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RESOLVED:
 
1. 
To approve the procurement strategy to go out to tender
for a range of Supported Living and Residential Services, (Lot 1
& 2) and blocks of care (Lot 3) via a framework agreement, with
an anticipated start date of 04 August 2025 and a maximum contract
period of 8 years (with an option to extend the existing
arrangements or reopen the framework to new suppliers after six
months then annually), moving from the current spot purchase
arrangement to a contract, for an estimated cost of £805.7m
over 8 years.

 
2. 
To approve the addition of naming all North East London
Partners from year 2 onwards (with a maximum framework value
sufficient to include all the potential activity)
 
North East London Local Authorities
who are able to access this framework from Year 2 onwards are:
 
London Borough of Barking &
Dagenham
City of London Corporation
London Borough of Newham
London Borough of Redbridge
London Borough of Tower Hamlets
London Borough of Waltham Forest
London Borough of Havering
 
 
Reasons For Decision
 
1. 
Scope
 
See table 1  within report.
 

Definition of Supported Living
 
Supported living is typically
defined as housing where support and or care services are provided
to help people to live as independently as possible. Supported
living provides people with individual tenancies, with the rent
funded by Housing Benefit or funded by the client. This means that
they have a home of their own and will benefit from a greater level
of autonomy as far as their environment is concern wied. Supported Living Schemes are generally not
registered under CQC unless they provide personal care (in this
case they must be registered).
 
People may live in an
individual flat, a room in a house with two or three other adults
with similar support needs or in single service accommodation (such
as a house solely occupied by them due to their complex needs).
Personalised care and support are designed and provided according
to the needs of the individual, with a focus on maintaining, or if
appropriate, increasing independence. Support workers work with
individuals to help them live the way they want to, where needed
support with activities of daily living and access social
activities as required.
 
Supported Living schemes for
adults are defined by Hackney Council (LBH). The two property types
which fit this definition are:
 
 
· 
A cluster of single occupancy units which are grouped together
either within a purpose-built block or within a defined area (such
as a street), with an element of shared (core) support for all
service users. Hackney Council's view is that ideally there would
be no more than 14 flats/units clustered together and each
single-occupancy unit should have its own bedroom, bathroom/wet
room, kitchen and living/dining area.
· 
Tenants live in a shared house or bungalow and have their own
bedroom, ideally with an en-suite
bathroom or wet room but share every other part of the property
with other tenants. Accommodation should, at a minimum, include a
fully equipped kitchen and a communal living/dining area. Group
sizes in this type of tenancy would ideally be small, normally no
more than 4 tenants depending on the size of the property and
communal areas; however the property
situation in and around London may not allow this.
 
In addition some clients with complex needs such as a
learning disability and behaviours that are challenging may require
single service accommodation as sharing with other clients can
trigger behaviours. These properties are usually adapted and are
bespoke to the individual which is described in a service and
accommodation specification.
 
Within Supported Living
Schemes there is usually ‘shared’ and 'core' support.
All properties are tenancy based, with the landlord being separate
from the support provider.
 
Where possible tenancies
should be separate from the care provider so that if the care
support element were to break down the individual should not have
to move and another care provider would come in. It can be
difficult to have this separation if core hours are tied to the
accommodation.
 
The rent for supported living
properties needs to be affordable to the tenant and within what is
payable by housing benefit (top ups by health or social care will
not be payable). The Housing Benefits team identifies what is
allowable under service charges etc. Any rental costs need to be
identified before the individual, their belongings or any tenancy
agreements are signed by the client (or through Court of
Protection). Tenancies need to be signed by the individual client,
through Court of Protection if the person is not deemed to have
Mental Capacity (and a Mental Capacity Act assessment and best
interests has taken place). Tenancies cannot be signed by families
on behalf of the adult client unless they have legal powers to do
so.
 

Definition of residential Services for (1) 18+ years and (2) 65+
older adults

 
A residential care home for
people under 65 years is a communal setting that provides
accommodation, care, and support for people between the ages of 18
and 64. They will usually be CQC registered (as they provide
personal care or other regulated care). These care homes can help
people who are unable to live at home due to a variety of reasons,
including:
 
· 
Physical or cognitive impairment including early onset
Dementia.
· 
Sensory loss.
· 
Frailty.
· 
Learning disabilities.
· 
Mental health problems.
· 
Addiction.
 
Residential care homes can
offer a range of services, including:
· 
Getting dressed and washed.
· 
Medication reminders.
· 
Cleaning.
· 
Nutritious cooked meals.
· 
Respite care.
· 
Nursing care.
· 
Specialised dementia care.
 
Some care homes may also have facilities such
as hair salons, cafés, bars, landscaped gardens, a library,
and access to a private minibus.
 
The cost of living in a residential care home
depends on the level of support required.
 
A residential care home for people aged 65+,
often also known as a care home without nursing, is a place that
offers 24-hour personal care and support for people who need help
with daily life but don't require nursing care:
 
Personal care
· 
This includes help with washing, dressing, using the toilet, taking
medication, and eating or drinking.
· 
Accommodation.
· 
Residents can treat the home as their own and live there with
access to services.
Community
· 
Residents live with others and receive support with social
interactions and meals.
Safety
· 
Residents feel safe and well looked after.
 
Residential care homes are suitable for people
who have difficulty with daily life due to physical frailty, a
physical or learning disability, mental health problems, addiction,
or other care needs. They can provide long-term, short-term,
respite, emergency, and palliative care.
 
Definition of Fixed
Term Packaged of care
 
Adult Social Care currently has a small number
of contracts with providers to provide care for a whole community
based in one or several buildings. The buildings are usually owned
separately by landlords and we contract a care provider to provide
the care to those people under a specific specification and set of
quality standards. We often can get a reduced rate due to the care
provider being in one or two buildings and being able to have staff
on rotas and senior management cover.
 
Bringing the ability to call off from this
proposed framework will reduce both the length of time and
therefore the cost to the Council of officer time calling off from
this framework. Providers are already quality checked, rather than
separate tenders, all going through governance on separate
occasions.
 
The Current
State  - what
we do now
 
Currently, supported living and residential
services are procured on a spot purchase basis. A spot purchase
should be an unplanned, one-time purchase of goods or services that
is made outside of a Council's regular procurement process. Spot
purchases are often made to address urgent needs, such as when a
Council cannot rely on long-term contracts, or when there are
supply chain disruptions. However, over the lifetime of the
Council, this has become custom and practice for all care
packages.
 
An evaluation of the costs and fees for these
services has highlighted massive differences between providers in
terms of costs, fees, quality of provision and what they charge us
for.
 
The current model of spot-purchasing does not
enable the Council to shape the market, nor to have sufficient
assurance of the quality and capacity of commissioned providers to
deliver good outcomes to residents. Procuring a framework via a
Competitive Flexible Procedure under the light touch regime will
ensure that all providers are vetted to ensure they adhere to legal
and quality standards and financial parameters.
 
Successful providers will join the framework,
which will be clearly publicised to customers, carers,
practitioners and brokerage officers. People assessed under the
Care Act as requiring a supported living and care home service will
then be placed with the most appropriate services to meet needs,
using a combination of customer choice, geography, availability,
quality etc versus value for money.
 
To support this we
will be using the new E-brokerage system to call off from the open
framework. This call off process will mean all providers on the
framework will have equal access to each package, providing an
open, transparent approach to procuring packages of care.
 
The process will also create greater
competition which will hopefully hold down and control prices for
the Council.
 
Option 1: Continue with current
spot purchasing arrangements, which has the advantage of retaining
the status quo for providers. The drawback of this option would
be: it is difficult to assure the quality of spot purchased
services without a specific service specification. It is also
difficult to negotiate fair rates for services and it is an
inefficient use of social worker/brokerage officer time, searching
for appropriate provider services and negotiating prices. Potential
providers may see spot purchasing as offering no level of security
to operating their business. Furthermore, it does not consistently
offer a choice for the people wishing to use these services.
Without an overarching contract, there is also no standardisation.
For example, some providers class half a day as 4 hours and some 3
resulting in inconsistency of offer to individuals. Ultimately,
spot purchasing does not conform to Council Financial and
Procurement Standing Orders.
 
Option 2: Complete appropriate
procurement processes to award a number of separate contracts based
on the scope of the existing provision. This would have the
advantage of regularising existing arrangements and establishing a
fixed model of provision for the duration of the contracts.
However, it would fail to deliver the added benefits of an open
framework that are detailed below and it would be extremely time
consuming to complete all of the separate contracting arrangements
required. There is significant risk or high number of VOIDS when
purchasing block contracts.
 
Option 3: Procure an open
framework, supported by the E-Brokerage system for call offs.
Providers would be admitted onto the open framework after having
been evaluated as adhering to the required legal, financial and
technical quality and ability to perform the contract(s). Providers
then sign up to a set of overarching Terms & Conditions which
govern the way they will operate, as well as set out a floor and
ceiling rate for fees and other standardised fee rates in line with
Care Cubed prices if they have anyone placed with them. Providers
would apply to be on the framework. However, this would not be a
guarantee of work, beyond their existing packages of care. This
would then create a “menu” for where Individuals would
then be placed with the most appropriate service, using a
combination of customer choice, geography, availability,
etc – with the most cost
effective option that meets need and choice being selected. Each
service user is placed with an individual placement agreement (IPA,
rather than an overarching or block contract), which stipulates the
needs and goals of the individual.
 
The process of call offs would be supported by
the new E-Brokerage ICT solution.
Option 4: Use of an existing
Framework. We have been a member of the Waltham Forest
Framework. However, no packages of care were procured from this
arrangement and this has since ended. The London Borough of Newham
has an alternative framework that Hackney could join. The number of
providers on the list is very low. Hackney would be charged for
using the framework, and would have little control over the
process.
 
Option 5: Insourcing. LBH does
not own or run any supported living or residential services. It
would be unrealistic for the Council to take on the number of
packages Hackney needs, due to the sheer number of packages being
procured. However, in time, once the framework has been running, we
will be able to clearly identify any services that would be
beneficial to bring in-house. This would be particularly relevant
in the services we propose to contract in Lot 3; block packages of
care contracts.
 
LOT 3 will also help support the capital build
programme by helping to source care staff to cover a large number
of packages, which can then in turn be taken over by the in-house
team, if agreed.
 
 
Alternative Options
Considered and Rejected
 

 
Option 1
 
 

Remain as is

Poor value for money. No control over costs
and what's included in provider costs. Costs and fees are not
transparent. No service specification or KPIs to maintain quality.
High risk due to no contracts and no quality checks. Providers feel
it is important to have contracts.
 

Option 2
 
 
 
 
 

Separate contracts (no overarching framework
or DPS)

Very time consuming, requiring a number of
separate procurement processes to be completed. Not seen as good
practice or best value.
 

Option 3
(preferred)

Open Framework

This is our preferred option

Option 4
 
 
 

Use of an existing Framework

The number of providers on the list is very
low. We would be charged for using the framework and would have
little control over the process.