1. business and industrial

Agenda Item 6
Open Report on behalf of the Director of Adult Social Services and the
Chief Information and Commissioning Officer
Report to:
Adults Scrutiny Committee
Date:
27 May 2015
Subject:
Decision
Reference:
Key
decision?
Home Based Reablement Service Re-Procurement
No
Summary:
This item invites the Adults Scrutiny Committee to consider a report entitled
Home Based Reablement Service Re-Procurement which is due to be
considered by the Executive Councillor for Adult Care and Health Services,
Children's Services on 29 May 2015. The views of the Scrutiny Committee will
be reported to the Executive Councillor, as part of her consideration of this
item.
Actions Required:
(1)
To consider the attached report and to determine whether the Committee
supports the recommendations to the Executive Councillor set out in the
report.
(2)
To agree any additional comments to be passed to the Executive
Councillor in relation to this item.
1. Background
The Executive Councillor is due to consider a report entitled Home Based
Reablement Service Re-Procurement on 29 May 2015. The full report to the
Executive is attached at Appendix A to this report.
2. Conclusion
Following consideration of the attached report, the Committee is requested to
consider whether it supports the recommendations in the report and whether it
wishes to make any additional comments to the Executive Councillor. The
Committee’s views will be reported to the Executive Councillor.
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3. Consultation
a) Policy Proofing Actions Required
Not Applicable.
4. Appendices
These are listed below and attached at the back of the report
Appendix A
Report to the Executive Councillor – Home Based Reablement
Service Re-Procurement
Appendix B
Equality Impact Analysis
Appendix C
Project Timeline
5. Background Papers
The following background papers as defined in the Local Government Act 1972
were relied upon in the writing of this report.
Document title
Where the document can be viewed
Equality and Human Commercial Services
Rights
Commission
report,
‘Close
to
home: an inquiry into
older
people
and
human rights in home
care’ 2011
The Care Act 2014
Legal Services
This report was written by Andrew Cook and Carl Miller, who can be contacted on
01522 554094 / 01522 553673 or andrew.cook@lincolnshire.gov.uk /
carl.miller@lincolnshire.gov.uk
Page 68
APPENDIX A
Report Reference:
Executive/Executive Councillor
Open Report on behalf of Glen Garrod, Director of Care
Date:
Executive Councillor for Adult Care and Health
Services, Children's Services
29 May 2015
Subject:
Home Based Reablement Service Re-Procurement
Decision Reference:
I008805
Key decision?
Yes
Report to:
Summary:
The current home based reablement service has been in place since April 2014
delivering reablement based services for eligible people over 18. Notice has
been served on the current provider due to unsatisfactory performance levels,
bringing the service to an end on 2 November 2015. At this point a new contract
must be in place and new packages of reablement care will be directed
exclusively to the new provider. This report seeks approval from the Executive
Councillor to procure a new contract for home based reablement.
Recommendation(s):
That the Executive Councillor
1. Approves a procurement be undertaken to deliver a contract to be awarded
to a single provider of a county-wide home based reablement service within a
fixed budget and guaranteed minimum volumes for a period of three years with
the possibility of a further two year extension.
2. Delegates to the Director of Adult Social Services in consultation with the
Executive Councillor for Adult Care and Health Services, Children's Services
the authority to determine the final form of the contract and to approve the
award of contracts and the entering into of all contract and other legal
documentation necessary to give effect to the said contract.
Alternatives Considered:
1.
Negotiate a revised contract with the current provider
Continuing with the current provider is not viable as performance levels
are substantially lower than specified in the legal agreement and could not
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be maintained with the necessary confidence in their delivery within the
available funding. These current performance levels fail to properly
address the pressing issues facing the council and health services and
would likely result in increased cost pressures and lack of provision for the
service user.
2.
To do nothing
Home Based Reablement is a critical service which is at the front line of
maintaining the independence of Lincolnshire's residents. Without this
service the impact on service users and the wider health system would be
far reaching and highly disruptive. It would also not address the statutory
requirements of Lincolnshire County Council for preventing, reducing or
delaying needs under the Care Act 2014.
Reasons for Recommendation:
The proposal is to establish a single provider model for eligible people over 18
who will benefit from a time limited period of home based reablement in
Lincolnshire.
1. Service provision under the current legal agreement has not delivered the
agreed volume of activity in terms of 'face to face' hours. This has had a
detrimental effect on the desired outcomes of service users and led to a
reduction in the number of people being able to benefit from this service. It has
therefore been necessary to terminate the current agreement and seek a new
provider in order to address the current level of underperformance.
2. The alternatives considered have been deemed unacceptable in delivering
the required outcomes of the service.
3. Addresses and supports the statutory requirements for preventing, reducing
or delaying needs under the Care Act 2014.
1. Background
1.1
The service was originally setup by Lincolnshire County Council in 2009
as The Lincolnshire Assessment and Reablement Services (LARS) The
service helps maintain a person’s independence, reduces the need for a
hospital admission and facilitates timely discharge. It provides intensive
interventions for residents experiencing a change in need, helping to
decrease the need for longer-term social care services, supporting
discharge from hospitals and reducing the chances of re-admission.
1.2
Following a meeting of the County Council's Executive on 3 December
2013 approval was given to the legal agreement which saw the service
transferred over to Lincolnshire Partnership NHS Foundation Trust
(LPFT). This grant agreement included the transfer of all LARS staff over
to LPFT. This decision was taken on the basis that transferring the
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service to LPFT would create a more integrated rehabilitation and
recovery service, and assist in the delivery of increasing demand for the
service within a constrained budget allocation.
1.3
The service was implemented on 1 April 2014 in accordance with the
legal agreement signed on 3 December 2013.
1.4
Unfortunately, whilst the total cost of service delivery has come down
during the 2014/15 period, the levels of activity undertaken are lower than
the amount agreed in the legal agreement.
1.5
Having taken due consideration of the levels of performance and the
knock on effect this has to people's outcomes and the delays this causes
to the Health and Social Care System, LCC has taken the decision to
give notice to terminate the current agreement. Formal notice of this
termination was sent to LPFT on 22 April 2015.
1.6
Adult Care has a strategic direction to enable people to remain living
independently in their own home for as long as possible.
1.7
An effective reablement service is key in supporting people to gain or
regain their skills by contributing to faster recovery from illness, fewer
unnecessary hospital admissions, prompt discharge from hospital and
more opportunities for independent living.
1.8
People using reablement experience greater improvements in physical
functioning and improved quality of life compared with using standard
home care.
1.9
From a social care perspective, there is a high probability that reablement
is cost effective. Reablement achieves cost savings through reducing or
removing the need for ongoing support via traditional home care or
admission to long term residential care.
1.10
Continuing demographic change means increased pressures and
escalating challenges for the Council and the Care Sector in the future.
1.11
It is essential that as many individuals as possible are reabled to their
maximum potential through the home based reablement service.
General Environment
2
Home based reablement is essential in maintaining the independence of
Lincolnshire's residents. Without this service the impact on the wider health
system would be far reaching and highly disruptive.
2.1
There are many policy developments which are influencing the care
market and commissioning activities on a national and local level
which can be summarised as follows:
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2.2
Implementation of personalisation - local authorities are required
to ensure that service users and carers have more choice and control
over the services they are able to access and the way in which the
services are provided. Although LCC will continue to adopt a single
provider model for home based reablement, service users will be able
to choose whether to use the LCC commissioned provider or self
fund with a privately commissioned provider.
2.3
The Care Act - focus on wellbeing - The Care Act is personcentred; it places the wellbeing of the individual at its core and
emphasises the need for greater integration and cooperation
between agencies. The Care Act attempts to rebalance the focus of
social care on preventing and delaying needs rather than only
intervening at crisis point. Wellbeing puts people at the heart of care
and support and enables a person to maximise their independence
for as long as possible.
2.4
Reablement - there is evidence nationally that where, following a
period of illness, people are supported to regain and retain their
independence they are less likely to need long term care services or
only require a reduced amount of care. Local authorities are working
with the NHS to ensure that they commission services which help
people to retain their independence.
2.5
Demographic changes and the need for preventative servicesas more people are helped to live at home for longer and given the
demographics of an increasingly ageing population, there is an
increase in the need for services which prevent or delay the
deterioration of wellbeing resulting from ageing, illness or disability.
The Council has undertaken a process of demand modelling for the
service, taking into account the hours delivered by the current
provider during 2014/15, as well as the referrals they were unable to
accept, which suggests that as much as 200,000 contact hours may
be required during the forthcoming 2015/16 financial year.
2.6
Hospital avoidance and early discharge - the NHS and local
authorities are developing a range of community based services and
initiatives to prevent the need for people to be admitted to hospital
and to ensure that people are discharged from hospital at the earliest
opportunity.
2.7
Workforce development – there is wide recognition that good
quality care services require investment in a skilled and trained
workforce which is motivated and well supported. Last year the
Equality and Human Rights Commission produced a report, ‘Close to
home: an inquiry into older people and human rights in home care’
which recommends that local authorities should ensure that the way
in which services are commissioned, procured and monitored,
adheres to the Human Rights Act. This includes ensuring that
services are provided in a way which promotes and maintains dignity
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with service users having some level of consistency in the care staff
that deliver their care. Market testing on the ability of providers to
deliver the service within the outlined cost envelope has delivered
positive feedback. It can therefore be assumed that providers will be
able to accommodate the TUPE transfer of existing staff including
their protected terms and conditions as a legacy of their service in the
public sector.
2.8
High quality care services - In addition to the above, the Care Act
requires councils to ensure that there are high quality social care
services available within the local market to meet people’s outcomes.
Commercial Model
3
Work to date has covered a variety of approaches in how to effectively
commission a home based reablement service required by the Council. The
existing arrangement operates as a legal agreement between LCC and the
current provider. This agreement however was implemented without being
exposed to any form of competition. Considering the under performance of
the current provider due to a lack of capacity to deliver the required 'face to
face' hours. It is essential to recommission the service through a competitive
tender process in order to increase confidence in the delivery of the required
level of provision and encourage value for money.
Contract Structure
3.1
Evidence collected on the current service indicates that where provision
has taken place it has been to a good standard. However the volume of
service hours delivered remains below expectations set within the
agreement. Based on this knowledge the core delivery model does not
warrant any significant change. We will therefore continue to seek a
single provider with an emphasis on ensuring that the required volume
'face to face' hours, as well as reablement outcomes, will be delivered.
Competition
3.2
The most significant change in recommissioning this service will be giving
both health and private markets the opportunity to competitively tender for
the running of the service. Exposing the service to the open market will
help to encourage improved value for money through quality, innovation,
reduction in costs and the added value any potential providers may bring.
Homecare
3.3
It is not uncommon for home care workers to be also trained in the
provision of reablement care. Through exposing this service to
competition it may provide an opportunity to the wider care sector within
Lincolnshire to align reablement services with their existing portfolio of
services, realising economies of scale, proximity and commonalities in
service delivery. Additionally, aligning the reablement contract term with
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the term of the new homecare contracts provides the Council and the
market opportunities for further efficiences by more fully integrating the
commissioning and delivery of these related services in three or five
years time.
Performance Management
3.4
Within the current agreement there is no mechanism to encourage high
performance or remedy of poor performance, by either penalties or
incentives. Payment is made in a quarterly lump sum or 'block payment'
regardless of the providers' level of performance. As a consequence we
have very limited control over performance, other than with the ultimate
remedy of termination.
3.5
Through the recommissioning of this service we will embed performance
management into the contract. This will be linked to manageable,
measurable and achieveable targets aligned to the agreed key
performance indicators, and a formalised system of managing and
monitoring performance against the contract. It will be made clear from
the outset that the provider will be contractually responsible for ensuring
that they are able to meet the required number of 'face to face' hours and
the qualitative outcomes.
3.6
The market engagement undertaken, discussed in more detail at
paragraph 5, has indicated that the expected minimum activity levels,
which will be a defined quantity of face to face contact hours, will be set
at a level that is realistic within the council's available budget and that is
still attractive to the market.
3.7
The payment mechanism will be based on a core payment with a
separate system of financial incentives and deductions according to
performance levels against a small number of key performance targets,
with a focus on the delivery of the quality outcomes for the service. Both
elements of the payment mechanism fall within the Council's maximum
budget allocation for the service. The core payment will be determined by
the actual volume of activity undertaken within the invoicing period. If
activity levels are equivalent to those that the provider commits to deliver
at the point of submitting their bid, they will receive their full core payment
allocation. The incentive mechanism will be limited to plus/minus 5% of
the total available budget, but are felt proportionate and of a level
significant enough to delivery of effective outcomes for service users.
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Single provider structure
Single Provider
3.8
Providing guaranteed volume through a single provider remains a viable
solution as the required hours are set at a number that in turn equates to
a sufficient amount of work so as to allow the provider a strong cost base
to work from.
3.9
By continuing to arrange the contract into a single strategic block the
Council will be able to achieve a position wherein it can be satisfied the
new agreement will be sustainable and will result in good quality care for
service users.
3.10
In determining a single provider the service model depends upon a
number of factors:
3.11
Cost & Duration
A core principle of the Single Provider model is that a commitment of
demand creates a strong commercial base for a provider and as such
will help support them to deliver better value back to the Council.
Similarly by guaranteeing this demand for a long period of time this
would further strengthen a provider's ability to establish a sound base
of business. This commitment will increase economies of scale for a
provider and providers it may wish to sub contract to, as well as allow
them to build better business plans, optimise resources, better
manage recruitment and the opportunity to plan reablement routes
better thus improving efficiency and lowering costs.
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3.12
Impact on the market
The current operating model is based on a sole provider providing all
home based reablement within the county. Because the new model
has a close resemblance to the current operating model the impact
on the market is likely to be minimal. There is however scope to
increase the number of providers delivering home based reablement
through sub contracting, consortium or joint venture arrangements
should the single provider be unable to deliver the volume hours
required alone.
3.13
Risk and flexibility
In addition to this the Council should also give regard to the resulting
balance of risk that follows from awarding the contract to a single
provider. The Council will seek assurance and conduct due diligence
through its procurement processes to ensure the single provider has
the capacity to deliver the volume of hours required in the service
specification. These assurances will increase the Council’s ability to
manage risk as well as provide greater flexibility of service provision.
This factor would also address the Council’s requirement under the
Care Act to effectively manage the market and address the risks of
market failure.
3.14
Service User choice
Related to the points already raised the issue of service user choice
should be properly considered. The Care Act states the importance of
allowing a recipient of care the ability to make choices about how that
care is delivered. The Act does not stipulate anything specific with
regard to how any particular commercial arrangement must conform
to or support this requirement. By ensuring that there is a stable high
performing provider able to deliver a home based reablement service
across the county service users will be better equipped to achieve
their chosen reablement outcomes. A change in provider is unlikely to
have any impact on service user choice due to the short term nature
of the service (maximum of six weeks).
Tender process
4
A key phase in the procurement will be in how organisations are assessed
and qualified at the tender stage. As previously stated it is essential that the
single provider or any organisation the provider sub contracts work to will be
able deliver the required volume of hours. The Council must therefore have
a clear understanding of the level of financial and business capacity a
tenderer must have before being allowed to proceed to bid. This must be set
at a level that represents an acceptable assessment of the level of risk
involved in delivering such a large contract as well as not being
unreasonably burdensome and therefore restricting consortia bids.
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4.1
The Procurement is being undertaken in accordance with regulations 74
to 76 of the Public Contract Regulations 2015 under "Light Touch
Regime" utilising an Open Procedure method. The ultimate decision as to
which provider is awarded the single provider status will be based on their
evaluation performance.
4.2
ITT evaluation will focus on service quality and the capability of the single
provider and any organisations they may wish to form sub contracting
arrangements with to deliver the required volume of hours and quality
outcomes across the county this is due to the significant risk of under
performance that is currently being experienced.
4.3
The contract will be awarded to the single provider based upon a clear
and unambiguous expectation, backed up by the terms and conditions of
the agreement, that they will be responsible for ensuring that the
minimum volume of hours expected of them must be delivered either
directly or by a subcontracting arrangement.
Scope
5
The forthcoming procurement will address home based reablement support
for Older Persons, Adults Physical Disability, Learning Disability to gain or
regain their abilities by contributing to faster recovery from illness, fewer
unecessary hospital admissions, prompt discharge from hospital and more
opportunities for independent living.
5.1
The resulting contractual arrangements will provide:

A solution that provides the required amount of capacity to deliver a
county-wide home based reablement service across Lincolnshire.

A sustainable service model with long term prospects
providers/provider to strengthen their business operations.

A home based reablement service which is capable of meeting and
further able to meet changing/increasing need.

A provider to act as 'the provider of last resort' and use their capacity
to support people with long term needs in their own home. If required
this would be on a short term basis.

A model which promotes an integrated approach to reablement to
improve outcomes for service users.

A strong foundation from which to work with the provider can move to
outcomes based working which will be explored and developed within
the term of the contract.
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for
Market Engagement
6
A Prior Information Notice was published on 20 March 2015. This initiated a
process of pre-tender market engagement. Feedback gained from this
process has provided an understanding of the market's preferred approach
to a number of important issues impacting on the commercial model,
including the contract duration, market capacity, budget viability,
performance management and pricing structure, and contract mobilisation.
6.1
Engagement with the community health provider has been conducted in
order to understand the impact on the referral pathway and the interrelationship between the wider health commissioned re-ablement
services and our own.
Market Rate
7
As a part of the engagement with the market, a clear indication of indicative
demand at between 160,000 and 200,000 contact hours, and annual
available budget of £4,000,000 have been shared with the market. The
estimated range of contact hours was defined by the demand modelling
exercise, referred to at paragraph 2.5, with the lower of the values being a
reasonable compromise point considering the current level of delivery being
achieved. The £4,000,000 budget is comprised of a £2,000,000 allocation
from the ASC revenue budget and a £2,000,000 allocation from the Better
Care Fund.
7.1
Given the underperformnace of the current provider it is important to
understand how economically attractive this offer is to the market.
The demand and budget figures shared would require the the service
to be delivered at a cost of between £20 and £25 per hour. The
feedback received from the market provided a clear indication that a
good quality and sustainable service is achievable at this rate.
7.2
Further, investigation of the hourly rates paid by other local
authorities has been undertaken. Whilst the response rate has been
low, this exercise has provided some additional assurance that the,
delivery of our activity volume requirements within our affordability
limits as defined by our maximum available budget, is commercially
viable and will be attractive to the market. A tender process will
ensure that the market competes to give the Council the best value
rate.
Contract Duration
8
The core principle of the single provider model is that the commitment of
demand will build a stronger commercial base for a provider and as such will
help support them deliver better value back to the Council. Similarly,
specifying minimum guaranteed activity volumes for a longer period of time
would further strengthen a provider's ability to establish a sound business
base.
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8.1
As discussed above the proposed duration of this contract will be for an
initial period of three years with an extension period of two years. The
attractiveness of this approach was tested as a part of the market
engagement process, and the views of the market provided validation
that the proposal is a realistic, reasonable and attractive term for the
contract.
8.2
As noted, the term also aligns with that of the new Home Care contracts
and provides the Council and the market opportunities for further
efficiences by integrating the commissioning and delivery of these related
services in three or five years time.
Transition & Mobilisation
9
Timescales between contract award and implementation are limited with a
transition period of eight weeks. This may present a transitional risk for
some providers in terms of the transfer of staff from the existing provider, if
that provider is not successful in retaining the contract, and in recruiting an
adequate amount of suitably skilled staff to deliver an effective service at the
required volumes from the contract start date.
9.1
The opinion of the market has been sought on the viability of an eight
week transition and mobilisation period, and the majority expressed a
view that this was adequate.
9.2
As discussed above the short term nature of reablement support, and the
probable transfer of the majority of staff currently providing the service will
mean that the impact on service users of a transfer between providers
are low. Any service users in the sevice within six weeks of the new
contract start date will receive full explanatory communications.
Procurement implications
10
The Procurement is being undertaken in accordance with regulations 74 to
76 of the Public Contract Regulations 2015 under "Light Touch Regime"
utilising an Open Procedure method.
An OJEU Notice will be published on 1 June 2015 and a Contract Award
Notice will be issued on any award to a successful bidder.
10.1
In undertakng the procurement the Council will ensure the process
utilised complies fully with the EU Treaty Principles of Openness,
Fairness, Transparancy and Non-discrimination.
10.2
The procurement process shall conform with all information as published
and set out in the OJEU Notice.
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10.3
All time limits imposed on bidders in the process for responding to the
OJEU Notice and Invitation to Tender will be reasonble and
proportionate.
Public Services Social Value Act
11
In January 2013 the Public Services (Social Value) Act 2013 came into
force. Under the Act the Council must before starting the process of
procuring a contract for services consider two things. Firstly, how what is
proposed to be procured might improve the economic social and
environmental wellbeing of its area. Secondly, how in conducting the
process of procurement it might act with a view to securing that
improvement. The Council must only consider matters that are relevant to
the services being procured and must consider the extent to which it is
proportionate in all the circumstances to take those matters into account. In
considering this issue the Council must be aware that it remains bound by
EU procurement legislation which itself through its requirement for
transparency, fairness and non-discrimination places limits on what can be
done to achieve these outcomes through a procurement.
11.1
Environmental benefits are secured by ensuring that the new model
allows providers to optimise the need for travel as effective route planning
will be a key element in both the expectation of the Council and as it will
reduce provider overheads. Moreover it is clear that a stronger and wellresourced community support service will have the potential to deliver
increased social and economic benefits to the area by;
11.2
Helping people live at home for longer; helping relieve pressure on acute
hospitals, care homes, and the wider health system by assisting with front
line care and preventing avoidable admissions to hospital.
11.3
Ways will be explored of securing social value through the way the
procurement is structured.
The operation of sub-contracting and
consortium arrangements will be explored as a means of ensuring a role
for local small to medium-sized enterprises (SMEs) in the delivery of the
services. Evaluation methodologies will be explored so as to incentivise
the delivery of a skilled and trained workforce.
11.4
Under section 1(7) of the Public Services (Social Value) Act 2013 the
Council must consider whether to undertake any consultation as to the
matters referred to above. The service and the value it delivers is well
understood. Best practice recently adopted elsewhere has been
reviewed. This and the market consultation carried out is considered to
be sufficient to inform the procurement. It is unlikely that any wider
consultation would be proportionate to the scope of the procurement.
Equality Act 2010
12
The Council's duty under the Equality Act 2010 needs to be taken into
account by the Executive Councillor when coming to a decision.
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12.1
The Council must, in the exercise of functions, have due regard to the
need to:
i.
Eliminate discrimination, harassment, victimisation and any other
conduct that is prohibited by or under the Equality Act 2010;
ii.
Advance equality of opportunity between persons who share a
relevant protected characteristic and persons who do not share it;
iii.
Foster good relations between persons who share a relevant
protected characteristic and persons who do not share it: Equality
Act.
12.2
Having due regard to the need to advance equality of opportunity involves
having due regard, in particular, to the need to:
i.
ii.
iii.
iv.
v.
Remove or minimise disadvantages suffered by persons who
share a relevant protected characteristic that are connected to that
characteristic;
Take steps to meet the needs of persons who share a relevant
protected characteristic that are different from the needs of
persons who do not share it;
Encourage persons who share a relevant protected characteristic
to participate in public life or in any other activity in which
participation by such persons is disproportionately low.
The steps involved in meeting the needs of disabled persons that
are different from the needs of persons who are not disabled
include, in particular, steps to take account of disabled persons'
disabilities.
Having due regard to the need to foster good relations between
persons who share a relevant protected characteristic and persons
who do not share it involves having due regard, in particular, to the
need to tackle prejudice, and promote understanding.
12.3
Compliance with the duties in this section may involve treating some
persons more favourably than others.
12.4
The relevant protected characteristics are:
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
12.5
Age
Disability
Gender reassignment
Pregnancy and maternity
Race
Religion or belief
Sex
Sexual orientation
A reference to conduct that is prohibited by or under this Act includes a
reference to:
i.
A breach of an equality clause or rule
Page 81
ii.
A breach of a non-discrimination rule
12.6
It is important that the Executive Councillor is aware of the special duties
owed to persons who have a protected characteristic as the duty cannot
be delegated and must be discharged by the decision maker. The duty
applies to all decisions taken by public bodies including policy decisions
and decisions on individual cases and includes this decision.
12.7
It is fair to say that the key purpose of the service is essential to enabling
all those individuals who require community care services to live more
independent and healthier lives. In that sense the delivery of the service
helps to advance equality of opportunity. The providers' ability to provide
services which advance equality of opportunity will be considered in the
procurement and providers will be obliged to comply with the Equality Act.
12.8
To discharge the statutory duty the Executive Councillor must consider
the relevant material with the specific statutory obligations in mind. If a
risk of adverse impact is identified consideration must be given to
measures to avoid that impact as part of the decision making process.
12.9
An Impact Assessment has been completed for the reablement service
reprocurement which addresses the risk of adverse impact on service
users which can be found as Appendix B.
12.10 A change of provider will impact on persons with a protected
characteristic arising out of the employment impact on staff. The staff
employed by the current provider will be affected by the termination of the
current grant agreement. Mitigating factors will relate to the legal
protections that will be in place through TUPE and general employment
laws. The contract that will be entered into will also contain clauses
requiring the contractor to comply with the Equality Act.
12.11 In these circumstances it is open to the Executive Councillor to conclude
that having considered the duty it considers that if appropriate steps are
taken to keep matters under review and address issues as they arise
through the procurement process that any potential there is for differential
impact or adverse impact can be mitigated.
Child Poverty Strategy
13
The Council is under a duty in the exercise of its functions to have regard to
its Child Poverty Strategy. Child poverty is one of the key risk factors that
can negatively influence a child’s life chances. Children that live in poverty
are at greater risk of social exclusion which, in turn, can lead to poor
outcomes for the individual and for society as a whole.
In Lincolnshire we consider that poverty is not only a matter of having limited
financial resources but that it is also about the ability of families to access
the means of lifting themselves out of poverty and of having the aspiration to
do so. The following four key strategic themes form the basis of
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Lincolnshire’s Child Poverty Strategy: Economic Poverty, Poverty of Access,
Poverty of Aspiration and Best Use of Resources.
13.1
The Strategy has been taken into account in this instance and does not
have any impact due to the specific nature of the reablement services in
question being provided to adults.
Wellbeing Strategy
14
The Council is under a duty in the exercise of its functions to have regard to
its Joint Strategic Needs Assessment (JSNA) and its Joint Health and
Wellbeing Strategy (JHWS).
The JSNA for Lincolnshire is an overarching needs assessment. A wide
range of data and information was reviewed to identify key issues for the
population to be used in planning, commissioning and providing
programmes and services to meet identified needs. This assessment
underpins the JHWS 2013-18 which has the following themes:i.
ii.
iii.
Promoting healthier lifestyles
Improving the health and wellbeing of older people
Delivering high quality systematic care for major causes of ill health
and disability
Improving health and social outcomes and reducing inequalities for
children
Tackling the social determinants of health
iv.
v.
Under the strategic theme of improving the health and wellbeing of older
people in Lincolnshire there are three priorities that are relevant;

Spend a greater proportion of our money on helping older people to
stay safe and well at home

Develop a network of services to help older people lead a more
healthy and active life and cope with frailty

Increase respect and support for older people within their
communities
The Reablement Service will contribute directly to these priorities.
2. Conclusion
Reablement Services are a fundamental part of the care system in Lincolnshire
and play a critical role in the overall healthcare system. By providing intensive
interventions for residents experiencing a change in need, helping to decrease the
need for longer-term social care services, supporting discharge from hospitals and
reducing the chances of re-admission, this improves their quality of life and
reduces pressures on already overburdened residential homes and hospitals.
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The challenges posed by the currently insufficient quantity of service delivery, and
the financial constraints the council operate in means the solution isn't
straightforward. However by broadening the market for the delivery of the service
and implementing an effective performance management mechanism, the issues
that are affecting the service will be more suitably addressed.
The focus of the procurement will be to establish a single provider for the county
that will be able to fully meet the quality requirements set out by the council,
guarantee that they are able to properly meet demand and manage the
subcontractor market effectively if appropriate, and ultimately to strengthen the
market for delivery of reablement services in Lincolnshire.
3. Legal Comments:
The Council has power to commission the services in question and the
proposed procurement process is lawful.
The reports sets out matters which the Executive must have regard to before
coming to a decision in order to discharge its duties in relation to Social Value,
the Equality Act 2010, the Joint Strategic Needs Assessment and Joint Health
and Wellbeing Strategy and the Child Poverty Strategy.
The recommendations are consistent with the Council's Policy Framework.
Consequently the decisions are within the remit of the Executive Councillor so
long as they are not contrary to and are wholly in accordance with the budget.
4. Resource Comments:
The Council has decided to re-procure the Lincolnshire Assessment and
Reablement Service (LARS) following a decision to terminate the grant
arrangement with the current provider. The budget for the service is set at £4m
from a combination of recurrent base funding (£2m) and funding via the Better
Care Fund (£2m). The new contract will look to significantly increase the output
of hours delivered from approximately 115,000 per annum to a minimum of
160,000 increasing to 200,000, therefore increasing economy and effectiveness
of the service as a whole.
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5. Consultation
a) Has Local Member Been Consulted?
Yes
b) Has Executive Councillor Been Consulted?
Yes
c) Scrutiny Comments
This report was considered by the Adults Scrutiny Committee on [
].
The comments of the Committee will be reported to the Executive Councillor prior
to reaching her decision
d) Policy Proofing Actions Required
Dealt with in the body of the report and Appendix A.
6. Background Papers
The following background papers as defined in the Local Government Act 1972 were
relied upon in the writing of this report.
Document title
Where the document can be viewed
Equality and Human Commercial Services
Rights
Commission
report,
‘Close
to
home: an inquiry into
older
people
and
human rights in home
care’ 2011
The Care Act 2014
Legal Services
This report was written by Andrew Cook and Carl Miller, who can be contacted on
01522 554094 / 01522 553673 or andrew.cook@lincolnshire.gov.uk /
carl.miller@lincolnshire.gov.uk
Page 85
APPENDIX B
Equality Impact Analysis to enable informed decisions
The purpose of this document is to:I.
help decision makers fulfil their duties under the Equality Act 2010 and
II.
for you to evidence the positive and adverse impacts of the proposed change on people with protected characteristics and
ways to mitigate or eliminate any adverse impacts.
Using this form
This form must be updated and reviewed as your evidence on a proposal for a project/service change/policy/commissioning of a
service or decommissioning of a service evolves taking into account any consultation feedback, significant changes to the proposals
and data to support impacts of proposed changes. The key findings of the most up to date version of the Equality Impact Analysis
must be explained in the report to the decision maker and the Equality Impact Analysis must be attached to the decision making
report.
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Please make sure you read the information below so that you understand what is required under the Equality Act 2010
Equality Act 2010
The Equality Act 2010 applies to both our workforce and our customers. Under the Equality Act 2010, decision makers are under a
personal duty, to have due (that is proportionate) regard to the need to protect and promote the interests of persons with protected
characteristics.
Protected characteristics
The protected characteristics under the Act are: age; disability; gender reassignment; marriage and civil partnership; pregnancy and
maternity; race; religion or belief; sex; sexual orientation.
Section 149 of the Equality Act 2010
Section 149 requires a public authority to have due regard to the need to:
 Eliminate discrimination, harassment, victimisation, and any other conduct that is prohibited by/or under the Act
 Advance equality of opportunity between persons who share relevant protected characteristics and persons who do not
share those characteristics
 Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.
The purpose of Section 149 is to get decision makers to consider the impact their decisions may or will have on those with
protected characteristics and by evidencing the impacts on people with protected characteristics decision makers should be able to
demonstrate 'due regard'.
Decision makers duty under the Act
Having had careful regard to the Equality Impact Analysis, and also the consultation responses, decision makers are under a
personal duty to have due regard to the need to protect and promote the interests of persons with protected characteristics (see
above) and to:(i) consider and analyse how the decision is likely to affect those with protected characteristics, in practical terms,
(ii) remove any unlawful discrimination, harassment, victimisation and other prohibited conduct,
(iii) consider whether practical steps should be taken to mitigate or avoid any adverse consequences that the decision is likely to
have, for persons with protected characteristics and, indeed, to consider whether the decision should not be taken at all, in
the interests of persons with protected characteristics,
(iv) consider whether steps should be taken to advance equality, foster good relations and generally promote the interests of
persons with protected characteristics, either by varying the recommended decision or by taking some other decision.
Conducting an Impact Analysis
The Equality Impact Analysis is a process to identify the impact or likely impact a project, proposed service change, commissioning,
decommissioning or policy will have on people with protected characteristics listed above. It should be considered at the beginning
of the decision making process.
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The Lead Officer responsibility
This is the person writing the report for the decision maker. It is the responsibility of the Lead Officer to make sure that the Equality
Impact Analysis is robust and proportionate to the decision being taken.
Summary of findings
You must provide a clear and concise summary of the key findings of this Equality Impact Analysis in the decision making report
and attach this Equality Impact Analysis to the report. Impact - definition
An impact is an intentional or unintentional lasting consequence or significant change to people's lives brought about by an action or
series of actions.
How much detail to include?
The Equality Impact Analysis should be proportionate to the impact of proposed change In deciding this asking simple questions
“Who might be affected by this decision?” "Which protected characteristics might be affected?' and “How might they be affected?”
will help you consider the extent to which you already have evidence, information and data, and where there are gaps that you will
need to explore. Ensure the source and date of any existing data is referenced.
You must consider both obvious and any less obvious impacts. Engaging with people with the protected characteristics will help you
to identify less obvious impacts as these groups share their perspectives with you.
A given proposal may have a positive impact on one or more protected characteristics and have an adverse impact on others. You
must capture these differences in this form to help decision makers to arrive at a view as to where the balance of advantage or
disadvantage lies. If an adverse impact is unavoidable then it must be clearly justified and recorded as such and an explanation as
to why no steps can be taken to avoid that consequence must be included.
Proposals for more than one option If more than one option is being proposed you must ensure that the Equality Impact Analysis
covers all options. Depending on the circumstances it may be more appropriate to complete an Equality Impact Analysis for each
option.
The information you provide in this form must be sufficient to allow the decision maker to fulfil their role as above. You
must include the latest version of the Equality Impact Analysis with the report to the decision maker. Please be aware that
the information in this form must be able to stand up to legal challenge.
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Background Information
Title of the policy /
project / service
being considered
Home based reablement service
Service Area
Who is the decision
maker?
Adult Care
Portfolio Holder / Executive Member
Date of meeting
when decision will
be made
29.05.2015
Person / people
completing analysis
Lead Officer
How was the Equality
Impact Analysis
undertaken?
Version control
Sue Blakemore Quality Assurance
Manager
Pete Sidgwick
Chief Commissioning Officer Adult
Frailty and Long-term Conditions
Discussion and email
V0.2
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Overview
To consider the impact of the re-procurement of a new home based re-ablement service contract,
as a replacement to the existing grant arrangement with Lincolnshire Partnership Foundation
Trust, at the end of the stipulated notice period
General overview and
description of the proposed
change
Background
 Adult Social Care has a strategic direction to enable people to remain living independently
in their own home for as long as possible.
 An effective re-ablement service is key in supporting people to gain or regain their abilities
by contributing to faster recovery from illness, fewer unnecessary hospital admissions,
prompt discharge from hospital and more opportunities for independent living.
 The Care Act, and its implementation guidance, includes reference to commission activity
which focuses on outcomes and well- being of people using services.
 The number of people aged 65 and over is projected to increase nationally by 23% from
10.3 million in 2010 to 12.7 million in 2018.

This trend towards an ageing population profile will continue, with the proportion of people
over 75 years of age predicted to increase by 101% between 2012 and 2037.(Source
Lincolnshire Observatory population trends 2013)





A home based reablement service contributes significantly to the overall well- being of
people in regaining or maintaining their independence and reducing their need for long
term support.
It needs to contribute to reducing avoidable hospital admissions and support prompt
hospital discharges.
Public sector finances remain under immense pressure and all local authorities have had
their funding reduced by central government and this is to continue going forward for the
period of the next Spending Review. For Lincolnshire County Council this means that it
must achieve further savings of £90 million over the next 4 years.
Nationally and in Lincolnshire there are immense pressures on Health and Care Services.
There is a need for all service provision to be effective and to provide value for money .
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Is this proposed change to an existing policy/service/project or
is it new?
Commissioned.
The re-procurement is for a contract for a new commissioned
service and provider at the end of the notice period for the
current grant. There is no reduction of service
Evidencing the impacts
In this section you will explain the difference that proposed changes are likely to make on people with protected characteristics.
To help you do this first consider the impacts the proposed changes may have on people without protected characteristics before
then considering the impacts the proposed changes may have on people with protected characteristics.
You must evidence here who will benefit and how they will benefit. If there are no benefits that you can identify please state 'No
perceived benefit' under the relevant protected characteristic. You can add sub categories under the protected characteristics to
make clear the impacts. For example under Age you may have considered the impact on 0-5 year olds or people aged 65 and over,
under Race you may have considered Eastern European migrants, under Sex you may have considered specific impacts on men.
Data to support impacts of proposed changes
When considering the equality impact of a decision it is important to know who the people are that will be affected by any change.
Population data and the Joint Strategic Needs Assessment
The Lincolnshire Research Observatory (LRO) holds a range of population data by the protected characteristics. This can help put a
decision into context. Visit the LRO website and its population theme page by following this link: http://www.research-lincs.org.uk If
you cannot find what you are looking for, or need more information, please contact the LRO team. You will also find information
about the Joint Strategic Needs Assessment on the LRO website.
Workforce profiles
You can obtain information by many of the protected characteristics for the Council's workforce and comparisons with the labour
market on the Council's website. As of 1st April 2015, managers can obtain workforce profile data by the protected characteristics
for their specific areas using Agresso.
Demographics


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
Lincolnshire is a large county, 95% of the land is rural. In England 18% population live in rural areas in Lincolnshire it is
48%; its population centres around 1 city, several large market towns and the remainder in sparsely populated in rural
locations and the transport infrastructure is poor.
The over 65's represent 52% of people living in rural areas and in those rural areas older people represent 23% of the
population as opposed to 19% in urban areas ( source Lincolnshire research observatory).
The number of people aged 65 and over is projected to increase nationally by 23% from 10.3 million in 2010 to 12.7 million in
2018. More people are living alone in old age and can access less informal care than in the past. People are living longer
and a higher proportion of older people receiving homecare are now considered to have complex needs. ( Source SCIE
commissioning home care for older people June 2014)



In Lincolnshire the proportion of people over 75's is predicted to increase by 101% between 2012-2037 (source population
trends in Lincolnshire 2013) and this is above the national average. There has also been an increase of 43% (5,900) in people in
the 85+ age group since 2003.
An aging population means that people are remaining at home with more complex needs. There are increasing numbers of
people living with comorbidities, an increased number of people living at home with dementia and more people who choose
to receive end of life care in their own home.
Adult social care supports people whose assessed needs meet the eligibility criteria of either substantial or critical. The
biggest age group which ASC supports is aged 85 +.
General
 There is a clear need to have an effective home based re-ablement service in place to support people to gain or regain their
abilities in place.
 People can be offered a period of home based re- ablement, for a period of up to six weeks, following a deterioration in their
health , e.g. due to an accident or illness.




It contributes to faster recovery from illness, fewer unnecessary hospital admissions, prompt discharge from hospital and
more opportunities for independent living therefore avoiding or delaying the need for longer term support.
There have been issues of underperformance with the current grant agreement which has resulted in fewer numbers of
people who are assessed as suitable and able to benefit from a period of re-ablement being able to receive the service which
was particularly significant in the winter months, and fewer people being re-abled to no service.
This re-procurement exercise will provide the opportunity to develop and award a contract with a new specification, clear
outcomes and performance measures, which would be subject to robust contract management against delivery.
Nationally and in Lincolnshire there are immense pressures on Health and Social Care Services and ASC needs to make
sure that services it funds are effective and offer value for money.
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Perceived positive impacts
 It is anticipated that a new contract will result in positive benefits for service users .
 There is no proposal for a reduction in service. The re-procurement exercise for a new contract and provider is taking place
following underperformance under the grant agreement. The proposal is a continuation of a countywide service using a prime
provider model.
 A contract, rather than a grant, will be set out in a service specification with clear outcomes and performance measures,
and be subject to robust contract management against delivery.
 It is anticipated that there will be an increase in service delivery and face to face hours of care for people who are assessed
as benefitting from a period of re-ablement .
 A new service provider would be in place ahead of the end of the notice period to provide continuity of service for people
 The new contract will include clear expectations for the smooth and timely transition for people whose needs mean they need
to move from the re-ablement service to long term home care support.
A home based re-ablement service is for people who are assessed as suitable and able to benefit from a period of reablement
regardless of the protected characteristics of

Age: gender re-assignment: pregnancy or maternity: race : disability: religion or belief: sex: sexual orientation : marriage &
civil partnership . However people's individual care needs and therefore eligibility for ASC support correlate to groups
identified by protected characteristics.
.
The following table shows the breakdown of clients who have been supported by the current service provider over a 3 month period
by the protected characteristics of age and sex.
Gender
Age Band
25-49
50-64
65-74
75-84
85+
Grand Total
Female
Male
12
37
87
243
285
664
6
16
56
151
170
399
Grand
Total
18
53
143
394
455
1063
This illustrates that older people 75+ and more females than males, benefit from a re-ablement service. This is
in line with the growth of an aging population and a life expectancy for women, nationally and in Lincolnshire, and correlates to
when the service was provided in house prior to the grant agreement.
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If you have identified positive impacts for other groups not specifically covered by the Equality Act 2010 you can include them here
if it will help the decision maker to make an informed decision
An effective re- ablement service can also benefit an individual's family and informal carers.
You must evidence how people with protected characteristics will be adversely impacted and any proposed mitigation to reduce or
eliminate adverse impacts. An adverse impact causes disadvantage or exclusion. If such an impact is identified please state how,
as far as possible, it is justified; eliminated; minimised or counter balanced by other measures.
If there are no adverse impacts that you can identify please state 'No perceived adverse impact' under the relevant protected
characteristic. If you have not identified any mitigating action to reduce an adverse impact please state 'No mitigating action
identified'
A home based re-ablement service is for people who are assessed as suitable and able to benefit from a period of reablement
regardless of the protected characteristics of

Age : gender re-assignment: pregnancy or maternity: race : disability: religion or belief: sex: sexual orientation : marriage &
civil partnership . However people's individual care needs and therefore eligibility for ASC support correlate to groups
identified by protected characteristics.
There is no adverse impact perceived that the re-procurement of the service by a prime provider , with a specification of outcomes
and increased outputs, will have a negative impact on those people assessed as suitable to benefit from a re-ablement service.
There will be a transition plan in place for people who need or are using the re-ablement prior to the end of the current grant
agreement. It should be noted that these people will not be long term users of the service.
If you have identified negative impacts for other groups not specifically covered by the Equality Act 2010 you can include
them here if it will help the decision maker to make an informed
Page 94
The staff employed by the current provider will be affected by the termination of the current grant agreement but will be subject to
current TUPE regulations and Employment law
Stakeholders
Stake holders are people or groups who will be directly affected (primary stakeholders) and indirectly affected (secondary
stakeholders)
You must evidence here who you involved in gathering your evidence about benefits, adverse impacts and practical steps to
mitigate or avoid any adverse consequences. You must be confident that any engagement was meaningful. The Community
engagement team can help you to do this and you can contact them on engagement.cop@lincolnshire.gov.uk
State clearly what (if any) consultation or engagement activity took place by stating who you involved under the protected
characteristics. Include organisations you invited and organisations who attended, the date(s) they were involved and method of
involvement i.e. Equality Impact Analysis workshop/email/telephone conversation/meeting/consultation. State clearly the objectives
of the consultation and findings from the consultation under each of the protected characteristics. If you have not covered any of the
protected characteristics please state the reasons why they were not consulted/engaged.
Objective(s) of the consultation
N/A, there is no public consultation planned for this re- procurement exercise.
In summary it should be noted that there is no planned reduction in service but the re- procurement exercise is taking place
following a period of underperformance by a provider via a grant agreement, which has not been able to be resolved
Page 95
Are you confident that
everyone who should have
been involved in producing
this version of the Equality
Impact Analysis has been
involved in a meaningful
way?
The purpose is to make sure
you have got the perspective
of all the protected
characteristics.
Once the changes have been
implemented how will you
undertake evaluation of the
benefits and how effective
the actions to reduce
adverse impacts have been?
Yes.
If No, who needs to be involved and how do you intend to involve them?
If yes, please explain the reason(s)
Further Details
Are you handling personal data?
Part of the analysis includes information taken from client data of the current provider
Actions required
Include any actions identified in this
analysis for on-going monitoring of
impacts.
Action
This impact forms part of the re-procurement
exercise
Page 96
Signed off by
Lead officer
Timescale
In line with
agreed project
timelines
Date
April 2015
APPENDIX C
Home Based Reablement Service Programme Procurement Timeline
Home Based Reablement Service - Procurement Timeline - 2015
As at 29th April 2015
04-May
Activity
March
April
11-May
18-May
25-May
May
01-Jun
08-Jun
June
15-Jun
22-Jun
29-Jun
06-Jul
13-Jul 20/17/15
July
27-Jul
03-Aug
10-Aug
17-Aug
24-Aug
August
31-Aug
07-Sep
14-Sep
21-Sep
28-Sep
September
05-Oct
October
12-Oct
19-Oct
26-Oct
02-Nov
November
Specification development,
financial modelling, scrutiny
report writing, notification on
forward plan etc.
PIN
20-Mar
Market Engagement
Contract Termination (LPFT)
22-Apr
Adult Care Exec DMT
22-Apr
Page 97
Adult Care Procurement Board
Adult Scrutiny Committee
Decision by Executive Cllr
Contract Notice
ITT Period
ITT Evaluation
Report Writing
Decision by Executive Director
and Exec Cllr
Bidders
event
10/06/201
5
Informal discussions / questionnaire
attendance tbc
20-May
16-Apr
attendance tbc
21-May
13-May
Papers
4-Jun
18-May
Distributi 27-May
on
29-May

1st June
6 weeks
6 weeks
2 weeks
tbc
Stand Still
10 calendar days
Contract Award
Intention to award
Transition Period
Transition Period (8 weeks)
Go Live

Contract Award
GO LIVE
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