North Yorkshire County Council
Health and Adult Services
Executive Members Meeting
10th March 2023
Procurement of a Shared Lives Scheme for North Yorkshire
REPORT TOCorporate Director of Health and Adult Services (HAS) in consultation with the
Executive Member for Health and Adult Services
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1.0 |
Purpose of Report
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To seek approval for the procurement of the North Yorkshire Shared Lives Scheme on the open marketplace, accompanied by a new placement evaluation tool and refined payment terms for Shared Lives Carers.
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2.0 Executive Summary
2.1 This paper sets out the proposed future operating model for an effective Shared Lives service in North Yorkshire - a model that achieves excellent outcomes for people and communities, and adds value to the supported accommodation pathway.
2.2 Shared Lives is a scheme whereby an adult or young person from the age of 16 who needs long-term support spends time with a host family and shares family life. It offers an effective alternative to traditional care options, such as residential or domiciliary care.
2.3 The current agreement with Avalon Group to deliver a Shared Lives Scheme in North Yorkshire commenced on 1st November 2013. No expiry date was included within the original contractual agreement, and it is vital that the service is re-procured on the open marketplace to ensure best value, as well as a refreshed, outcomes-driven approach.
2.4 A decision was taken at NYCC Executive July 2022 to re-procure the Shared Lives Scheme. Notice has been served to the current Scheme provider and the re-procurement process is due to commence in Spring 2023.
2.5 Since the decision at NYCC Executive, further engagement has been undertaken with the market. Whilst the Council’s proposals were warmly received, it was felt that there could be some additional improvements / enhancements embedded within the new Shared Lives Operating Model; namely
· Clearer definitions of the levels of care and support offered to people within the Shared Lives Scheme, based on a person’s strengths and abilities.
· A simplified payment model for Shared Lives Carers; and
· The introduction of a defined level of Short Breaks built into the service (and guaranteed payment to Shared Lives Carers when the person is taking a break).
The above proposals have been welcomed by the council’s social care practitioners, the incumbent scheme provider and by Carers themselves (although it is proposed to contact all Carers to ensure that they are fully aware of the proposed terms and conditions of the new Scheme).
2.6 HASEX is asked to consider the content of this report and agree to the proposed Option as identified in 1.1 above.
3.0 Background
3.1 As identified in 2.1 above Shared Lives is a scheme whereby an adult or young person from the age of 16 who needs long-term support spends time with a host family and shares family life. It offers an effective alternative to traditional care options, such as residential or domiciliary care. People receive safe, personal care and support, in a place which feels like home. The service currently supports 68 people with an assessed care need.
3.2 The incumbent provider’s role primarily involves recruitment and training of Shared Lives Carers, matching young people and adults in need with an appropriate Carer family and offering ongoing support to the Carer family and the person in need.
3.3 The scheme has historically supported older people and adults with a learning disability. However, Shared Lives can also benefit other people including care leavers, people fleeing domestic abuse, people with mental health issues or chaotic lifestyles and those who are homeless or seeking move-on from temporary accommodation. It is anticipated that the re-procured service will reach out and engage with a wider range of individuals.
3.4 The refreshed scheme will be Visible, Accessible and deliver Meaningful Outcomes for the Shared Lives Carer and the Person
3.5 In summary the re-procured scheme will;
• Promote independent living and self-reliance within the safety of a family home,
• Be personalised to each person who uses the service, enabling co-produced care which is tailored to them,
• Enable people to stay in touch with their family, friends and communities while they receive support; and
• Be safe, of a high quality standard and carefully monitored by social care colleagues and the Care Quality Commission.
3.6 Proposals
The new service specification will be Outcomes focused, ensuring it meets the needs of individuals. Market feedback has indicated that the Scheme could be further enhanced through introduction of the following:
Introduction of a new Placement Evaluation Tool
• The introduction of a new Shared Lives Placement Evaluation Tool as part of the re-procured Scheme will help to better understand individuals’ strengths and abilities as they enter the service, ensuring that the service builds on those strengths – and that the person achieves more meaningful outcomes through their Shared Lives placement.
• The tool has been designed by the Shared Lives Steering Group, drawing on national best practice.
A Simplified Payment Model for Shared Lives Carers
• The current payment process for Shared Lives carers is complex and confusing, with multiple payment levels for different tasks. Care and support colleagues, and carers themselves, find the model difficult to understand.
• The proposal is to simplify payments to Shared Lives Carers.
Paid Carer Breaks
• In many other authorities the long-term carer is typically paid (in full or in part) when the cared-for person is staying in short break provision.
• Shared Lives carers in North Yorkshire currently receive no payment when the person is in short break provision.
• The proposal is to allow each Shared Lives Carer to be paid for up to one break-week. (Carers are not currently paid for any time off from their caring role).
4.0 Issues
4.1 Impact on people:
Key Benefits of proposed model
· Simplifies and standardises the current payment model so it is easy for carers, practitioners and the new Shared Lives provider to understand and apply consistently.
· Ensures payments are more directly aligned to the cared for person’s assessed needs, ensuring fairness, equity and transparency.
· Introduces a paid carer break of one week.
· Ensures Shared Lives remains significantly less expensive that other forms of accommodation with care; and
· Will help to recruit more Shared Lives Carers.
Proposed Implementation
· All Carers will be transferred to the new model as of 1st November 2023, when the new contract commences.
· Existing Carers would be transferred on the new banding that most closely aligns with their current rate. Our assessment is that none of the existing Carer cohort are disadvantaged by this approach.
· We will write to all Carers in advance of the change being implemented to inform them of their new payment, and provide details of how it has been calculated. If they disagree with their new payment, they will be able to request a review for the person they care for.
· Bandings will be reviewed as part of the cared-for person’s annual review.
4.2 Impact on the market:
4.2.1 There is likely to be interest from regional and national providers in the procurement exercise. Recent market testing has demonstrated an interest from a range of providers. This will be further enhanced by the proposed amendments to the new operating model as identified in this paper.
4.3 Impact on the Local Authority:
4.3.1 The care market is facing unprecedented issues related to cost increases and workforce pressures. The proposal will benefit the authority by expansion of a model that harnesses the strengths and assets of local communities, and offers an outcomes-focused, and cost effective alternative to traditional models of accommodation with care / residential care.
5.0 Performance Implications
5.1 The future vision for the service has been developed based on extensive research and engagement undertaken with Carers, people accessing the scheme and the provider marketplace. A new outcomes-focused service specification will ensure the scheme is visible, accessible and will deliver meaningful, personalised outcomes for both the Shared Lives Carer and the Person. It will also ensure support can be offered to include a wider range of people within the community who may benefit from the service.
6.0 Policy Implications
6.1 This procurement is in line with the intentions set out within the Council Plan and the Health and Adult Services 2025 vision and priorities. The service has been developed in line with national policy and legislation.
A dynamic and successful Shared Lives Scheme will make a significant, meaningful contribution to the vision set out in the NYCC Council Plan 21-25; a vision that every adult has a longer, healthier and independent life, and in particular that;
· People have control and choice in relation to their health, independence and social care support.
· People can access good public health services and social care across our different communities.
The HAS 2025 Vision and the adult social care Market Position Statement reinforces this vision, focusing in greater depth around the person and their outcomes, and ultimately reducing the need for health and social care services. Recurrent themes include;
· The person remaining as independent as possible and living in a place they can call home for as long as possible.
· Spending much more on prevention and alternative provision for complex needs and switching away from residential homes and nursing beds.
The refreshed, outcomes-focused Shared Lives Scheme will attract new carers of all ages and backgrounds, and (in line with LGR priorities) focus on supporting a far wider range of people e.g.
· Care Leavers and Young People in Transition
· People who are homeless or vulnerably housed.
· People with Mental Health issues
· Victims of Domestic Abuse
· Victims of Modern Day Slavery
· Parents with Learning Disabilities
· Older People
· NHS patients
• The service will alleviate pressure on the wider care market, harnessing the power of people and communities to deliver care which is far more cost-effective and personalised than residential and supported living provision. Year-on-year stretch targets for expanding access to the service from a broader range of people (as identified above) are built into the refreshed service specification.
7.0 Options Considered
7.1 HASLT has carefully considered the following three options for the payment of Shared Lives Carers as part of the new service model:
1. Keeping payments precisely as they are.
2. Introducing a more radical approach which pays Carers a single sum per week; and
3. Refining and simplifying the current model, without making radical changes.
It was felt that Option 3 would remove some of the more confusing elements of the existing payment model, without financially disadvantaging carers – and at the same time allowing a two-week break to be bult into their support offer.
The preferred option refines the current payment model by:
· Merging the Carer’s base fee and their weekly night responder payments into a single base rate or weekly payment. (Retaining an additional, standalone responder element where there is a clear likelihood that the carer will need to offer support at night).
· Introducing four care bands to accommodate a wider range of people and needs as identified in 6.1 above (as based on a more rigorous assessment via the new Placement Evaluation Tool).
· Introducing a simplified day break services model i.e. When the person goes to home of another Shared Lives Carer for a day i.e. a single payment rather than multiple payments.
· Introducing a simplified respite service model i.e. When the person stays at the home of another Shared Lives Carer for a short break i.e. a single payment rather than multiple payments.
· The overall costs of this approach are set out in Appendix A.
Financial Impact – Carers
· We currently have 47 Shared Lives carers, providing either long term or short stay support to 68 people.
· We have applied the new costing model to all existing packages, which has enabled us to calculate an estimated net impact on current Carers. This is summarised in the table at Appendix A.
· Our assessment is that payments for all existing carers will increase between 0.2% and 13.6%. The amount of increase will be dependent on individual care and support plans. The increased cost will be found from within existing budgets to avoid higher costs from different types of provision.
· The maximum increase will be £3,751 per annum. The minimum will be £39.63 per annum.
8.0 Financial Implications
8.1 The current shared lives contract includes a relatively high management fee. It is proposed that the new procurement seeks to reduce management fee/central overheads so that funding can be redirected to Carers.
8.2 The new model will be delivered in budget. Furthermore, Shared Lives remains significantly less expensive than other forms of accommodation with care. The new proposed model simplifies and rationalises the current, highly complex, payment process – and will help to make the service more attractive to new carers.
9.0 Legal Implications
9.1 Due to the likely value of the contract, the procurement process will be undertaken in accordance with the Public Contracts Regulations 2015 and the Council’s Procurement and Contract Procedure Rules.
10.0 Consultation Undertaken and Responses
10.1 Extensive engagement has been undertaken with Shared Lives carers and cared-for people, gathering information on their lived experiences of the service via a mixture of digital questionnaires and face-to-face engagement sessions. Engagement with the provider marketplace has also been undertaken, in partnership with the Council Procurement Team.
10.2 Five providers responded to the Market Engagement Exercise, ranging from large providers managing multiple Shared Lives Schemes to smaller social enterprises and Community Interest Companies. All providers submitted thorough responses and identified examples of innovation and good practice from elsewhere in the country.
11.0 Impact on Other Services/Organisations
11.1 It is anticipated that the re-procured scheme will work alongside the Council’s Children and Young People Services Directorate and local Integrated Care Systems to ensure a seamless, joined-up approach to supporting adults and young people in need.
11.2 The pathways into the Shared Lives service are being considered as part of the wider supported accommodation opportunities in the Housing Local Government Review workstream.
12.0 Risk Management Implications
12.1 Any risks associated with the scheme will be regularly reviewed and managed, with mitigations and controls put in place to minimise the likelihood and impact.
13.0 Equalities Implications
13.1 Consideration has been given to the potential for any equality impacts arising from the procurement of the Shared Lives Service, the Equality Impact Assessment Screening Tool is attached at Appendix C. 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.
14.0 Environmental Impact
14.1 A Climate change impact assessment has been completed and is attached at Appendix D. No significant change is expected as a result of the procurement, however it is acknowledged that the wider adult social care transformation programme will provide further opportunities to make improvements.
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Recommendation(s) HASEX is asked to note the contents of this report, and to approve the procurement of the Shared Lives Scheme on the open marketplace, accompanied by a new placement evaluation tool and refined payment terms for Shared Lives Carers as identified above.
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Richard Webb
Corporate Director – Health & Adult Services (HAS)
County Hall
Northallerton
10 March 2023
Report Author – Adam Gray
Report Presenter - Joanne Waldmeyer
Appendices:
Appendix A – Summary Finance Table
Appendix B – Shared Lives Placement Evaluation Tool
Appendix C – Equality Impact Assessment Screening Tool
Appendix D – Climate Change Impact Assessment