Contract and Commissioning Update
North Ayrshire Council · 16 November 2023
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Integration Joint Board 16th November 2023 Subject : Contract and Commissioning Update Purpose : • This report is for awareness to updated members of North Ayrshire Integration Joint Board (IJB) of the current contract and commissioning landscape. Recommendation : IJB members are asked to note the update on the contract and commissioning landscape. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership IJB Integrated Joint Board NAC North Ayrshire Council NCHC National Care Home Contract 1. EXECUTIVE SUMMARY 1.1 This report informs members of the IJB of commissioning updates and details and patterns of spend for care and support services. It provides an overview of current performance of purchased services, contract management approaches, current challenges within the social care market, efforts to support Providers and future development plans for the Contract and Commissioning Team. 2. BACKGROUND 2.1 North Ayrshire Council (NAC) commission a variety of types of care and support, on behalf of the Health and Social Care Partnership (HSCP) noted at Appendix 1 During the period 2022-23 care and support was purchased from 248 Providers. The total spend for the period was £62.8 million which does not include spend on non-care items such as aids and adaptations.
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The largest volume of spend at 43% was across the adult services market (mental health, learning disability, physical disabilities) followed by Health and Community Care and then Children Services. Overall, 40% of services were commissioned via Self Directed Support Option 2, which is a positive indication of supported people exercising choice in terms of their preferred Provider. At the financial year end 95% of purchased services were subject to contract. In the past two years there have been various developments in the area. This includes an increase in the use of supported accommodation models across North Ayrshire, opening of a new complex care supported accommodation service, a specialist mental health unit and the opening of an alcohol and drug rehabilitation centre. Two older people care homes and two care at home services have closed during this period. 3. CURRENT POSITION 3.1 Purchased Services The HSCP purchase various types of care and support as noted at Appendix 1. The table below provides a snapshot of the type and scale of care being commissioned within key services such as residential care and community support, where spend is the highest. 46 residential beds and 57 nursing beds for adults with LD, MH and PD 330 residential beds and 469 nursing beds for older people 44 residential beds for children or young people 295 hours of Community Support for 87 children with disabilities 2,178 hours of Care at Home per week for 176 adults 140 foster care placements 20,244 hours of community support for 393 adults (LD, MH, PD)
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3.2 Current Performance The table below provides a summary of the current quality performance of registered services based in North Ayrshire. Overall, 85% of services are graded good, very good or excellent by the Care Inspectorate across all inspection themes. Minimum Grade Care Service Sub Type 2 Weak 3 Adequate 4 Good 5 Very Good 6 Excellent Adoption Service 1 Adult Placement Service 2 Care Home Older People 1 5 8 2 Children 2 3 4 3 Alcohol & Drug Misuse 1 LD 1 2 MH 1 Respite 2 Fostering 1 Support Service Care at Home 2 12 9 Other 7 1 Totals 1 11 36 18 4 3.3 Managing Concerns The HSCP has a robust Contract Management Framework and Managing Care Deficiencies Procedure in place (Appendix 2), which outlines our approach to contract management, roles and responsibilities and details the steps taken when there are issues or concerns. Managing contracts is a partnership approach between the Care Inspectorate who have overall responsibility for regulating of care services, Providers, HSCP care managers, Contract Management Officers and Senior Managers. Other partners such as HSCP Finance, provider representatives or Economic Development can also be invited to attend contract management discussions where this aids joint working. Enhanced Clinical and Care Oversight Groups are also in place for care homes and care at homes services, these groups meet at least fortnightly, or sooner if required. Members of these groups include the Chief Social Work Officer, who has a responsibility to advise on the specification, quality and standards of commissioned services and other senior officers across health, social care and the Care Inspectorate.
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Oversight groups are tasked with: • maintaining effective care standards to prevent avoidable harm • managing and monitoring outbreaks • supporting workforce planning and deployment • ensuring appropriate wellbeing support for staff • encouraging effective engagement with General Practices • ensuring the right supports where palliative and end of life care is appropriate The strengthened oversight arrangements put in place as part of the pandemic response have facilitated an invaluable forum for multi-agency partners to share intelligence and any emerging risks and also act as forum for providers to escalate any of their own concerns or challenges. 3.4 Current Challenges The challenges faced by the HSCP and its partners in North Ayrshire are well documented. The care and support sector in North Ayrshire faces similar challenges to other Local Authorities across Scotland. There is an increase in demand, a shift towards more complex and long term conditions, financial pressures, significant workforce challenges in terms of both recruitment and retention of staff. The workforce is also ageing and reports indicate that when people do leave the service it’s to find employment in alternative markets. The National Care Home Contract (NCHC) sets the contractual arrangements for over 70% of older people care home placements in Scotland and is negotiated annually between COSLA (on behalf of Local Government) and Scottish Care. This year’s fee negotiations resulted in the highest ever proposed increase and was the best offer that could be made based on the financial challenges at this time. Scottish Care indicated that they acknowledge the challenges Local Authorities face, however, they were highly critical of this year’s offer and have expressed significant concerns about fragility of the care home market, particularly for rural or smaller sized care homes. Challenges specific to North Ayrshire include the number of actual beds available to the older people care home market with bed numbers having reduced, due to care home closures and the impact of the pandemic with some units closing and not reopening. It has proven extremely difficult this year to secure interim beds in care homes to support initiatives such as discharge to assess. Whilst the opening of additional resources such as complex care supported accommodation and residential care is very welcome it also places additional challenges on already stretched health and social care services in the area. The impact of these challenges is an adult community support market which is becoming increasingly fragile, longer than necessary stays in hospital for people who are medically fit to be discharged, lack of choice, waiting lists, additional pressures on
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the current workforce and unpaid carers and the ongoing difficulty of both recruiting and retaining staff. 3.5 Support to Care and Support Providers The HSCP have a range of supports in place to support Providers in an attempt to encourage partnership working and maintain positive working relationships. There are a range of Provider Forums which provide the opportunity to share information, discuss joint challenges, explore opportunities for joint working and review best practice. A Fair Work Practice Academy was delivered this year to encourage Providers to enhance their knowledge of fair work and consider how they could improve in this area. Discussions are underway with Ayrshire College to enhance learning pathways for Providers. Collaboratives with IRISS (Institute for Research and Innovation in Social Services) and the Care Inspectorate have taken place to consider key challenges and joint solutions across both the adult and older people care home markets. Providers have access to a range of free training and other free resources, with a number of Providers having taken up the offer of accessing funds to enhance staff wellbeing. 3.6 Next Steps The Contract and Commissioning team will: • Continue to support the HSCP to progress its commissioning objectives and Transformation Plans. • Fair Work Practice is key objective in terms of addressing workforce challenges and a significant focus will be placed on enhancing practice in this area during 2024. • Consider how we improve on how we engage with supported people, carers and Providers in the design of services. • Consider the requirements of Ethical Commissioning Principles in relation to commissioning, procurement and contract management to ensure that we are operating in efficient manner in relation to these principles. • Continue to encourage honest, trusting relationship amongst all stakeholder, internal and external, with a focus on ensuring high quality, effective care and support 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None
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4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk None 4.6 Community Wealth Building None 4.7 Key Priorities None 5. CONSULTATION No specific consultation was required for this report. Caroline Cameron, Director Author – Paul Doak, Head of Finance and Transformation Betty Saunders, Senior Manager, Contract & Commissioning [pdoak@north-ayrshire.gov.uk/bsaunders@north-ayrshire.gov.uk] Appendices • 1: Types of Services Being Purchased by HSCP • 2: Contract Management Framework & Managing Care Deficiency Procedures
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Appendix 1 Types of care and support services being commissioned. Number of Providers Subject to Contract by Service Area Contract Type Children and Justice Services Health & Community Care Services Mental Health Services Residential Care 20 91 46 Respite Care 10 10 Community Support 10 12 23 Advocacy Services 1 1 2 Peer Support & Recovery Services 2 1 5 Day Care 0 1 7 Fostering 7 Counselling Services 1 Information and Support Services 1 1 1 Employability Services 1 Wellbeing and Recovery College 1 Distress Brief Intervention Breastfeeding 1 Online / Face to Face Neurological Development Assessments 2 Combat Stress 1 Appendix 2 Contract Management Framework NA HSCP Contract Management Framew Managing Care Deficiency Procedures Managing Care Concerns Procedure.d