Agenda item

Joint report of Directors for Adult Health and Social Care & Commissioning and Procurement

Lisa Lopez, Lead Commissioning Officer, presented the report, which sought approval to commission new overnight Short Breaks provision for children and young people with complex health needs, in order to meet the needs of the families and NCC’s statutory obligations as a local authority.

Ms Lopez stated that the proposed provision would include an emergency bed for young people with complex health needs, to support hospital discharge and avoid unnecessary hospital stays for the same cohort of young people, and the cost of this bed would be funded by NHS Nottingham and Nottinghamshire CCG, who would also contribute to the costs of the overnight short breaks beds.

Resolved

(1)  to approve:

(a)  the procurement of a block contract for overnight short breaks for disabled children with complex health needs, as detailed in appendix 1, through an appropriate procurement process, and to award the contract(s) for the services based on the outcomes of the procurement process. The approved contract(s) would commence on 1 October 2023, for a five-year period, with an option to extend for a further three plus two years (i.e. 5+3+2, to a maximum of 10 years in total);

(b)  the expenditure of £7,600,000 (of which £2,850,000 is from Nottingham City Council funding) over the entirety of the contract(s) for the provision of the block contract for overnight short breaks for disabled children with complex health needs, as detailed in appendix 1;

(2)  to delegate authority to the:

(a)  Director for Commissioning and Procurement to approve the outcome of the procurement processes and award the contract(s) to the most suitable provider of these services;

(b)  Head of Contracting and Procurement to sign the final contract and agree extensions on the basis of performance and budget availability.

Reasons for recommendations

(i)  To provide high quality, overnight short breaks for children and young people with complex health needs and their families. ‘Short breaks’ provide opportunities for disabled children and young people to spend time away from their primary carers, providing a break for their families to support them to continue in their caring role, and for the children and young people to take part in activities and socialise with peers as part of their healthy development. Where the needs of the young person are highly complex, families are more likely to require overnight short breaks. No overnight provision exists locally which is able to support the young people of Nottingham City with the most complex health needs.

(ii)  The length of contract provides stability for this vulnerable group of children and young people who could spend up to 20% of their year on site and enables the children and young people and the facility to be seen and feel they are part of the community. Services which were historically commissioned by NHS Nottingham and Nottinghamshire CCG to offer overnight breaks to children and young people with complex health needs have now closed, making it difficult to find appropriate breaks for their families. As of March 2022, there are 5 children who have not been able to access any suitable alternative and a further 7 who are accessing provision that is either out of area, is not able to fully able to accommodate their needs, or they have a direct payment but are unable to purchase a suitable alternative.

(iii)  To meet Nottingham City Council’s statutory duties. Local authorities have a statutory duty under the Breaks for Carers of Disabled Children Regulations 2011 to provide appropriate breaks for the parent/carer of a disabled child, however that break must also meet the child’s individual outcomes as identified through assessment. The Chronically Sick and Disabled Children’s Act 1970 requires local authorities to provide activities and support which are appropriate to meet the needs of the disabled child/young person. Overnight short breaks for children/young people with complex health needs provision, which was commissioned by NHS Nottingham and Nottinghamshire CCG, closed in March 2019. A number of other services aimed at this cohort have ceased to operate, leaving significant gaps in provision and a risk that Nottingham City Council could be seen as not fulfilling its statutory duties to this cohort. Therefore, Nottingham City Council and NHS Nottingham and Nottinghamshire CCG are obliged to create new local provision.

(iv)  To provide a statutory service in the most efficient way, securing the best value for money. NHS Nottingham and Nottinghamshire CCG have agreed in principle to jointly commissioning this service, with funding contributions of 50% of the cost of a Short Breaks unit. The CCG would be unlikely to agree to fund 50% of provision which was delivered in any other way (for example, by providing a new internal service).

(v)  The commissioning organisations will not be paying upfront costs for the building and equipment – instead the provider will be responsible for these costs and they are built into the annual contract value, reducing financial impact on commissioners by spreading the cost over the lifetime of the contract. The length of the contract reflects the long-term capital investment required by the provider in this very limited market. Commissioning the new provision is likely to be the most cost-effective option for delivery.

(vi)  In order to avoid the unnecessary hospitalisation of children and young people with complex physical health needs, the CCG wish for the new provision to include an additional bed solely for emergency and step-down care. This bed will be for children and young people who are at risk of hospital admission due to their medical care needs not being able to be met at home on an emergency basis, and for those who are medically fit for discharge, but care and/or housing arrangements are not yet in place. The CCG will fully fund this bed and both City and County children will be eligible. Combining this bed with overnight short breaks provision offers value for money whilst providing an alternative to hospitalisation which is not currently available locally.

Other options considered

(i)  Do nothing. Nottingham City Council is currently not fulfilling statutory duties to those families who do not have appropriate short breaks in place. There is a significant gap in support options, particularly for young people with profound/complex disabilities and health needs. This may lead to parents feeling unable to continue to care at home, leading to a huge impact on the family, potential family breakdown, and very high, potentially life-long costs. It also risks legal action from families, as Nottingham City Council could be taken to judicial review for not fulfilling statutory obligations. This would also be likely to generate significant negative publicity, potential legal costs, and pose a reputational risk to the local authority.

(ii)  Costs of providing breaks to those families who previously attended the Villas, and for whom alternative breaks are can be provided, are currently being met by the CCG as they were previously. However, the full costs of these breaks will not be sustained by CCG indefinitely. This leaves Nottingham City Council at risk of bearing additional unexpected costs if the CCG decide to fund these young people to a lesser extent. The costs would be higher than we could expect to pay for more local services, as the provision is outside the city, and not only more expensive, but transport costs to and from the service is required.Therefore, this option is not recommended.

(iii)  Expand existing provision at Nottingham City Council’s adapted bungalow staffed by Short Breaks foster carers. Nottingham City Council currently has access to one such adapted bungalow which could be utilised to meet the needs of this cohort, and expanded to include a further bungalow as needed. However, some families are unwilling to accept breaks where their child is placed in a different family, as this model is, for them, too similar to the child becoming ‘looked after’. The current bungalow is also physically unsuitable for some of the older young people due to the size of the young person plus their equipment taking up the majority of the space in key rooms. Any new bungalow would need to be significantly larger to accommodate this cohort. Bungalows are proportionately expensive forms of housing, so acquiring a large bungalow is likely to increase the costs of this model significantly. Capacity would be limited, as the current bungalow is fully utilised, and recruitment of sufficient Short Breaks foster carers has been a long-standing issue. This model does not readily support the young person to socialise with peers as part of their healthy development. This can be a significant issue for young people with complex health needs, as they often lack opportunities for play and sleepovers, which are common to other children.Therefore, this option is not recommended.

(iv)  Utilise County provision (Caudwell House) to meet needs. Caudwell House have declined to support some of our more complex young people due to staff training and registration, so provision cannot be expected to meet all needs. Parents have raised concerns regarding the impact of the journey (approx. 1-1.5 hours’ drive) on a young person with complex health needs. This journey makes the facility unsuitable for some young people, so this option would leave them without suitable overnight breaks. Because Caudwell House is County Council provision, young people from the County will always take priority in terms of places, so places will not always be available for City young people. Therefore, this option is not recommended.

(v)  Borrow capital to build a new facility which could accommodate both the Crocus Fields cohort and the physical disabilities/complex health cohort. This option would require significant upfront funding (expected costs approx. £2.6m+ for the new build) and there is a risk that costs may increase during the project, leading to unexpected strain on financial resources available. Sources of capital funding are severely limited. The option of a Capital Loan which could be recouped through revenue has been explored - but predicted revenue costs of this model do not demonstrate a clear saving. However, this option would address the long-term issues around the structure of the Crocus Fields building.

(vi)  A new building project such as this would require approx. 2 years before the new provision became operational. New land would need to be identified for the development, or it would need to be built on the existing Crocus Fields plot (which would require re-location of Crocus Fields for approx. 18 months, at considerable expense, and disruption for families and young people with complex behavioural needs, many of whom do not respond well to changes). Therefore, this option is not recommended.