Transform Issue 32 January 2023 Edition - CareCubed

2 – Column and introduction from Dr Andrew Larner, Chief Executive at iESE, CareCubed updates and intelligent sockets news.

3 – News: Procure with G-Cloud, iESE at the NCCTC and your CareCubed team.

4-5 – Feature: About CareCubed and FCOC exercises.

6-7 – Feature: CareCubed case studies.

8 – Feature: CareCubed’s uses in children’s social care.

9 – In Focus: Meet the consultancy Peopletoo.

10 – In depth: CareCubed support package.

EDITORIAL CONTACTS

TRANSFORM IS PRODUCED BY: iESE www.iese.org.uk Email: enquiries@iese.org.uk @iESELtd

CREDITS: Designed by SMK Design (Aldershot)

Editorial by Vicki Arnstein

Views expressed within are those of the iESE editorial team. iESE Transform is distributed to companies and individuals with an interest in reviewing, remodelling and reinventing public services.

© Copyright iESE 2023

CareCubed well placed for social care reform

Reform is the current big agenda for both adult and children’s social care. Whether this is driven centrally by government or not, both providers and commissioners will agree that change is needed immediately to keep services running sustainably. Whatever changes are on the horizon, our unique care funding tool CareCubed is well placed to sit at the heart of any commissioning team now and in the future. It can immediately help councils agree costings with providers for day-today placements and uplift requests by assisting fair and transparent negotiations based on regularly updated benchmarked costings. It is also being strategically used by local authorities to map out provision to meet future needs, including using the tool to conduct Cost of Care exercises beyond the mandated exercise for over-65s (see page 5). The platform also offers potential solutions to ease the challenges highlighted in two separate recent reports on the children’s market (see page 8).

There are several modules of CareCubed available covering both the adult and children’s market, either as a council licence, where council employees input costings received by providers, or as a place-based licence which allows local authorities to give limited access to providers to allow them to input their own costs. You can read case studies about how CareCubed is being used on pages 6 and 7.

As a not-for-profit, owned by the sector, for the good of the sector, iESE want to see local authorities and providers thrive and use CareCubed to best effect. We have recently joined forces with the consultancy Peopletoo to offer new subscribers access to a package of consultancy (see page 10), while our ongoing extensive value-added support helps all users get the best from the tool (see page 9).

We hope this special edition of Transform is useful to current users and for non-subscribers to understand more about the product.

To find out more about CareCubed, see page 4 of this issue or contact: craig.white@iese.org.uk

Cost of living recognised in interim CareCubed release

An interim updated version of CareCubed has been released to support a growing backlog of uplift requests which need to be assessed and agreed to ensure services remain sustainable. This reflects cost of living increases and include some other costs which may be affecting providers, such as high use of agency workers due to staff shortages in the sector.

iESE typically provides an updated version of CareCubed annually to reflect annual changes to costings such as the National Living Wage, as well as other inflationary rises, and regulatory changes. In recent years, an annual update has been sufficient to properly reflect relatively stable economic conditions, but the recent economic situation meant an interim update was necessary. The extra update in November was provided at no additional cost to customers and means they can have confidence in the model and a much-needed evidence base to support conversations about individual placements.

“We were getting a lot of feedback from providers saying they were struggling with massive increases in some of their costs. There is currently enormous pressure driven by the cost-of-living crisis, for food and fuel costs particularly. We engaged with providers and councils to understand their position and then we made a series of updates to support people costing care packages. Importantly, this means each case can be looked at on its own merits, rather than an ‘across the board’ increase,” explained Sherif Attia, Head of Design at iESE. For example, inflation updates built into the interim update included an increase of more than 50 per cent for utilities and 10 per cent for food compared with the March 2022 figures.

The November update also allows providers to identify maternity cover, suspension cover, use of agency staff and occupancy rates. “It is about supporting the conversation between the provider and

the local authority to ensure they can model the price impact of their current operational circumstances,” said Vanda Leary, Digital Business Lead at iESE. “It helps them have that well-informed discussion. Everyone knows there are currently inflationary pressures across all aspects of the cost base, but this update shows the actual impact of those changes and ensures every pound is spent where it is most needed.”

These new features are already enabling wider conversations between providers and commissioners. “The new CareCubed features can give an informed view of the cost impact of high agency staffing, for example. But just as importantly, it facilitates discussion about the reason for the situation, what actions the provider is taking to remedy it, and whether it is temporary or long-lasting. This allows the commissioner and provider to be clear about why these costs are as they are, and to consider together what is and is not reasonable to include in the price, and for how long. Rather than fixing the price, these updates allow additional information to be provided to inform the context in the current economic climate,” Leary added.

Attia recognised that while the updates were likely to increase benchmark costings for local authorities, it would be “disingenuous” to ignore the cost-of-living crisis and its impact on placement prices.

“Commissioners and providers both want to achieve a sustainable market with a fair price for the right care for vulnerable people,” he explained, “The most expensive part of a care package is still always staff time so it is important to ensure support is prescribed at the right level for the individual, delivering positive outcomes and considering how you can share support in a setting where appropriate.” The next release of CareCubed will be available in March 2023.

New technology prevents electrical fire

Local authorities can now access patented technology designed with the aim of preventing another disaster such as the Grenfell Tower fire in 2017.

The solution is intelligent sockets designed to detect the signs of an electrical fire before it happens by monitoring the heat and electrical gases released from electrical components. If this activity is detected, the electricity supply to the socket is automatically cut.

Andrew Kelly, Chief Operating Officer at Connected Innovations (Ci), the company behind the technology, said there are 12,000 fires per year in the UK caused by electrical malfunction and that this was likely to increase in the future due to the increase in electrical devices. “The problem is that we are bringing more electricity into our homes with things like electrical vehicle charging, so the problem is going to get worse. Also, people are trying to save money and are turning on appliances at night which is very dangerous, particularly if it is dishwashers and tumble-dryers,” he explained.

“There are 6,000 tower blocks owned by local authorities in the UK and around 2,500 fires in high rise buildings every year,” added Kelly, “I would say that every single local authority is sitting on a potential Grenfell. Electrical fire is the most dangerous and expensive type of fire with the highest death rate. With this technology it is almost entirely preventable.”

The sockets also help monitor and manage electricity consumption giving the added benefit of reducing a user’s carbon footprint.

• Find out more by visiting: https://connectedinnovations.com

Dr Andrew Larner, Chief Executive

CareCubed represented at NCCTC conference

IESE ATTENDED THE ANNUAL NATIONAL COMMISSIONING AND CONTRACTING TRAINING CONFERENCE (NCCTC) IN DECEMBER WHERE JONATHAN WRIGHT, STRATEGIC COMMISSIONING MANAGER AT BRISTOL CITY COUNCIL (BCC), LED A WORKSHOP ON CARECUBED.

The conference, which was attended by more than 150 commissioners, was aimed at anyone involved in the commissioning and contracting of adult and children’s services. iESE also sponsors the children’s services event each year. The session led by Wright on behalf of iESE was titled Understanding the True Cost of Care for Working Age Adults.

“I was delighted to lead the session on CareCubed at the NCCTC recently to share how Bristol has been using the tool and the benefits it has provided,” said Wright. “Bristol City Council, like most local authorities is under financial pressure, has limited resource available and wants to improve relationships with providers. Using iESE's new place-based version of CareCubed is helping us meet these challenges.”

Within the session there was some key discussion around ‘lessons learnt’ by BCC and what the longer-term planning strategy looked like for Wright and his commissioning team.

Wright highlighted that negotiation after initial placement is difficult in a market where demand outstrips supply, explaining that all

new placements are now input into CareCubed from the outset to help ensure new packages are close to CareCubed benchmarked rates when first commissioned.

A commissioner from another region pointed out that data entry and miscommunication can add significantly to timescales and impact heavily on resource. Wright explained that the CareCubed Place-based licence helps address this by passing much of the work to the provider and means information is provided in a consistent format. He also outlined future uses for CareCubed, underlining its importance as a vital tool in Bristol’s commissioning armoury, including:

• Making the completion of service templates mandatory for new framework applications.

• Using the tool to model costs for new services.

• Requests for increase not by percentage but on individual package of care.

• Consistency of approach and shared intelligence between the Integrated Commissioning Board and other local authorities.

Lastly, Wright explained that BCC would look to use CareCubed to manage the market and incentivise providers longer term, while looking to develop strategic partnerships with guaranteed volume of placements at CareCubed rates to allow partners to grow their market share.

Procure CareCubed faster through G-Cloud

LOCAL AUTHORITIES WISHING TO PROCURE A CARECUBED LICENCE CAN NOW DO SO MORE QUICKLY AND SIMPLY THROUGH THE CROWN COMMERCIAL SERVICE DIGITAL MARKETPLACE G-CLOUD FRAMEWORK.

The framework is an agreement between government and suppliers which makes buying services faster than entering procurement contracts.

iESE’s CareCubed products for the adult and children’s markets are now listed alongside 31,000 other services on the framework. To be listed, iESE has been through a full tender exercise and verified as an accredited supplier. All public sector organisations are eligible to use the framework. A Unique Customer Reference Number (URN) is required to gain access and then a new or repeat customer simply needs to search based on requirements or search terms and go through the quick and easy process to be sent a prepopulated order form for review or sign off.

“The G-Cloud framework is a dynamic purchasing system which enables customers to search a catalogue of suppliers and solutions before directly awarding contracts, so it makes it a really quick and easy process for us and the customer,” explained Craig White, Head of Business Development at iESE. “The framework is fully compliant, so it ticks all the boxes for local authority procurement processes. It avoids having to go to a full procurement where they might need to go to the market and ask for three quotes or full tender submissions. There is no point doing that because there is no other product which does what CareCubed does, it is a unique product. This is a way of procuring CareCubed really quickly in a way that meets internal governance and procurement rules.”

• To find out more visit: www.gov.uk/guidance/g-cloud-buyers-guide

Upcoming exhibition dates:

IESE WILL BE EXHIBITING AT SEVERAL CONFERENCES IN 2023.

COME ALONG AND VISIT OUR STAND:

• ADASS Spring Seminar 2023 | Wednesday 26th – Friday 28th April 2023

• NCCTC 2023 – Children’s Conference | Wednesday 29th – Thursday 29th June 2023

• LGA Conference 2023 | Tuesday 4th – Thursday 6th July 2023

• NCCTC 2023 – Adults Conference | November 2023 (dates TBC)

• NCASC 2023 | November 2023 | Wednesday 29th November – Friday 1st December 2023

Craig White, Head of Business Development craig.white@iese.org.uk

Craig has more than 20 years’ experience building software businesses and providing innovative solutions that make a real difference to all parts of the public sector. He is responsible for continuing to grow the CareCubed customer base and has recently been busy showing councils how the full version of CareCubed can be used to carryout cost of care exercises for all parts of the market – over and above the 65+ exercise mandated by Department of Health & Social Care.

Nik Jones, Sales Executive nik.jones@iese.org.uk

Nik has 25 years’ experience in the health and social care sector having worked as a social worker and registered manager for a large national provider. He is the CareCubed account manager for around 60 local authorities and providers. He has recently been demonstrating the new functionality and modules to our customers to ensure they get the maximum value from the tool. He also helps with onboarding new customers to help them get maximum strategic and commissioning value from CareCubed and provides lots of great ideas for product development.

Sherif Attia, Head of Design sherif.attia@iese.org.uk

Sherif and his Product Design Team has overall responsibility for delivering the CareCubed product roadmap, constantly enhancing the tool based on customer feedback and policy change. With Sherif’s oversight, the Product Design Team ensure we identify and understand customer needs and translate this into system design and requirements for our developers to build.

Jim Weir, Senior Consultant jim.weir@iese.org.uk

Jim is a social worker by background and has many years of Senior Management experience working in healthcare and adult social care in the US and UK. He has been working with iESE since 2016, helping in the development and transition to CareCubed and now leads the training and provides operational support to new and existing subscribers of the CareCubed tool.

Diana Sherwood, Associate Consultant diana.sherwood@iese.org.uk

Diana works as an Associate Consultant for iESE supporting implementations of CareCubed, delivering important negotiation training for council staff and providing short mentoring sessions to support customers on specific cases or challenges they face. As well as the work Diana does for iESE she also works directly in councils on secondment helping embed the tool in processes and extracting value such as cashable savings and cost avoidance.

Lydia Wootton, Functional Lead Lydia.wootton@iese.org.uk

Lydia’s main role is managing the CareCubed data model updates, such as the recent October interim release and the annual update in March. She ensures the costs which sit behind CareCubed are reflective of the current climate by collecting and collating data from various sources. She also manages the monthly CareCubed user forums and the online community.

Lexie Colston, Support Analyst lexie.colston@iese.org.uk

Lexie joined iESE in September 2022 after gaining a Sociology degree. She is pleased to have joined an organisation which contributes to improving social care. Lexie answers support queries in the CareCubed mailbox, schedules training, updates written documents relating to CareCubed and helps test updated versions of the tool.

What is CareCubed?

CareCubed is the next generation of digital care pricing which offers a secure online platform to support the open and transparent negotiation of care placements. It is now being used by almost half of all local authorities in England as both a day-to-day negotiation tool and strategic planning solution to map out future provision and plan for reform.

CareCubed is the market-leading secure online tool which generates a guide price for new and renegotiated care placements based on the person-centered needs and desired outcomes for the client. The nationally recognised, independent tool produces an initial benchmark costing based on robust and regularly updated data as a starting point for open and transparent discussions between a provider and commissioner.

The tool is available as an annual subscription for care commissioners and providers and offers a

CareCubed has made an immediate impact and delivered significant benefits, exceeding our expectations we had for the first 12 months. It is now embedded into our processes and playing a critical role both in day-to-day commissioning and also as a strategic tool for us to work closely with providers to shape our market and ensure it is sustainable.

The CareCubed Community is used by more than 350 commissioners and brokers to share ideas, intelligence and collaborate across multiple councils.

Using CareCubed has meant 65% of young people (16-18) requiring semi-independent provision in Surrey are now remaining local compared to only 35% a year ago.

CareCubed helps control costs – the tool pays for itself for many years from just one or two uses.

“

To not be using CareCubed means you are missing a crucial tool in your armoury for both tactical, day-to-day commissioning, and for those wider strategic projects. It is robust, nationally recognised, impartial and pays for itself from just one or two uses.

modular solution which provides flexibility based on the specific customer requirements. There are four modules currently offered:

• CareCubed for Working Age Adults,

• CareCubed for Older Persons,

• CareCubed for Children & Young People and

• CareCubed for Health.

These are available under two different licence types – a council licence which gives unlimited user licences for officers to work on the cohorts of cases

covered by the modules purchased, while the placebased licence has the same functionality but also allows the local authority to give controlled access to care providers and health service colleagues. This supports collaborative working and allows costings and needs information to be submitted directly to CareCubed, reducing time spent inputting data and aiding transparent negotiations.

“

CareCubed’s clear and visually appealing outputs have helped take the heat out of negotiation. CareCubed reduces uncertainty for us as a provider, and promotes greater collaborative working with commissioners and shared accountability for changes.

Index: Shaded areas indicate CareCubed subscribers.

Adult Services Children Services Adults & Children Services

CareCubed powered the 65+ Cost of Care Exercise commissioned by Department of Health & Social Care, the LGA and ADASS. Cost of Care data was submitted by more than 2,500 care providers to 95% of all councils.

CareCubed is now used by 45% of all councils in England and more than 50 care providers

CareCubed has a user group and steering group made up of sector experts from both councils and providers.

Hugh Evans, Executive Director of People, Bristol City Council

Lynsey Robertson, Director of Business Development and Programme Management, The Disabilities Trust

Chris Tisdall, Commissioning Service Manager (Corporate Parenting), Surrey County Council

Why choose CareCubed?

1. CareCubed is unique and purpose-built with the support of councils and care providers.

2. Full implementation and support available to deliver instant results.

3. Cost data is regularly updated helping ensure calculations are accurate and fair and using the best available market information.

4. Regular functional upgrades driven by legislative changes and customer needs.

5. Aids with negotiation of new packages, renegotiations and uplift requests.

6. Increasingly being used as a strategic market shaping solution to model lots of different scenarios such as new provision, changes to salaries and new partnerships with providers.

Tactical

Evidence to negotiate/ challenge providers

New placements

Review existing placements

Uplift requests

Transition process

Audit trail/history of changes

Commercial awareness

Strategic

Cost of care exercise

Retrospective analysis

Streaming processes

Performance management Partnership working CHC Integration Service redesign

Market shaping - keep people local Business cases

CareCubed aids Fair Cost of Care exercise

While adult social care reform hangs in the balance, with changes proposed in the People at the Heart of Care White Paper outlining the Government’s ten-year social care reform delayed by the Chancellor’s Autumn statement, the Fair Cost of Care (FCOC) exercise has still been successful in giving greater visibility of the shape and state of local care markets.

The Department for Health & Social Care (DHSC) FCOC exercise, which local authorities were mandated to complete by October 2022, required councils to survey a range of providers to improve their understanding of the costs of delivering over-65s care in their area.

To enable local authorities to meet the requirement, a free data collection tool commissioned by CHIP (delivered by the Local Government Association and the Association of Directors of Adult Social Services) was developed by iESE based on its tool CareCubed which is already used by more than 100 councils and care providers across the UK.

The iESE-designed tool was used by more than 95 per cent of councils and 60 per cent of all over-65s

care providers, representing around 40 per cent of all beds nationally. “We had really good engagement with the tool,” said Sherif Attia, Head of Design at iESE, “Local authorities will now use the information to create a Market Sustainability Plan that they will submit to the DHSC in February.”

Craig White, Head of Business Development at iESE, said the exercise had encouraged interest in the full CareCubed package from local authorities not yet subscribed, with iESE carrying out around 100 demonstrations in response in recent months. In addition, iESE is seeing interest from some local authorities in using CareCubed for further Cost of Care exercises for other parts of the market. “The Government asked local authorities to gather

information about the market for older persons, but many councils are realising they need to get a view of the whole market. Local authorities have highlighted to us that the cost of care is not just about the over65s, it is about the entire market, and they see CareCubed as the perfect solution to gather this information,” he explained.

Alongside a partner organisation, Peopletoo, iESE is working with several councils already on further exercises for the 18-64 care market, covering supported living services, residential, and day opportunities for adults with a wide range of support needs, including learning disabilities, autism and mental health. Whilst this is not part of the reform agenda, these forward-thinking councils have seen the benefit of working with local providers to gain a clearer understanding of the true cost of service delivery, the key market sustainability challenges faced by the sector and steps that can be taken towards mitigating these and future market shaping activities.

While the future of adult social care reform is currently unclear with elements of the planned reform, such as the cap on lifetime costs for private funders now delayed, CareCubed and iESE remain an ideal partner and ensure councils have the tools to quickly adapt and model various scenarios. One policy change highlighted in People at the Heart of Care White Paper was that from October 2023 more self-funders would be able to ask their local authority’s brokerage team to arrange their care placement. The status of this potential change was unknown at the time of writing, but iESE is actively looking at ways to help councils prepare for this potential eventuality. One possibility would be to make a simplified version of CareCubed available for self-funders. Councils interested in exploring this are encouraged to approach iESE. “This service for self-funders was part of the original paper,” White explained, “There is a lot of uncertainty and councils are in limbo with that currently, but having CareCubed in your armoury will help support local authorities with whatever might be thrown at them. We know there is a lot of uncertainty currently, but as a supplier we can respond quickly to whatever policy decisions are coming down the line,” he added.

• Find out more about Peopletoo on page 10 • Contact Craig at iESE to find out how CareCubed can help with cost of care work and reform or for an introduction to other councils that have done this: craig.white@iese.org.uk

Case studies: CareCubed in action

Learn how four local authorities are using CareCubed strategically and in day-to-day negotiations for their children’s and adult markets with the council and place-based licence.

Surrey County Council: CareCubed Children’s

Using CareCubed strategically has helped Surrey County Council (SCC) work with providers to increase the number of looked-after children aged 1618 staying in county, rather than being placed further afield –boosting this number from 35 per cent to 65 per cent – and has also delivered savings of around £1m on block contracts for beds in supported living accommodation.

The council was already using CareCubed Adults successfully when it subscribed to CareCubed Children’s in 2021. The county has a looked-after children’s population of 1,050 with a budget of around £50m to £60m per annum. A new Corporate Parenting Commissioning Team was established in January 2021. At that time the county had a shortfall of providers in the supported accommodation sector for young adults, with only 35 per cent of its looked-after age 16-plus children being placed in county.

The first thing the authority used CareCubed for was to help new providers coming into the market understand how to develop a costing model. James Atkins, Commissioning Manager (Corporate Parenting) at Surrey County Council, said: “Working with providers to co-produce this has meant we can now use the templates as part our tender process for block contracts going forward. It has strengthened the relationship with some of our providers, maturing the relationship and changing the conversation, but it has also really pushed the sufficiency on as well. We are up to 65 per cent of young people being placed in county, which is a big turnaround since last year.”

The team then used CareCubed as part of a cost audit where they looked at some providers deemed to be cost outliers and started using the tool for uplift requests. Providers are required to submit a cost of care template which is then run through CareCubed. “It is how we decide whether to agree to an uplift or not – it gives us an evidenced-based way to do that and quickly make a decision. This has led to considerable amounts of cost avoidance where these requests would have previously been accepted as there was no evidence base or benchmark to compare against,” Atkins explained.

The tool helped the council make considerable savings in its first year of use. The authority recently recommissioned its block contracts for beds in supported accommodation, increasing the number from 229 to 350, but at the same time saving up to around £1m through using CareCubed. This was achieved through renegotiation of costs and utilising CareCubed to commission block beds (avoiding costs compared to spot purchasing on the open market).

CareCubed is also aiding sustainability by also highlighting providers not charging CareCubed benchmarked rates. One provider, for example, had massively under costed their provision. “They were paying around half of what CareCubed said we should be paying. It is not just about saving money, it is about sustainability and sufficiency too. CareCubed will give us a very good steer either way,” added Atkins.

• Download the full case study here: www.iese.org.uk/downloads/sustainable-care-fair-cost

The London Borough of Hackney: CareCubed Children’s

The London Borough of Hackney started using CareCubed Children’s having seen the benefits of the tool for its adult care commissioning. The council first looked at its commissioning processes and streamlined these to make them much more efficient and effective. Then some of the council’s high-cost care placements were benchmarked against CareCubed to understand the market position, sustainability of providers and whether value for money was being achieved. This identified some significant outliers which needed to be understood and priced based on the support required. This resulted in the council delivering £200,000 per annum cost avoidance on just four existing placements.

The council then developed a template that social workers now use to capture information about provider services in a format that can be input into CareCubed in a few minutes. Maria Zazovskaya, Resource Manager for the Children & Families Placement Management Unit at The London Borough of Hackney, said: “Capturing this data helps the council and social workers know key information such as: the capacity of the home, how many staff it has and whether it has a sleeping night or a waking night, for example. This core information is inputted once and saved for future use, and the focus is then the person-centred support, giving us clarity and supporting our decision-making processes. This is about making sure our residents are getting the right level of support and improvement in outcomes based on their unique circumstances. Unless you are a local authority which runs its own children’s homes it is hard to know what the true costs are, and CareCubed gives us this knowledge and information in a format that can be easily discussed with providers,” she added.

iESE also supported with training and helped the council officers responsible for commissioning and brokerage understand the cost breakdown by sharing experience from across the customer base of more than 80 councils and providers. “iESE advised us to get a clearer view of the services available in our area so that we could quantify our market position. This information helps challenge providers and provides a better understanding of the unique services on offer in our local market. It has meant we have a commercial awareness across the team and much more intelligence available to support our decisions,” Zazovskaya said.

The council sees CareCubed as a key tool for commissioning authorities and providers. “It is an excellent way to standardise breakdown of costs and get some consistency. The tool is very clear in terms of how you input information and the structured outputs allow us to have a sensible discussion with providers. The tool can help raise knowledge across social care for every local authority so that when social workers are looking at costs or requests they don’t just take things at face value. It encourages that natural curiosity to question and challenge,” she added.

• Download the full case study here: www.iese.org.uk/downloads/fair-price-childrens-placements

Surrey County Council: CareCubed Adult

urrey County Council is one of the largest in England, serving a population of 1.2m across 11 District Councils. Surrey started using CareCubed in 2020 to help right price its learning disability placements in residential and supported living and hopes to start using it in other areas of adult social care to ensure fair and sustainable pricing throughout its services.

Nicollette Browne, Contract and Commissioning Manager (CareCubed and Fee Review) for Surrey County Council Adult Social Care, said the council had looked at between 300 and 400 learning disability cases since the introduction of CareCubed. By the start of May 2022, around 50 social workers in the learning disabilities team and a further 20 staff in the brokerage team had been trained on how to use the tool. All uplift requests for adult learning disability care are now being routinely run through CareCubed. Introducing both internal staff and external providers to the tool was a delicate exercise, but one the council feels was worth it and which all parties now see the benefits of. Initially there was some trepidation from providers who were concerned the introduction of CareCubed was simply a costcutting exercise, but these concerns have been allayed with many seeing an uplift: “On a positive note, some of the providers that have worked with us on CareCubed have benefitted from going through CareCubed because they have had increases, but importantly these are realistic and based on local data. Without CareCubed it was very difficult to know whether we were getting value for money and whether the market was sustainable” explained Browne.

While staff members were initially sceptical that CareCubed was just “another thing” adding to their workload, they now feel more adept and confident in negotiating vague or unclear costings as they now have an evidence-based model to assist in those negotiations. “Our staff have found it quite empowering to be able to gently challenge a provider where costings are unclear, and we now know where we stand with all of our placement costs and can plan for the future,” she added. “As CareCubed is built on an independent evidence-based model used by both commissioners and providers, it has opened up better dialogue and allowed us to share our workings with the provider based on the information provided. We can then focus on getting the right care and support for the resident, knowing CareCubed will give us an accurate price for that placement.”

Browne said the implementation and support from iESE had been very good. In particular, she feels the council has benefited from the online user forum which all CareCubed licence holders can attend. “I have linked in with two other local authorities where we are all having the same challenge from the same provider and we are sharing intelligence in terms of confirming that we are all seeing the same thing. Working together is invaluable and adds lots more weight to the conversations,” she added.

• Download the full case study here: www.iese.org.uk/downloads/tacklingcommissioning-challenges

Bristol City Council: CareCubed Adult Place-Based

ristol City Council (BCC) were early adopters of the placebased licence of CareCubed – a version of the tool which allows local authorities to give restricted access to providers to enable them to input their own cost base.

BCC started using CareCubed in 2020 when they realised the tool could replace the manual and labour-intensive way it had been gathering provider data in Excel spreadsheets to form guide prices for the Learning Disability (LD) market. BCC initially bought the council licence, but quickly switched to the place-based licence as an early adopter.

Using the place-based licence, Bristol City Council (BCC) council can now allow providers to submit information relating to specific person-centred placements (new/reviews/uplift requests) or whole services directly via the CareCubed platform. The council can then review this information, add comments and work through cases with the provider all within a single system. This removes the need for duplication of data entry, but also cuts down on the subsequent checking of what different amounts relate to or include because the provider enters the information themselves in an already structured format. It also means the council can compare services because the data is in a consistent format, and they can agree cost templates for services once instead of having the same conversation about a provider's specific costs each time a placement is made.

“When dealing with organisations with large volumes of placements the place-based licence is a godsend because they are entering the data and we are reviewing it for consistency,” explains Jonathan Wright, Strategic Commissioning Manager at Bristol City Council, “It makes the negotiations a lot less fraught and complex – there is no quibbling because they enter the data themselves. It takes about 20 minutes to review a case in CareCubed which is significantly less time in comparison to our previous approach. And the data is saved in a digital system that can be used as part of our day-to-day commissioning processes.”

The place-based licence is also allowing greater collaboration with health colleagues in other organisations where the cost of care is being shared. “Joint funded cases have been an issue for us, but now we have a tool which can be used to support these conversations with health colleagues,” Wright explained.

CareCubed has made an immediate impact, with lots of examples of cost avoidance on new and existing placements. One provider, for example, wrote to the Chief Executive stating they should be being paid £3,700 a week. “We CareCubed it and it came out at about £2,600 at the top end. We asked to talk through the differences, and they said ‘capital costs’ without any detail or explanation, so we said no to the request. It is about having a conversation and giving providers the opportunity to help us understand the unique services they offer, whilst paying for what is being delivered,” said Wright.

Wright recommends iESE and the place-based licence, citing the aftercare and engagement from iESE as “some of the best support we have had” “Any ideas we have from a user-perspective are implemented quickly or the iESE team go away and present back a suggested approach. You get a lot of companies saying we can do this and that, but once you’ve paid your licence fee you don’t hear from them. We have been working closely with iESE and it is reassuring that they come from a local government background and continue to rapidly develop the tool. We know we are working with a company focused on not just the challenges we face now but in the future too,” he said.

• Download the full case study here: www.iese.org.uk/downloads/ prepare-for-asc-reform

CareCubed and children’s reform: why doing nothing is no longer an option

While local authorities wait to see the Government’s plans for what has been hailed a ‘once-in-a-generation’ reform in children’s social care, it is possible to get ahead and start understanding and shaping local provision better now with the help of the market-leading strategy and negotiation tool CareCubed.

The children’s social care market has been under much scrutiny of late with two recent reports shedding light on the state of the sector: the Independent Review of Children’s Social Care and the Competition and Markets Authority (CMA) Children’s Social Care Report. A Government response was due to be published by the end of 2022 but is now expected early in 2023.

The CMA report found a shortage of appropriate places in children’s homes and with foster carers and highlighted that children are often being placed too far from their previous homes and families. It also highlighted high levels of debt being carried by some private providers of children’s homes in England and Wales and found that large private sector providers of fostering services and children homes appear to be making higher profits in England and Wales than would be expected in a wellfunctioning market. The strain being placed on local authorities as a result was found to be limiting scope to fund other important children’s activities and services.

One of the suggestions made by the CMA report was for the formation of collective bodies to support local authorities and help them leverage their role as purchasers. The Independent Review of Children’s Social Care echoed this with a recommendation for the establishment of Regional Care Cooperatives.

At iESE we are all too aware that children’s services face a lack of options and are often under pressure to accept what is offered by providers. We know this is a difficult market to operate in but remain confident the children’s CareCubed licence can bring immediate quick wins and help support medium-to-longer term strategic planning to start allowing local authorities to understand their market and identify ways to work more closely with those providers offering value for money and good outcomes. This is evidenced in our case studies (see pages 6 and 7). There are two versions of the CareCubed children’s module – a council version which gives unlimited user licences for council officers to work on the cohorts of cases, and the Place-based licence which gives controlled access to care providers and health service colleagues to allow them to input information directly into CareCubed. This supports collaborative working, reduces local authority workload, and helps aid transparent negotiations due to

standardised information being collected across providers. It means that councils can take a ‘snapshot’ of the local market to get a better understanding of the different business models, operating profits and services offered.

The CareCubed tool can help address the main issues highlighted in the CMA report and help local authorities prepare and be on the front foot for any upcoming children’s market reforms. Find out below how our marketleading product can help local authorities with 1) capacity 2) collaboration 3) costing:

1) Capacity

The CMA report identified supplier barriers including regulation, property and planning, and recruitment and retention. Many of these elements can be factored into the CareCubed tool to help model services and help reduce provider concern. “CareCubed can help with bringing new supply to market. By using the place-based licence and working from the ground up it helps reduce the fears providers have around regulation, property and recruitment,” explained Nik Jones, Sales Executive at iESE. “For example, if you are going to start a new service you might say we need to pay what the local Tesco is paying so you can add that in alongside other what-if scenarios.” The report noted that some private providers were carrying high levels of debt, increasing the risk of failure, but it also true that some providers may not be costing high enough to ensure sustainability. CareCubed can help give oversight of the whole market to identify outliers and start having transparent discussions with providers. While historically local authorities have moved away from in-house provision, current market challenges, including workforce shortages, may lead to council-run services being re-established. CareCubed can help model what this provision could look like both in-house and externally and what the related costings would be.

2) Collaboration

While it is currently unknown what the Government’s recommendation will be regarding collaboration until a response to the CMA and independent report is given, we know some local authorities are already successfully using CareCubed to help allocate costs for placements across

different stakeholders. “You can use CareCubed so these services can be jointly funded with neighbouring local authorities to develop a cross county collaborative procurement strategy and co-production of new services. If greater collaboration becomes mandatory in the future CareCubed offers an easy way to work together across the same cases,” Jones explained.

3) Costing

Placements in children’s social care are often expensive and lack of capacity results in these prices being agreed so care can be allocated. However, several local authorities including Surrey County Council and the London Borough of Hackney are already using the CareCubed Children’s licence to successfully manage uplift requests and agree prices based on benchmarked data for new placements (see pages 5 and 6 for more information). The place-based licence allows users to collect data from any provider, reducing the workload for the local authority. “With a place-based licence, all providers, can be given access to a lite version of CareCubed. This allows them to input their costs into a template which gives the local authority standardised data, helping them spot those outliers and do those sanity checks,” Jones said.

While the market is understandably a tough one to operate in, local authorities can still gain significant immediate benefits from implementing the CareCubed children’s tool ahead of any mandatory changes introduced by any future children’s social care reform.

“We have many examples where just from a few changes clients have made considerable cost savings. While not every provider is going to accept the benchmark price, the tool enables local authorities to start negotiations on the front foot with a robust evidence-based approach, helping guide providers in the right direction and giving local authorities some immediate cost control with the added advantage of helping develop medium-to-longterm strategic projects too. It also means that Senior Managers at the local authority can understand the gap between prices currently paid and the true cost to deliver these services with a sensible amount of profit and return on capital. The focus then turns to marketshaping and strategic projects to create a vibrant market with a choice of high-quality services,” Jones concluded.

• To read more about how the children’s version of CareCubed is being used successfully by local authorities see pages 5 and 6.

• For a demonstration or to find out more about how CareCubed can help negotiate placements and shape children’s provision in your local authority contact: nik.jones@iese.org.uk

CareCubed updates

At iESE we listen to user feedback from providers and local authorities on the CareCubed tool to continually develop its functionality and usability. We update the data behind the tool annually to reflect market changes and sometimes carry out an extraordinary release such as in November 2022 which took account of the cost-of-living crisis.

Asa not-for-profit organisation with a desire to improve local government and its services at its heart we see CareCubed as a key tool for councils, Integrated Care Boards and providers to help them gain visibility and transparency around care costs, ensure sufficiency in the market and assist them in strategically shaping their care markets going forward. We regularly work collaboratively with clients to incorporate updates they feel would improve the tool’s useability. We also regularly make our own improvements and updates to the tool.

Recent CareCubed developments and upcoming changes include:

• November 2022 update

This extra release was issued to allow local authorities to consider provider increases in their cost base due to the cost-of-living crisis and staff shortages. The main changes were to allow inputting of agency costs, occupancy rates and running costs related to food, utilities and fuel (see the news story on page 2 for more information). This has proved critical for councils considering uplift requests.

• Steering group

We are in the process of appointing an advisory group of members across providers and commissioners to help give a strategic steer on development priorities and develop best practice on how to make best use of CareCubed in a constructive, collaborative discussion between provider and commissioner. The group will meet around three times a year, with the first meeting set to take place early in 2023 where a key agenda item will be agreement of terms of reference for the group.

• Future release

Our standard updated release at the end of March 2023 will incorporate changes to the National Living Wage (NLW) increase. The majority of care staff are paid around the NLW so there will be a significant cost impact for providers. Local authorities should expect some corresponding price impact and uplift requests which CareCubed can help evidence and model in advance.

• Platform update

We are currently undertaking major development of the CareCubed platform to make it more powerful and

allow us to develop new functionality at pace. When this takes place, the data will migrate across seamlessly. Users won’t see any obvious changes to the way the system looks but there should be a noticeable change in platform processing speed. Further information will be provided in due course.

How we support you

Our team of experts are on hand to help with any questions you may have relating to the product and demonstrations, onboarding and embedding the tool, implementation training, ongoing consultancy, and queries around usage.

A CareCubed subscription includes a range of support which we encourage customers to fully utilise. These value-adds include:

• Helpdesk

Users can access helpdesk support by emailing carecubed@iese.org.uk or by completing a support webform at www.iese.org.uk/carecubed-support.

Our helpdesk is available 09:00-17:00 MondayFriday (excluding bank holidays). Customers are also allocated an Account Manager who will manage the business relationship and contract.

• Online support

Online support is available within the CareCubed application to guide users through processes in the tool. The help menu contains several walk-through tutorials, instructional videos and resources, such as our User Guide and Costs & Assumptions guide.

• CareCubed Community

The exclusive CareCubed online community has around 350 registered users. It is a space where clients can ask iESE questions and interact with each other on common issues and share best practice and provider insights. It is necessary to be part of the community to get invites to our monthly User Forums and access recordings of previous forums – please make sure you are registered.

• User Forums

Our monthly User Forums take place on Teams. They are free to attend and help bring users together to

share their experiences of using the tool and share ideas for its functionality. We have recently changed the format so that these are now chaired by a customer and driven by whatever their current challenges or CareCubed learnings are. Our most recent session, for example, was hosted by Bristol City Council on negotiating with providers.

• Implementation support

We offer a range of training and services focused on understanding where CareCubed can help on a dayto-day basis and on a wider strategic level through our partner organisation Peopletoo (see page 10 for more information). Other support, such as system training and negotiating skills, and tactical delivery sessions are also available to focus on specific cases, negotiations or challenges faced by our customers.

• CareCubed Charter

Our fair care fair price charter developed in conjunction with councils and providers aims to act as a protocol for users and sets the expected behaviour and principles for both parties when using CareCubed, but also more broadly through the commissioning process. It is hoped that by actively applying the principles within the charter, commissioners and providers are more likely to build trust and mutual respect, achieve a better balance of risk and streamline the negotiation process. We invite all local authorities and care providers to sign up to the principles outlined in the charter. You can sign up to the charter here: www.iese.org.uk/carecubed-charter

• Directors’ Briefing sessions

We offer existing and prospective customers access to our informative Directors’ Briefing sessions which cover a range of important topics that CareCubed can support with. In these sessions we share case study examples of the benefits (including big savings) being delivered both for commissioners and providers and provide a reminder of the package that is available to help ensure you are getting the maximum return on investment. These sessions are aimed at relevant directors and assistant directors. Our next round of Director’s Briefings are in February 2023, to book onto an upcoming Directors’ Briefing please contact: annabelle.atkin@iese.org.uk

Partnership helps councils use CareCubed strategically

ESE has further strengthened the implementation package offered to customers by including specialist consultancy support from its partner Peopletoo. This is available to new and existing customers and is aimed at helping CareCubed clients honestly appraise their current commissioning environment, drive transparency and value for money, as well as analyse CareCubed data to assist with future strategic planning. It will also help provide assurance around the delivery of health and wellbeing outcomes for individuals.

Once new customers are onboard, they complete a self-assessment matrix which aims to get them to reflect on how effective their commissioning and contract management is currently. This is designed to help them appraise areas such as how well the market is working for them and how well current processes are supporting commissioners. Using the service’s open package data, Peopletoo collate a baseline position that provides a measurement to assess the effectiveness of implementing CareCubed and also gives valuable insight as to the current challenges and opportunities in commissioning.

Peopletoo present the baseline and analysis supported by the self-assessment back to the local authority and collectively work with the service to agree key actions and activities and identify where consultancy support could be used to work on the priorities highlighted and deliver some quick wins. As a real-life examples, some councils we are currently supporting have identified the following as priority areas of focus:

• Development of key strategic partnerships where councils commission with a high volume of providers across a broad range of costs.

• Hands-on support for commissioners and contract managers to upskill teams in relation to provider engagement, provider management and negotiation.

• Market sustainability and sufficiency and undertaking collaborative planning for the future together with their partners, including the provider market.

Maggie Kenney, Chief Executive at Peopletoo, said the new implementation package provided worked

best when clients are honest and when senior stakeholders are involved. “It is all about maximising the benefits of CareCubed and looking at it in the context of the strategic commissioning cycle. It is a very complex market in both adults and children’s social care right now but for different reasons, and therefore being able to use the rich information coming out of a system like CareCubed is really important,” she explained. “This is a real opportunity to forensically analyse what commissioning is currently delivering for the service and take some of the learning and experience from an external viewpoint. It is an opportunity to look at how commissioning functions and where the focus should be. When you have finite resources, you end up having to be quite reactive and therefore you could be focusing your resources on something that isn’t giving you the maximum benefit.”

Having already taken several new clients through the process, Kenney said it has been revealed that many local authorities are using a large number of providers in quite a reactive way, which is making it more difficult to build strategic relationships. “Quite often the service does not analyse this data and therefore they don’t realise how many providers they are using and the different rates they are securing. We are quite often seeing figures like 60 providers for 80 placements, for example. When you start to analyze that data, you can see the providers you want to work with where outcomes are strong and value for money is greater. A local authority might not currently know whether a particular provider is offering value for money. From the baseline data we would be able to work out who is potentially providing value for money and good outcomes consistently and then drill down to see how they are doing that. Is it that their profit is lower or is it that their operational costs are lower? Then you can start to have a conversation where you say we want to work with you more and how can we encourage and enable that,” Kenney added. This might be through a range of measures, including joint ventures and capital investment, for example.

The new add-on consultancy package has been

well received by local authorities and Peopletoo is encouraged to see the benefit it is adding to iESE clients. “Whilst CareCubed will drive greater transparency and improve value for money, local authorities can potentially gain so much more from its implementation with our help to use it as a key source in building a robust and informed commissioning cycle,” she concluded.

• To find out more about how your organisation can benefit from consultancy with Peopletoo contact: craig.white@iese.org.uk

About Peopletoo

Peopletoo is a consultancy which works with public organisations across the UK to transform services. Founded in 2009, Peopletoo builds on the long-term experience and skills developed by the management team throughout extensive careers in both the public and private sector.

The consultancy has delivered several hundred transformation programmes, working with more than 120 local authorities to identify and deliver sustainable change.

The company’s values are truly aligned with iESE’s, making it a strong and exciting partnership. While traditional consultancies often frontload resources at significant cost, with the risk that the transformation and change is not owned or delivery maximised when they leave, Peopletoo prides itself on delivering sustainable and affordable transformation.

• Find out more about Peopletoo at: www.peopletoo.co.uk

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CareCubed customers can now access specialist consultancy through iESE’s partner Peopletoo to help them maximise the benefits of CareCubed and ensure it is embedded into processes.