FAQs for providers

What if the client wants to take a Direct Payment and live in supported living with a shared hours arrangement?

The Shared Hours element of a care package within a Supported Living environment is not appropriate to be paid through a Direct Payment

In other words, the Shared Hours element must be commissioned directly by DCC.


Why?

Devon County Council offers direct payments to people to enable them to be creative in how their care and support needs are met increasing choice and promoting independence.

Where it has been chosen to meet a person’s eligible needs using carers whose time is shared between everyone living in the same property (often called a shared hours offer), this part of the support plan must be commissioned by DCC

The shared hours offer is carefully devised by social workers to match compatible services users with a specific care agency in a specific property. It therefore becomes a condition of living at the property for each person to pay an equal share of the cost.  As a result, it is not possible for the person with a direct payment to spend that money differently

With the appropriate oversight, shared hours arrangements ensure Personal Budgets remain sufficient to meet people’s needs in full. They also promote wellbeing by ensuring that the cared for person is supported to live and interact with their peers, which avoids the risk of social isolation.

Needs that are not appropriately met using shared hours of care (e.g. safely accessing the community) may still be met using a direct payment.

Exceptions: There may be exceptional circumstances where it is appropriate to make a direct payment available to fund a shared hours offer.  For instance where the person is planning on moving out within 6 weeks and needs to know how much is in their personal budget.

What if the client has a Direct Payment and wants to move into Supported Living with a Shared Hours arrangement?

Devon County Council offers direct payments to people to enable them to be creative in how their care and support needs are met increasing choice and promoting independence.

Where it has been chosen to meet a person’s eligible needs using carers whose time is shared between everyone living in the same property (often called a shared hours offer), this part of the support plan must be commissioned by DCC

The shared hours offer is carefully devised by social workers to match compatible services users with a specific care agency in a specific property. It therefore becomes a condition of living at the property for each person to pay an equal share of the cost.  As a result, it is not possible for the person with a direct payment to spend that money differently

With the appropriate oversight, shared hours arrangements ensure Personal Budgets remain sufficient to meet people’s needs in full. They also promote wellbeing by ensuring that the cared for person is supported to live and interact with their peers, which avoids the risk of social isolation.

Needs that are not appropriately met using shared hours of care (e.g. safely accessing the community) may still be met using a direct payment.

It is strongly recommended that Devon County Council take on the commissioning of the shared hours elements of the package. The individual hours for outcomes that will not be met by shred support can of course remain funded as a direct payment if you wish.

If they or the nominated or authorised person does not agree and continues to wish to have all the package supplied as a direct payment, please be aware that the advice to the client is: –

  • A new request for a direct payment would not be offered however as you already have one and have already been using it for this purpose there is no intention to withdraw it.
  • The personal budget will be set at the amount that considered sufficient to meet the needs were Devon County Council to commission the care directly, which will generally be their share of the shared hours offer plus any individual hours required to meet outcomes that cannot be met through the Shared Hours arrangement.
  • It is strongly recommended that you have a signed contract with the provider of the shared hours offer that includes details of what will happen if you or another party in the shared hours offer leaves, or joins, the arrangement and if you have any concerns about the contract you should take independent legal advice.
  • If, at any point, you wish to cease receiving a direct payment for the purposes of purchasing the shared hours offer, then please notify the Care Manager and DCC will seek to make alternative commissioned arrangement as soon as reasonably practicable.

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 that 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

 

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.

Selling your care business, buying a care business from another provider – what do you need to do to ensure a smooth transition of your commissioned business?

In order to ensure a smooth transition, it would help to receive formal notification as far in advance of any sale completion date as possible. We realise that matters are subject to satisfactory commercial negotiations and that the situation may change, however we are required to carry out due diligence in respect of any new care provider before agreeing to novate contracts, and this takes time. In order to avoid delays after the sale, including payment of invoices, it is in everyone’s interest to commence the process as soon as possible.

The formal notification must come from the current care provider and provide information on the new care provider including

  • contact details
  • which parts of the business the new provider is acquiring with addresses for building based services such as residential care and supported living
  • whether the provision name will remain the same or, if it is being altered, the new name if known,
    an anticipated completion date, accepting that this is subject to change
  • a list of all service-users being supported, whether these are DCC/DPT/CHC/Out of County/ Direct Payment or Private. This will enable us to cross-reference with our own records and advise other placing authorities of the impending changes

This information should be sent to our Procurement Team: procurementpeople-mailbox@devon.gov.uk and copied to our Business Relations Team: socialcarebusinessrelations-mailbox@devon.gov.uk

We would also suggest that the new care provider meets with Commissioners to ensure that there is mutual understanding around current and future commissioning intentions and future business plans. This would be the start of a process of regular engagement. Please contact us at socialcarebusinessrelations-mailbox@devon.gov.uk if this would be of interest.

What do we tell clients & families about Quality of support?

DCC has a Provider Quality Support Policy: Provider Quality Support Policy.

What things might indicate concerns around the quality of provision?

There are some key things which might indicate that there is an issue around the quality of the service being provided such as:

Management and leadership

  •  There is a lack of leadership by managers
  •  The service is not being managed in a planned way, but reacts to problems or crises
  •  Managers appear unaware of serious problems in the service
  •  The manager is new and doesn’t appear to understand what the service is set up to do
  •  A responsible manager is not apparent or available within the service

Staff skills, knowledge and practice

  •  Staff appear to lack the information, skills and knowledge to provide the necessary support
  •  Members of staff are controlling
  •  Members of staff use negative or judgemental language when talking about the people they support
  •  Record keeping by staff is poor
Behaviours and wellbeing
  •  People appear frightened or show signs of fear
  •  Behaviours have changed
  •  Moods or psychological presentation have changed

Resisting the involvement of commissioners, families and others

  •  Managers/staff do not respond to advice or guidance from practitioners and families who visit the service
  •  Staff or managers appear defensive or hostile when questions or problems are raised by external professionals or families
  •  People feel isolated and don’t feel they can talk to anyone about their concerns

The way services are planned and delivered

  •  There is a lack of clarity about the purpose and nature of the service
  •  The service is accepting people whose needs they appear unable to meet
  •  Peoples needs as identified in assessments, care plans or risk assessments are not being met

The environment

  •  The service is not providing a safe environment
  •  The accommodation is dirty, in a poor state of repair or unsuitable

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 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://www.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.

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.

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 a Shared Hours Offer 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 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 draft 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.

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.

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

The Council commissions approaching 100% of services provided from the independent sector. There are a few in house Day service centres available 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.

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.