Decision Maker: Cabinet Procurement and Insourcing Committee

Outcome: For Determination

Is Key Decision?: Yes

Is Callable In?: Yes

Date of Decision: March 3, 2025

Purpose:

Content: RESOLVED:   1.  To approve the procurement strategy to go out to tender for a range of Supported Living and Residential Services, (Lot 1 & 2) and blocks of care (Lot 3) via a framework agreement, with an anticipated start date of 04 August 2025 and a maximum contract period of 8 years (with an option to extend the existing arrangements or reopen the framework to new suppliers after six months then annually), moving from the current spot purchase arrangement to a contract, for an estimated cost of £805.7m over 8 years.   2.  To approve the addition of naming all North East London Partners from year 2 onwards (with a maximum framework value sufficient to include all the potential activity)   North East London Local Authorities who are able to access this framework from Year 2 onwards are:   London Borough of Barking & Dagenham City of London Corporation London Borough of Newham London Borough of Redbridge London Borough of Tower Hamlets London Borough of Waltham Forest London Borough of Havering     Reasons For Decision   1.  Scope   See table 1  within report.   Definition of Supported Living   Supported living is typically defined as housing where support and or care services are provided to help people to live as independently as possible. Supported living provides people with individual tenancies, with the rent funded by Housing Benefit or funded by the client. This means that they have a home of their own and will benefit from a greater level of autonomy as far as their environment is concern wied. Supported Living Schemes are generally not registered under CQC unless they provide personal care (in this case they must be registered).   People may live in an individual flat, a room in a house with two or three other adults with similar support needs or in single service accommodation (such as a house solely occupied by them due to their complex needs). Personalised care and support are designed and provided according to the needs of the individual, with a focus on maintaining, or if appropriate, increasing independence. Support workers work with individuals to help them live the way they want to, where needed support with activities of daily living and access social activities as required.   Supported Living schemes for adults are defined by Hackney Council (LBH). The two property types which fit this definition are:     ·  A cluster of single occupancy units which are grouped together either within a purpose-built block or within a defined area (such as a street), with an element of shared (core) support for all service users. Hackney Council's view is that ideally there would be no more than 14 flats/units clustered together and each single-occupancy unit should have its own bedroom, bathroom/wet room, kitchen and living/dining area. ·  Tenants live in a shared house or bungalow and have their own bedroom, ideally with an en-suite bathroom or wet room but share every other part of the property with other tenants. Accommodation should, at a minimum, include a fully equipped kitchen and a communal living/dining area. Group sizes in this type of tenancy would ideally be small, normally no more than 4 tenants depending on the size of the property and communal areas; however the property situation in and around London may not allow this.   In addition some clients with complex needs such as a learning disability and behaviours that are challenging may require single service accommodation as sharing with other clients can trigger behaviours. These properties are usually adapted and are bespoke to the individual which is described in a service and accommodation specification.   Within Supported Living Schemes there is usually ‘shared’ and 'core' support. All properties are tenancy based, with the landlord being separate from the support provider.   Where possible tenancies should be separate from the care provider so that if the care support element were to break down the individual should not have to move and another care provider would come in. It can be difficult to have this separation if core hours are tied to the accommodation.   The rent for supported living properties needs to be affordable to the tenant and within what is payable by housing benefit (top ups by health or social care will not be payable). The Housing Benefits team identifies what is allowable under service charges etc. Any rental costs need to be identified before the individual, their belongings or any tenancy agreements are signed by the client (or through Court of Protection). Tenancies need to be signed by the individual client, through Court of Protection if the person is not deemed to have Mental Capacity (and a Mental Capacity Act assessment and best interests has taken place). Tenancies cannot be signed by families on behalf of the adult client unless they have legal powers to do so.   Definition of residential Services for (1) 18+ years and (2) 65+ older adults   A residential care home for people under 65 years is a communal setting that provides accommodation, care, and support for people between the ages of 18 and 64. They will usually be CQC registered (as they provide personal care or other regulated care). These care homes can help people who are unable to live at home due to a variety of reasons, including:   ·  Physical or cognitive impairment including early onset Dementia. ·  Sensory loss. ·  Frailty. ·  Learning disabilities. ·  Mental health problems. ·  Addiction.   Residential care homes can offer a range of services, including: ·  Getting dressed and washed. ·  Medication reminders. ·  Cleaning. ·  Nutritious cooked meals. ·  Respite care. ·  Nursing care. ·  Specialised dementia care.   Some care homes may also have facilities such as hair salons, cafés, bars, landscaped gardens, a library, and access to a private minibus.   The cost of living in a residential care home depends on the level of support required.   A residential care home for people aged 65+, often also known as a care home without nursing, is a place that offers 24-hour personal care and support for people who need help with daily life but don't require nursing care:   Personal care ·  This includes help with washing, dressing, using the toilet, taking medication, and eating or drinking. ·  Accommodation. ·  Residents can treat the home as their own and live there with access to services. Community ·  Residents live with others and receive support with social interactions and meals. Safety ·  Residents feel safe and well looked after.   Residential care homes are suitable for people who have difficulty with daily life due to physical frailty, a physical or learning disability, mental health problems, addiction, or other care needs. They can provide long-term, short-term, respite, emergency, and palliative care.   Definition of Fixed Term Packaged of care   Adult Social Care currently has a small number of contracts with providers to provide care for a whole community based in one or several buildings. The buildings are usually owned separately by landlords and we contract a care provider to provide the care to those people under a specific specification and set of quality standards. We often can get a reduced rate due to the care provider being in one or two buildings and being able to have staff on rotas and senior management cover.   Bringing the ability to call off from this proposed framework will reduce both the length of time and therefore the cost to the Council of officer time calling off from this framework. Providers are already quality checked, rather than separate tenders, all going through governance on separate occasions.   The Current State  - what we do now   Currently, supported living and residential services are procured on a spot purchase basis. A spot purchase should be an unplanned, one-time purchase of goods or services that is made outside of a Council's regular procurement process. Spot purchases are often made to address urgent needs, such as when a Council cannot rely on long-term contracts, or when there are supply chain disruptions. However, over the lifetime of the Council, this has become custom and practice for all care packages.   An evaluation of the costs and fees for these services has highlighted massive differences between providers in terms of costs, fees, quality of provision and what they charge us for.   The current model of spot-purchasing does not enable the Council to shape the market, nor to have sufficient assurance of the quality and capacity of commissioned providers to deliver good outcomes to residents. Procuring a framework via a Competitive Flexible Procedure under the light touch regime will ensure that all providers are vetted to ensure they adhere to legal and quality standards and financial parameters.   Successful providers will join the framework, which will be clearly publicised to customers, carers, practitioners and brokerage officers. People assessed under the Care Act as requiring a supported living and care home service will then be placed with the most appropriate services to meet needs, using a combination of customer choice, geography, availability, quality etc versus value for money.   To support this we will be using the new E-brokerage system to call off from the open framework. This call off process will mean all providers on the framework will have equal access to each package, providing an open, transparent approach to procuring packages of care.   The process will also create greater competition which will hopefully hold down and control prices for the Council.   Option 1: Continue with current spot purchasing arrangements, which has the advantage of retaining the status quo for providers. The drawback of this option would be: it is difficult to assure the quality of spot purchased services without a specific service specification. It is also difficult to negotiate fair rates for services and it is an inefficient use of social worker/brokerage officer time, searching for appropriate provider services and negotiating prices. Potential providers may see spot purchasing as offering no level of security to operating their business. Furthermore, it does not consistently offer a choice for the people wishing to use these services. Without an overarching contract, there is also no standardisation. For example, some providers class half a day as 4 hours and some 3 resulting in inconsistency of offer to individuals. Ultimately, spot purchasing does not conform to Council Financial and Procurement Standing Orders.   Option 2: Complete appropriate procurement processes to award a number of separate contracts based on the scope of the existing provision. This would have the advantage of regularising existing arrangements and establishing a fixed model of provision for the duration of the contracts. However, it would fail to deliver the added benefits of an open framework that are detailed below and it would be extremely time consuming to complete all of the separate contracting arrangements required. There is significant risk or high number of VOIDS when purchasing block contracts.   Option 3: Procure an open framework, supported by the E-Brokerage system for call offs. Providers would be admitted onto the open framework after having been evaluated as adhering to the required legal, financial and technical quality and ability to perform the contract(s). Providers then sign up to a set of overarching Terms & Conditions which govern the way they will operate, as well as set out a floor and ceiling rate for fees and other standardised fee rates in line with Care Cubed prices if they have anyone placed with them. Providers would apply to be on the framework. However, this would not be a guarantee of work, beyond their existing packages of care. This would then create a “menu” for where Individuals would then be placed with the most appropriate service, using a combination of customer choice, geography, availability, etc – with the most cost effective option that meets need and choice being selected. Each service user is placed with an individual placement agreement (IPA, rather than an overarching or block contract), which stipulates the needs and goals of the individual.   The process of call offs would be supported by the new E-Brokerage ICT solution. Option 4: Use of an existing Framework. We have been a member of the Waltham Forest Framework. However, no packages of care were procured from this arrangement and this has since ended. The London Borough of Newham has an alternative framework that Hackney could join. The number of providers on the list is very low. Hackney would be charged for using the framework, and would have little control over the process.   Option 5: Insourcing. LBH does not own or run any supported living or residential services. It would be unrealistic for the Council to take on the number of packages Hackney needs, due to the sheer number of packages being procured. However, in time, once the framework has been running, we will be able to clearly identify any services that would be beneficial to bring in-house. This would be particularly relevant in the services we propose to contract in Lot 3; block packages of care contracts.   LOT 3 will also help support the capital build programme by helping to source care staff to cover a large number of packages, which can then in turn be taken over by the in-house team, if agreed.     Alternative Options Considered and Rejected     Option 1     Remain as is Poor value for money. No control over costs and what's included in provider costs. Costs and fees are not transparent. No service specification or KPIs to maintain quality. High risk due to no contracts and no quality checks. Providers feel it is important to have contracts.   Option 2           Separate contracts (no overarching framework or DPS) Very time consuming, requiring a number of separate procurement processes to be completed. Not seen as good practice or best value.   Option 3 (preferred) Open Framework This is our preferred option Option 4       Use of an existing Framework The number of providers on the list is very low. We would be charged for using the framework and would have little control over the process.