Agenda item

[Report of the Assistant Director for Commissioning. To be introduced by the Cabinet Member for Adults and Health.]

Request award of contract for Intermediate Nursing Care bed block contract with in borough Nursing home.

The Cabinet Member for Adults and Health introduced this report which sought Cabinet’s authorisation for a direct contract award under Contract Standing Order 9.01.2 (g) negotiation without publication of an advertisement to The Supplier outlined in the exempt appendix for the provision of 10 Intermediate Care Nursing beds.

The Cabinet Member noted Intermediate Care Nursing beds helped to alleviate the issue of delayed hospital discharges and inappropriate admissions which could lead to lengthy stays in hospital. The use of a block contract for 10 Intermediate Care beds would help to plan, care more efficiently and help to avoid unnecessary hospital stays. This would help residents remain and regain independence quicker.

The Cabinet Member closed by commending the recommendation to Cabinet.

Further to considering exempt information at item 29,

RESOLVED

To approve the award of contract under CSO 9.01.2 (g) for intermediate nursing care beds to the Supplier named in the exempt appendix for a period of eight (8) years, commencing from 1^st August 2019 at a value of £4,400,000 with an option to extend for a further period of up to two (2) years, for an estimated total value over the life of the contract of £5,600,000

Reasons for decision

Intermediate nursing care beds are an essential component of Haringey’s intermediate care pathway, providing enablement to patients that cannot be supported within extra care facilities or within their own homes due to the complexity of their health needs. Intermediate care beds differ in nature from standard nursing care as the purpose of Intermediate care is to improve a resident’s level of independence, predominantly through activity based therapies. A nursing care setting is appropriate for some people due to the complexity and medical nature of their needs, as well as the high levels of activity required of the service provider to safely mobilise residents.

These beds are a component of Haringey’s wider intermediate care provision and are supported by a dedicated community health multi-disciplinary team (MDT) comprised of occupational therapy, physiotherapy, nursing and social work for example, which was established following a multi-agency review of the intermediate care offer. It is commissioned outside of this contract and funded through Haringey’s Better Care Fund. The MDT works across two bed based intermediate care services in Haringey and is critical for ensuring efficient bed flow and therapy input to achieve better outcomes for individuals and reduce long term care costs and ensures that Haringey’s intermediate care pathway meets the NICE guidance definition of intermediate care. Moreover, in-borough delivery of this contract is in the Council’s overall interest. The MDT service is provided by community health professionals and the referral criteria for community health is based on the location of a patient’s GP – they can, therefore, only provide a service to those both residing and registered with a GP in borough. Nursing home residents outside of the borough would not be registered with a Haringey GP and therefore would not be able to receive services from the MDT which is at the heart of the success of this type of provision – limited or no access to the MDT will significantly reduce the effectiveness of the service.

The use of a block contract will mitigate the significant risk that local nursing beds will otherwise not be available when needed which would lead to a delay in transfers of care within acute care and a reduced opportunity to support residents to return to their previous levels of mobility and independence. The remaining capacity will be used by LBH in lieu of spot purchasing step up and step down nursing beds. In order to father alleviate the risk of void beds we will be able to make the beds available for use by partners across North Central London, where the full costs will be recharged to them

There is a paucity of nursing home provision within the borough with only 2 Care Quality Commission registered nursing homes (one of these provisions currently has an embargo on new placements). Haringey’s commissioning service intends to secure block contracts with this service provider for differing levels of nursing care to ensure access to local nursing is protected for Haringey residents. Notwithstanding a Cabinet decision on the future of OGNH, it is expected that capacity locally will not exceed that of the local demand. This award of contract will therefore enable the Council to continue working with a local provider to deliver intermediate care nursing bed service in Haringey.

This contract will be partly funded from existing resources within Adults Social Care and funded from a combination of:

• NHS Continuing Health Care, Individual client funding
• North Central London Partners, Individual client funding
• Systems Resilience Funding

The Home (see exempt appendix) run by the Supplier delivered an Intermediate Care Nursing Bed Service between two winter periods (September 2017 and March 2018) and (September 2019 and March 2019). The initiative was highly successful in supporting:

·        Hospital discharge, demonstrating clear commitment to partners to resourcing reduction in delayed transfers of care (DToCs). Haringey’s intermediate care provision has supported Haringey to achieve a 21% reduction in delayed transfers of care in 2018/19.

·        Development of the trusted assessor pilot.

·        Achievement of the 90% CHC assessment target.

For the reasons outlined above it was considered that a direct award under s.32 of the Public Contracts Regulations 2015 was the most appropriate method to secure an already scarce provision, along with the added benefit of the MDT, on the basis that there was no competition, i.e. there is no other currently available nursing provision in borough, and certainly none with MDT input. The MDT element is the main requirement for Intermediate care provision and would not be available to residents if they were placed out of borough. Moreover intervention of this type is short and intense to enable residents to avoid hospital readmission, reduce or mitigate against delayed hospital discharge and costly long-term care. It also would not be an option to decant vulnerable, aged, residents to alternative out of borough placements if a tender was undertaken.

Alternative options considered

Do nothing

This would result in Haringey having no nursing beds as part of our intermediate care pathway and being solely reliant on spot purchasing. Due to the limited availability of nursing bedprovision within the borough this would likely lead to out of borough provision, significant delays to discharge and the loss of the benefits of rehabilitative input from the MDT.

Go out to tender

The Council considered undertaking a competitive tender process in line with the Public Contract Regulations 2015. However, as the Home is the only CQC registered nursing home rated Good in the borough it would have been necessary to obtain quotes from nursing homes outside the borough. This was considered problematic as there would not be the same access to the multi-disciplinary support in place at the Home. Out of borough provision would result in the loss of the benefits of rehabilitative input from the MDT and diminish the effectiveness and value of the service. Moreover, residents were already insitu and it would not be a viable proposition to remove elderly, vulnerable residents to another establishment if one were available.

Deliver in-house

This was rejected as the only other nursing home in-borough is the Council managed service at OGNH. However, it is currently being considered for redesign and development to meet future demand and is presently unsuitable for the provision of intermediate care.