Adult care commissioning and procurement plan approved by Council cabinet

Screenshot of council adult care web page

Recommendations to the adult care commissioning and procurement plan for 2017/18, including contract extensions and a change to the Council’s contribution of Mind were approved at Thursday’s cabinet meeting (23 March).

The recommendations approved include:

The adult care commissioning and procurement plan for 2017/18

12-month contract extensions for approved provider lists for Learning Disabilities, Older People, Physical Disabilities and Mental Health, and Healthwatch Rochdale

The approved provider lists contracts all end on 31st March 2017.

Learning Disabilities

The Learning Disabilities Approved list covers residential, respite, home care, skills and development activities, supported living and specialist services.

Work is progressing at Greater Manchester level to support the development of a GM Ethical Framework for Learning Disability (LD) services which Rochdale could utilise once it has been established. The future of the local approved list will be considered as part of the work in establishing the GM Ethical Framework for Learning Disabilities.

Given the development of this commissioning work at GM level it would be reasonable to extend the current approved list whilst this work is carried out as tendering for a short period of time at this stage would risk destabilising the market.

The Council will also continue to work with Learning Disability Supported Living Providers to increase the range of services for people with learning disabilities available across the borough and manage the market to provide cost effective service models.

The current spend on the Learning Disability approved list contracts is £19.5million; the list has been open for application on several occasions over the last three years and there are currently 57 approved providers on the list.

Older People

The Older Persons approved list covers residential and nursing care, home care and day care provision.

With respect to residential and nursing care, the Care and Support and After-care (Choice of Accommodation) Regulations 2014 enable people requiring this type of provision to choose which home they would prefer to live in (if the home provides placements at the adult care fee rate). As a consequence of these regulations and because of set rates, there is not a competitive element to the provision of this type of service.

It is proposed there is no longer an approved list for older people’s residential and nursing care, and that the Council work with STAR procurement to develop a process for ensuring that in borough care homes have the correct policies, insurances etc. in place and that appropriate financial viability checks are carried out on the care homes.

This element of the Older People’s approved list does not therefore require an extension. There is also work taking place at GM in relation to Residential and Nursing home provision which may impact on our approach to commissioning this type of care in future years.

The current spend for residential/ nursing care for older people (65 +) is £14,860,977. With respect to Home Care, a 12-month extension for these contracts until 31st March 2018 is requested.

However, the intention is to initially extend the contracts with the providers for 6 months whilst the development work detailed below is carried out. The approval to extend for 12 months will allow for any slippage in the delivery plan.

The role of home care is significant in the sustainability of the whole health and social care system as it supports people to remain living independently at home and contributes to the reduction of hospital admissions, reduction in the length of stay in hospital and delays the need to go into residential or nursing care.

There is currently work taking place at GM level and North West level to remodel the way that home care is delivered in order to sustain the market and integrate the provision with other home support e.g. district nurses.

There is also a proposal in Rochdale’s transformation bid, which is subject to approval, to integrate home care into an expanded neighbourhood offer and reconfigure our model of home care. This will require further development over the next 6 months and RMBC request an extension to the existing home care approved list for 12 months whilst working with providers to develop the new approach.

The current spend on Older People’s home care is £5,567,573 and there are 19 providers on the list of which 13 regularly take up work. The list has been opened once since it was established.

Physical Disabilities

The Physical Disabilities approved list covers residential care and nursing care, home care, supported living, respite and day services.

Many of the providers are the same providers that are on the Older People’s list and the Learning Disability list. It is intended to bring all the approved provider lists into one list for all client groups.

In order to achieve this, RMBC would need the work at GM level in relation to Learning Disabilities, Home support and Residential and Nursing Care to have progressed to ensure that this approach fits in with the GM approach to commissioning. Consequently, a 12-month extension to the physical disability approved list contracts is requested.

The current spend on the physical disability approved list contracts is £1,440,000.

The list has been opened twice in the last three years and there are 29 providers on the list, of which 15 regularly take up work.
Mental Health

The Mental Health approved list covers community support and universal services, enablement services, residential and nursing care, home care, supported living and specialist services.

Work is taking place at GM level to implement a GM Mental Health Strategy and there is a proposal in Rochdale’s transformation bid, which is subject to approval, to implement a Mental Health transformation plan.

A 12-month extension to Mental Health approved list contracts is requested, as it is intended to develop one approved list for all client groups after some of the GM work has been completed.
The current spend on the Mental health approved list contracts is £2.3 million. The list has been open for application on four occasions over the last three years and there are currently have 64 approved providers on the list.

Healthwatch

The Council has a statutory requirement to provide a local Healthwatch to act as a consumer voice for Health and Social Care Services that operate in Rochdale. In 2014 Cabinet agreed to establish an independent organisation to provide this statutory function and reduced the funding available to the organisation from £175,451 to £156,000.

The outcomes delivered by the organisation have improved over the last two years and approval is sought to extend the current contract by a further year subject to a further reduction in funding of £20,000 to £136,000. The saving is part of the council’s 2017/18 savings programme.

Work is taking place at Greater Manchester level to develop a GM approach to Healthwatch with a single specification and contract and exploring the potential for combined management structures across bordering authorities, which comply with the statutory requirements in relation to Healthwatch.

Extending the contract for 12 months will enable this work to be completed and to be fed into the future approach to commissioning Healthwatch.

The council’s contribution to Mind being integrated with the Clinical Commissioning Group’s funding for the service and the Council to become an Associate of the NHS contract

Historically, adult social care has contributed funding to Mind to provide low level mental health services across the borough which prevent people from requiring more acute services or reduce their dependence on such services.

The CCG also fund Mind to provide these services and the level of funding available enables Mind to access other sources of income using the funding from the council and the CCG as matched funding. The level of funding from the council is £132,000 and from the CCG is £366,255 (2017/18).

The outcomes from the service contribute to the delivery of both organisations’ objectives and recent work to develop an outcomes-based performance framework, has demonstrated that the work that Mind does with individuals reduces their dependence on health and social care services, reduces social isolation and medication dependency all of which are objectives in the Rochdale locality plan and transformation bid.

Mind use the money they receive from both organisations in an integrated way in order to deliver the overall service offer. Consequently, approval is sought for Rochdale Council to become an Associate to the CCG contract rather than having separate contracts.

This has been discussed with Mind and negotiations are taking place with them on the basis that the council funding will be reduced by £10,000 as part of the continuation of the provision of services.

Subject to approval, the council will continue to work closely with the CCG in order to implement an outcomes-based performance framework, and review the overall service offer, within the context of locality priorities.

Signing historical spot purchase contracts for Learning Disability and Mental Health providers who did not apply to go on the approved lists

When the approved lists were established, some out-of-borough providers did not apply to go on the lists. The service users had been with the providers for several years and it was not possible to move them to a new provider because it was not in their best interests.

The commissioning team have been working with these providers to get them to apply to go on the approved list but have not succeeded. This has meant that it has not been possible to issue these providers with spot purchase contracts.

These contracts are in Mental Health and Learning disability services. Approval is sought to issue spot purchase contracts to these historical cases.

Authority to award contracts delegated to the Director of Adult Social Care of the Assistant Director

The Cabinet delegate authority to the Director of Adult Social Care or the Assistant Director to award the contracts based on the outcome of any selection process and to the Assistant Director (Legal, Governance and Workforce) or to the Head of Legal Services to sign the contracts.

The delegation would also apply to the signing of any other contracts or contract variations resulting from the proposals.