Agenda and minutes

Councillor Adele Williams (other Council Business)

Lucy Hubber (other Council Business)

Sara Storey (unwell)

None.

Minutes of the meeting held on 27 July 2022, for confirmation.

The minutes of the meeting held on 27 July 2022 were confirmed as a true record and signed by the Chair.

Katy Ball, Director of Commissioning and Procurement, introduced the report, with contributions from Charlotte Dodds, Commissioning Officer (Nottingham City Council).

Points highlighted and responses to Members’ questions included:

a)  Local authorities have a statutory duty to proactively identify, assess and support carers in their area under The Care Act 2014, and to young carers under The Children and Families Act 2014;

b)  The value of carers supporting citizens in their own homes is recognised, as is the necessity to provide early intervention to support those carers, including their wellbeing, and ensure they can continue in their roles which can sometimes be stressful;

c)  There is a statutory duty to achieve best value so Nottingham City Council, Nottinghamshire County Council, and the Integrated Care Board (ICB), are working together to determine and jointly procure carer support services over an extended contract period of 4 years (with an option to extend for a further 4 years which enables tendering organisations to secure and invest in resources for longer than the usual limited time frames, and hence offer improved value;

d)  Carers had been found often have higher levels of stress and lower levels of health, but their quality of life and health can be improved if they accept career support including rest bite;

e)  Carers had persistently asked for a single point of contact for all carer support services (adult and young careers) and this has now been included within the Carer’s Hub which operates across the City and County for home based carers;

f)  Carer services are underfunded considering the personal value they provide to those cared for, but also for the saving to of residential care, for which there is a shortage;

g)  The budget has not been increased but recognise it is a difficult time with rising costs, but communication will be ongoing for the potential 8 year period 

h)  Collaborative working at this level is a sign of organisational maturity and none of the partners would want to see that the contract became unviable so if national price rises continued to increase at their current pace, discussions would take place with organisations. 

Comments from members of the Committee included:

i)  This is a great example of co-procurement and working together. All involved in bringing this arrangement together are thanked for their hard work;

j)  The potential for an 8 year contract is welcomed as it presents an opportunity beyond medium term planning and provides tendering organisations to secure appropriate resources and provide security of employment;

k)  The proactive seeking of hidden young carers is welcomed to ensure that they can be supported;

l)  The creation of the Carers Hub one access point will more smoothly support young people as they transition to adult carers;

m)  A collaborative and integrated approach works better for everyone and is very much welcomed.

Resolved:

1)  to approve the procurement of the three Carer Support Services detailed in Appendix 1 to the report, through an appropriate procurement process, and to award the contracts for the services based on the outcomes of the procurement process. The approved contracts would commence on the expected start date of 1 October 2023, for a four-year period with an option to extend for a further four years (i.e.4+4), to a maximum of 8 years in total. The procurement of and contractual arrangements for the Carer Support Services are to be undertaken jointly by Nottingham City Council, Nottinghamshire County Council and the ICB, subject to agreement of suitable processes and arrangements by the Director of Commissioning and Partnerships (Nottingham City Council), the Adult Social Care Cabinet (Nottinghamshire County Council) and the appropriate ICB approval route;

2)  to approve the expenditure of £6,426,360 of the Better Care Fund budget over the entirety of the terms of the contracts for the provision of the Carer Support Services detailed in Appendix 1 of the report (Nottingham City’s proposed spend only);

3)  to delegate authority to the Director of Commissioning and Partnerships (Nottingham City Council) in conjunction with the Adult Social Care Cabinet (Nottinghamshire County Council) and the appropriate ICB approval route to approve the outcome of the procurement processes and award contracts to providers that are deemed most suitable to provide these services;

4)  to delegate authority to the Head of Procurement (Nottingham City Council) in  conjunction with the Adult Social Care Cabinet (Nottinghamshire County Council) and the appropriate ICB approval route to sign the final contracts and agree annual extensions on the basis of performance and budget availability;

5)  to approve extension of the current carers support services contracts, for up to 12 months, to enable the seamless transfer of the current contract with the start date of the new contract, at a maximum cost of £714,040, beyond the agreed contract end date of 31st March 2023.

Reasons for the decision

 i.  to provide support for carers in Nottingham City and give carers greater autonomy and choice to meet individual needs;

ii.  to support the fulfilment of statutory duties towards carers under The Care Act 2014, and to young carers under The Children and Families Act 2014;

iii.  to support joint commissioning across the whole health and social care system in Nottinghamshire and the City of Nottingham;

iv.  to support co-production of the new carer support services as a new way of working for all organisations;

v.  to improve efficiency and best value for money in the services we commission by providing  single efficient combined Carers Hub with a single point of contact across City and County, with reduced costs in service management, and in procurement and contract management.

Option 1: Do nothing. The contracts for carer support services would end and not be re-commissioned, removing support for carers outside of support for the cared-for citizen, which is contrary to the statutory requirements of the Care Act 2014 and the Children’s Act 2014. As well as the potentially disastrous impact on the quality of life of these citizens, this would be likely to result in increased costs to both Health and Social Services. Therefore, this option is not recommended.

Option 2: Re-commission services for Nottingham City only, without jointly recommissioning with Nottinghamshire County Council. Many carers provide care across City/County boundaries, with the carer living in one local authority area and the cared-for citizen living in another. This Strategic Commissioning Review has been the first opportunity the local authorities have had to jointly review and recommission services together. Not to do so would be to disregard both the wishes of our carers, and the aims and plans set out in the draft Joint Carers Strategy. Therefore, this option is not recommended.

Joint report of Sarah Fleming- Head of Joint Commissioning, NHS Nottingham and Nottinghamshire Integrated Care Board, and Katy Ball, Director of Commissioning and Partnerships, Nottingham City Council.

This item is not subject to call-in as it for retrospective approval.

Sarah Fleming, Joint Chair and Head of Joint Commissioning, NHS Nottingham and Nottinghamshire Integrated Care Board, and Katy Ball, Director of Commissioning and Partnerships, Nottingham City Council, presented the joint report which seeks retrospective approval for the Nottingham City 2022-23 Better Care Fund planning requirements, which were submitted to NHS England on 23 September 2022.

The following points were highlighted:

a)  The report includes the proposed planning template with metric targets focused around the national Better Care Fund requirements, including local additions and narrative, along with the Nottingham City Intermediate care capacity and demand plan;

b)  These newly revised planning requirements ensure that there is clarity on the services provided from the BCF programme, specifically around strengthening the systems which support citizens being discharged from hospital but who still require some level of care. This approach supports a shared understanding of intended outcomes, alignment of schemes to current ICS plans, and supports the development of a shared understanding of opportunities for greater alignment in commissioning and delivery of services;

c)  The report outlines the key evidence based findings of the review which has resulted in the some pilot schemes becoming core elements of the plan and whilst budgets are pooled within the BCF, there will be elements which will move away from BCF;

d)  A branch and root review will be undertaken on existing schemes to consider what more can be jointly provided, including learning opportunities;

e)  This joint collaboration process shows organisational maturity for a range of important services which are working well. Further work is now required to look in depth at efficiency and effectiveness and also more broadly for further appropriate collaboration opportunities;

f)  Once systems are working well, further collaboration can be applied to applications for funding and further with consideration of how resources can be moved around to most effectively achieve the target outcomes;

Members of the committee commented:

g)  This progress links well with existing themes to ensure that homecare packages are in place for safe hospital discharge;

h)  The planning template is welcome, as is the additional £1 billion of additional funding (separate, new funding not part of this report), but this doesn’t address the issue of there not being able to recruit enough care staff. Until the staffing shortage can be addressed, many of the on-going problems will remain unresolved;

i)  Learning labs including home based care, and a system based approach appear to be progress in the right direction, but there is still a lot to do;

j)  Joint commissioning and learning now needs to be applied to the broader system ensuring that it is understood, so it’s important that there is clarity what is wanted from the ICS, including an improved appreciation of commissioning;

k)  The ICS still appears very health focused.. This could be a starting point on how we think about funding, service connectivity and how it’s linked into the greater system;

l)  The aim is further collaboration, but the understanding of the system by different partners appears to vary so needs to be united view to ensure success. This theme could be suggested to the health and well-being board for further discussion;

m)  If working to bring partners to a united understanding of the system, providing case studies is very helpful in supporting meaningful and relatable discussion which results in better engagement;

n)  The needs to be a better understanding of the system as a jigsaw to identify how it all fits together and if there are any missing pieces which can be addressed;

o)  Contracts are now aligned with regard to the BCF commissioning, but work can now start to look at contracts and understanding alignments in other areas;

p)  It should not be overlooked is that as local authority funding reduces, other sources of funding may be available for organisations, such as charitable funding, which currently isn’t recognised but could be investigated;

q)  As part of the further co-commissioning process, removal of duplication between partners is to be addressed and provision gaps filled.

Resolved to approve the 2022-23 Better Care Fund Planning Requirements.

Reasons for decision

Nottingham City Health and Wellbeing Board Sub-committee is asked to formally ratify the Nottingham City 2022-23 Better Care Fund planning templates as attached to the report for submission to NHSE.

Other options considered

To be eligible to receive the funding available from the BCF programme, the 2022-23 Better Care Fund Planning Requirements, as set by the NHS, had to be complied with and approved, so no other 

options were considered.

Wednesday 25 January 2023 at 4:00pm

Wednesday 29 March 2023 at 4:00pm

The future meeting dates were noted as follows:

Wednesday 25 January 2023 at 4:00pm

Wednesday 29 March 2023 at 4:00pm