Agenda item

Report of Interim Corporate Director of Adult Social Care and Health

Cllr Pavlos Kotsonis joined for this item and for the remainder of the meeting. 

Claire Labdon-West, Commissioning Manager, introduced the report on the re-commissioning of Extra Care services in Nottingham City, highlighting the following information:

a)  the report proposes re-commissioning Extra Care services at five existing schemes, with provision in the budget to fund an additional service if needed, depending on demand;

b)  the schemes will be funded from the existing Adult Social Care budget, with a block-funded element and an individual element. This report seeks approval for the block-funded element, while individual care packages will be approved individually;

c)  Extra Care allows people to maintain independence in the community for longer, maintaining social contacts and routines as their care needs change, rather than going into residential care too soon;

d)  the strategic commissioning review of Extra Care conducted in 2023/24 identified demographic pressures, including a large increase in the cohort aged 75-84, and without developing alternatives to residential care that would be the only option for many individuals;

e)  there are risks in the market, due to rising costs and instability of care providers. Providers have advised that the current financial envelope provided for Extra Care is not enough to maintain those services;

f)  consultation with citizens has shown that they want consistency, the ability to get out and about and maintain social contacts, while receiving support around any health conditions and feelings of isolation and loneliness, and this has feedback has fed into the specifications for Extra Care;

g)  the new model includes three new elements: night care and background hours as standard across all the schemes, to make them a viable alternative to residential care, and an expectation that care providers and housing providers will work together to support residents’ overall wellbeing;

h)  an implementation group is being set up to help implement the framework. The contract will be managed by colleagues, with appropriate termination clauses if providers do not accept those with high levels of need;

i)  the revised scheme will help to bolster the market, deal with demographic pressures, and help to reduce the number of people in residential care.

Cllr Pavlos Kotsonis, Executive Member for Adult Social Care and Health, commented:

j)  at the moment Extra Care is not able to provide a consistent offer, with night-care not always available, but the new model corrects that. The new offer is streamlined and flexible enough to meet people’s needs as those needs change. The new model will enable other types of provision than residential care to meeting growing demand;

k)  modelling has been completed to understand the impact on the budget. It is not a saving at this point, but it is an avoidance of cost and may become a saving in time – if the target occupancy of 192 citizens is achieved, it will imply a saving of 0.582m per year;

l)  it is important than residential care and more intensive kinds of care do not grow out of proportion, in the context of rising demand for care services.

During subsequent discussion and in response to questions from the Committee, the following points were made:

m)  Extra Care facilities can provide a wonderful atmosphere, with a community feeling, communal spaces, and self-contained spaces. They can provide independence, dignity, and community while meeting care needs;

n)  lack of people wanting to take up Extra Care is a risk, even though they are very good facilities. The lack of geographical spread may be a barrier, as it may mean moving away from local connections, so wider provision would be welcome;

o)  it would be useful to start conversations with citizens about different housing options early, and arranging visits so that people can see them for themselves.

Resolved to:

(1)  Establish a framework of up to 10 providers for Extra Care services, for a duration of 4 years, and to undertake call off competitions under the framework to contract for individual scheme providers, for a maximum of 9 years;

(2)  approve the Nottingham City Council budget expenditure on call off contracts of £2,777,777.77 per year, with an overall projected spend for the entire contract term under all call off contracts of £25,000,000;

(3)  delegate authority to the Interim Director of Adult Social Care and Health to approve the outcome of the procurement process for the framework and to call off and award contracts;

(4)  delegate authority to the Head of Personalisation, Quality and Contracting to agree and sign the contract documentation relating to the services, save where sealing as a deed is necessary, which shall be sealed and signed by the Director for Legal and Governance / Head of Legal and Governance.

Reasons for decision

p)  Extra Care services support citizens to maintain their levels of independence and enable them to remain living in the community for longer, resulting in better outcomes for citizens as they can maintain social contacts, interests, and routines even as their care needs change;

q)  Extra Care can provide flexible support to meet changing needs and delay the need for intensive forms of care, such as residential care. This supports the Better Lives Better Outcome (BLBO) programme to reduce the number of older citizens requiring residential care;

r)  the current contracting arrangements for the on-site care providers at five Extra Care services end in 2025 and there are no provisions for extending the contracts beyond their current end dates. Therefore, the services must be recommissioned;

s)  the estimated contract value is based on current commissioned packages of care, which have been agreed through separate Adult Social Care processes, as well as the block contract values for night care and background hours which have been modelled against existing block contracts for night-care and the existing Extra Care hourly rate for the background hours;

t)  whilst the proposed contract awards are likely to increase the current annual spend on Extra Care, this will be offset by the avoidance of costs if citizens were to receive care under homecare and residential care contracts;

u)  the decision will enable a compliant procurement process to be undertaken;

v)  the framework will enable new services to be secured in the future if and when required for the existing schemes. Best value will be secured through competitive tender and call off procedures.

Other options considered

w)  Do nothing, and allow Extra Care contracts to terminate when they reach their end dates throughout 2025, without procuring new services. This would not fulfil the authority’s statutory duty to provide care to all citizens with an eligible need through Extra Care, and would not represent best value, as the authority would have to put more costly alternatives in place;

x)  Procure Extra Care services under the current model operating within Nottingham City. This was not recommended, because consultation with citizens living in Extra Care and providers indicated that a new model is needed. This is also reflected in the underutilisation of Extra Care currently, partly due to the lack of a standard offer in areas such as night-care.