Agenda item

Report of Corporate Director for Children and Adults.

Claire Labdon-West, Commissioning Manager presented the report on the Extra-Care Charitable Trust, outlining that the current contracting arrangements for Lark Hill Extra Care Village and Seagrave Court have now come to an end and new arrangements are required.

RESOLVED to:

(1)  dispense with Contract Procedure Rule 5.1.2 in accordance with Financial Regulation (3.29) (Operational Issues) to allow for a direct award for the Extra Care Charitable Trust to continue to deliver the care services at Lark Hill and Seagrave Court, subject to consultation with the Deputy Leader;

(2)  agree to a contract length of 3+2+2+2 for Lark Hill;

(3)  agree to a contract length of 2+1+2+2+2 for Seagrave View to allow for a break after 2 years when it is anticipated that the landlord function for the property will be transferred back to its owner Midland Heart. At this point a decision will be taken about the contracts future. If the contract continues then this will align to the contract for Lark Hill.

Reasons for decision

Nottingham City Council has a long relationship with the ECCT. Lark Hill Village was built at the agreement of the Council under the understanding that the ECCT would operate the same care model on site as was in operation at Seagrave. There have never been any concerns over the care and support delivered at each scheme and the Council has maintained a good working relationship with the ECCT for over 15 years.

There are currently 72 citizens receiving services in these two schemes under the current contracts with the ECCT. If these contracts were not renewed, alternative care provision would need to have been made for these citizens. The ECCT is not willing to allow an alternative care provider to deliver onsite as this would destabilise their operational model. As the service users are residents of the schemes, failure to renew the contracts would lead to a complex situation which would include securing their agreement to move home or tenancies. This would be likely to be complicated and potentially distressing for vulnerable citizens, involving loss of social networks and carers with whom they have developed a relationship. Moving their residence may also impact negatively on care needs and is likely to be particularly detrimental where there is dementia.

Moving 72 Citizens with care needs to alternative accommodation would have a resource implication on Adult Social Care. Care packages would need to be reviewed and alternative accommodation options pursued which would be both time consuming and costly.

There are many citizens within these schemes who have high care needs and whose needs are currently being met through a personalised package of care. If a new contract were not put in place, it is highly likely that residential care would be the only alternative option for these Citizens

Work is currently underway with Nottingham City Council’s extra care providers and Adult Social Care to ensure that referral rights are maximised and that wherever possible vacancies are targeted towards citizens with a care need. This will then allow citizens to receive the flexible support they need at the earliest opportunity which will help to prevent the escalation of their needs. This early intervention will enable citizens to maintain their independence for as long as possible and help to prevent the need for alternatives such as residential care. Nomination Agreements between NCC and ECCT will form part of the new Service Specification.

The fee banding agreed with the ECCT allows for flexible provision of care, enabling changes in needs, whether temporary or permanent to be addressed swiftly. Analysis has shown that a banded rate is more cost effective for the Council than an hourly rate would be. The contract value is based on current commissioned packages of care which have been agreed through separate Adult Social Care processes. There is no minimum purchase agreement and this contract does not provide a guarantee of business to the ECCT.

The length of contract requested (9 years in total) has enabled Nottingham City Council to negotiate a minimal price increase of just over 2% on existing fees. This is less than the average inflationary uplift given to domiciliary care (4.63%) and Residential Care (3.80%) for 2016/17. The length of contract also reflects the complexity in locating alternative accommodation for service users. Break clauses allow for periodic review at which point the contract can be exited. The contract also allows for termination with 6 months’ notice at any point (less if there are delivery issues). 6 months was considered the minimum time necessary to relocate affected citizens. In order to safeguard the interests of the Authority we propose to include break clauses after the initial 3 years and then every two years after that. Nottingham City Council will also have the ability to terminate the contract with 6 months’ notice at any point during its lifetime.

Seagrave Court is currently owned by Midland Heart and leased to ECCT. There has been a decision by Midland Heart to withdraw from this arrangement nationally and they plan to take back both the landlord and the care function from ECCT in May 2018. The initial contract period for Seagrave will coincide with this timescale and a decision will be made as to whether to Novate the contract to Midland Heart at this time.

Other options considered

Do nothing – the current contracts are expiring and new contractual arrangements are needed in order to ensure that the citizens requiring these services continue to receive them.

Tender the care service at the existing locations– tendering the service is not an option as the ECCT operational model does not allow for the care element to be separated out and as a result they are not willing to allow another care provider to take over the service. Previous experience with Extra Care schemes has shown that separating out the landlord and care function can be problematic. The schemes achieve economies of scale by providing landlord, support and care functions. This allows for the 24hour presence on site and for additional social functions such as encouraging volunteer groups and managing services such as a gym room or community shop. Where the functions are separated out the additionality that the scheme offers is likely to be lost as was the case with Woodvale, or the scheme may become economically unviable as happened with Glenstone Court which ceased providing extra care in 2013. Were a new contract with the ECCT not negotiated directly the schemes would no longer operate as Extra Care and citizens with high care needs may be forced to move to alternative accommodation, most likely residential care.

Move the residents currently in receipt of care into alternative Extra Care accommodation – there is currently not sufficient Extra Care Capacity within Nottingham City to facilitate moving this number of residents to alternative provision. If alternative provision was available within the required timescale there would be a number of complications and risks to services users. Lark Hill and Seagrave offer permanent accommodation on either a rented or ownership basis. If alternative provision was available this would require a number of vulnerable citizens to leave their homes and move in order to continue to receive a care service. This is likely to necessitate a change in carer and may have a negative impact on care needs particularly where there is a risk of dementia. As a result of the level of care being provided and the specialist nature of the service being provided by the ECCT it is highly likely that the only viable alternative for many of the Citizens would be residential care. At £509.69 per week this is higher than the most expensive care level of £378.20 per week and so is very likely to lead to an increase in the cost to the Authority.

Build alternative accommodation provision and tender for a provider – there are proposals currently seeking approval to redevelop an NCH site into Extra Care in the City in order to try to reduce reliance on residential care. In order to make the care contract cost effective, respite care with a focus on re-ablement and potentially end of life care is being included in the contract. Reliance on residential care is unlikely to be reduced if the scheme is repurposed to move residents from Lark Hill and Seagrave. Developing a new alternative accommodation provision would take several years to develop and would require a significant amount of capital funding from Nottingham City Council. This approach would also involve moving vulnerable residents into alternative provision, which is also likely to have fewer facilities available than their current accommodation with ECCT.  It is unlikely that this approach would achieve savings for the Authority as the hourly rate charged by the other current Extra Care provider in the City is such that the cost of care packages is unlikely to be cheaper than the ECCT banded rates.

Consideration was given as to whether it would be beneficial to move to an hourly rate rather than the current bands for care. It was felt that this would present a financial risk in terms of packages of care being more costly if citizens were receiving care at the higher end of the band. There would also be a resource implication for social care practitioners to review all of the current care packages. In addition the current banding system allows for a degree of flexibility within a citizen’s day to day care needs that is not possible under an hourly rate.