Report of the Corporate Director for Strategy and Resources and the Corporate Director for Children and Adults
Christine Oliver, Head of Commissioning, presented a report on the review into the provision of residential and nursing care homes, to inform the development of a new specification for the procurement of care homes for Nottingham’s most vulnerable citizens, where no other suitable options are available. The following points were discussed:
(a) the value of the decision is substantial, at £418,500,000, and the cost is in line with the Council’s mid-term Financial Plan. The contract is for up to nine years and can be cancelled earlier, if required. The length of the contract will reduce the procurement pressures on providers and will ensure best value for money in a sector where prices are rising;
(b) a major strategic focus is to help people in care move back into their own homes, or other independent living arrangements, if appropriate.
(1) approve the procurement of Residential and Nursing care services via a joint accreditation process with NHS Nottingham City. The contracts awarded will be for a term of up to 5+4 years, depending on the commencement date. The contracts awarded to providers carry no guarantee of business during that time;
(2) delegate authority to the Director of Commissioning and Procurement to approve the outcome of the tenders and award contracts to providers as a result of the process;
(3) delegate authority to the Head of Contracting and Procurement to sign the contracts arising from the tender process once the tender outcome is agreed.
Reasons for the decision
The contract for Residential and Nursing Homes is due to end in on 31 March 2020. This is in the form of an Accredited List utilising the Light Touch Regime. The current contract was commissioned jointly with the Nottingham Clinical Commissioning Group (CCG), utilising the standard NHS Contract. This enables placements to be jointly, or fully, funded by the CCG. The performance management of the contract is undertaken by the Council on behalf of the CCG for residential homes. The CCG performance manage registered nursing homes.
In order to effect a new contract, to continue to provide residential care to Nottingham citizens, the Council will need to undertake a procurement process on behalf of its citizens. The proposed model for procurement is to commission services through an Accredited List. This will require all current care home providers to complete an application process. By completing this process, the care homes are required to meet a minimum set of required standards and to be subject to regular Council oversight. The accreditation process remains open, so any new provider can be directed to apply for accreditation at any time.
Through the proposed accreditation process, failure to meet the criteria set out in the procurement process means failure to gain accreditation and the Council will not commission providers that are not accredited. However, providers can re-apply if they remedy the reason for failure, therefore promoting a culture of constant improvement of services.
The proposed new contract is a joint contract on behalf of Nottingham and Nottinghamshire CCGs, as well as the Council. This means that citizens will be able to access residential care homes or nursing homes as required and that the same contract can be used, whether or not the citizen is entitled to health-funded care.
Other options considered
Do nothing: This is not an option, as the current contract will end on 31 March 2020.
Procure a closed Framework of Providers: This approach would enable the Council to impose a more stringent application procedure and reduce the number of providers being contracted. However, if this were undertaken based on Care Quality Commission or Council Quality Standards, this would not enable improvements in lower rated care homes to be recognised and would pose difficulties for care homes who subsequently receive a bad rating. The principle concern would be, that if a home was unsuccessful, then current residents would then have to be moved out to alternative provision. This could be very disruptive for citizens and may well lead to a deterioration. It would also have negative reputational implications for the City.
Develop a joint integrated contract with Nottinghamshire County Council: This approach would standardise arrangements for care home providers who have contracts with both the City and the County Council and would provide a consistent approach with the CCG. However, given the significant differences between the current approaches of the two Authorities around contracting and pricing, this has not been achievable at this point. However, working is taking place to ensure that the specifications will be aligned fully.