Agenda item

[Report of the Assistant Director for Commissioning . To be introduced by the Cabinet Member for Adult Social  Care and Culture.] The ‘Positive Behaviour Support Service’ framework aims to address the needs of adults and young people with complex needs (including learning disabilities and/or autism; those who display behaviour that challenges; and those with mental health conditions) through the delivery of specialised interventions in a supported living environment.  Cabinet approval will be sought  to award the contracts under this framework.

The Cabinet Member for Adult Social Care and Culture introduced the report which set out contract to enable stronger offer to improve the life outcomes for the most vulnerable social and health care users. These were mainly adults and young people with complex needs (including learning disabilities and/or autism), those who display behaviour that challenges and those with mental health conditions. The contract would improve community based intervention as part of wider strategy to promote independence and enable clients to live locally in the community.

Big Lottery Fund, England Committee, had also agreed to offer an in-principle award of up to £1,465,018 revenue funding (over four years) to Haringey Council to contribute towards the PBS contract provision.

RESOLVED

To approve the proposal to enter into framework agreements with the successful tenderers listed in paragraph 3.2 to deliver Positive Behaviour Support (PBS) Services as allowed under Contract Standing Order (CSO) 9.07.1 (d), for a period of four (4) years.

Successful Tenderers were as follows:

·      Care Management Group Limited

·      Centre 404

·      Dimensions (UK) Limited

·      Support for Living Limited

·      The Avenues Trust Group

Reasons for decision

At a time of limited financial resources, the Council continues to seek innovative solutions to funding intervention that deliver good outcomes for local people, and especially for those with complex needs that present with behaviour that challenges. Haringey Council has a growing number of customers with complex needs and it expects to see a long-term increase in numbers of people with challenging behaviours.

For various reasons, those users with the highest and most complex needs have often been accommodated in health facilities or in the most expensive form of out of area residential provision. In these situations, the quality of life outcomes for vulnerable customers (mainly those with Learning Disabilities) are typically not good and there have been well publicised court cases (most recently Winterbourne View) where carers were found guilty of abusing vulnerable residents and jailed. A recent review of residential and nursing care undertaken by Haringey Public Health shows that the customer group with the largest net expenditure per year is Learning Disability. This group also has the largest average net unit cost per person per year.

It is part of Haringey’s objective to keep people healthy and living in their own communities for longer and to see a greater emphasis on promoting independence, dignity and choice, with care and support shifting away from institutional care towards community and home based support.

To address the gap in service provision for these customers, Haringey Council has undertaken a procurement process to commission a framework of a small number of specialist providers to deliver the evidence based PBS intervention in a community setting with the intention of preventing traditionally poorer quality of life outcomes particularly for Children and Adults with Learning Disabilities. This project aims to reach in total 98 customers over its life.

The main rationale for choosing a PBS approach is because of the strong evidence base and because it is a NICE best practice recommendation from the Department for Health for provision of community based care and support for Adults with Learning Difficulties. NICE issued a specific PBS guidance in 2015. The effectiveness of the intervention is also recognised by central’s government Big Lottery’s Fund Commissioning Better Outcomes program ‘Commissioning for Better Outcomes’ that has created the opportunity for Haringey Council to successfully bid for additional funding in order to be enabled to offer the PBS intervention in a community setting.

The Council’s approach to providing outcomes based PBS Services is intended to reduce and/or prevent escalation of needs by offering bespoke interventions and a value for money service. The Service will be expected seamlessly to provide both care and support as defined by the needs of the individual. The appointed Providers will be expected to work with customers and their Carers, key Haringey teams such as the HCCG, clinicians, social care practitioners, Haringey’s Learning Disabilities Partnership and Mental Health team in order to develop and implement successfully these individual outcomes plans.

Care and support services should aim to maximize an individual’s independence and support the reduction of need, wherever possible, through the delivery of PBS Services, including making use of existing community resources and personal social networks.

In order to ensure that the Providers can offer a financial sustainable service for the whole duration of the project, they may choose, as deemed necessary, to access social investment to finance their operations and staffing structures. This approach aims to encourage particularly voluntary, community and social enterprises (VCSEs) and small and medium-sized enterprises (SMEs) organisations to also become part of this framework if they have the skillset to provide the particular intervention. Social investment provides such an option, as it:

(i)              Leverages funds from investors who want to put their money into causes that improves people lives, particularly vulnerable people;

(ii)             Ensures investment is only paid back to investors when outcomes are achieved; and

(iii)            Provides a ‘catalyst’ to schemes to grow and deliver good outcomes by providing additional funding up front, alongside existing investment from the local authority

Once Providers are on the framework, the performance will be judged by the extent to which the agreed outcomes are met and the extent to which an individual’s independence is maintained with stable or decreased care and support levels. Providers, in partnership with the Council will be expected to develop review processes, to measure and record achievement of individual outcomes and to meet the requirements of the Council’s Performance Monitoring Tool on which payment of the outcomes rewards will be based.

The outcomes payment model will be based along the following measures:

(i)     Eighty percent (80%) of the outcomes payment will be based on the successful transition of customers to a community based setting or on the sustained caring arrangement in family/parental home; and

(ii)    Twenty percent (20%) of the outcomes payment will be relevant to each customer individually and based on measures relevant to their respective improvements in quality of life outcomes. These include:

a)     Reduction in incidents of behaviours that challenge.

b)     Improvements in health conditions management.

c)      Successful social and community integration/engagement.

The proposed providers will be appointed to the framework agreement because of their skill and expertise in delivering a high-quality service. The Council will therefore be placing reliance on their skill, expertise and judgment in providing PBS interventions and in working with the specific cohort. Providers will be expected to have a flexible approach to supporting vulnerable individuals and to take a holistic approach in planning, designing and delivering the service.

In summary, the main innovations Haringey Council is seeking to implement through this framework agreement are:

(i)        the design of the commissioning process with appropriate referral pathways that include inputs from the customer, their family, the social care and health teams and the Provider in order to address effectively and efficiently the needs of the most complex and costly customers in health and social care;

(ii)       an outcome based payment model with a basket of outcomes linked to the improvement in the individual quality of life measures for each customer; and

(iii)      access to social investment financing with its risk transfer benefit to encourage growth in VCSE Providers' capacity and capability;

(iv)      foster the development of a competent Provider market for this group of service users; and

(v)       reduce and/or prevent escalation of needs by offering bespoke interventions and a value for money service.

Alternative options considered

The alternative options considered as part of this are set out below:

a)              Do nothing (as is) –The PBS is a new and innovative service and constitutes one of the few pilots of its kind in the country. To decide not to offer the intervention for our most complex and high cost clients especially as there was an opportunity to receive extra funding through the Big Lottery Fund programme would have disadvantaged the life outcomes of our highest need customers. Furthermore, it would have compromised the opportunity of Haringey Council and HCCG to provide more sustainable health and social care at a time where the public sector is facing unprecedented demand and budgetary pressures. The project could also be extended to include other Local Authorities in the country, such as the London Borough of Islington which has already decided to join the project. If we did not capitalise on the opportunity, we would still have to continue providing services to the same cohort based on less effective and financially efficient interventions. To offer the PBS service without the financial assistance from the Big Lottery Fund would have required significant investment from the Council to support providers to invest in specialist staff and expert support in order to enable them to offer the PBS service. As a result, the risk of the investment would have been fully borne by the Council.