Decision details

The Cabinet Member agrees that;

1.1  The proposed commissioning arrangements of the following specialist services for adults with complex mental ill health aged 18-64 should be made, with regard to:

(1)  Independence at home services (home / domiciliary care, outreach, floating support)

(2)  Supported living (any scheme where housing, support and sometimes care services are provided as an integrated package)

(3)  Specialist residential care homes

1.2  Any annual decision-making regarding funding arrangements for this commission will be delegated to the Director of Adult Social Care.

This approach will achieve a flexible, and outcomes-focussed system where people can move seamlessly along a pathway to independent living and reduce cost.

The desired outcomes for people are those as agreed by the B&NES Mental Health Collaborative:

•  Outcome 1: Individuals with mental health needs are better able to manage their lives, are more resilient, and more engaged with their communities

•  Outcome 2: Individuals with mental health needs are engaged in meaningful activities, courses, volunteering and work / work like opportunities which match their skills, interests and lifestyles

•  Outcome 3: Individuals with mental health needs feel safe and secure at home and in their community

•  Outcome 4: More people are aware of, and receive, their right and entitlements as individuals detailed under the Family, Friends and Carer's and Mental Health & Wellbeing Charter

Commissioning a Consortium will create cooperation between providers and commissioners with a mutual obligation to act in a way that is ‘best for people’ and not necessarily best for individual organisations only. By having a single Agreement, all parties will work to the same outcomes and will be committed to the same success measures.

The benefits of the proposed approach for people are:

•  Better, seamless, care and support – people will be able to move from 1 type of support to another with ease, retaining continuity of support

•  Better client choice, closer to home through utilising all in-area capacity and by growing what we need

•  A whole system approach will improve outcomes and experiences for people and their families, friends and carers – through thinking about what the whole of the system needs and thinking holistically about people’s lives

•  A reduction in the cost of care

The benefits for our providers are:

•  A positive and strategic relationship with the Council and CCG where we design solutions together

•  Financial stability through agreed and understood demand analysis (including future demand) and guaranteed volume of work

•  Flexibility to work collaboratively with each other as no 1 provider holds the entire pathway of services

The benefits for the Council and CCG are:

•  Delivering Council savings and ensuring better value for money

•  Good supplier relationship management – we want to ensure good market management to ensure the best standards of care and support for people in B&NES

•  Robust, agreed and fit for purpose contractual arrangements and good evidence of impact

Do nothing. We have rejected this option because to take no course of action would mean we cannot achieve value for money; our contractual arrangements will remain unfit for purpose; pathways of care and support for people with mental ill health are unlikely to improve; and we will not be able to work with partners to create the shape of services needed in B&NES now and in the future.

Procure through a block and / or framework contractual arrangement. We have rejected this option on the grounds that nothing substantial is likely to change for people, for providers or for the Council and CCG if we take a standard procurement approach. Our analysis shows that putting a framework in place for independence at home services will create a cost pressure for the local authority. We believe we need to do something different, in partnership with our providers, to achieve better outcomes in the long-term and our soft market testing with local and national providers indicate that they wish to take the approach we are recommending.