North Yorkshire County Council
Health and Adult Services
Executive Members Meeting
Friday 13th January 2023
REPORT TO Corporate Director of Health and Adult Services (HAS) in consultation with the
Executive Member for Health and Adult Services
Countywide Dementia Support and Advice Service
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1.0 Purpose Of Report
1.1. To consider extending the Countywide Dementia Support and Advice Service for a period of 24 months with additional funding of £60,000 per annum. |
2.0 Executive Summary
2.1. This paper sets out proposals to extend the countywide Dementia Support and Advice Service for a further 24 months with additional funding. The service is critical for the delivery of the North Yorkshire Dementia Strategy “Bring Me Sunshine – Living Well with Dementia in North Yorkshire” and achieving improved health and social care outcomes for individuals, providing a person centred, proactive support and advice service to any resident of North Yorkshire regardless of age, who have a formal diagnosis of dementia, or who is suspected to be living with dementia, as well as supporting their carers, family members and loved ones.
3.0 Background
3.1. The service commissioned in 2019 is jointly funded by North Yorkshire County Council
and what was then the five Clinical Commissioning Groups - Airedale, Wharfedale & Craven - now known as West Yorkshire Integrated Care Board; Hambleton, Richmondshire &Whitby, Harrogate & Rural District, Vale of York and Scarborough & Ryedale - now known as Humber and North Yorkshire Integrated Care Board.
3.2. The service supports through: -
· Signposting to other related services enabling them to better understand their condition, developing self-management skills and accessing support in their local community to promote independence, well-being, and give choice and control.
· Dedicated educational sessions for those living with or suspected to be living with dementia, carers, schools, community groups, providers and businesses to better understand dementia and its impact on individuals, families and communities.
· Working as a key strategic partner with North Yorkshire County Council and the Integrated Care Boards to deliver the principles and priorities of “Bring Me Sunshine – Living Well with Dementia in North Yorkshire Strategy.
3.3. The service can demonstrate high levels of success. Robust referral pathways and public engagement ensures people know where to turn for advice and support, with the service being delivered by a stable and qualified workforce.
4.0 Issues
4.1. At contract award, in line with a procurement related savings plan, the initial 4 years identified no inflationary uplift within the contract with a view to reviewing at the first extension stage. The provider has continued to deliver the service over and above expectations in terms of activity levels and quality, subsidising the service since its contract award.
4.2. Service demand is far outstripping supply, particularly following on from the Covid-19 pandemic, with more complex referrals from individuals living with dementia or those who care for them. The waiting list in achieving a formal diagnosis is at an all time high which also contributes to higher levels of activity for this service.
5.0 Performance Implications
5.1. The provider has experienced growth in terms of referrals to the service from day one and importantly the number of people using their helpline. Their model offers proactive support throughout the illness so that people do not reach a crisis before reaching out for help.
5.2. Following recruitment issues for a Dementia Specialist Nurse (formerly Admiral Nurse) the provider took the decision to upskill their own staff to become specialist Dementia Support Advisors and this had been productive in their service delivery.
5.3. Well attended educational workshops were delivered and 15 weekly wellbeing cafes were taking place from the first year of the contract supported by employed staff and volunteers.
5.4. Throughout the Covid-19 pandemic the provider responded and redesigned their service due to the closure of building-based services, delivering an alternative model whilst also retaining, not reducing staff, extending their Help Line Team and investing in new equipment to cope with demand. During this period, official contract monitoring ceased, however, this did not prevent provider reflection on their practice, working with the University of Chester to assess the impact of Covid-19 on the wellbeing of people living with dementia and their carers – useful research to inform future commissioning.
5.5. In the wake of the Covid-19 pandemic the service supports people who are on waiting lists of up to 10 months and referrals and help line calls are often more complex than those pre Covid. Hub Clubs and Cafes have reopened to support individuals and awareness raising continues in the form of local businesses, other providers and the general public, particularly in relation to Young Onset Dementia and the provider’s most recent campaign “U & ME” which has just been launched. Strategy work is linking with Age Friendly Communities to ensure there is no duplication and the service can work across all age groups.
5.6. The provider has worked with officers of the Council to revise the performance framework to ensure a full picture of service activity is captured and reported.
6.0 Options considered
6.1. Contract Extension - At contract commencement a longer than normal term was deemed appropriate to ensure service delivery aligned with the North Yorkshire County Council Dementia Strategy to achieve improved health and social care outcomes for individuals and their carers.
6.3. The provider’s “model” is well embedded, carrying the ethos of “local for local” whether it be through their helpline offering support and advice, through to using innovative technology such as robotic cats as stimulation and/or calming effects for those living with dementia. They have committed to take over and develop Garget Walker House in Richmond as a base/hub club working alongside other community-based services, demonstrating an indication of their long-term commitment to this contract, and their willingness to share good practice and peer support to other community-based support providers ensuing a consistent approach to supporting those living with dementia or their carers.
6.4. Continuation of the existing contract gives stability to the market, enabling a specialist service to work in an integrated way across the health and care sector.
6.5. As a voluntary sector organisation, scope to attract grant funding, receive additional monies through private fundraising and donations and recruit volunteers is greater. This in turn can be used to provide additional services such as pop-up cafes/hub clubs not only offering peer support to those living with dementia but their carers too, reducing the reliance on more statutory services.
6.6 Acting at arms-length from the Council the provider is able to influence and create change such as honest co-production and feedback that would not otherwise be achieved through the usual Council feedback mechanisms.
6.7. The provider works with NHS England and other locality health colleagues to enable earlier diagnosis, particularly for those with early onset dementia, who may be lost within the system as they move into older people’s services.
6.8 New Procurement - Due to the nature and specialism of the service providers with expertise in this field within the market are limited which could lead to a failed procurement exercise. Whilst the current contract is working so successfully and continues to provide value for money there is no evidence to suggest that a new procurement would be beneficial.
7.0 Financial Implications
7.1. The current contract value is £321,757.48 per annum which for the 24 month extension is a total of £643,514.96. The extension of this contract requires additional investment from North Yorkshire County Council and/or the Integrated Care Boards of £60,000 per annum, over the 24-month extension a total of £120,000 additional investment (not included in the totals above). Following discussions with Health & Adult Social Care Leadership Team it has been defined that the additional activity levels in some way relate to health needs and outcomes, discussions remain ongoing with the Integrated Care Boards in relation to the additional funding approval. At the point of presenting this report this shall be finalised. In the short-term, there is a financial impact to the available budget, however, in the longer term it is anticipated that early service intervention will prevent more intensive support being required and shall reduce budget pressures further down the line for both adult social care and associated health services.
8.0 Legal Implications
8.1. Advice has been sought from North Yorkshire County Council Legal services who have stated
that there is no risk in relation to the public contract regulations and the Council’s contract procedural rules in extending the contract or varying the current funding. The proposed increase in annual contract value for the remaining 6 years of the term is does not raise any substantive risk of procurement law challenge and the amendment is not “substantial” in accordance with regulation 72 (e).
9.0 Risk Management Implications
9.1. Failure to continue with the contract extension would result in the inability to meet our strategic requirements as outlined in the “Bring Me Sunshine – Living well with Dementia in North Yorkshire” Strategy.
9.2. The existing service is highly regarded so there is a risk that a change of provider may lead to a reduction in market stability and performance. A new procurement would also require the current provider to outlay unnecessary resources and funding to submit a tender which would detract from the services delivered.
9.3. The Integrated Care Boards may withdraw contributions towards the cost of the service. This is not anticipated due to their involvement in the initial procurement of the service but may be a possibility if they were unhappy with any re-procurement.
9.4. Increased referrals to the service along with individual’s presenting complexities are influencing timely follow up of welfare calls and increasing waiting lists. Lack of investment at this stage will result in further triaging of referrals, longer waiting time lists and a reduced capacity workforce along with possible carer breakdown.
10.0 Equalities Implications
10.1. It is the view of officers that the proposals should not have significant adverse impact on any groups of people with protected characteristics identified in the Equalities Act 2010.
11.0 Climate Change Implications
11.1. No significant change is expected, however, it is acknowledged that the wider adult social care transformation programme will provide further opportunities to make improvements.
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12.0 Recommendation/s
12.1. Executive Members are asked to note the contents of this report, and to recommend
i) Extending the Dementia Support and Advice Service for 24 months. ii) Authorisation of the additional funding requirements of £60,000 per annum.
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Name and title of report author: Carol Armstrong,
Strategic Service Development Manager,
Hambleton & Richmondshire with Dementia portfolio
Date of Report: 14th December 2022