Forward Plan reference number: FP/834/05/17 Report title: Residential Reablement Service Report to: Councillor John Spence, Cabinet Member for Health and Adult Social Care Report author: Andrew Spice, Director Strategic Commissioning & Policy (ASC) Date: 20 November 2017 For: Decision Enquiries to: Dale Evans, Acting Head of Commissioning – Vulnerable People County Divisions affected: , Braintree, Brentwood, Castle Point, , Epping Forest, , , & Divisions

1. Purpose of Report

1.1. The purpose of this report is to seek approval to decommission the Residential Reablement Services currently delivered by Cares Limited (ECL).

2. Recommendations

2.1. Agree to terminate the existing contracts for the Residential Reablement Service with ECL at the earliest opportunity.

3. Summary of issue

3.1. The Residential Reablement Service (the Service) was designed as part of the intermediate care pathway for older people which aimed to manage demand by maximising people’s independence and reducing the need for on- going care services.

3.2. The Service is primarily aimed at those leaving an acute hospital bed, providing a short and intensive period of support (for up to 6 weeks) to people in a residential care environment to enable them to regain independent living skills and return to their own homes, thus avoiding a longer term residential care home placement.

3.3. In 2011 (ECC) commissioned a two year pilot with BUPA to deliver the Service in Drake House, Chelmsford, before being extended to Ghyll Grove in Basildon. In 2015 ECC and the Clinical Commissioning Groups (CCGs) agreed to commission the Service across Essex from ECL. ECC led this activity and is the signatory to the contracts. Three services were commissioned from ECL, namely:  Brewster House in Maldon covering the Mid Essex CCG locality;  Woodbury Court in Basildon covering the Basildon & Brentwood CCG locality; and  Alexandra House in Harlow covering the West Essex CCG locality. (the ECL Sites)

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3.4 A fourth site was commissioned at the same time from Anglia Community Enterprise (ACE) at Corner House in Clacton covering the North East Essex CCG locality. Commissioners had sought a fifth site in the Castle Point & Rochford CCG locality but were unable to secure suitable bids from providers at that time.

3.5 At each of the four commissioned sites ECC has block purchased 10 beds, which means ECC is required to pay for these 10 beds regardless of whether they are in use; with a further option of purchasing an additional 5 beds on a spot basis, which ECC pays for when they are in use. The use of spot purchase beds is dependent on the level of demand for the Service and capacity at each residential provider.

3.6 Since 2015, across the ECL Sites there were a total of 609 referrals into the Service up to the end of May 2017. This accounts for 69% of the total number of referrals into the Service. However, a number of declined referrals and failed admissions meant that only 391 referrals actually resulted in a use of the Service. The main reason providers declined a referral was because of an adults unsuitability for reablement, whilst the majority of admissions failed because the service user or their family refused the admission, the individual was not fit for discharge or the referral was withdrawn.

3.7 The low number of admissions along with a number of admissions not lasting for the full 6 weeks across the ECL Sites has resulted in a significant under usage of the Service between May 2015 and May 2017:

Void Bed Days Mid 48% South West 39% West 43%

3.8 As well as regularly operating under capacity the Service across the ECL Sites has not met the KPI within the contract to support 80% of service users to return to their own home at the point of discharge from the Service. Only 57% of individuals admitted into the Service at the ECL Sites returned to their own home either with a self-caring or a domiciliary care package, with 40% either returning to hospital or being admitted to a long term residential care service.

3.9 ECL have indicated to ECC that they do not believe the current model of delivering the Service is cost effective and they do not wish to proceed with the contract, and have sought ECC’s views on terminating the contract early.

3.10 In the current financial climate ECC cannot sustain services that are not achieving value for money or are failing to achieve their anticipated outcomes.

3.11 Accordingly ECC has looked at alternative measures, and will continue to meet the assessed social care needs of people who would have used the Service through utilising alternative services including temporary residential care placements, Short Term Support in the Community, Reablement at

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Home, and ‘Live at Home’ services. As a result officers anticipate very little impact, if any, on the overall health and social care system if the contract is terminated. ECC will continue to monitor the impact on service users going forward as part of any future consideration for the Service.

3.12 Whilst the preferred option is to decommission the three contracts with ECL, the contract with ACE would remain in place in the short term whilst commissioners continue to review the impact of Service in the North East. This is because there has been a greater level of demand for the Service in this area and the contract is currently being fully utilised.

4. Options

4.1. Option 1: Decommission ECL contracts (Preferred option)

4.1.1. The current contracts for the Service with ECL would be terminated at the earliest agreed date.

4.1.2. Any funding that is released as a result of terminating the contracts ahead of the first contract break will be used to fund alternative social care services for people that would have used the Service. Any savings achieved would be allocated to alleviate other funding pressures within ECC’s adult social care budget.

4.1.3. The Residential Reablement contracts do not provide for termination for convenience however, ECL have indicated a willingness to terminate these contracts as early as possible.

4.1.4. Terminating the existing contracts with ECL where possible could result in the savings identified in paragraph 5.1.3 being achieved.

4.1.5. If this option is approved, ECC would serve Notice of termination on ECL at least 6 weeks before the contract termination date. This would allow any service users in receipt of the Service at the time notification is served to complete their 6 week residential reablement period.

4.1.6. Going forward, ECL will not accept any new referrals into the Service from the point that notification to terminate is served. People using the Service at the time the notification of termination is served will finish their residential reablement period as planned This will ensure that there is no disruption to people receiving the Service and that no service users remain in the Service at the point the contract is terminated.

4.1.7. When the Service with ECL is decommissioned all beds currently allocated to the Service at the ECL Sites will revert to residential care beds increasing the overall capacity of residential care beds in Essex

4.2. Option 2: Do Nothing

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4.2.1. ECC could continue to run the Service until the contract expiry on the 10th June 2018 with all contracts terminating at this point.

4.2.2. This would mean Essex residents could continue to be offered the Service as an alternative to the reablement at home service for residents who are fit for discharge from hospital but unable to return to their own home.

4.2.3. This would result in ECC continuing to commission a service that is not effective.

4.2.4. Allowing these contracts to continue until the 10th June 2018 rather than terminating them early where possible would reduce the potential savings identified in paragraph 5.1.3 that could be realised.

4.3. Option 3: Recommission the Residential Reablement Service

4.3.1. ECC could choose to undertake a competitive tender process in order to recommission the Service.

4.3.2. An option to re-tender the Service would provide ECC with an opportunity to review the existing contracts and amend these in order to try and overcome some of the difficulties encountered in the first two years of the Service operational period.

4.3.3. Currently ECC does not fully understand the potential delivery options for the Service that could deliver better value than the current model. Terminating the existing contracts early does not preclude ECC from exploring these options and re-commissioning a different service model in the future.

5. Issues for consideration

5.1. Financial implications

5.1.1. Within the 2017/18 Medium Term Resource Strategy (MTRS), the Service was budgeted for at full cost, including provision for a service in South East Essex where the original procurement was unsuccessful. The total budget is £2.8m per annum.

5.1.2. If the recommendation in this report is accepted and the contracts terminated, ECC will incur additional costs within residential and domiciliary care as a result of adults accessing these services who otherwise would have started residential reablement. These additional costs partially offset the saving from ending the contract.

5.1.3. Taking into account these additional costs, the expected savings are £1.4m in 2017/18 and £1.6m 2018/19. The 2018/19 saving is only marginally higher than 2017/18 due to the full year impact of additional residential and domiciliary care being purchased, as shown in the following table:

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2017/18 2018/19 £000 £000 Residential Reablement Cost 1,200 359 Residential Reablement Budget 2,807 2,807 Gross Saving (1,607) (2,447) Additional Residential Care 94 381 Additional Domiciliary Care 136 526 Total Additional Cost 230 907

Net Saving (1,377) (1,541)

5.1.4. The 2017/18 saving has already been accounted for within the forecast outturn position with the expectation that it is used to offset service budget pressures. Likewise, the 2018/19 saving has already assumed to be used for this purpose.

5.2. Legal implications:

5.2.1 As indicated above, the ECL Contracts do not contain any no fault termination provision. Therefore terminating these contracts for reasons other than default by a party, prior to the expiry date of 10th June 2018 requires the mutual agreement of both parties. ECL has indicated that they wish to cease providing the Service and therefore their consent to terminate these contracts is not expected to be withheld.

5.2.2 ECC Essex residents’ needs can be met by other services commissioned by ECC, with minimal impact on the health and social care system. ECC shall therefore continue to meet its duties under the Care Act 2014 in relation to unmet needs.

6. Equality and Diversity implications

6.1. The Public Sector Equality Duty applies to the Council when it makes decisions. The duty requires us to have regard to the need to: (a) Eliminate unlawful discrimination, harassment and victimisation and other behaviour prohibited by the Act. In summary, the Act makes discrimination etc on the grounds of a protected characteristic unlawful. (b) Advance equality of opportunity between people who share a protected characteristic and those who do not. (c) Foster good relations between people who share a protected characteristic and those who do not including tackling prejudice and promoting understanding.

6.2. The protected characteristics are age, disability, gender reassignment, pregnancy and maternity, marriage and civil partnership, race, religion or belief, gender, and sexual orientation. The Act states that ‘marriage and civil partnership’ is not a relevant protected characteristic for (b) or (c) although it is relevant for (a).

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6.3. The equality impact assessment indicates that the proposals in this report will have a disproportionately adverse impact on any people with a particular characteristic. As outlined in the Equality Impact Assessment there are a number of alternative services that adults could be referred into in place of the Service including: (a) Temporary Residential Care Placements (b) Short Term Support (c) Reablement at Home (d) Day Opportunities (e) Live at Home

7. List of appendices

7.1. Equality Impact Assessment

8. List of Background papers

8.1. None

I approve the above recommendations set out above for the Date reasons set out in the report. 4 Dec Councillor John Spence, Cabinet Member for Health and Adult 2017 Social Care

In consultation with:

Role Date Executive Director for Social Care and Education 4 Dec Dave Hill 2017 Executive Director for Corporate and Customer Services (S151 Officer) 20 Nicole Wood (Deputy S151 Officer), on behalf of November Margaret Lee 2017 Monitoring Officer

Kim Cole, on behalf of 10 October Paul Turner 2017

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