has therefore been agreed with individual providers that this is a reasonable holding position for the interim contracts pending further discussion during the coming months that will inform the new Supported Living Framework tender.

In adopting this position for shared hours the Council has acknowledged that additional individual hours for each legacy client’s support will be priced at the current (i.e. 2016/17) spot contract rate, or a negotiated rate aligned with that of the majority of the market.

What hourly rate do you use for your Day Care services?

The Council commissions approaching 100% of all services provided from independent sector providers. There are a few in house Day service centres available at a rate of £85 for a full day / £42.50 half day for Learning disabled clients which may be selected by people to use, however many people are encouraged to focus of developing independence through  community based opportunities rather than Day Centres.

Should there be a specific reason for choosing a Day Centre, including DCC Day Centres, then this cost will be part of the persons budget for individual hours.

What if the cost of providing shared hours exceeds what you are willing to pay?

In the short term, where our discussions identify a requirement for a shared hours offer we will negotiate a sustainable solution, which will be kept under review.

In the longer term, if the person does not require the level of shared hours offer within the building we will look, with the person and their family, at the options available to them so that a choice can be made.

What happens if I also provide regulated care to clients in my building?

Where, over and above the shared hours offer, someone has eligible needs that include any element of regulated care we will expect to put that through our new Living Well @ Home contract. As a Supported Living provider you offer services within that contract either as a primary or link provider.

The service user can choose to have a Direct Payment if they want a different solution.

I offer shared hours, how do I negotiate a Supported Living contract?

We have been conducting workshops and individual discussions since early 2015, and we’ve also written out to providers that have multiple DCC-funded clients in a single building to request basic details to inform us of the potential of any provider as a Supported Living provider. If you have not already been contacted email us at supportliving-mailbox@devon.gov.uk and we will send you the submission form to complete and return.

What if I decide to set up a new service?

Email supportedliving-mailbox@devon.gov.uk to tell us and we will contact you to discuss the process. This will be influenced by your position in the implementation schedule and whether you are an existing Supported Living provider.