Care home services for older people

Transcription

1 Care home services for older people Procurement strategy - engagement report September

2 CONTENTS: 1. Introduction Language Survey analysis... 4 a) People living in care homes b) Current contract approach c) Market overview... 7 d) Workforce... 8 e) Opportunity assessment f) Sustainability and risk g) Future purchasing options and monitoring h) Other comments Conclusion / summary Our response

3 1. INTRODUCTION. Scotland Excel has been working with COSLA, Scottish Government and other partners on the reform of adult social care in Scotland, which includes a review of the procurement of care home services for older people. From market research and engagement with stakeholders, Scotland Excel produced a procurement strategy that provides a comprehensive look at the present contract, commissioning and procurement arrangements in Scotland. An invitation to submit responses to a procurement strategy survey was extended through a Prior Information Notice (PIN) and by to Health & Social Care Partnerships, provider and older people representative groups. In total 59 responses were received. The survey consisted of nine key questions. People were free to respond to all or any of the questions. People were also invited to add any additional comments on any aspect of the strategy. The survey largely invited qualitative responses. This report provides an overview of responses capturing the predominant issues, concerns and comments raised across the spectrum of respondents for each question. Scotland Excel would like to extend its appreciation and gratitude to all those who participated in this survey. 2. LANGUAGE This report does not use procurement speak and therefore it is useful to set out the meaning of some of the terms that are used in this report in the diagrams which follow. Term National Care Home Contract Model National rate HSCPs National framework approach Meaning in this report The National Care Home Contract has been used in Scotland since 2008 and sets out terms and conditions of service for care home care. It is used across Scotland when someone enters care home care if the provider is willing to offer service under its terms and conditions. Some providers only wish to offer services under their own private terms and conditions. Refers to the nationally negotiated rate in Scotland which applies to Care Home Care. It applies when a provider agrees to provide services under the national care home contract. Some providers wish to provide services only at their own private rates. Health and Social Care Partnerships have been set up in Scotland to bring together health and social care into one system for the strategic planning and delivery of health and care services. In this report, National Framework simply means a bespoke process by which services are sourced for people who need to use care home care. It is not used to indicate the more formal procurement process set out in procurement legislation. 3

4 3. SURVEY ANALYSIS A) PEOPLE LIVING IN CARE HOMES. Report summary: The majority of people who live in care homes do so for between 1 and 3 years. Nursing care is required by 63% of the older people living long-term in care homes. Dementia, whether medically diagnosed or non-diagnosed, is prevalent in 62% of older people living in care homes. Hospital admissions account for 44% of people entering a care home. In 2015/16, 32% of all delays from hospitals were due to people waiting for either funding or availability in a care home. While two thirds of people in care homes are publicly funded, there are a growing number of people funding their own care. Some providers are now designing care homes exclusively for people who fund their own care and this could have an impact on the local availability of care home places. Under Free Personal and Nursing Care (FPNC) in Scotland, people funding their own care are offered the choice to: make their own contract arrangements and not access FPNC (Option 1); apply for FPNC and make their own contract arrangements (Option 2); or apply for FPNC and come under the NCHC when their funds are exhausted (Option 3). 1) Do you think there is enough choice of care home care for people funded by councils and people funding their own care? A number of respondents elected to restrict their response to yes or no. However, of those who expressed a view, there was a split between those who were based in or near urban areas, who believed that there was sufficient choice which contrasted with those based in rural areas who felt there was insufficient choice. Some people advised that if the urban / rural issue was explored in more detail, this would provide a more realistic picture. Some respondents highlighted that choice was not only related to the number of places available, but also to a two tier system emerging in the market, which leads to sufficient choice only for those who are self-funding. Respondents also highlighted insufficient choice for people with more complex needs, for example people with dementia. Some respondents correlated lack of choice for people with complex needs, to innovation inertia within the sector. It was suggested that this inertia is caused by a number of factors including current contractual limitations, funding models and regulatory restrictions. These factors were also highlighted in relation to the future sustainability of small care home businesses....homes are built in areas where the majority of prospective residents are, thus at times choice can be limited An issue specific to responses from providers was a perceived potential for bias among assessors / care managers towards prioritising in house provision. 4

5 No. of respondents No. of respondents YES NO URBAN V RURAL GREATER CHOICE FOR SELF FUNDERS LACKS INNOVATION 2) Do you have a view on the biggest issues today for people living in care homes? There were a broad range of inter related responses to this question. Some of which people expanded on in other, more relevant sections, for example, recruitment & retention. (This matter, highlighted as one of the biggest issues across the spectrum of respondents, is addressed more fully at question 5, Workforce Issues). Impact on quality of care was raised in relation to a number of factors including, lack of a person-centred approach to service delivery, staff training and insufficient staff skill mix. Complexity of need and increased levels of dependency were linked to many of the factors noted under recruitment. Issues surrounding self-funding residents featured particularly in relation to rate differentials, which providers viewed as a necessary cross subsidy to balance the perceived inadequacy of public funding. Others were concerned at the lack of transparency and different levels of self-funding rates, and the practical implications when funds were exhausted. Isolation for residents, where relatives had difficulty visiting and lack of meaningful interaction through activities was also cited.. should be looked at within a wider context and as part of a continuum of care. Other issues mentioned less frequently included lack of care management, lack of activities (due to environmental constraints), the complexities in choosing a care home and defining nursing care within a care home context. For some respondents, the quality of care being experienced was an issue RECRUITMENT & RETENTION QUALITY OF CARE COMPLEXITY OF NEED / DEPENDENCY SELF FUNDER ISSUES NCHC RATE INSUFFICIENT ISOLATION 5

6 No. of respondents B) CURRENT CONTRACT APPROACH. Report summary: The NCHC is modelled on the recommendations of an Office of Fair Trading Report (2005) into terms and conditions in contracts for people using care home services. Councils/Health and Social Care Partnerships award individual contracts for care homes with providers based on national agreed rates and terms and conditions ensuring that no matter where people live in Scotland there is a rate for Nursing Care and Residential Care against which they are assessed for their contribution. The rates for nursing and residential care have risen by 42% since the national rate was introduced in An annual negotiation between commissioners and providers is held to set the rate for Nursing Care and Residential Care. The Adult Social Care Reform Group chaired by COSLA and comprising key stakeholders has agreed that current arrangements, while broadly helpful, need to change to respond to the new legislative environment and policy direction. 3) Do you think the national care home contract should be varied to cover other types of services and other people, e.g. people with learning or physical disabilities? Most respondents expressed a preference for the inclusion of other groups within the terms of a national care home contract. The main reasons cited was standardisation of terms and conditions and the potential to promote flexible and wider service provision, for example, those under 65 with dementia and young physically disabled. The largest yes response came from providers (17), however, with emphasis that funding models would need to reflect levels of dependency. This was partially echoed by HSCPs (11) who generally saw contract standardisation as the main attraction to reduce bureaucracy. Those who felt that the contract should not cover other groups believed that outcomes were different. In, future, contract conditions needed to emphasise a more personalised approach; aligning with current legislation. Those who expressed uncertainty appreciated the benefits a national contract had brought to care home services, such as simplifying out of area placements, however, also held concerns about such a model having had a negative impact, for example on innovation. Contracting arrangements should not inhibit the support of innovation or development of new models of care. The majority of respondents felt that services needed to be personalised and that there was no one size fits all YES NO FUNDING PERSON CENTRED STANDARDISED TERMS 6

7 No. of respondents C) MARKET OVERVIEW Report summary: There continues to be a higher number of registered places than people living in care homes. While places that the public and voluntary sector offers have been decreasing, the number of places offered by the private sector has been increasing. There is considerable variation in the size and age of care homes. Providers range from single home ownership to large multi care home owning companies with complex company structures. There are 36 providers who operate four or more care homes in Scotland. 4) Do you have any view on the way the market is structured in Scotland? Concern over large providers dominance in the market was evident in responses. This concern emanated from the potential lack of reprovisioning options if one of the larger providers were to close care homes. In any market, overreliance on a small number of providers can introduce risks around sustainability and limit choice, competition, and innovation. There was concern from some respondents that smaller providers find it difficult to operate as they do not benefit from economies of scale. Some held the view that this needed redress through a review of the existing weekly rate. It was also felt that larger scale providers are not sufficiently responsive to local market interests as decisions may be taken in the interest of the wider group. This was linked to the belief that the sector is market driven, with too high a proportion and reliance on private sector provision. There was consensus, across respondents, of the need to develop and / or maintain a more mixed economy, for some, to redress the market imbalance, for others to promote diversity in the market to meet future demand, maximise choice and better align with self-directed support. Others emphasised the need for a focus on innovation, by developing diverse models of care to meet assessed need and individual choice, rather than an emphasis on which sector might provide services. review commissioning relationship between IJBs and providers to maximise opportunities and balance the market Strategic planning emerged as a theme from the range of respondents. The broad consensus was that it needed to improve which in turn would provide a platform to not only manage care home capacity but the future shape and range of service models LARGER PROVIDER MARKET DOMINANCE STRATEGY / MARKET FACILITATION MARKET DRIVEN PROMOTION OF SMALLER PROVIDERS DOMINATED BY PRIVATE SECTOR 7

8 No. of respondents D) WORKFORCE Report summary: 52,430 people were working within care homes in Scotland in This represents approximately 33% of the total social care workforce. The average age of the care home workforce is 46 years old. The workforce is 85% female/ 15% male, this compares to 71% female/ 29% male split of people living in care homes. The job mix is 74% care staff, 23% auxiliary staff and 3% managerial staff. Care workers are paid the Scottish Living Wage, while nursing staff tend to be benchmarked against the NHS Agenda for Change. Providers report widespread staff vacancies, with the use of agency nursing staff particularly prevalent. At time of writing the impact of the UK decision to leave the European market on care homes is not known. Across Scotland, NHS provides a number of services to care homes including district nursing and the provision of additional support, for example training and equipment supply. 5) What do you think would make the biggest impact in addressing workforce issues? Most responses focused on adequacy of pay, terms & conditions of employment, training and career structure. These were the principal features, mentioned across respondents which, if adequately addressed, would lead to improving the attractiveness of working in care homes, and promote staff recruitment and retention. Emphasis was given to the difficulty in recruiting and retaining nursing staff. Related to this, was reliance on agency staff. Use of agency staff increase costs for providers and can have a negative impact on the quality of care delivered. Opinion varied on possible ways forward. For some respondents, addressing recruitment and retention issues meant stability and maintenance of a nursing presence, others due in the main to parallel tensions within the NHS wished to develop the senior carer role, whilst others thought pressures would reduce with better use of an HSCP liaison nursing provision. There was broad consensus about the importance of the nurse role, however, examination of what nursing care meant within the care home context, specifically in relation to the wider skill mix of staff providing care, was raised as an issue. Also expressed was a desire to see better deployment of the workforce across sectors to provide person-led care failure to meet needs in one part of the system impacts on other parts. Recognition that a career as a care home worker is rewarding, challenging with career progression potential... Other issues mentioned, however, did not feature as significantly in responses to this question were rurality, Brexit, recognition for pay differentials and lack of finance PAY CAREER STRUCTURE TRAINING EMPLOYMENT T&CS CAREER ATTARCTIVENSE AGENCY STAFF 1 8

9 No. of respondents E) OPPORTUNITY ASSESSMENT. Report summary: Procuring care home services requires a detailed understanding of both social care and procurement legislation. The Scottish Government has designed specific guidance on the way care services are purchased. 2 As a result of changes to procurement legislation and guidance, a fresh look at the present approach is required. Outcomes that any new approach will need to incorporate include: a new emphasis on local variation to suit local circumstances, for example different reflecting different workforce skills shortages, while still maintaining a national approach on rates and terms; new care models which respond to the need for increased rehabilitation and respite and increased use of technology; affordability of care home services against tight budget settlements; need to support choices for people against increasing numbers of homes not accepting publicly funded care and not offering the national rate when people have exhausted their own funds; Councils/Health and Social Care Partnerships commissioning care home services rather than market decisions taken by providers. 6) Do you think there are other outcomes which need to be considered? Respondents reflected on a range of individual and market structure outcomes. However, in the main, responses focussed on personal outcomes for people living in a care home setting; for example, individual choice and control, protection, promoting independence, equity and transparency between those publicly and privately funded. For this analysis, these have been clustered as they largely mirror the National Health & Wellbeing Outcomes and corresponding indicators. Self-directed support principles also featured as the mechanism which would serve to maximise outcomes for people. However, it was commented that transition, from policy principle to practical application and consequential contractual implications, within the context of residential care, needed greater consideration. we need to be far clearer about the strategic role that the sector is assuming in support of the unscheduled care policy area The need for diverse models of care was highlighted, such as rehabilitation and intermediate care. Respondents referred to the work being undertaken in the development of the cost of care calculator and dependency tool as instruments to assist with change outcomes particularly in relation to local issues such as workforce availability NH & WO* SDS PRINCIPLES MODELS OF APPROACH WORKFORCE AVAILABILITY COST TRANSPARENCY * National Health & Wellbeing Outcomes 2 Guidance on the Procurement of Care and Support Services 2016 (Best Practice) 9

10 No. of respondents F) SUSTAINABILITY AND RISK Report summary: The Care Inspectorate ensures that all homes meet the National Care Standards. The Care Inspectorate does not monitor the contracts put in place by councils/health and Social Care Partnerships. Locally councils/health and Social Care Partnerships undertake robust contract management activity linked to their statutory adult protection and care management duties for some of the most vulnerable people accessing services. This has produced some success in relation to management of service performance, with the majority of the care home sector delivering good care 72% of all private sector homes have grades of 4 or more for all quality themes rising to 78% for public sector homes and 76% for homes provided by the voluntary sector. It is however often difficult to access all the information for providers who operate across council boundaries. To help reduce duplication of effort, a national framework could share the monitoring burden for providers and councils/health and Social Care Partnerships. Commercial aspects and community benefits could be monitored at a national provider level, leaving councils/health and Social Care Partnerships free to monitor outcomes for people at the care home level in line with their statutory care management and adult support and protection responsibilities. 7) Do you have a view on what action is needed to respond to risk? There was a broad consensus among respondents for national oversight, particularly in relation to larger provider s financial performance, ownership and company structure. Some respondents felt this was a role for the Care Inspectorate. Other respondents thought good input from local council monitoring was effective and should be combined with national oversight of financial information. Reference was made to the dangers of unnecessary duplication, over regulation and additional bureaucratic processes. Conversely, others saw potential in reducing monitoring requirements. National monitoring was seen as an opportunity to promote consistent practice across cross-authority placements. A cross section of respondents emphasised the importance of maintaining robust local monitoring processes, which might be informed by national intelligence, but not replaced or weakened. Difficulty in fostering a trusting open dialogue between HSCPs and providers was raised, making it difficult for both to take a collaborative and proactive approach to issues. monitoring is important, but should not create duplication of effort & time NEED FOR NATIONAL FINANCIAL MARKET INFO ROBUST LOCAL CONTRACT MONITORING NATIONAL MONITORING BY CARE INSPECTORATE LACK CONFIDENCE IN CARE INSPECTORATE PROCESSES 10

11 G) FUTURE PURCHASING OPTIONS AND MONITORING. Report summary: Reform of the NCHC and consideration of the most appropriate national framework to deliver different care models and meet national and local objectives, takes place against the background of increasing demand, increasing costs and reducing council budgets. It also needs to take into account rising expectations of quality and value for money for people using services, particularly if people are selffunding their care. This means that commissioners and the sector need to jointly find a mechanism to absorb costs in the future while preserving and improving quality. This could be in terms of reducing bureaucracy (doing once not several times), innovating in new care provision (increasing use of telecare/telehealth) and simplifying the system. Consideration of these areas generates a range of options at either a national or local level: Do nothing this would not meet the need to ensure continued choice for people accessing care home services and the desire on the part of commissioners and the sector for new arrangements; Develop a Qualified Providers List with co-produced criteria - this meets current procurement legislation to ensure contracts are published and placed with providers suitably qualified to deliver services. A national approach would offer opportunities to reduce bureaucracy and burden on providers and councils/health and Social Care Partnerships by doing qualification checks once and freeing up time for local engagement on new approaches; Develop a national framework arrangement based on a national rate with local variation to accommodate rural/urban and other local factors. This would have to be co-produced with people using services and their carers and the sector. It would deliver clarity around the choice of services available to people and deliver consensus on local variation. 8) In your opinion, what approach offers the best way to ensure services are delivered and supports choice of care home across Scotland? Most respondents supported a national framework with a national contract that would capture personalisation and promote innovation, be responsive to the changing nature of the sector (through the wider reform work), the needs of individuals, levels of dependency, address selffunding related issues, and be flexible to accommodate and reflect locality differences. The importance of HSCP planning and commissioning strategies to underpin any future work was emphasised. Some respondents felt that greater clarity on the potential impact of the different procurement options was required while for others, none of the approaches in the strategy added anything to current arrangements. A proportion of respondents indicated no preference, however, echoed the principles of responsiveness etc. underlined with those preferring a national framework. Several respondents preferred continuing with the NCHC model, whilst caveating the need for revision and reform. Some respondents called for a more local commissioning approach promoting personalisation and alignment to SDS principles. a national framework with local flexibility and variability is a much better option Some emphasised the need for HSCPs developing effective and robust commissioning approaches. Whilst not in many responses, there was a request to consider wider use of block contract arrangements arguing that it would offer assurance and promote business continuity. 11

12 No. of respondents No. of respondents MAINTAIN A NATIONAL CONTRACT MODEL NATIONAL FRAMEWORK APPROACH NO PREFERENCE MUST BE FLEXIBLE TO MEET LOCAL NEEDS ADDRESS SELF FUNDING ISSUES 9) Do you think there is a role for monitoring at a national level? Responses to this question mirrored many of those for question 7 (risk). A large proportion of respondents believed that there is a role for national monitoring. However, there was no clear preference as to who might undertake the task. A number of responses highlighted national monitoring as the role of the Care Inspectorate. The most significant issue related to avoidance of unnecessary duplication between local monitoring arrangements and regulatory bodies. While some respondents thought, national monitoring would be an opportunity to standardise, others feared the introduction of another layer of bureaucracy. HSCPs, in the main, stressed that local monitoring remained of critical importance and should be neither diluted, nor compromised, with any proposed national monitoring activity. National monitoring should therefore focus on providing an overview on the financial, business risk, matters of the larger scale providers operating across several councils. Absolutely but this should also take into account what is happening at a local level YES NO DECREASE / AVOID DUPLICATION IMPORTANCE OF LOCAL MONITORING UNSURE 12

13 H) OTHER COMMENTS. There were several comments that were unique to particular groups and these are set out below. Providers: Insufficient funding was referenced in most responses and was cited as the principal reason for stifling innovation. It was stated that, in addition to adequate funding, innovation could only be achieved through more open and transparent joint working between the sector and HSCP commissioners. Whilst there was no expressed opposition to a procurement solution, a national framework approach with a national model contract, able to facilitate local flexibility emerged as the preferred direction. small care homes may be forced out of the sector due to increased costs and low fees Some raised concern about the impact larger scale providers were having in the sector, specifically on smaller providers, stressing that it was becoming increasingly difficult for smaller providers to continue to operate and compete. Consequently, there was a request for consideration to be given to the development of incentives solely for smaller providers, thus maintaining choice. Health & Social Care Partnerships: There was an appreciation of the need for business sustainability. However, it was felt that there was more time in discussing the cost of services and required fee rate, rather than overall market reform and outcomes for people using the services. In fact, some respondents believed, that service users were not sufficiently at the heart of reform. For many the NCHC provides a stable platform, which should be retained, a sentiment endorsed several times through the desire to have a national approach with standardised terms and conditions. Additionally, flexibility to accommodate local variation was underlined. Activity to incentivise innovation was by far preferred to the status quo as it was questioned whether the existing, traditional care home model, would be fit, and able to harmonise, with future requirements and alternative support models. There was concern about potential inequitable treatment of providers, within the full range of purchased care and support services, where most other care services are scrutinised through well-established traditional procurement processes which provide evidence of best quality and best price. are we actively seeking to incentivise innovation or simply maintain the traditional models of provision Others (individuals and representative groups): Some respondents believe that the sector is in a perilous condition with very little time left to prevent implosion. Additionally, it was believed the sector was stagnant, with little innovation or creativity, reflecting wider societal attitudes towards care for older people. 13

14 For some respondents, there was a need to reflect a true cost of care as the narrowness of the residential / nursing definitions did not take account of the acuity of health needs experienced in care homes. very comprehensive document and well laid out strategy There was appreciation for the positive contribution a national contract has made and again the preference for a national approach emerged with emphasis, that strategy, must help design quality driven care for older people by promoting a range of good practice models. 4. CONCLUSION / SUMMARY A wide range of opinions have been expressed on the draft procurement strategy, with key observations being On choice half of the respondents thought that the present approach has produced sufficient choice. Others did not think sufficient choice existed, pointing to differences between rural and urban areas and council-funded and self-funded residents. On the current contract approach - there was strong support in favour of a national approach, but respondents felt that contracts should not stifle innovation. On the market there was concern over the market share held by larger providers dominance in the market with potential risks to sustainability and limits to choice of provider in certain areas. There was a broad consensus that enhanced strategic commissioning could improve capacity planning and the shape and range of service models available. On the workforce most responses focused on pay, terms and conditions, training and career structure. There was concern about recruitment challenges across the sector. On opportunity respondents are keen to ensure services positively contribute to national health and wellbeing outcomes and personalisation. On sustainability and risk there was support for national financial monitoring regardless of who does this, complemented by robust local monitoring. On future purchasing there was support for the continuance of a national approach with a need for revision and reform with local flexibility. On monitoring there was consensus around the need for national monitoring tied to local arrangements but no duplication of effort. National monitoring should focus on financial and business risk particularly across the largest providers. As a group, providers referenced funding as the main reason for the lack of innovation and the need for joint working. A national framework approach with a national model contract 14

15 with local flexibility was the preferred direction. There was a request for consideration of incentives for smaller providers to maintain choice. Health and Social Care Partnerships wanted people using services at the heart of reform. They too wanted the retention of a national approach, with more innovation. Representative groups for older people felt the sector exhibited little creativity and there was a need to move on from definitions of residential and nursing care. Again, there was a preference for a national approach to ensure quality driven care for older people. 5. OUR RESPONSE Partnerships, representative groups and providers have been clear about the need for choice and innovation in the care home market and agree that the current approach does not promote this sufficiently. They have been equally clear that a national approach works, if there is the ability to build in local variation to take account of difference across Scotland in terms of geography and local markets. Current research suggests that in Scotland there are few new entrants to the market and some evidence of further concentration in terms of numbers of providers. The Reform Agenda debate has created a climate for change, but current sourcing of services using a ten-year-old contract and service specification will not deliver this. There is a clear need for agreement on a new service specification and contract that can use best practice and the latest technology to absorb costs and deliver quality care at affordable rates. Housing providers are preparing to deliver a revolution in long term care using digitallyenabled health and assistive care solutions together with smart home technology. New conversations with the care home market are required - on service developments to further personalise the care and support people receive, when more intensive care services are needed, and to work in partnership to deliver services which meet National Health and Wellbeing outcomes and targets. Scotland Excel therefore recommends that we build on the best practice already used in Scotland to deliver a process which maintains the national contract and rate which provides everyone with the care outcomes they seek. If care home providers continue to be willing to provide service to National Care Home Contract terms and conditions and rates, people across Scotland can receive quality care and support regardless of geography. Where providers are unable to provide at the national rate for whatever reason, we will work with partnerships if requested to source these vital services for people in their area. Scotland Excel will work with key stakeholders on delivering the Scottish National Care Home Framework scoped out below. This uses the best of current practice but builds in new opportunities to approach the wider care home market in areas where it is difficult to secure places under the national care home contract and rate. 15

16 Scottish National Care Home Framework: Accessing the framework Advertise nationally for providers to participate - NEW Entry requirement - Care Inspectorate registration Entry requirement - self declaration of business financial status, competence and suitability for a public contract - NEW Applications received at any time new build, acquisition and mergers - NEW Framework operation National Care Home Contract terms and rate negotiated nationally Partnerships monitor outcomes at local level Care Inspectorate monitors overall quality of service National monitoring of jointly agreed contract elements e.g. Implementation of Scottish Living Wage, Community benefits - NEW Leaving the Framework Notification process - NEW Nationally advertise opportunity to other providers (subject to Local Joint Strategic and Market Facilitation plans) - NEW Providers can leave framework at any time giving sufficient notice - NEW The bespoke approach for this sector builds on the Care Inspectorate s role in Scotland as Regulator and reduces bureaucracy for partnerships by conducting one check at a provider level in Scotland. For some of the major operators this would reduce bureaucracy considerably. Operation of the framework maintains current partnership involvement in monitoring outcomes locally and, when a provider leaves the market, introduces wider advertising of opportunities to provide care home services under the National Care Home Contract terms and conditions and rates. This process retains current national negotiation on contract and fees but introduces access to the framework at any time supporting maximum choice for people who choose this service. This approach provides several benefits 16

17 Scottish National Care Home Framework Benefits People Choice of service Clarity around homes delivering the national contract and rate Improving services Providers Reduced bureaucracy New Opportunities in the market Opportunity to work in partnership on modernising care Partnerships Release resources for planning and local monitoring Transparency around supply at national contract terms and rate National monitoring of commercial aspects This approach will not in itself deliver the innovation seen in care home developments across Europe. However, it will provide the opportunity to work with people using services, partnerships and providers to define the service and procurement approach in the future using the best of practice and new technology to give people purposeful lives in care. 17