Purpose

Proposed decision :
 
Extend
the Care and Support in the Home Contract, for a
maximum of up to three years from 1 April 2024 to 31 March 2027 and
delegate authority to the Corporate Director Adult Social Care and
Health to take other relevant actions, including but not limited to
finalising the terms of and entering into required contracts or
other legal agreements, as necessary to implement the
decision.
 
 
Reason for the decision:
 
The Care Act 2014 gave
local authorities in England, the NHS
and the Care Quality Commission (CQC) clear legal responsibilities
for managing different elements of the adult social care market
that include considering need, provider sustainability, value for
money and integration.
 
Framing Kent’s
Future and Securing Kent’s Future and the Adult Social Care
Making a Difference Everyday Strategy, identify New Models of Care
and Support as key priorities by recognising the importance of
health and social care integration, building effective strategic
partnerships with our providers through coproduction whilst being
innovative in the way we look to redesign services to improve
quality and importantly respond to budget constraints.
 
To help achieve this,
the council has procured external expertise to undertake three
distinct pieces of work that will help with the redesign of a new
service. This will help inform the commissioning intentions for
adult social care services and provide commissioners with the
required information to design new specifications and a robust
commissioning and procurement process.
 
The commissioning
exercise will include extensive engagement with people who use care
and support services to develop a new specification which ensures
high quality and cost-effective services in the future.
 
This is a demand
driven service and due to increases in complexity, increased
demand and fees in excess of that funded
for inflation, spend has grown year on year. It is recognised that
during the contract extension period mitigations will be put in
place to help halt the increased spend to the service through the
development of a robust savings action plan. This will require a
collaborative approach across Kent County Council and NHS Kent and
Medway Integrated Care Board colleagues and proactively engaging
with providers to determine fair costs for both legacy and new
placements.
 
The council will need
to consider looking to develop alternative care and support offers
which support people to remain in their own home for longer. These
include an enhanced technology offer, integrated reablement
service, homecare offer, increasing direct payments and support
that can be purchased such as personal assistants and niche
services delivered by the voluntary sector and micro
providers.
 
Commissioners will
develop new models, supported by the cost of care exercise
completed by the external consultants, which will ensure best value
for future services. The extension will allow this activity to be
completed.
 
The Contract is by way
of closed framework with 30 providers on the framework.
However this contract and the provider
market has been significantly impacted through the COVID period,
with a large proportion of off framework providers (over 100) now
being used.
 
There are currently on
average 72,000 calls per week to people that are
supported.
 
The contract includes
provision to cover domiciliary care, supporting independence
services (SIS), Extra Care background support hours, Care and
Support in Prisons. The contract is divided by geographical
provision (clusters) to cover Urban and Rural areas.
 
The Care and Support
in the Home commenced in 2019, for an initial period of four years,
with options to extend. The current Care and Support in the Home
contract end date is 7 April 2024 and there is an optional
three-year extension built into the contract, which could take the
contract through to 7 April 2027.
 
An extension to the
current contract is required to allow the external consultants to
complete the assessment and for the new service to be procured.
However, it is anticipated that the exercise carried out by
external experts will not be finalised until March 2024. This will
enable a full procurement process to commence once the extension to
the contract has been implemented.
 
The proposed contract
extension will be put in place for a maximum of three years.
However, a robust reprocurement
exercise is to be completed as quickly as possible and break
clauses will be written into the contract extension to allow the
council to terminate the contract when appropriate and to fit in
with the mobilisation of a new contract.
 
Subject to the outcome
of the work currently being undertaken by consultants, we expect to
commence the procurement process in April 2024 with a view to
implement from early in 2025.
 
The proposed decision
supports objective 2 of Securing Kent’s Future to deliver
savings from identified opportunity areas to set a sustainable
2024/25 budget and MTFP and priority 4 of Framing Kent’s
Future – New Models of Care and Support.
 
Options (other options considered but discarded):
The council can choose not to
extend the current contract. However
there are significant risks, as set out below, to choosing this
option and no benefits have been identified.

 
Legal and Policy: The council commissions services from the
independent sector to meet the needs of individuals deemed to be
eligible in accordance with and following a Care Act assessment. If
the contract ends the council will be pressured to fully meet its
statutory obligation under the Care Act with regards to providing a
high quality, safe service that is at an affordable
price.

 
Financial: A lack of robust fee setting mechanisms and
contractual leverage may result in a significant increase in
placement costs which will be challenging to control. Savings
targets set out by the council and to be met through greater
partnership working and negotiation will be difficult to achieve
through spot purchasing agreements and providers will be within
their right to give notice on individual placements that may be
hard to source at an affordable price.
 
Reputational: A shift to partnership working with providers will
be challenged as the expectation from providers is that the
contractual arrangements with the council will be maintained due to
the mutual benefits to both parties. People using this service
expect a robust oversight of the service and the perception will be
that this is not the case if the service is not part of a KCC
Contract.

 
Resource Implications: If the contract ends there will be a
requirement for the review, renegotiation, and repurchasing of all
individual placements with new contract and terms and conditions
established. This will also require significant system and process
updates.
 
Financial Implications:
 
The initial contract cost is
set out below along with the current cost. Various market pressures
and increase in demand and complexity of care has resulted in an
increased spend on the service. Robust actions are being put in
place to limit this spend.
 

Contract

Initial contract cost advertised (per annum)

2022/23 spend

Care and Support in the
Home

£110,000,000

£76,000,000

 
Dedicated commissioning and finance resources
will be required to ensure a collaborative approach
to determine a robust fee model and pricing guide and the
identification of any financial risk.

 
Legal
implications:
 
The extension is necessary to
enable the council to undertake a detailed Cost of Care review,
which is likely to be completed by 28 February 2024. As such, the
council will not be in a position to
undertake a reprocurement, based on the
outcome of the review, in time for a new service to be in place in
2024. Therefore, a change is not proposed at
this time for economic or technical reasons. Any procurement
of the service, prior to the completion of the Cost of Care review,
will cause significant inconvenience and substantial duplication of
cost. It is also unlikely that a procurement will attract market
interest, as providers may be reluctant to bid, prior to the
completion of the Cost of Care review.
 
An extension is available to be
utilised in the contract. The extension was included in the
Contract / PIN Notice advertising the original procurement of this
service and therefore the extension is permissible and compliant
under PCR 2015 regulations.
 

Decision

Decision:
As Cabinet Member for Adult Social Care and
Public Health, I agree to:
a) EXTEND the Care and Support in the
Home contract, for a maximum of up to three years from 1 April 2024
to 31 March 2027; and
b) DELEGATE authority to the Corporate
Director Adult Social Care and Health to take other relevant
actions, including but not limited to finalising the terms of and
entering into required contracts or other legal agreements, as
necessary to implement the decision.