Decision details

(1)  To delegate to the Director of Adult Social Care, in consultation with the Lead Member for Adult Services, the decision to contract for the delivery of Integrated Community Based Care for Children, Young People and Adults services as from April 2025 in accordance with the outcome of the tender exercise currently being co-commissioned with the Integrated Care Board and other Bath and North East Somerset, Swindon and Wiltshire Local Authorities as detailed in the report.

(2)  Subject to (1) to agree ‘in principle’ to commit B&NES and Better Care Funding of £5,062,923 (2025/26) to the Integrated Care Board Integrated Community Based Care for Children, Young People, and Adults contract from 2025-2032 (with a potential for a further 2 years to 2034). The total funding commitment over the initial 7-year contract term from B&NES is £35,440,461. The overall contract is a fixed envelope. Within this there will be annualised uplifts by the cost uplift factor for the NHS and BCF element in line with National operating guidance as published. So, any Local Authority funding is not subject to an automatic uplift.

(3)  Subject to (1) to appoint the Director of Adult Social Care to be the Council’s representative on the Collaborative Oversight Forum as required in the Collaborative Commissioning Agreement (Principle 2.1.3 and clause 5) and delegate to the Director the power to appoint other B&NES officers to sub groups of that body to ensure appropriate governance arrangements are put in place to support shared leadership and accountability for the Collaborative, and to build a strong working relationship and culture of trust between the Collaborative.

Integrated Care Board – The Case for Change

The purpose of an Integrated Care System is to bring partner organisations together to:

•  Improve outcomes in population health and healthcare

•  Tackle inequalities in outcomes, experience and access

•  Enhance productivity and value for money

•  Help the NHS support broader social and economic development

The Integrated Care Board (ICB) developed a detailed Memorandum of Information (MOI) which set out the main ambitions for delivery of a new model of care in support of these objectives with a Case for Change which demonstrated that current provision of services is unsustainable and unequitable.

The Integrated Community Based Care programme is seeking to maximise the opportunity for transformational change in the way that services are designed and delivered across the three communities of (Bath and North East Somerset) B&NES, Swindon and Wiltshire. It presents a significant opportunity and is a key part of delivering the agreed Integrated Care Partnership strategy.

The programme is therefore a contract for much more than traditional NHS Community Services contract. The focus is upon prevention, addressing health inequalities and enabling the left shift away from hospital-based care into the community. By commissioning Integrated Community Based Care for Children, Young People, and Adults across all life stages; Starting Well, Living/Ageing Well and Dying Well, BSW ICB and its Local Authority partners wishes to ensure provision of health and care services that work seamlessly and harmoniously with primary care, secondary care, mental health services, local authorities (in particular Public Health and Social Care) and third sector organisations. The intention is to support local people to stay healthy, well and independent in the community.

The ICB and BSW Local Authorities are looking for a lead community partner to deliver this new vision for community care. The way in which they deliver these services will have a key role in transforming the out of hospital care setting in a way that delivers proactive care and person centred outcomes.

One of the transformative changes in the contract is to focus on outcomes for the population as opposed to specifications for the delivery of individual services. There is an outcomes framework jointly agreed by Local Authority colleagues and ICB colleagues, to support this to ensure we deliver across Children and Adults integrated community based care.

Scope of Services

To date the ICB and Local Authorities have jointly reviewed the services, both in scope and potentially in scope (on reserve list) over the lifetime of the contract and have provided detail for the ambitions for transformation of services.

The proposed core services are aligned across BSW and must be delivered within the contract. These will cover key elements of community-based health services for adults and children, plus any additional services that the ICB and Local Authorities decide to include in the contracts from 1st April 2025. For services identified within the core list there is a requirement that these will be harmonised across BSW, ensuring equity of access across all local authority areas, with only warranted variation

Integrated Care Board Procurement Process

There have been several stages to the procurement process. The first stage was a selection qualification process in line with traditional procurement. Invitation to Negotiate (ITN1) required a bidders’ submission before entering the dialogue phase and ITN2 which was launched in July is the final stage and will conclude with a traditional evaluation process during August. Evaluators include ICB and Local Authority representatives and the lived experience voice.

The dialogue phase was a very successful step in process and ensured bidders really understood the requirements.

All steps have been robust and followed procurement and legal requirements and approved by the Integrated Community Based Care Programme Board (joint membership of ICB and Local Authority officers). Assurance has been through the Integrated Care Board Finance and Investment Committee (including Local Authority representation) on behalf of the ICB.

The ICB Board will consider any recommendation for contract award in late September 2024. After any decision there will be the required 10 day stand still period before the contract award. There is a necessary six-month mobilisation period for a contract of this nature and scale, this period would then take us up to the contract starting on 1st April 2025.

Public announcement and briefings will follow the stand still period. A full Equality Quality Impact Assessment (EQIA) has been undertaken throughout and is updated iteratively. The EQIA will be shared as part of those briefings.

Public engagement ad co-production on the delivery of transformation priorities will be led by the provider with ICB and Local Authority engagement earlier public engagement, having been deferred due to the announcement of the general election. This does however allow meaningful collaborative engagement when the known bidder is in place.

Contract Arrangements

The Integrated Community Based Care contract arrangements will be covered by a Collaborative Commissioning Agreement (CAA) between the Integrated Commissioning Board and Local Authorities as co- commissioners. This will refer to Section 75 arrangements in the BSW localities and will set out the governance to ensure oversight of the ICB commissioned contract.

All feasible options have been considered by the Integrated Care Board and reviewed at the Integrated Community Based Care Programme Board for approval of the strategic outline case for the delivery of integrated community services across Bath and North East Somerset, Swindon and Wiltshire as of April 2025.