Contract Management Framework Committee Report - Appendix 1
Page 1 of 42 Version 1 November 2012 Commissioning and Performance Team
A Contract Management Framework to Support
A Guide to Commissioning for Community Care
2011-14
‘In Moray we will monitor what matters and use the information
collected to improve services’
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Contents
1 Introduction ... 3
2 Purpose... 3
3 Principles of contract management ... 3
4 Managing the contract ... 3
5 Managing the relationship between the Council and Provider ... 6
6 Managing any care failures ... 6
7 Reviewing the service ... 7
8 Reviewing the Contract Management Framework ... 7
Appendix 1a – Contract Monitoring and review process ... 8
Appendix 1b – Care deficiencies process and handling complaints ... 9
Appendix 2 – Assessing contract monitoring level – Risk Assessment Table ... 10
Appendix 3 – Contract Monitoring Return ... 12
Appendix 4 – Care Deficiencies Procedure ... 27
Appendix 4A – Moratorium imposed by Council – Process, timescales and responsible persons . 33
Appendix 4B – Moratorium imposed by Council ... 34
Appendix 5 – Service Review Procedures ... 35
Appendix 6 - Consultation ... 42
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1 Introduction
A monitoring framework was developed as part of A Guide to Commissioning for Community Care 2011-14 and is an essential part of making sure that people get the services they need and
contributes to future commissioning and contract processes. This framework follows on from that original document and provides more detail.
This framework was originally devised by North Ayrshire Council who kindly allowed us to adapt it to meet the needs of the Moray Council.
This framework continues to be based on best practice as outlined in Scottish Procurement Directorate guidelines, “The Procurement Journey”.
(http://www.scotland.gov.uk/Topics/Government/Procurement/buyer-information).
2 Purpose
The award of a contract or framework agreement is not the end of the process, but the beginning of ensuring that effective services are delivered to support service users.
The purpose of contract management is to ensure that services are being delivered in line with service users‟ stated outcomes, Best Value (quality and price), continually meet contract and regulatory requirements and strive for efficiencies and improvements.
It is always the providers‟ responsibility to maintain quality assurance systems, which ensures that services are delivered in line with these requirements. Therefore, it is with an emphasis on
providers‟ responsibilities, that the contract management framework outlined in this document aims to provide an approach to evidencing the quality and performance of all care and support services, which is as light touch a process as is possible.
3 Principles of contract management
Providers can be confident that information which they exchange will be used appropriately for the contract management task, will be supported in their quality assurance efforts and decision making around service improvements.
4 Managing the contract
The process of managing the contract is outlined diagrammatically at appendix 2. This shows the link between the original determination of risk to the Council and impact on service users, through allocation of monitoring level, activity and potential outcomes at each level. In more detail the following sections outline how this is achieved. In cases where there are jointly commissioned services there will be agreement between authorities on the lead and if additional information is required by any authority separate arrangements can be made for this to be received.
What is the monitoring process?
We will use a monitoring risk matrix to help us determine the level of monitoring services require. It includes consideration of the risk to service users/carers, of outcomes failing to be met, financial risk and reputational risk.
Providers will be encouraged to self assess their performance against achievement of service users outcomes and this will become a vital part of determining whether services should continue and contracts re-awarded, where this is permitted by contract terms and procurement regulations (the provider‟s own assessment of the level to which they meet outcomes is featured in the contract monitoring return (Appendix 3) and this will be checked against service users views (as outlined in
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recorded review information on Carefirst and via the Care Plan Review process), carers views and the views of appropriate local authority staff.
The Commissioning and Performance Team/Operational Lead Officer will risk score the service using all available information and this will determine the level of contract monitoring applied. Appendix 2 illustrates the contract monitoring level and types of contract monitoring activity that are appropriate to the level of risk, value of contract, regulatory and service user and carer‟s opinion. Contract value must also be taken into account when assessing the level of monitoring required in order to provide a safe but cost effective process, however, for social care contracts, care quality and service user outcomes must lead in determining the levels of contract activity. Providers will be allocated to one of the following levels:
Low – where scores are low for all areas as evidenced by external regulator, internal information from care managers and finance evidence no cause for concern and the risk scores are within the range of low monitoring;
Medium– where there are care deficiencies for more than one individual in a service or a pattern of care deficiencies over a 3 to 6 month period which have not been sufficiently rectified and/or where care inspection scores have reduced over more than one area since the last inspection and where risk scores in relation to knowledge of service, value of contract, level of needs of service users and risk are within the range appropriate to medium level monitoring;
High– where there have been serious care deficiencies and/or adult protection concerns relating to care provision, or where care inspection scores have reduced over a year to scores of 2 or 1; and or where financial concerns threaten the ongoing sustainability of the service and will potentially
require recommissioning of services and where risk assessment scores fall into the scope of high level monitoring.
The process of assessing providers‟ capacity to deliver is an ongoing one and therefore requires performance review meetings. There will be as a minimum an annual performance review meeting conducted by Commissioning and Performance Team/Operational Lead Officers, using desktop analysis of returns, care inspectorate reports and service user and carer information. Changes in information e.g. shift in care inspection scores will trigger a reconsideration of the level of risk and thus level of contract monitoring to be applied.
What do Commissioning and Performance Team/Operational Lead Officers do at each level of monitoring?
If a provider is on a low monitoring status, then monitoring will be mainly desktop scrutiny of available monitoring information. Information from Care inspectorate reports, Carefirst and Care Plan review information relating to the success of the provider in meeting service user outcomes, finance information relating to invoicing arrangements and assessment of the financial health of the organisation will be analysed. If there are no issues relating to the quality of care or the financial sustainability of the provider then a record to that effect will be made in contract files, noting that low monitoring will continue. The provider should be notified by e mail of this decision and feedback on their performance.
A provider will be on medium monitoring status if there are care failures for more than one individual in the service or a pattern of care failures and/or if a provider fails to return monitoring information or accounts or if risk assessment of knowledge of the organisation, value of service, level of needs and risk in the service demands. This demands a closer look at the service and in addition to scrutiny of desktop information, the provider should be alerted to the Council‟s concerns
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in writing, referring to the appropriate sections of the current contract if appropriate, and asked to respond.
A meeting should be convened, preferably in the providers‟ premises, which provides an
opportunity to speak to service users, staff and managers about the issues of concern. This meeting is key to agreeing that there are issues to be addressed, endorsing the provider‟s approach to resolving these and jointly agreeing the key performance measures which will be an indicator of service improvement.
It is important that there is a quarterly review of these measures to ensure improvement is being made. When there is joint agreement that the issues which gave rise to concern are resolved, the provider should be advised in writing that the Council is satisfied that sufficient progress has been made to cease quarterly visits and return to low level monitoring.
It is important that throughout the process contract records are updated and information is shared with providers, Care Officer/Social Workers/managers and service users and carers. In terms of the latter, this is often undertaken by providers through service user and carer meetings and reviews.
High monitoring status applies when there has been a care failure or serious incident initiating
adult protection investigations, or if the quality of care and support as notified by the care inspectorate has been judged to be unsatisfactory (1) or poor (2) or an improvement notice is
served, or the risk assessment scores high in terms of knowledge of service or unregistered service, value of contract, or high level of needs and risk. It is important to recognise that although the Care Inspectorate regulates the quality of the service for all users; it is the specific responsibility of the Council to ensure the safety and wellbeing of the service users for whom we have commissioned or purchased the care.
In addition to the actions outlined above, reviews of service users‟ care plans need to take place to ensure that the service is delivering on their outcomes and that the issues which gave cause for concern have not affected them. At the same time, a discussion will take place with the provider on whether referrals to the service should be temporarily stopped to allow the provider time to address the issues of concern. It is preferable that the provider elects to put a voluntary moratorium (where the service stops taking referrals) in place, however, if the Council judges the issues affect service users generally in the service then a decision may be taken to enforce a moratorium.
Meetings will be required with the provider to agree the actions to improve services (there may be an action plan in place as required by the care inspectorate). In cases where an improvement notice is in place, it is essential that this work is undertaken jointly with care inspectorate staff and helpful if joint visits can take place at a minimum of 4 weekly.
When there is joint agreement that issues are resolved it is recommended that the provider move to medium level monitoring for an agreed period prior to returning to low monitoring status. This will allow assurances regarding the sustainability of the improvements. There are some specific
contracts which have a quality award payment for care Inspectorate grades of 3 or above. If grades fall below this, Commissioning and Performance Team/Operational Lead Officers will initiate
discussion with services and this may result in the removal of the quality award. To ensure consistency with the care inspectorate view of improvements, if a quality award deduction is not made and the care inspectorate subsequently maintain the low grade or find the action plan
improvements unsatisfactory, then the quality award will be withdrawn backdated to the date of the original inspection.
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What will be reported and to whom?
Commissioning and Performance Team/Operational Lead Officers are responsible for programming and maintaining the system of contract monitoring. However, agreement to their recommendations is required by the Commissioning and Performance Manager. There is a clear reporting structure via regular Commissioning Meetings with Senior Officers.
What financial information is monitored?
In addition to managing the contract from a care quality perspective, the Commissioning and Performance Team/Operational Lead Officer‟s task is also commercial – to ensure that variations and exceptions to the original service specification and contract terms are minimised and that services continue to be delivered within the quoted price for service.
Working closely with finance colleagues there is also a requirement to ensure that services are sustainable. The provider‟s financial health will be measured by a combination of annual scrutiny of submitted accounts, use of companies‟ house information for limited companies and reports from social work finance on adherence to invoice procedures. Any issues which arise will be discussed with providers to ensure that contingency plans can be put in place timeously in the event of the potential for insolvency or bankruptcy.
Are there other monitoring requirements?
Contracts are signed by the Council and provider which set out the terms and conditions under which services will be delivered.
Information will be gathered from service users and carers through Carefirst records, Social
Services Care Officer/Social Workers/Managers, service user and carer forums, Care Inspectorate Inspection reports (this list is not exclusive). This information will inform monitoring status and quarterly review.
The information gathered from providers quarterly is the standard common information which will be collected for all contracted services in order to monitor that outcomes are met in line with the quality, cost and service terms and conditions set out in service specifications and contracts.
5 Managing the relationship between the Council and Provider
It is important that from the beginning of the contracted relationship there is an open dialogue between the Commissioning and Performance Team/Operational Lead Officers and providers, which will clearly set out the monitoring level to be applied, the reasons for this and the conditions under which this will be changed.
As the contract life progresses there will be ongoing feedback to providers on the level of monitoring applied. Group meetings with providers will focus on encouraging best practice in services.
6 Managing any care failures
A separate detailed set of procedures is appended (Appendix 6) which outlines the process to be followed, roles and responsibilities of community care staff and impact on providers, in terms of requirements to develop action plans, agree improvement measures and performance measures to indicate that issues are addressed and any financial impact on delivering the contract are also addressed.
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7 Reviewing the service
The purpose of service review is to meet the obligations of the contract to have a review process in order to determine whether the contract should continue and to determine:
What is going well - is it delivering?
What is going wrong - where is corrective action needed?
What can be improved - where is service development possible? What the service has delivered - performance/outputs
What the effect of the service has been - tangible outcomes
In the last year of the contract term a service review will be conducted. This is an opportunity to examine whether the service fits with the Council‟s objectives for service users and carers, and whether services should:
Continue with the same service specification and same level of usage;
Continue but with a different service specification (variation) and decreased/increased use; Cease service or contract with provider.
It is also an opportunity to identify any improvements that could be made to the care and support arrangements and should involve providers and service users and carers to identify changes as well as the relevant Community Care Officer/Social Worker or Team Manager, where appropriate. At the beginning of the final year of the contract a service review will take place. A service review procedure is outlined at Appendix 5. It is important to recognise that this is not “done to” but “with” service providers and must take into account the views of service users and carers who receive the service. The procedure identifies the roles and responsibilities of community care staff and
information requirements.
The information requirements include a review of the performance objectives, the performance of the service against these, usage of the service, quality and cost. These are part of regular contract monitoring requirements therefore the review should not require additional information from
providers but be based on collated information from the contract monitoring process. The conclusion of the service review should result in:
A decision to maintain, vary or cease services An action plan for improvements
Identification of any efficiencies which could be made.
These should be set out in an action plan with agreed actions, responsibilities and timescales. If a significant change is proposed then the Council needs to consider whether the current contract is still appropriate. Under Procurement regulations “material” changes, e.g. extension beyond the advertised scope of the contract is a new contract and should be advertised and subject to competition. However, the Council holds service users choice as central to the selection and delivery of all services and will seek to support service users to maintain services if that is their choice and their outcomes are being met. This may be through the provision of an individualised budget or direct payment using a Self Directed Support approach to service delivery.
8 Reviewing the Contract Management Framework
There will be a review of A Guide to Commissioning for Community Care 2011-14 during the January to March 2014 quarter. The review will include this framework. This will be led by the
Commissioning Officers. Thereafter the framework will be reviewed at 3 year intervals to ensure that it remains fit for purpose and does not duplicate any other processes.
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Appendix 1a – Contract Monitoring and review process
Commissioning and Performance Team/Lead Officer Assesses current performance
and assigns monitoring status
Issue contract Monitoring return Provider completes And returns monitoring form Low Issue contract monitoring return – request action plan and arrange meeting Issue contract
monitoring return/ request action plan/ arrange meeting and consider compliance action Medium High Input outcome to Quarterly Report
Quarterly reports collated and annual report produced identifying issues of concern and best practice/service innovations
Return is analysed against other information from Care Inspectorate, service users/carers and care officers
Return validated
Return not validated Discussion with provider And amendment to return
Annual reports collated and used as a basis for service review, considering whether outcomes met, service volumes delivered, continued strategic fit and relevance to council objectives, cost competitive
No service concerns – continue service and
current contract
Service concerns but service redesign capacity and/or market shortage – arrange contract variation
Service concerns and no service redesign capacity – terminate contract and re-commission service
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Appendix 1b – Care deficiencies process and handling complaints
Review available information and assign contract monitoring level
Low Level
Services with CI scores of 3 or above and no adverse service review comments recorded no
gaps in financial information submitted and
no pattern of complaints/ critical incidents. Low risk assessment
scores
Medium Level
Services with CI scores of 2 and/or adverse service review comments recorded and/or gaps in submission of
financial information and developing pattern of
complaints or critical incidents.
Medium risk assessment scores
High Level
Services with CI scores of 1. Pattern of adverse Service review comments
recorded and/or adult Protection issues. Pattern
of complaints and critical incidents and/or high Risk
assessment scores.
Activity
Desktop monitoring, Email communication with provider. Inclusion in quarterly Service monitoring. Report to management/ care officers. Activity Desktop monitoring. Communication by letter to provider. Agreed action plan and performance measures.
Analysis of recent Review information. Minimum of quarterly visit. Inclusion in quarterly service monitoring. Report to management/ care
officers.
Activity
Desktop monitoring. Communication by letter to provider and agreed action plan/performance measures.
Active reviews of carer. Minimum of 4 weekly visits. 4 weekly service monitoring
report to senior management/care officers.
Potential contract and service review outcome
Services maintained with no variation or conditions
attached.
Potential contract and service review outcome
Contract and services maintained if improvements sustained.
Potential contract and service review outcome
Termination of Existing contract and Commissioning of Alternative services
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Appendix 2 – Assessing contract monitoring level – Risk Assessment Table Criteria
Quality of Infrastructure
Score
1 2 3 4 5
Organisation Local service; well
established and known to the department as well organised
service.
National organisation; experienced in service field.
Out of area but known, or local service, not well established but known
Out of area and not known, or local service, not well established and
not known
Local service; known to be of concern to other authorities or with poor Care Inspectorate grades.
Management & Staffing
1 2 3 4 5
Competent management and well trained staff.
Competent management but largely untrained staff.
Recent change in local management but competent regional management No real knowledge of management. Weaknesses in management or staffing identified.
Terms Annual Spend 1 2 3 4 5
Under £100k £100k - £200k £200k - £500k £500k - £750k £750k +
Service Specification/ Contract Position
1 2 3 4 5
Contract/Specification in place with outlines service requirements and obligations
of provider.
Contract / Specification in place, but needs updated.
Contract / Specification in place but problematic
working relationship evident.
No contract or specification in place, but
established positive service relationship
evident.
No contract or service specification in place and
no substantial service history evident.
Monitor Evidence form routine monitoring
1 2 3 4 5
Monitoring findings from range of sources positive.
Limited monitoring but findings positive.
No monitoring but positive track record.
Monitoring arrangements still to be established.
Monitoring identifies complaints and concerns
re service.
Care Inspections Grades
Care inspection scores of 6 for care and support staffing, management and leadership.
Care inspection scores of 5 for care and support and
staffing, management.
Care inspection scores of 4 for care and support
and staffing, management and
leadership.
Care inspection scores of 3 for care and support and staffing, management and
leadership or new registration.
Care inspection scores of 2 or 1.
Risk Service Type/Client Risk
1 2 3 4 5
Support and / or advice only. Low levels of personal care and clients able to
self-advocate.
Low levels of personal care and clients unable
to self-advocate.
High level of personal care provided in group
living setting.
High level of personal care provided in client‟s home.
Fit Strategic Fit 1 2 3 4 5
Service clearly fits with Departmental strategies.
Service in process of modernising.
Standards of delivery satisfactory, but service
model dated.
Service model dated and provider reluctant/unable to change and modernise.
Standards of delivery unsatisfactory and service
model dated.
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Finance Financial Assessment 1 2 3 4 5
Service viable, accounts submitted and operating within financial parameters.
Service not subject to financial review in past 2
years but accounts available and operating within financial framework
set.
Service has occasional difficulties in operating
within financial frameworks and gaps in
submission of financial accounts.
Service has repeated difficulties in operating
within financial frameworks and accounts
not submitted.
Service subject to concerns about financial viability of organisation, no
accounts submitted since contract awarded and/or key indicators of concern.
Note: As a general principal scores in the range 8 to 28 should be considered low monitoring (since high levels of personal care supplied and/or high value are not in themselves a risk – only in combination with other factors), 29 to 34 medium and 35 to 40 high.
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Appendix 3 – Contract Monitoring Return
Contract
Monitoring
Return
The Moray Council
Date reporting
from/to:
Provider Details: Contract Details
Provider name:
Contract Ref: (If known)
Service name: No. of actual service users attending for this
quarter
No. of voids for
this quarter
Main Service type:
No. of registered service users for
this quarter (Registered
Capacity) Completed by: Contract value or
rate (State per hour/
(registered manager
name) day/week/4 week)
e-mail: Contract Review date Contact Number:
Care Inspectorate Grades:
Date of most recent
Inspection:
Care and support
Management and
Leadership
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Date of completion:
Staffing Environment
Key Performance indicators
Self
assessment Comments
1 Service User Outcomes
Note: comments should always be provided if you have self assessed unsatisfactory or
very good Independence Involvement Security Confidence 2 Quality
Service User Reviews
Service User Satisfaction
Continual Improvement/Innovation 3 Service Complaints and compliments Incidents Contract Information Qualifications and training Staffing levels 4 Cost Invoice Accuracy Efficiency Initiatives Financial viability
Overall comments (if you have had voids for this quarter please tell us
why you think this is -
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illness, lack of referral etc::
This return has 4 sections. Each section focuses on a different aspect of key contract information and asks for some basic information, self assessment and has specific guidance on completion. Please save your first return and then amend for subsequent returns. This will reduce the time to complete. This information will be used to determine the level of contract monitoring appropriate to the service and for service reviews to determine whether contracts should continue or be re-awarded. You should always use the comments section if you have self assessed unsatisfactory or very good and e mail supporting information. Your input to developing this return is vital and we will be inviting feedback and reviewing this with you after the first year of operation.
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Key Contract Information from your management information systems
How many Moray Council service users have been asked their opinion for this return? What % of users
is this?
How did you ask service users? (Choose from - care plan review, questionnaire, focus group, other -
please advise)
How many of these service users required assistance to express a view (e.g. through family members,
advocacy services)
Who helped the service user express their views? (family member, other carer, advocacy service, care
staff)
Self Assessment
Key Performance Area Performance CriteriaIndicators Unsatisfactory Adequate Good Very good
Outcomes
Good Quality of Life
Defined as the Service User feeling valued, being able to decide on day to day matters, having influence and making choices
Less than half of the people in the service asked advised that the service met these
outcomes.
Half (at least 50%) of people in the service said that the service helped them
to meet most of these outcomes
Three quarters (75%) of people in the service said
that the service helped them meet almost all of
these outcomes.
Almost all (95% or above) people in the service said that the service helped them
meet all these outcomes.
Independence
Defined as the Service User being part of the decision making process, having an input into day to day activities, making choices and encouraged to maximise their independence
Less than half of the people in the service asked advised that the service met these
outcomes.
Half (at least 50%) of people in the service said that the service helped them
to meet most of these outcomes
Three quarters (75%) of people in the service said
that the service helped them meet almost all of
these outcomes.
Almost all (95% or above) people in the service said that the service helped them
meet all these outcomes.
Involvement
Defined as the Service User being informed and enabled to influence the way in which care is provided in a flexible and appropriate way.
Less than half of the people in the service asked advised that the service met these
outcomes.
Half (at least 50%) of people in the service said that the service helped them
to meet most of these outcomes
Three quarters (75%) of people in the service said
that the service helped them meet almost all of
these outcomes.
Almost all (95% or above) people in the service said that the service helped them
meet all these outcomes.
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Security
Defined as the Service User being confident that care/support is provided in a manner which ensures their well being
Less than half of the people in the service asked advised that the service met these
outcomes.
Half (at least 50%) of people in the service said that the service helped them
to meet most of these outcomes
Three quarters (75%) of people in the service said
that the service helped them meet almost all of
these outcomes.
Almost all (95% or above) people in the service said that the service helped them
meet all these outcomes.
Confidence
Defined as the Service User feeling certain that the care/support is received from know and trusted people whose allocation is managed and trusted.
Less than half of the people in the service asked advised that the service met these
outcomes.
Half (at least 50%) of people in the service said that the service helped them
to meet most of these outcomes
Three quarters (75%) of people in the service said
that the service helped them meet almost all of
these outcomes.
Almost all (95% or above) people in the service said that the service helped them
meet all these outcomes.
Guidance on completion
Please answer the questions at the top at the date of completion of this return, which lets you tell us how many people have been asked their opinion about whether their outcomes were met in this return. It is expected that over the course of one year (4 returns) all people in the service from Moray Council will have been asked. It is appreciated that some people may find it difficult to express a view and in this case you are asked to identify how many people required assistance and who helped them. All assessments and reviews will focus on the outcomes that people want from the service and therefore asking people who use the service is vital to establishing whether it meets their needs. Please see the 'Information on Outcomes' section which gives more detail on how the outcomes can be met. Note that not all will be relevant to the service you deliver.
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Key Contract Information from your operational records and management information
systems
Reviews
How many service user reviews have been held this quarter? How many have had social work input?
Customer Satisfaction surveys
How frequent are your customer satisfaction surveys? What format do you use, e.g. focus groups? What areas have been surveyed?
Self Assessment
Key Performance Area Performance CriteriaIndicators Unsatisfactory Adequate Good Very good
Quality
Reviews
Reviews are regularly undertaken by you to ensure that services are still meeting outcomes, are recorded and information routinely shared with service user, family and social work.
Reviews do not take place timeously, do not focus on outcomes, are not recorded fully and
no information is routinely shared.
Reviews take place timeously and are recorded, but are not outcomes focused, and information is sometimes
shared with some of the people referenced.
Reviews take place timeously, are outcome focused and recorded but information is not shared routinely
with all parties.
All indicators are met and outcomes
collated into potential areas for
improvement or satisfaction surveys.
Information is shared will all
parties.
Satisfaction
Customer satisfaction surveys are regularly undertaken by you (in addition to reviews) around specific service areas, e.g. quality of food,
environment, care provided, social activities, and these are used to improve services to people.
No customer satisfaction surveys
take place.
Customer satisfaction surveys take place but are
not regular and outcomes do not always feed through to improvements
in service.
Customer satisfaction surveys regularly take place and outcomes feed
through into improvements in
service.
Customer satisfaction surveys regularly take place and outcomes feed
through into improvements in
service and are shared with other
services and acknowledged in
best practice literature and research for that particular care group
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or service.
Continual
Improvement
Provider regularly researches best practice e.g. managing dementia, mental health issues, falls management, service specific improvement and introduces into the service by consulting with staff and service users and providing appropriate training, sharing this with all stakeholders and with other providers and contributing to research.
No research is undertaken and no innovative practices are
introduced into service.
Best practice is identified and training provided but
there is no implementation plan to
ensure that change is sustained, and no sharing
with others. Best practice is identified, introduced through training and consultation and shared with service
users but not shared with other
providers or contributes to learning elsewhere.
All indicators are met and the provider
is acknowledged in best practice literature and research for that particular care group
or service.
Guidance on completion
Providers should complete the number of reviews and satisfaction surveys for the quarter and identify which areas have been surveyed in this period. (Please note these are your in-house service reviews). The self assessment then asks for an objective view of whether these have fed through into service improvements and contributed to best practice across the sector. Learning organisations seek to use practice and research together to improve services and the last section lets you demonstrate the extent to which you are a learning organisation. This helps us identify organisations which could improve performance across all contracted services and lead workshops at provider forum meetings.
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Key Contract Information from your operational records - (in the reporting quarter prior to this
return)
Complaints , Compliments and Incidents (please
continue to use and send us the monthly or quarterly
return which records details)
How many compliments did you receive?
How many complaints have you received in the reporting quarter prior to this return? After investigating how many complaints were upheld? How many were resolved to the satisfaction of the
service user?
How many incidents have you recorded in the reporting quarter prior to this return?
Training and
qualifications
How many staff are permanently employed in your service at the date of this return? (includes any permanent bank staff).
How many staff are listed on your registration staffing schedule? If these two figures are different, how do you cover gaps in service provision e.g. agency,
overtime hours?
What percentage of your staff have qualifications appropriate to their role at the date of this return? What percentage of your staff do you plan to have qualified by the time of the next return? How many staff have received training in the reporting quarter prior to the date of this
return?
What % of your care staff is
this?
What type of training have they received?
How many staff have left your organisation in the reporting
quarter?
How many staff have you employed in the reporting quarter? Total number of staff employed in the reporting quarter?
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Key Performance
Area
Performance Criteria
Key Indicators Unsatisfactory Adequate Good Very good
Service
Complaints and compliments
There is a complaints and compliments system, which identifies informal from formal complaints, records outcome of investigations, takes appropriate action and shares outcome with service user, families carers and social work. Trends are identified and become areas for improvement at system level leading to changes in policy or staff training.
There is no complaints or compliments system or there
is a system but no separation of formal from informal and no record of discussion or action taken.
There is a complaints and compliments system
which identifies formal complaints and investigates, but
outcomes are not always shared and there is limited feed through into service
improvement.
There is a complaints and compliments system which identifies
formal complaints, investigates and takes
action and shares outcomes with all relevant parties. However there is limited
trend analysis. There is a complaints and compliments system which identifies formal complaints, investigates and takes action and shares outcomes
with all relevant parties. There is good trend analysis. Incidents There is an incidents system, which identifies and records outcome of incidents, takes
appropriate action and shares outcome with service user, families carers and social work. Trends are identified and become areas for improvement at system level leading to changes in policy or staff training.
There is no incident system or there is a system but no
record of discussion or action taken. There is an incidents system which identifies and investigates, but outcomes are not always shared and there is limited feed through into service
improvement.
There is an incident system which identifies,
investigates and takes action and shares outcomes with all relevant parties. However there is limited
trend analysis.
There is an incident system which identifies, investigates and takes action and shares outcomes
with all relevant parties. There is good trend analysis. Contract information
Contract information (see checklist under) is provided in the agreed format and within the agreed timelines.
No or partial information is provided or information is
provided only after the Council intimates the potential for enforcement
action if not received.
Information is provided but is often
out with timescales.
All information is provided and is complete and within
timescales.
All indicators are met and the provider from time to time initiates discussion over aspects of the information returned in order to improve service.
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Qualifications
Suitably qualified staff are provided which meet SSSC registration requirements/care commission staffing schedule/contract specification/job
descriptions and service user needs.
Some staff are qualified but insufficient to meet service
requirements and with no plan in place to address this.
Not all staff are qualified to meet requirements (or planned requirements) but there is a plan in place to address this.
Staff are qualified to meet requirements and
there is a plan in place to sustain this when
new staff join the organisation.
All indicators are met and a proportion of the staff are qualified
above required standards.
Training
Suitably trained staff to meet SSSC
requirements/care commission
requirements/contract specification/job
descriptions and service user needs. There is a regular training audit to establish any competency gaps, and evidence of investment in training in order to meet required training levels.
There is some ad hoc training provided but often
following some incident rather than part of a planned
process.
There is regular training although not
linked to identification of staff
competence and with no audit that
practice has changed as a consequence.
Investment in training is minimal.
There is a training plan for the delivery of regular training which is
linked to staff competence directly. Investment in training is good. There is a significant and constant investment in training. Staffing Staff turnover is at a minimal and service is not disrupted
There is a high level of staff leaving the service and service is majorly disrupted.
There is a low level of staff leaving the service and service is sometimes disrupted.
There is a low level of staffing turnaround and service is rarely disrupted. There is a low level of staffing turnaround and normal service is maintained.
Guidance on completion: Please complete the information at the top of the form, this will let you demonstrate that you have an active complaints and
compliments processand incidents process that enables you to deal effectively and promptly with complaints/incidents and records levels of satisfaction. The self assessment section lets you tell us whether you analyse complaints/incidents, look at trends over a period of time and use improvement areas to discuss with stakeholders how systems can be improved and complaints/incidents in this area reduced. Please continue to return the monthly/quarterly return to us as this provides more detail. Contract information that you are required to submit on an annual basis includes annual accounts, certificates of insurance (public and employers liability), certificate of registration, staffing schedule, care inspectorate reports and action plans and notification of care inspectorate feedback sessions. In time all staff will require to be registered with the SSSC and have appropriate qualifications. The questions above and self assessment let you demonstrate that you are working towards this and that even after staff are qualified there is regular training around the specifics of service user care requirements e.g. dementia training, managing challenging behaviour etc.
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Key Contract Information from your financial systems
Cashflow and Transaction analysis
(in the last reporting quarter prior to date of return)
How many invoices have you submitted?
What percentage of invoices have been returned incorrect?
What was the main reason advised for the majority of returns?
What percentage of invoices have been paid within 28 days of your submission to us?
Have you submitted your annual audited accounts to The Moray Council?
Key Performance Area Performance Criteria
Key Indicators Unsatisfactory Adequate Good Very good
Cost
Invoice accuracy
Invoices are accurate, reflect ordered service and where queries are raised are resolved within 7 days.
Invoices are regularly inaccurate and queries are seldom
resolved within 7 days.
Invoices provide detailed, accurate information, queries seldom occur but are
always resolved within 7 days.
Invoices provide detailed, accurate information, queries seldom occur but are
always resolved within 24 hours. The provider is proactive in identifying opportunities to improve the invoice process by engaging with the council to clarify service requirements prior to invoicing to reduce error and always resolves any queries within 24hrs.
Identifying
efficiencies
Where there are multiple invoices of small value the provider promotes opportunities for consolidated invoicing and/or other efficiencies.
The provider does not identify initiatives which could result in cost reductions being
achieved.
The provider responds positively to
but never proposes cost reduction initiatives. The provider is occasionally proactive in identifying cost reduction initiatives and then implementing these. The provider is always proactive in identifying cost reduction initiatives and working with the council to implement
these.
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Financial
viability
Evidencing financial viability of organisation through provision of audited and/or management accounts
The provider fails to submit required financial information.
The provider submits required financial
information on prompt.
The provider submits required financial information within the
agreed timescales without prompt.
The provider submits financial information in the agreed format and within the agreed
timescales and additionally provides six monthly expenditure and income returns allowing early identification of any issues arising.
Guidance on completion:
Invoice accuracy and identifying efficiencies have a crucial role in ensuring that you are paid on time for the services that you deliver and this section is designed to try and identify where things are going wrong that prevent this. Through analysis of this section over the course of a year, the Council hopes to improve the percentage of payments on time to you. You are asked to tell us how many invoices you submitted and how many were returned incorrect, with the main reason for these returns. The section also lets you self assess how quickly you resolve outstanding queries and proactively engage with the Council. The council needs to be aware of any financial health issues for providers in order that we can take appropriate action so you are asked to self assess your record of returning annual accounts (required contract information).
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Service User Outcome: Good Quality Of Life
Defined as the Service User feeling valued, being able to decide on day to
day matters, having influence and making choices in all aspects of their life.
Required Outcomes:
Evidence that the Service User:
i. leads a fulfilling life
ii. is listened to, and takes part in day to day discussions
iii. lives safely in their own community and home
iv. has physical, mental or emotional needs identified (i.e. sadness or depression) and appropriate
assistance sought
v. is shown respect and is not subject to any form of discrimination
vi. is given the opportunity to follow their cultural and spiritual beliefs.
To enable the achievement of the outcomes the Provider must:
a) reflect the needs and wishes of the Service User when structuring the service as agreed in the
Care Plan
b) encourage Staff to build up a relationship of mutual trust and respect with the Service User
c) train Staff to recognise and report signs and symptoms of mental and physical ill-health and
changes to their conditions
d) train Staff about adult protection practice
e) have a complaints procedure that has been understood by and shared with the Provider‟s staff
and Service Users
f) encourage interaction between the Staff and Service User during the delivery of the service
g) have a process in place to alert Care Officers to the need for a review of services.
Service User Outcome: Independence
Defined as the Service User being part of the decision making process, having an input into day to
day activities, making choices and encouraged to maximise their independence.
Required Outcomes
Evidence that the Service User:
i. leads an independent life
ii. takes greater control of their life
iii. is involved in day to day decisions about the care/support and housing support offered
iv. lives independently in their own communities and home;
v. experiences and performs useful and meaningful activities with whatever; assistance is required
vi. develops and maintains maximum independence.
To enable the achievement of the outcomes the Provider must:
a) encourage Staff to enable the Service User to be as independent as possible
b) Have a policy relating to supporting the independence of clients
c) encourage the Service User to develop and maintain their skills and abilities to perform
functional and meaningful activities
d) encourage the Service User to be involved in agreeing their Care Plan, including where
appropriate reducing hours
e) make sure that Staff work towards carrying out tasks „with‟ the Service User and not „for‟ the
Service User.
Service User Outcome: Involvement
Defined as the Service User being informed and enabled to influence the way in which
care/support is provided in a flexible and appropriate way.
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Required Outcomes
Evidence that the Service User:
I. contributes positively to the support planning process
II. makes informed choices based on sufficient information about alternatives and implications
III. is listened to whether complaining or complimenting the service, or suggesting improvements
IV. has minor changes made to his/their care/support in order to meet day-to-day changing needs.
To enable the achievement of the outcomes the Provider must:
a) make sure that the Service User is able to contribute to, and influence, the content of their
Support Plan
b) make sure that the Service User receives a copy of the Service User‟s guide describing
services provided
c) have a system for assuring the quality of care/support which the Organisation arranges
d) have a complaints procedure that has been understood by, and shared with the Provider‟s
Staff, Service Users, their advocate or relatives
e) make sure that Staff have the necessary skills and confidence to respond positively to the
changing needs of the individual Service User and to advise the Care Officer of the changing
need.
Service User Outcome: Security
Defined as the Service User being confident that care/support is provided in a manner
which ensures their safety and well-being.
Required Outcomes
Evidence that the Service User:
I. is introduced to the Service in order to reduce fear and anxiety
II. knows what time visits will take place
III. is visited at the appointed time
IV. knows that their personal information is kept confidential
V. knows when and why it is appropriate for their confidential information to be shared
VI. knows that keys to their home are stored safely and that the security of their home is not
compromised
VII. undertakes individual activities that have been risk assessed and are not restricted from
valued activities unnecessarily
VIII. has trust and respect for members of Staff and confidence in their abilities
IX. has confidence that policies and procedures are in place in respect of their safety and that
these are understood by staff
X. has confidence that staff are aware of probity issues.
To enable the achievement of the outcomes the Provider must:
a) Provide an introduction to the Service, by a personal visit, except in an emergency situation
b) The introductory visit to provide the service user with an introductory pack containing (as a
minimum) provider contact numbers, complaints procedure and staffing arrangements and for the
provider to assess all necessary health and safety issues
c) have a process in place to ensure that the Service User knows in advance about their
care/support visit and any changes in their visit (e.g. change of staff or time). Providers must
ensure that processes are in place to inform service users of changes in an emergency situation
e.g.; home carer/support is sick
d) ensure that staff attend to client within thirty minutes of planned visit time
e) make sure that the Service User and their property are protected, have policies and procedures
that reinforce the Service User's sense of security, and ensure that these are shared with and
understood by Staff
f) Hold a pass key in a central office and to be used in accordance with Council/Provider
procedure
g) make sure that the Service User's security code, telephone number(s) and key safe numbers
are stored appropriately and shared only on a need-to-know basis
h) make sure that staff are easily identified as the Provider‟s Staff by use of badges/photographs
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and/or uniforms
i) make sure that staff know that receipts are required for any purchase made on behalf of the
Service User, that the receipts are provided to the Service User, and that loyalty cards of Staff are
not to be used when purchasing on behalf of a Service User;
j) make sure that staff are aware of all probity issues (e.g. Staff must not knowingly be the
beneficiaries of a Service User‟s will, accept and receive gifts from the Service User, use contact
with the Service User for private gain and for the witnessing of legal documents)
k) have a written risk assessment for the Service User and be sure that staff know of the policies
and procedures in place in respect of Service User safety
l) have documented environmental risk assessments
m) have a planned training and induction programme for Staff; and
n) have a process in place for staff to report ongoing health and safety risks
Service User Outcome: Confidence
Defined as the Service User feeling certain that care/support is received from known
and trusted people whose allocation is managed and recorded.
Required Outcomes
Evidence that the Service User:
i. has continuity of Staff
ii. is confident that the records accurately reflect the care/support delivered
iii. feels confident that assessments of need and Care Plans inform the service delivery
iv. knows that records are shared only on a need to know basis
v. knows that they are able to trust the integrity and skill of the Provider‟s Staff.
To enable the achievement of the outcomes the Provider must:
h) minimise the number of different Staff involved in the care/support of each Service User
i) make sure that staff have the training and competence to record accurate information in the
Service User‟s records in an objective manner
j) make sure that Staff have the training and competence to accurately record the care/support
delivered
k) Ensure that staff update records in a timely manner and where appropriate and available, store
such records in a combined client file
l) have a procedure in place to ensure confidentiality (e.g. level of care/support given, financial
matters and security of the premises)
m) have policies and procedures in place to make sure that confidential information is not retained
by Staff who leave or change roles
n) train Staff appropriately, including any specialist training needed to satisfy the Service User's
needs, including training in medicines management
o) Ensure staff are trained appropriately, and are aware of their responsibilities, in relation to adult
and child protection legislation
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Contract Management Framework Committee Report - Appendix 1
Page 27 of 42 Version 1 November 2012 Commissioning and Performance Team
Appendix 4 – Care Deficiencies Procedure
A process for dealing with service failures and minimising the impact on service users and carers
This procedure forms part of the contract management framework and should be referred to when care deficiencies arise. It does not replace any other procedures which require to be followed, for example Adult protection procedures and it is critical that at all times activity should be mindful of the protocol in place with the Care Inspectorate for the sharing of information. It also does not replace/substitute existing relevant procedures for individual care groups which may be applicable to individual service users whether or not they receive purchased care services for example
Adult Support and Protection procedures Critical Incident Reporting/Review procedures Complaints handling process
Reporting of incidents to Mental Welfare commission Procedures relating to Adults with Incapacity
The document control procedures outlined at the beginning of this contract management framework apply to this appendix which should be reviewed regularly to ensure that it is updated and continuously fit for purpose.
1 Deficiencies in care 1.1 Definition
A care deficiency is a failure of the service to ensure that the agreed care and support for an individual or group of service users are not fully met. This could include:
Inadequate staffing Poor care practice
Poor environmental conditions
Lack of care planning and/or review irregularity Lack of choice in eating or drinking
Lack of social activities or choice of things to do
Set or inflexible routines that restrict service user choice
Consistent failure to respond or acknowledge service users views/request for change Failure to protect service users
Poor practice in assistance or management of personal finances
1.2 Identifying care deficiencies
Information about the failure of the service may be identified through Individual complaints
Failure to communicate serious care issues notified by others Knowledge about lack of implementation of procedures
Concerns expressed by service users, carers/families or advocates Service User and Carer Forums
Issues relating to service users‟ finances identified by care managers Concerns reported by other professionals, members of the public Concern arising from care management/reviews
Lack of submission of contract management information Medical or other health interventions
Care Commission intervention
Whistleblowers within service or temporary agency staff
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Information from other bodies with statutory obligations for aspects of service i.e. Mental Welfare commission
For most cases the issues may be satisfactorily resolved through
The providers‟ complaints procedure, Care Inspectorate or Council‟s complaints procedures. Care Officer/Social Worker/management intervention, including review or amendment of
care or support plans.
Action by other bodies with statutory responsibility for the service, e.g. care inspectorate, Health and Safety, Mental Welfare Commission, Council services – Environmental Health. Ensuring compliance with contract requirements.
However, even where issues have been resolved it is important that there is consideration of the wider impact on other service users and that the contract monitoring level is adjusted accordingly.
1.3 Role of Care Officer/Social Worker
Care Officer/Social Workers need to be aware that any concerns for one service user may also have implications for others using the service. There is a responsibility to share concerns about service deficiencies with Commissioning Officers in order that the best course of action can be determined. Care Officer/Social Workers also have a professional duty to record and address or report deficiencies of care, whether this relates to the service user they are care managing or more generally. The Commissioning Officers should be contacted by e mail or telephone to discuss the appropriate approach. The responsibility to manage the issue initially rests with the Care
Officer/Social Worker; however the Commissioning Officers will assess any information provided within the wider context of the service they are monitoring. If this information corroborates any other patterns of poor behaviour the Commissioning Officers will advise the Care Officer/Social Worker of action that will be taken and advise any role for Care Officer/Social Worker, e.g. providing review information. As a general guideline, issues which arise at individual level should always be dealt with by Care Officer/Social Workers, only where there are multiple instances of the same issue does this indicate systemic failure and is a commissioning concern.
1.4 Role of Commissioning Officers
Commissioning Officers are responsible for ensuring that any care deficiencies reported are
recorded and cross referenced with other information i.e. Care Inspectorate reports. Commissioning Officers will take action where there is indication of systemic failure sufficient to consider whether breaches of contract have occurred.
2 Service Deficiencies 2.1 Definition
Examples of deficiencies in care are outlined at 1.1 above and account needs to be taken of: Severity of the care deficiency – some instances, e.g. wilful neglect or harm leading to
hospital admission, may be so serious that a provider can move from a low to high monitoring status on that incident;
Risk to other service users still accessing services
Condition of environment within which the service operates Adequacy, competence and continuity of staffing
Frequency and persistence of care deficiencies
Any patters in reported concerns indicative of underlying issues
The awareness and past record of provider Contract management activity should take place alongside any other appropriate actions e.g. adult or child protection procedures.
