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Meeting: |
Executive Meeting |
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Meeting date: |
10TH October 2024 |
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Report of: |
Corporate Director of Adult services and Integration (DASS) |
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Portfolio of: |
Cllr Lucy Steels-Walshaw, Executive Member for Health, Wellbeing and Adult Social Care |
Decision Report:
Community
contracts to support early intervention and prevention in Adult
Social Care (ASC)
Subject of Report
2. This report asks approval to tender for 2 new services:
a) Advice and Information Service
b) Supporting Independence Service
3. The tender process request is made to provide a prevention offer to be delivered to support Adult Social Care for individuals who need some additional support to remain in their own homes. Local authorities have a duty to prevent, reduce or delay needs for care and support (Care Act 2014 s2) for all adults including carers; this means early intervention to prevent deterioration and reduce dependency on support from others.
Benefits and Challenges
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Table 1 – Pros and Cons detail |
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Advantages (Pros) |
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· CYC will be fully compliant with CYC’s Contract Procedure Rules and the current Public Contract Regulations 2015 by tendering both services on our e-tendering website portal called YORtender. · Offers an important opportunity to offer a re-developed specification outlining clear expectations of service delivery and outcomes for our residents. · Providers will progress though a neutral selection process with clear set obligations and the selection will be made based on a rigorous evaluation of what CYC requires. · The new Contract will have an initial term of 3-years, with an option to extend for up to a further 2-years (5-year contract). |
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Disadvantages (Cons) |
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· Tendering services does not mean that there is a guarantee of Providers bidding for these services. However, York has a vibrant voluntary sector who would be capable of delivering these services. · To complete the tendering exercise can be time consuming and will require commitment of staff resources from various departments including Legal, Commercial Procurement, Finance alongside ASC commissioners. The Open Procurement procedure will be used that will combine stages of the process and is a single stage procurement procedure to progress the receipt, evaluation and award of contracts in an open, fair, transparent process within an efficient timescale. · These will be revised models of support therefore the incumbent provider may not wish to apply for the opportunity, however there is a vibrant market. This will be managed through the implementation process. |
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Key Risks |
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· Tendering the Service does not mean that there is a guarantee of Providers bidding for the Services, and this would lead to CYC not providing these services in line with the Care Act 2014. · Timescales to reprocure the Service are sufficient currently but if there are delays within the process this may not allow sufficient time to embed the new service if there is a new Provider. · Pension Scheme implications for the Advice and Information Service currently provided by Age UK York. · TUPE implications for the Advice and Information Service currently Provided by Age UK York. |
Policy Basis for Decision
4. The Commissioning Strategy, Market Sustainability Plan and the 10-year vision ‘People at the Heart of Care: adult social care reform paper’ clearly outlines that the Council will work with existing Providers within the market to provide sustainable, quality and value for money services.
5. The Care Act 2014[1], places a series of duties and responsibilities on local authorities to improve people’s independence and wellbeing. It makes clear that local authorities must “provide or arrange services that help prevent people developing needs for care and support or delay people deteriorating such that they would need ongoing care and support”[2]
6. The proposal within this report covers two key aspects of prevention within the Care Act, 2014. The Care and Support Statutory Guidance[3] states that “primary prevention / promoting wellbeing services” are,
“generally universal (for example, available to all) services, which may include, but are not limited to interventions and advice that:
· provide universal access to good quality information…
· reduce loneliness or isolation (for example: befriending schemes…)”
Statutory Guidance[4] goes on to define “Delay: tertiary prevention / formal intervention” stating these “are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia). supporting people to regain skills and manage or reduce need where possible”
This describes the purpose of the proposed Advice & Information and Supporting Independence Services
7. Advice & Information and Supporting Independence Services will directly support the achievement of The Council Plan 2023 to 2027, One City, For All, which sets a strong ambition to increase opportunities for everyone living in York to live healthy and fulfilling lives, as follows:
a) Health-Improve health and wellbeing and reduce health inequalities, taking a Health in All Policies Approach.
b) Equalities and Human Rights- Equality of opportunity
c) Affordability- Tackling the cost-of-living crisis.
8. A key priority in Adult Social Care is the continued development of our Home First Model where one of the 5 key priorities outlines in City of York Council’s (CYC) All Age Market Position Statement[5] is to “Move to a community asset approach of prevention and living well in older age.”
9. The Joint Health and Wellbeing strategy[6]’s, 2022-32, sets out ‘Ten Big Goals’ within it and this proposal supports the strategy as outlined in the table below.
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No. |
Description |
Action Plan |
How |
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1 |
Reduce the gap in healthy life expectancy between the richest and poorest communities |
Overarching priority which will be achieved if all other priorities are successful |
Advice & Information and Supporting Independence Services |
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10 |
Reduce the proportion of adults who report feeling lonely |
identify gaps in provision for those at greatest risk of loneliness |
Advice & Information and Supporting Independence Services |
Financial Strategy Implications
10. The £227k annual budget can be met from within existing resources. However, in order to cover off other contract pressures, the budgets managed directly by the Head of All Age Commissioning have been rebased which gives little flexibility to find future budget savings from this area.
Recommendation and Reasons
11. Recommendation: to approve the approach to commission, through a competitive tendered process, the following two services for a period of 3 plus 2 years:
a) Advice and Information Service (value £100,000 per annum)
b) Supporting Independence Service (value £127,000 per annum)
Reason: The option proposed will comply with CYC’s Contract Procedure Rules in terms of completing an open, fair, and transparent process as the market has not been approached since 2017. The procurement procedure is subject to the Light Touch Regime under the Public Contracts Regulations 2015 and will be completed as an Open Procurement Procedure.
Reason: The provision of the Advice & Information and Supporting Independence Services ensures the Council meets the statutory duty under the Care Act 2014 through prevention and delay.
12. Recommendation: To delegate authority to the Corporate Director of Adult Services and Integration (“DASS”), in consultation with the Head of Procurement and the Director of Governance to take such steps as are necessary to procure, award and enter into the resulting contracts.
Reason: This will enable the Contract Award to be implemented within the Procurement timescales.
Background
13. Adult Social Care funds a variety of community contracts to enable the Council to fulfil its duties and responsibilities so there is sufficient provision to improve people’s independence and wellbeing as described in the Care Act 2014[7].
14. These contracts are described in Annex A and have been under review.
15. The commissioned contract which provides the current prevention offer is an Older People Community Wellbeing Contract which ends 31st September 2024 with an agreed bridging service until 31st March 2025. This service has not been reprocured on the open market since 2017 and other community prevention contracts have ended.
16. There will be an increase in those needing care, those providing unpaid care and those living with dementia as described in York’s Joint Strategic Needs Assessment[8] for adults over the age of 65:
|
Population |
2020 |
2040 |
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Living with dementia |
2,927 |
4,291 (+47%) |
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Needing care |
11,380 |
15,207 (+34%) |
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Providing unpaid care |
5,271 |
6,592 (+25%) |
17. All health and care services will be put under increasing pressure with an increased and ageing population. Population growth forecasts indicate:
· The resident population of York is forecast to grow by approximately 35,000 between 2023 and 2033 with the largest percentage increases in the over 65’s, an estimated additional 13,800 residents aged 65+ by 2033.
· The GP registered population is forecast to increase from 251,000 (currently) to 255,600 by 2033.
18. Population health forecasts indicate continued challenges on an already stretched system:
· In 2022, life expectancy for males declined from a peak of 80.2 years (2019) to 79.2 (2022), and for females declined from a peak of 84.1 years (2019) to 83.3 (2022). Male life expectancy in York has now crept below the national average for the first time (York is 75th out of 148 LAs).
· The number of individuals living with multiple Long-Term Conditions is increasing in York, indicating increased and more complex health and care requirements for these individuals in future years.
19. Good, accessible information and advice are essential to enable people in later life to play a full part in their community, make informed decisions and be able to access the right services for them. Care and Support Statutory Guidance[9] states; “It is critical to the vision in the Care Act that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point.” It states prevention services include services that, “…provide universal access to good quality information…”
20. The current information/advice/signposting service currently provided by Age UK York received 5,444 enquiries in 2023/24 split between health/community care, benefits and finance advice and other general enquiries. This service offers and directs older people to services in the community who may not otherwise be computer literate and not know where to go for advice or support before coming to ASC.
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information / advice / signposting |
17/18 |
18/19 |
19/20 |
20/21 |
21/22 |
22/23 |
23/24 |
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TOTAL no. of enquiries/actions recorded pa |
4,281 |
5,646 |
6,504 |
4,872 |
5,847 |
7,118 |
5,444 |
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Health / community care / non res & res care |
1,760 |
2,033 |
2,316 |
2,066 |
2,043 |
2,092 |
1,781 |
|
Benefits / housing / legal |
1,220 |
2,141 |
2,636 |
1,817 |
2,073 |
2,553 |
1,406 |
|
Other general enquiries |
1,301 |
1,472 |
1,552 |
989 |
1,731 |
2,473 |
2.257 |
21. We know the population in York is aging, with an estimated increase of 50% for those aged 80 and over[10]. Social connection is a vital part of a good life and access to good information and advice plays a key role in this.
22. For those not able to leave their homes as often as they would like, tohave the benefit of a regular befriender plays a role in their connections to the community and supports them to be less isolated. There are currently 85 matches with 61 waiting for a match (this involves assessment and finding volunteers to match with).
23. The impacts of not having social connection is well documented on a human level and the links between loneliness and poor health are well established, the LGA comment in their report, Combating Loneliness[11], “It is associated with higher blood pressure and depression, and leads to higher rates of mortality-comparable to those associated with smoking and alcohol consumption. It is also linked to higher incidence of dementia, with one study reporting a doubled risk of Alzheimer’s disease in lonely people compared with those who were not lonely. As a result of these health impacts, lonely individuals tend to make more use of health and social care services, and are more likely to have early admission to residential or nursing care.”
Engagement around Future service delivery
Social Work and Local Area Coordinators survey May 2024
24. An online survey was sent to social workers and local area coordinators asking their views on gaps in community provision that are most important for the residents that are either supported by Adult Social Care (ASC) in their own homes or those who are supported by Local Area Coordinators in the community which would enable our residents to stay as independent as possible for as long as possible.
25. As well as receiving 16 separate responses from social workers to the survey the Team Manager also collated views and summarised as follows:
“As well as identifying gaps to assist with shopping, loneliness, and paperwork we also struggle with transport and management of finances/ money- especially when cash is involved as this results in two workers having to attend.
….we have been referring customers to LAC’s but they do not have the capacity to pick up long term support work- they may be able to help with a one off situation but cannot sustain regular support due to the demands on their service.”
26. Overall 18 social workers and Local Area Coordinators responded to the survey
27. There was a wealth of verbal feedback including:
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Many of the customers we support have no internet access and due to hearing, memory issues or dexterity issues are unable to use the shopping lines from supermarkets. Many often do not have anyone who is able to support them with shopping. |
People are unsure want is out there and where to find support not everyone is turned into technology. |
Many clients need support to either get to the shops or help with carrying. Not just food or essential either ~ some want to buy clothes |
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Working with increasing numbers of isolated and lonely older people. This includes permanent residents of care homes who sometimes don’t want to chat with other residents but enjoy a visitor who will let them talk about their past |
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Early intervention and information is vital to encourage residents to access community resources/understand eligibility before requiring adult social care |
carers report feeling overwhelmed with paperwork, particularly when having to deal with the ‘cared for’ mountain of social care/health documents, as well as their own and household paperwork. |
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loneliness is a critical issue and people can get attached to care to manage these feelings when befriending referrals are closed as they are currently. Also an absolute gap in befriending services which will also support people with dementia |
Support with Bills/correspondence (this is an eligible care act need, “Maintaining Home” – low level support 1 hour per week as an example could prevent the need for paid for services. |
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There are current gaps to the befriending service which leaves some carers lonely and isolated, particularly those caring for adults with severe learning disabilities or advanced dementia or those in any caring role where companionship has gone |
Previous wellbeing service to support with paperwork etc - I felt that we really reduced the need for people to have care packages |
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Many will attempt to do little jobs increasing falls risk when using ladders, drill to fix or repair things |
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The services identified help to prevent, reduce and delay the need for formal services and referrals. I can already see an increase in the number of referrals being made through the front door to the social work teams due to a reduction in the community-based resources available. |
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Age Friendly York Operation Group, May 2024
28. As well as consulting with social workers and local area coordinators the commissioner also attended an Age Friendly York Operation Group meeting to discuss Adult Social Care’s community contracts.
29. The key areas of importance for funding were considered:
· Reducing social isolation
· Access to information and advice
· Dementia
· Falls prevention
· Getting out and about
Customer feedback from the Older People Wellbeing Service- befriending satisfaction survey 2024
30. 33 people were surveyed in relation to be Befriending Service offered by Age UK York. Of the survey’s returned 92% were very satisfied with the service they received.
31. Comments included:
· Just nice to know you can talk to someone on phone or by person. It is lovely to know someone calling once a week
· Since I am alone with no close family I value the weekly visits on those days that I don’t see friends, most of whom are elderly like myself and are limited in their ability to visit.
· I think that I am less down/ depressed. X has cheered me up a lot. I wish I had met her before. Once again thanks to coordinator.
· It is great to have a natter with him whilst enjoying a cuppa together. It is good to see & talk to someone life can be very lonely at times.
Organisational Impact and Implications
Financial Implications
32. The cost to commission the services in this report is £227,000 p.a. The total cost over the full life of the contracts (3 plus two years) will be £1,135,000 and can be met from existing budgets.
Procurement Implications
33. There will be two separate services for Advice and Information Service, Supporting Independence Service to be procured and therefore CYC’s Contract Procedure Rules and the current Public Contract Regulations 2015 (PCR’s) in terms of completing an open, fair, and transparent process as the market which has not been subjected to an advertised tender opportunity to invite competition since 2017. The procurement procedure will also subject to the Light Touch Regime under the PCR’s which applies to social care and health services and these procurements will be completed as an Open Procurement Procedure.
The tendering of the two services for an Advice and Information Service, Supporting Independence Service to award two contracts will need to comply with the current Public Contracts Regulations 2015 and with the total contract value of these two services exceeding the Light Touch Regime threshold of £663,540 which means an open, fair, transparent procurement exercise which is advertised through a published Contract Notice for suitable interested providers to express their interest would be required to be completed. This will ensure that the market of suitable providers of Community services of advice, information and supporting independence to support early intervention and prevention in Adult Social Care are invited to submit a tender response to encourage competition and that CYC receive Value for Money by evaluating suitable providers within the procurement exercise.
The Open procurement procedure will require ASC to develop and include appropriate evaluation criteria weightings for Quality and Price. Underpinning this procurement will be the principle of obtaining Value for Money for CYC and therefore a robust, suitable Price evaluation criteria will need to be developed and included within the tender documents to robustly assess how bidders will assign the total contract value because this information will be contained within the Contract Notice and tender documents that are published.
The legislation that governs procurement for the Public Sector is due to change from 28th October 2024 when the new Procurement Act 2023 will replace the current Public Contract Regulations 2015 and so if CYC decide to commence the Open procedure procurements for these two services until this date or beyond then there are a series of other procedures, notices and actions that will need to be completed which could impact on the timescales for the completion of the procurements.
Human Resources (HR) Implications
34. There are no HR implications for City of York Council.
Legal Implications
35. The proposals in this report will ensure the Council is fulfilling its duties and responsibilities in relation to people’s independence and wellbeing under the Care Act 2014.
Health and Wellbeing Implications
36. Prevention in social care is about encouraging people to be more proactive about their health and wellbeing. It can increase independence and reduce or delay the need for care and support services.
A consensus statement published in 2019 and updated in 2023 set out 5 principles to give all older people the opportunities and support they need to have a healthy and good quality later life, the first of these is: Putting prevention first and ensuring timely access to services and support when needed.
The services outlined in this paper and proposal for commissioning of advice and support together with early intervention and prevention support the public health principles to ensure that all people have the opportunity to live healthier for longer.
Equalities and Human Rights Implications
37. An Equalities Impact Assessment has been carried out and is annexed to this report at Annex C. In summary, the results of the assessment are that overall, it is considered that the proposal will have a positive impact in creating fairer and more equitable community provision for the population of York.
Data Protection and Privacy Implications
38. The data protection impact assessment (DPIAs) screening questions were completed for the recommendations and options in this report and as there is no personal, special categories or criminal offence data being processed to set these out, there is no requirement to complete a DPIA at this time. However, this will be reviewed following the approved recommendations and options from this report and a DPIA completed if required.
Communications Implications
39. There are the usual stakeholder management challenges that we would associate with any tendering process and subsequent contracts, but we are confident that a cross-team approach and robust organisational processes that are in place can alleviate any significant challenges
Economy Implications
40. There are no economic implications arising from the recommendations in this report.
Affordability Implications
41. This new model will be “targeting our support at those who need it most, supporting communities to build on their own strengths and those of the people around them” by investing in our residents and communities earlier we will ensure that if additional, more formal support, is required this will be at lower level or much later in a resident’s life journey. This support includes information and advice about financial support for those who may find it difficult to access services online.
Special Implications Officers
42. There are no specialist implications.
Options Analysis and Evidential Basis
Option 1 – Commissioning 2 new services (3 + 2 years) for:
i. Advice and Information Service (£100,000 per annum)
ii. Supporting Independence Service (£127,000 per annum)
(Preferred option)
43. Reason: The services will be remodelled from previous contracts to ensure an updated offer is available to provide services for those residents who are nearest adult social care’s ‘front door’. The services will meet all statutory requirements in relation to early intervention and prevention under the Care Act 2014.
44. Benefits:
· Advice and Information will still be available for those who are not digitally literate - good, accessible information and advice are essential to enable people participate fully in their community, make informed decisions and be able to access the right support for them.
· Advice and information about support opportunities are crucial to help support carers in maintaining their caring role.
· Expands community provision to enable people to remain independent for longer or to regain independence where appropriate.
· Reduces/delays need for more formal support.
· Enables strength based practice by assisting people to manage their own health and wellbeing in their own homes whenever possible.
45. Risks:
· No opportunity to develop and expand the current limited offer.
· No Supporting Independence Service would increase isolation and loneliness with the potential impact of needing more formal support sooner.
· Not having these services will put additional pressure on other parts of the system which could be at more costly levels as people hit crisis sooner.
Option 2: Collaborative model
46. Reason: CYC is keen to for new providers / voluntary sector to offer services in a collaborative way ensuring services offered fit the needs of the residents of York.
47. Benefits:
· Opportunity for expansion / innovation to allow development of a new service model.
· Service will develop in line with local needs and priorities and will be available at a community level.
48. Risks:
· With the current available budget a collaborative model is a risk in relation to consolidated service offer.
Option 3: No services
49. Reason: Adult Social Care has finite resources and these services may evolve naturally within the voluntary
50. Benefits:
· Opportunity to make additional savings.
51. Risks:
· Not having these services will put additional pressure on other parts of the system which could be at more costly levels as people hit crisis sooner.
52. If the recommended approach is adopted the timeline for the procurement and implementation of these two services will be the following:
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Pre-tender approval process |
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|
Portfolio lead briefing |
08-Aug-24 |
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Corporate Governance Board MEETING |
14-Aug-24 |
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Report deadline for Exec/CMT |
23-Aug-24 |
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Forward Plan publish date |
09-Sep-24 |
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Exec / CMT MEETING |
10-Sep-24 |
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Executive MEETING |
10-Oct-24 |
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Tender Process |
|
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ASC commissioning team to prepare tender documents (plus legal and procurement input) |
Sept 24 |
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Tender Process |
Oct - Nov 24 |
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Evaluation and award of contract |
Dec-24 |
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Implementation phase |
Jan - Mar 25 |
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New services commence |
1st April 2025 |
Risks and Mitigations
53. Risks are regularly reviewed and managed with required mitigations and controls put in place to minimise likelihood and impact.
Wards Impacted
54. All wards are impacted.
Contact details
For further information please contact the authors of this Decision Report.
Author
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Name: |
Katie Brown |
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Job Title: |
Commissioning Manager |
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Service Area: |
All Age Commissioning Team |
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Telephone: |
01904 554068 |
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Report approved: |
Yes |
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Date: |
3 October 2024 |
Annexes
· Annex A: Summary of Community Services Contracts, including those that ended 23/24
· Annex B: Impact Assessment for Adult Social Care Reduced Funding for Community Contracts
· Annex C: Equalities Impact Assessment for Adult Social Care Community Contracts – Future commissioning options