Agenda item

The Cabinet Member for Health, Social Care, and Well-Being considered the report which sought seek authorisation for a direct contract award under Contract Standing Order 16.02 in line with CSO 9.01.2 (g), negotiation without publication of an advertisement, to Magicare Ltd T/A Priscilla Wakefield House for the provision of 8 Intermediate Care Nursing beds.

The report also detailed the Council’s requirement for Nursing Intermediate Care provision and demonstrated that these specialist nursing beds were an essential element of Haringey’s intermediate care pathway, which is made up of a range of integrated care services that aim to support residents at risk of an unnecessary hospital admission and to support patients to increase their independence following hospital admission.

The Cabinet Member enquired whether alternative providers had been considered. The Commissioning Officer noted that this had been considered but highlighted that Priscilla Wakefield House, run by Magicare Ltd, was currently the only Care Quality Commission (CQC) registered nursing care home in the borough and that in-borough delivery of the service was key for the patients and their families. It was added that the beds were supported by a dedicated Multi-Disciplinary Team (MDT) which also operated from Priscilla Wakefield House. It was noted that, if there were to be a tender, this would be open to bids from out of borough and it was considered that, given the key role of the MDT, this would impact on the viability of the bids.

In relation to queries about staffing pay and conditions, the Commissioning Officer noted that Priscilla Wakefield House currently offered the National Living Wage and officers were working with the provider to move towards the London Living Wage. It was noted that it was aimed to phase this process in order to ensure that it was sustainable. It was added that there was currently an increased degree of uncertainty, including fuel costs, and so the phased approach was considered the most appropriate and deliverable option.

The Cabinet Member RESOLVED

1.    Pursuant to CSOs 9.07.1(d and e) and 16.02, to approve the award of contract to Magicare Ltd for the provision of eight (8) Nursing Intermediate Care Service beds for a period of three (3) years, from 1 April 2022 to 31 March 2025 with the option to extend for up to two (2) years, up to a maximum contract value of £2,288,000.

2.    To give delegated authority to the Director of Adults and Health to agree the final sum for the service within the upper limit referred to above.

Reasons for decision

Evidence from the 2015 National Audit of Intermediate Care shows that intermediate care services are key to reducing the financial, quality and activity pressures being experienced in secondary care and the social care sector.

There is a very limited market for nursing beds in the local area. Priscilla Wakefield House (PWH), run by Magicare Ltd, is currently the only Care Quality Commission (CQC) registered nursing care home in the borough with a bed base of 117 Nursing beds.

The award of this contract will enhance Haringey’s intermediate care pathway by continuing to work with a local provider to deliver a co-ordinated intermediate care nursing bed service in Haringey allowing Haringey residents to remain close to home whilst recovering.

The Joint intermediate care pathway was established in 2016 and is a partnership approach between health and social care to managing hospital discharges for patients requiring short term health and care interventions. The proposed Nursing Intermediate Care Beds will be funded through the Clinical Commissioning Group (CCG) Minimum Allocation for the Better Care Fund (BCF) which will be recharged to the Local Authority by the Clinical Commissioning Group and shall not have a financial implication to the Local Authority.

The Nursing Intermediate Care Beds will provide an alternative nursing care offer for those with ongoing health needs following a hospital discharge. These beds will support patients with high intensity and/or more specialised nursing needs who may require a spell of ‘active nursing convalescence’ as part of the joint intermediate care pathway to prevent patients needing to go to, or to facilitate their return home from hospital. This time-limited response forms part of the wider intermediate care and community nursing solutions available for Haringey patients.

Traditionally these patients would have been provided care by health partners through spot purchased health step down. It is recognised that patients placed in these provisions frequently deconditioned due to a lack of timely therapeutic input and following period of convalescence had higher than anticipated needs requiring Long Term Care placements funded predominantly by adult social care. It is believed that incorporating these beds into the joint Health and Social Care intermediate care pathway will streamline connections between Intermediate Care Services and Continuing Health Care (CHC) assessments through closer collaboration between the Single Point of Access (SPA), CHC team and Reablement services and will better accommodate and manage this patient group improving patient outcomes and the effectiveness of care.

It is anticipated that the provision of these beds will improve outcomes for patients as a result of the convalesced individuals receiving co-ordinated care from the Nursing Home, Care Homes Assessment Team (CHAT)1 and Multi-Disciplinary Team (MDT)2 who are already providing intermediate care services within Priscilla Wakefield House. This will enable patients to ‘step down’ to less intensive solutions following their intervention which will be beneficial to health and social care Long Term Care budgets and will reduce the risk of subsequent hospital readmissions.

Purchase of these eight beds will support Haringey’s intermediate care pathway by mitigating the significant risk that beds will otherwise not be available when needed. This will result in delayed transfers of care for Haringey patients and increased risk that patients will be placed in out of borough spot purchase arrangements with no access to multi-disciplinary input to support the patients recovery which potentially lead to irreversible deconditioning increasing probability of requirement for long term nursing placement. The CCG has recently reinforced its commitment to these Integrated Care Beds by agreeing to increase its funding of the contract from six beds to eight beds.

Should need or demand for these beds change during the course of this contract, the Council will retain the right to use the beds flexibly, including for general nursing, but with the prior notification to the provider.

The Nursing Intermediate care beds are part of Haringey’s wider intermediate care provision. As noted, the beds are supported by a dedicated community health multidisciplinary team (MDT). The MDT is critical for ensuring efficient bed flow and therapy input to achieve better outcomes for individuals and reduce long term care costs.

Haringey’s MDT Service is comprised of a part time GP, Social Worker, Physiotherapist, Occupational Therapist, Rehab Technician and Pharmacist all working holistically with the service user to maximise their independence. The MDT service is funded through the Boroughs Better Care Fund and covers other intermediate care services within the borough, providing continuity of care for patients transferring between establishments. The Team are also able to access additional support from other community health providers such as District Nursing and Rapid Response within borough. However, it should be noted that the funding and contracting of the MDT is under a separate element of the Section 75 Agreement between the Council and the CCG, and are not included in the contract under discussion in this paper. If as an alternative, we utilised a nursing home outside of the borough for these intermediate care beds, this would result in no MDT input. In-borough delivery of this service and MDT is in the patients’ and families, and Council’s overall interest.

Alternative options considered

Do nothing – this would result in Haringey CCG being solely reliant on spot purchasing for the provision of these beds. Due to the limited availability of nursing bed provision within the borough this would likely lead to out of borough provision, delays to discharge and the loss of the benefits of rehabilitative input from the MDT and CHAT.

Go out to tender – The Council and CCG could have undertaken a competitive tender process in line with Contract Standing Orders. However, as Priscilla Wakefield House is the only nursing home in the borough it would have been necessary to obtain bids from nursing homes outside the borough. Due to the multi-disciplinary support already in place at PWH out of borough provision would result in the loss of the benefits of rehabilitative input from the MDT and CHAT and diminish the effectiveness and value of the service.

Across the North Central London footprint there is limited provision of nursing care. Currently there are approximately 2500 nursing home beds within the five partner boroughs. It is Haringey’s policy to place residents only in homes which are rated ‘Good’ and ‘Outstanding’ by CQC and 28% of beds within the North Central London footprint are in establishments rated ‘requires improvement’ which further limits the number of available supply.