Agenda item

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

Award of  contract for small number of providers  to deliver  Home Support & Reablement bundled  hours across the different localities Borough wide.

The Cabinet Member for Adults and Health introduced the report which set out the outcome of a mini-competition tender process conducted via the Council’s Dynamic Purchasing System (DPS) for Home Support and Reablement Services and sought approval to award a ‘Call-Off’ contract (referred to as a Service Agreement) to the successful Providers in accordance with the Contract Standing Order 9.07.1(d).

Service Agreements were proposed to be awarded for a period of 29 months commencing from 12th April 2021 to 31st August 2023 with an option to extend for further period of up to two (2) years. The estimated cost of the service for 29 months was set out in the report.

The Cabinet Member emphasised that this proposed decision was an important step in a process to transform home support in Haringey, recognising the critical role it played in enabling people to live in their homes for as long and as well as possible.

The Cabinet Member outlined that by offering London Living Wage to all front-line care workers, the Council were honouring their commitment to the Ethical Care Charter and recognising the importance of care workers – their status and their value – in the delivery of home support. The Council were continuing to recognise that for the majority of people the experience of home support is their experience of social care – representing a real opportunity to make the necessary changes when people are at their frailest and vulnerable.

In response to questions from Councillor Palmer, the following was noted:

Locality working was at the heart of this strategy and issues around travelling around visits would be reduced and provide a better working experience. The Cabinet Member agreed with Councillor Palmer on the provision of sick pay to carers, but this was reliant on national government funding. There had been campaign for sick pay for care workers and increasing levels of sick pay for people on low incomes. These issues had been raised with ministers in writing by the Council.

The Council were seeking to improve the quality of care offered and not reduce the hours provided of personal care. The nature of care has been transformed over the last year and the contracts recognised this as there were lots of ways of delivering care and improving quality of care.

The co- design group process had started with the RSA and LGA working with the Council  to consider innovative ways of designing services which involved  a range of   stakeholders including: frontline care workers, council staff and local residents.  This led to the proposals for ‘working  together differently’ and there then continued to  have stakeholder meetings  to ensure there was the right offer  linked to localities. There were regular reports to the ASC design group with work continuing with users on improving locality working, ensuring the residents had access to the same  regular carer who lived locally and ensuring links to existing  services in localities.

[At 9.40pm the Leader moved to invoke Committee Standing Order 63 which was the suspension of Committee Standing Orders. This was to allow suspension of standing order 18 and the meeting to progress after 10pm. ]

This motion was agreed by Cabinet and the meeting continued after 10.pm.

Further to considering exempt information at item 26,

RESOLVED

1. To approve the award of Service Agreements for bundled hours of Home Support and Reablement services to the successful Providers (identified in the exempt appendix of this report) for a period of 29 months commencing from 12th April 2021 to 31st August 2023 with an option to extend for further period of up to two (2) years. The estimated cost of the service for 29 months would be £17,793,060 and for duration of 53 months (if extended) would be £34,261,190 inclusive of LLW for financial 21/22 but exclusive of annual inflationary increase for subsequent years.

2. That if a successful Provider is awarded a Service Agreement for a Bundle and rejects the award, then the next ranking Provider for that Bundle will be offered the Service Agreement (if required);

3. To vary the contract price annually in line with LLW (as published by the Living Wage Foundation periodically) inflationary increase from 1st April for each and every subsequent year for the term of Service Agreements; and

4. To waive Contract Standing Order (CSO) 9.08.8 (requirement to execute the contract under seal as a deed where value of the contract is above £250,000) as permitted under CSO 10.01.1(a) as the Service Agreements are electronic on DPS.

Reasons for decision

All home support and reablement Service Providers currently enrolled on the DPS were invited to tender for the bundled hours home support and reablement service. The providers’ submitted offers were evaluated using a 40% quality and 60% price weighting, on this basis, the recommended Service Providers’ bids were deemed to be the most economically advantageous, representing the best value option to deliver the required service. The split of quality and price was selected on the grounds that price variations have to some extent been covered by the requirement to pay London Living Wage.

Commissioning a locality-based home support and reablement service will bring several benefits: Service providers will be able to develop a good knowledge of the area they work in and the community resources available for service users to access, there will be dedicated service providers for each locality, removing the current hard- to- reach area problem and in turn this will mean Service providers will be based closer to the people they are serving, with a consequent reduction of travel time for care workers.

By working with a smaller number of providers across three Localities, the new model will provide several benefits: a unified approach between care providers, social workers, community nurses, therapists, and the voluntary and community sector, which aligns to Haringey’s locality-based working with the NHS and particularly primary care. Working with fewer providers lends itself to more effective contract monitoring as it will require less Council resource to ensure efficacy in delivery outcomes, as well as allowing the Council to develop crucial partnerships with Providers to assure quality and continue to improve value.

It is anticipated that the new model will deliver improved outcomes, offer a more sustainable service, and create better conditions for the workforce. Features of the new model include:

-      For each Locality, the Council will commit to commission a minimum number of guaranteed hours from the Service Providers each year. This will enable the Service Providers to organise and manage their resources;

-      70% of home care packages will be through a bundled hours’ arrangement;

-      30% of home care packages would remain as spot purchases to enable opportunity for small/micro, including not-for-profit organisations and existing Small and Medium Sized Enterprises, to remain in or to enter the market as well as to provide market resilience;

-      Providers will be required to pay all care workers LLW meeting the Council’s commitment to LLW. Employee wage is connected to the service providers’ capacity to recruit and retain care workers, and continued non-payment of LLW would impact negatively on the quality of service delivery, whilst payment will support better quality care;

-      Providers will operate across a wide range of health and care needs for both Adult Social Care and NHS Continuing Health Care (CHC) packages;

-      All providers will be required to have an Electronic Call Monitoring system in place so that we can effectively understand the costs of care provision whilst maintaining an outcomes-focused approach;

-      The new model will see improved workforce recruitment and retention through improved contractual arrangements; and

-      Career progression pathways through greater skills development, workforce planning and linking in with the pan-London ‘Proud to Care’ initiative. Appropriately skilled care workers will be an essential part of the new model of care and will ensure that they have career opportunities to develop skills that will offer a pathway into more advanced social care or health care provision.

Alternative options considered.

In house Provision - An option to proceed with an in-house home support service was considered but rejected based on the assessed additional financial impact, as well as the scale of the infrastructure required to implement an in-house model.

Implementing an in-house home support service at an additional (to the higher costs set out here) cost of £3.5m per annum would be challenging, particularly in the context of the significant level of savings already being implemented for the financial years 2019 – 2021 for Adult Social Care, totalling approximately £16m and the current financial pressures aggravated by Covid 19.

In-house services can give greater control over the care that is provided, delivering improvements and minimising risks by ensuring supply and balancing cost and quality requirements against the available budget although quality is not guaranteed through an in-house delivery model. Previously in-house services have, however, been shown to be significantly more costly than external provision, due either to lack of efficiency and/or to better staff terms and conditions. No London borough currently has an in-house model for home support.

Do nothing - An option to continue with the current model of home support was considered but rejected on the grounds that it does not meet the Council’s commitment to delivering LLW, nor does it transform the service to deliver in an integrated way to meet user needs.

An option to deliver the existing model but at LLW rates was considered but rejected on the grounds that this would not deliver the improved outcomes for service users that a high quality, integrative model would achieve.