Executive	18 November 2021
Report of the Director of Prevention and Commissioning / Corporate Director of People Portfolio of the Executive Member for Health and Adult Social Care

Recommissioning of Carers Support Services

1.     Summary

1.1  The purpose of this report is to seek the agreement of CYC Executive to recommission the Carers Support Services for adults and young people. The service will be recommissioned through an open tender exercise. The tender will seek to deliver a sustainable, integrated support model for unpaid carers, delivered by a competent and professional external provider who fully understands the needs of carers of all ages and from all backgrounds.

1.2  Members are asked to agree the approach in line with section 7.8 of the council’s Contract Procedure Rules which stipulate that where the aggregate contract value (including any extension) is £500,000 or more the decision will be regarded as a Key Decision unless the Chief Finance Officer, acting in consultation with the Monitoring Officer, has approved the procurement as Routine.

1.3  The existing contract is due to expire on 31st March 2022. The current contract receives a financial contribution from VoY CCG. The VoY CCG have confirmed an agreement to continue the financial contribution over the next 7yrs at the current annual amount for the proposed duration of the re-tendered contract in line with any inflationary uplifts that may apply.

1.4  The recommendation is fully in line with the principles of the Care Act 2014 and the NHS long term plan, placing emphasis on prevention, early intervention and the maximisation of self-care.

2.    Recommendations

2.1  The Executive are asked to:

a)      Approve Option 1 within the report - undertake a tender exercise to re-commission Carers Support Services for adults and young people in line with the Key Decision criteria as set out in section 7.8 of the council’s Contract Procedure Rules.

b)    That the decision to award is then delegated to the Director of         Prevention and Commissioning Jamaila Hussain in consultation with the Executive Member for Adults Cllr Carol Runciman and the Chief Finance Officer and the Director of Governance.

2.2  Reason: To deliver a sustainable, integrated support model for carers, delivered by a competent and professional external provider who fully understands the needs of carers of all ages and from all backgrounds. Working within the principles of the Care Act 2014, placing emphasis on prevention, early intervention and the maximisation of self-care.

3. Background

The Care Act 2014

3.1  The Care Act 2014 brought about the most significant advance in carers’ statutory rights since the first legislation in 1996, giving carers the right to      be recognised and involved in assessments and care planning of the person they care for.

3.2  The Care Act made material changes to the pre-existing statutory duty to assess carers’ needs. Under Care Act guidance the duty to assess is triggered by the ‘appearance of need’ and is no longer dependent upon the carer making a request or dependent upon the carer providing (or intending to provide) regular or substantial care.

3.3  The Care Act also provided a clear definition of eligible needs, placing a duty upon local authorities to ensure that these assessed eligible needs are met – either through the provision of services to the carer or by making a Direct Payment available on request, thus enabling carers to exercise control over their own care and support requirements.

3.4  Furthermore the Act introduced a general duty to prevent, reduce and delay needs for care and support and to have regard to both the needs of the whole family and particularly young carers within this process. The Act also introduced a duty to provide information and advice to carers in relation to their caring role and their own needs.

Need and Demand

3.5    National Context: Census data and Carers UK research:

- The 2011 Census found that over 6.5 million people in the UK are carers however in 2019, using population projections from the ONS and polling by Carers UK it was estimated that 8.8 million adults in the UK are carers

- The 2011 Census indicates almost 4 million of the UK’s carers care for 1-19 hours each week whilst 775,000 provide 20-49 hours and 1.4 million provide 50 hours or more unpaid care

- Three in five people will be carers at some point in their lives in the UK. 

- Out of the UK's carers, 42% of carers are men and 58% are women.  

- The economic value of the contribution made by carers in the UK is £132bn a year (average of £19,336 per carer).

- In 2020 Carers UK estimated there were around 13.6 million people caring through the pandemic

- By 2030 the number of carers is estimated to increase by 3.4 million (around 60%).  

- Informal carers are increasingly undertaking more hours of care per week and are, on average, getting older.

- 19% of carers known to local authorities are not in paid work due to their caring responsibilities.

- Caring has affected the health of 86% of carers.

- 20% of emergency hospital admissions for carers/cared-for are for existing conditions which could be managed effectively by primary, community or social care and could be avoided.

- An estimated 35% of working age in-household carers may be entitled to, but not receiving, Carer’s Allowance.

- Research suggests that funding carer support services is a cost effective preventative investment – that for every £1.00 invested in carers, there is a potential equivalent reduction in local authority cost of £5.90, and with significantly greater ‘social return’ benefits.

3.6    Local Context: Figures obtained from the 2011 Census, York Carers Centre and the Joint Strategic Needs Assessment for York indicate that;

- There are 18,224 carers recorded in the 2011 census in York, comprising 9.2% of the population.

- The number of registrations with York Carers Centre is increasing at a rate of over 10% per annum.

- Figures from the 2011 census show that there has been a 25% increase in the number of young adult carers, aged 16-25. Most of these carers remain hidden.

- City of York Council and its partners are aware of over 5,000 carers (or 27% of the total number of carers registered through the 2011 census).

- 19% of these carers provide 50+ hours of care per week.

- In the next 15 years the number of York residents aged over 65 will increase from 36,000 to 46,000 and those aged over 75 will increase from 17,000 to over 26,000.

- As York’s population increases so does the prevalence of dementia and other long term health conditions. As a result it is envisaged that the demand for spouses and adult children to provide unpaid care will more than double over the next 30 years.

3.7    Impact of the Pandemic

The Carers UK research “Caring Behind Closed Doors: 6 months on” (October 2020) found:

- 4 in 5 unpaid carers (81%) are currently providing more care than before lockdown.

- More than three quarters (78%) of carers reported that the needs of the person they care for have increased recently.

- Most carers (64%) have not been able to take any breaks at all in the last six months.

- More than half (58%) of carers have seen their physical health impacted by caring through the pandemic

- 64% of carers said their mental health has worsened

Carers Hub Approach

3.8    City of York Council and the Vale of York CCG currently commission York Carers Centre to deliver a wide range of support services to adult and young carers in the city. The existing contractual arrangement commenced on 1^st April 2018 and is due to expire on 31^st March 2022.

3.9    In 2016 an agreement to support the creation of a Carers Hub was achieved, a highly visible referral point where carers could be offered early-stage assessment and preventative support in order to reduce and delay the need for more complex interventions.

3.10  Under the branding of the Carers Hub York Carers Centre has successfully established itself as highly visible, front-door contact point in the city which responds rapidly to carers’ needs. Carers therefore have one clear point of contact; a competent and highly respected provider who is able to offer immediate support - or signpost to an appropriate partner agency.

3.11  The Carers Hub has delivered strongly against the strategic priorities set out in the operating model for Adult Social Care, particularly the principle of ‘preventing, reducing and delaying the need for ongoing care and support’.

3.12  Through a combination of early intervention, proportionate assessment and triage for more complex cases of need the Hub provides a highly responsive, integrated and flexible carers support model - one which has proved effective in sustaining carers in their care giving role and reducing the demand for permanent, long-term care. This in turn has led to measurable cost savings across the health and social care system.

3.13  Outcomes associated with the current Carers Hub approach include:

- Consistent growth in new registrations.

- Targets for carer referrals being met and often exceeded.

- Targets for Carers Assessments of Need being met and often exceeded.

- Increase in the number of outreach hubs available to carers.

- Preventing the complete breakdown of the care giving role and associated longer term benefits

- Prevention in admissions to residential care / reduction in the take up of domiciliary care packages

- Prevention of a significant deterioration in carer mental health

- Prevention of a significant deterioration in carer physical health

- Sustaining carers in employment and alleviating financial hardship

3.14  It is the continuation and extension of the successful Carers Hub model that is proposed to be taken forward through the re-tendering arrangements.

3.15  It is envisaged that this investment will continue to significantly reduce the call on long term care, welfare and other benefits and physical and mental health services.

3.16  The current provider York Carers Centre has added significant value to the contract through their registered charity status, leveraging additional funding into the city to support carers as well as further volunteering opportunities for our population.

4. Consultation

4.1  Consultation and customer feedback has been sought on a continual basis by York Carers Centre as part of their contract monitoring arrangements and annual review process, through focus groups, surveys and interviews with carers of all ages from a wide variety of backgrounds. Quarterly monitoring reviews have taken place throughout the current contracted period.

4.2  Consultation feedback has been consistent - customers see significant value in the alignment of carers support services through the existing Carers Hub model and are strongly in favour of its continuation. Customers also see particular value in this model being delivered by the voluntary sector, often placed closer to the service user and able to understand and deliver on their support requirements.

4.3  Case notes from the York Carers Centre system and from Carers Assessments also point to customer satisfaction with existing support arrangements - particularly the co-ordination of all services through a single point of contact. The emphasis on early intervention and prevention through community outreach provision has been particularly valued. The ability to access Carers Assessments simply and easily within a community setting has also been widely appreciated.

4.4  The results and key findings of the 2021 National State of Caring Survey is due to be released in November 2021.

4.5  The current York Carers Strategy 2019 – 2024 and accompanying action plan was introduced following extensive consultation with carers across the city. Continuous feed-in and delivery of the strategy and action plan takes place with the oversight of the York Carers Strategy Group attended by carers, health and social care providers and voluntary sector partners crucial to the delivery of carers support services. The York Carers Action Group have direct feed-in to the strategy group through carer representatives.

4.6  The agreed vision of the York Carers Strategy is to create a carer friendly city. One where all carers in York will be able to say:

· I know who to turn to for help

· I can cope

· I can live a life of my own

· My voice is heard – my views make a difference

5. Options 

OPTION 1: The Re-commissioning of Carers Services

5.1    The Preferred Option. Through Option 1 CYC would approach the market to seek a single external provider or consortium to deliver the carers support service provision from 1^st April 2022 onwards. (A timetable for the procurement is attached as Annex A: Carers Service Open Procedure Procurement Timetable).

5.2    The VoY CCG have been approached and have agreed to continue to contribute £81,153.75 per annum for up to a maximum of seven year contract duration.

5.3    If the re-procured carers services were delivered by a provider other than the York Carers Centre it is likely that the York Carers Centre staff supported through existing contractual arrangements would transfer to the new provider in accordance with the Transfer of Undertakings Protection of Employment Regulations (TUPE). However, this would be a process to be determined and taken forward by the incoming and outgoing service providers.

Option 1: Advantages

5.4    A re-commissioned approach (driven and co-ordinated by a dynamic lead organisation) is likely to see a continuation and expansion of the existing good practice realised through the tendering of carers services, bringing about more sustainable, customer focused solutions and outcomes.

5.5    Although open to all providers this approach would be particularly suited to the local voluntary sector. The opportunity to leverage external funding into the city would bring added value to the contract.

5.6    Whilst valuing the strengths of the local voluntary sector a re-commissioning approach could also potentially open up the market to national providers who might bring an added dimension in terms of innovation and best practice gleaned from other areas. Such organisations might also bring experienced consortia management and leadership skills.

Option 1: Additional Considerations 

5.7    Expectations around innovation and added value and evidence of the savings realised by health and social care services are contained within the existing service specification and captured / monitored through contractual arrangements. The existing provider has successfully delivered a highly valued service. The service specification has been reviewed and outcomes are clearly defined to support the carers support service and carers hub approach through the re-tendering process.

5.8    If a consortia approach were to be successful the providers would need to evidence robust governance / joint working arrangements and indicate how they will effectively draw together various strands of service delivery and financing models. If partnership arrangements were to break down this could impact negatively on a highly vulnerable group.

ALTERNATIVE OPTIONS

Option 2: Do Not Recommission

5.9    Through this option CYC would not approach the market to re-procure carers support services. The existing carers services contract (and the activities delivered through it) would cease as of 31^st March 2022. The in-house element of carers provision delivered by the Adult Social Care Community Team Carers Support Workers would continue.

Analysis

5.10  Whilst the in-house Carers Support Workers are able to fulfil some of the authority’s statutory duties (these staff undertake the most complex carers assessments and support planning functions alongside York Carers Centre staff) the full range of statutory obligations as set out in the Care Act 2014 would not be met.

5.11  Section 2 of the Act requires local authorities to provide a range of support services that will prevent or delay the development of needs by carers. (It is not sufficient for authorities to rely on their general preventative services to meet these needs). In light of legal guidance contained within the Care Act it is therefore not possible for the council to discontinue providing a comprehensive range of support services for carers in the city and only proceed with a restricted level of in house provision post March 2022.

Option 3: In House Delivery Model

5.12  Through this option CYC would seek to deliver carers support services through an entirely in-house approach. The existing Carers Services contract with York Carers Centre would cease on 31^st March 2022 and all carers support services would thereafter be delivered in-house by the Adult Social Care Community Team.

Analysis

5.13  Carers’ services are already closely aligned and carefully co-ordinated through the Carers Hub. All referrals for carers support in the city are channelled through the Hub, where York Carers Centre and CYC staff meet on a weekly basis to jointly assess customer needs and agree which provider is best placed to offer ongoing support.

5.14  Delivering all carers support services directly through the council would not improve upon the existing co-ordination and alignment of services, and could cause confusion by changing a model which is widely recognised and understood by customers and other partner agencies.

5.15  It is also recognised that this may also put additional pressure on front line staff teams and managers to support and deliver.

5.16  This approach would not be in line with the principles set out in the Care Act 2014 of developing the provider marketplace, and ensuring that provision is flexible, responsive and tailored to the specific requirements of customer need; nor would it be in line with the approach of other local authorities, many of whom have already delegated the majority of their functions to local, independent carer support groups.

5.17  The approach also goes against the broader direction of travel identified in the Care Act to promote outreach, early intervention and prevention within community and neighbourhood settings and to encourage preventative approaches to independence and wellbeing.

5.18  Option 3 contradicts the wishes of carers in terms of the operating model that might best deliver their          desired outcomes. Customer case studies evidence the belief that carers’ provision would be better supported by strengthening and sustaining the existing voluntary sector driven approach.

6. Analysis

Financial Analysis

6.1    The current contract value is £422,286.75 pa (including a VoY CCG contribution of £81,153.75 per annum. The CYC element of the contract is from the BCF.

6.2    The VoY CCG have been approached and have agreed to continue to contribute £81,153.75 per annum for up to a maximum of seven year contract duration.

6.3    A range of studies have been conducted nationally related to the financial impact of carers including:

6.4    Carers UK and Leeds University’s “Valuing Carers”

http://www.leeds.ac.uk/news/article/2008/unpaid_carers_save_119_billion_a_year

“New estimates show the care provided by friends and family members to ill, frail or disabled relatives is now worth a staggering £119 billion every year.”

· The figure has risen by over a third since the 2007 estimate, which stood at £87

· billion

· Carers' contribution now far outstrips the total cost of the NHS (£98.8 billion).

· The figure amounts to £2.3 billion per week and £326 million per day.”

6.5    Royal College of GPs

http://www.rcgp.org.uk/clinical-and-research/clinical-resources/carers-support.aspx

“1.2 million carers spend over 50 hours caring for others, this equates to a full time workforce larger than the entire NHS. Carers are estimated to save the UK economy £119 billion a year in care costs, more than the entire NHS budget and equivalent to £18,473 per year for every carer in the UK."

6.6    NHS England

http://www.england.nhs.uk/commissioning/comm-carers/

Commissioning for carers: Principles and resources to support effective commissioning for adult and young carers. The study indicates that this could equate to a saving of almost £4 for every £1 invested.

6.7    Department of Health – Impact Assessment (Carers)

http://www.legislation.gov.uk/ukpga/2014/23/impacts

The Impact Assessment published by the Department of Health (October 2014) makes an estimate of the “monetised health benefits” of additional support for carers. This estimates that an anticipated extra spend on carers for England of £292.8 million would save councils £429.3 million in replacement care costs and result in “monetised health benefits” of £2,308.8 million. This suggests (as a ratio) that each pound spent on supporting carers would save councils £1.47 on replacement care costs and benefit the wider health system by £7.88.

7. Council Plan

7.1  The proposals are fully aligned with the Council Plan 2019 – 2023 and its corporate priorities, particularly:

- good health and wellbeing

o The carers support service and carers hub model supports carers to undertake their carer role. This approach is aligned to early intervention and prevention to avoid carer breakdown and improve the physical and mental health of carers across the city enabling them to undertake their carer role.

- well paid jobs and an inclusive economy

o The carers support service supports carers and their employers to recognise and adapt to carers needs, allowing them to gain and remain in employment alongside their carer role.

- a better start for children and young people

o The carers support service supports young carers and very young carers in their carer role, giving them a better start and sustained support to enable them to live a life of their own and have their own voice.

        8. Implications

8.1  No implications at this stage in terms of inequalities and quality. However this is time critical

· Financial: 

8.2 The contract value for re-commissioning will be set at £402,286,75 per annum. There is a slight reduction in contract value recognising the increase in innovation within the contract and Social Value resource.

· Human Resources (HR)

8.3  If the tender is awarded to a new provider through a re-procurement process. Then then the existing York Carers centre staff may be able to TUPE under the Transfer of Undertakings Protection of Employment Regulations (TUPE). However, this process would not involve the council as it would be up to the incoming and outgoing service providers to meet their respective HR obligations under the TUPE regulations.

· Equalities

8.4    Equalities Impact Assessment is attached (Annex B: Carers Support Service Equality Impact Assessment)

· Legal

8.5  Legal Advice has be sought in regards to procurement timescales and contract structure.

· Crime and Disorder: N/A

· Information Technology (IT) N/A

· Property N/A

· Other N/A

9. Risk Management

9.1  There are limited risks associated with the recommended approach other than the need to determine clear outputs and outcomes expected from the service and exercise robust contract management procedures to ensure that the outputs and outcomes are delivered to a high standard.

Contact Details

Author:	Chief Officer Responsible for the report:
Craig Waugh Commissioning Manager ASC Commissioning Team 01904 551053 craig.waugh@york.gov.uk	Name: Jamaila Hussain Title: Director of Prevention and Commissioning
	Report Approved	ü	Date	08/10/2021
	Jamaila Hussain, Director of Prevention and Commissioning
	Report Approved	ü	Date	03/11/2021
Wards Affected:  List wards or tick box to indicate all					All	ü
For further information please contact the author of the report

Annexes

Annex A: Carers Service Open Procedure Procurement Timetable

Annex B: Carers Support Service Equality Impact Assessment