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Subject: |
Mental Health Supported Accommodation Procurement |
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Date of Meeting: |
Adult Social Care & Public Health Sub Committee 8th June 2021 |
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Report of: |
Rob Persey, Executive Director Health & Adult Social Care |
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Contact Officer: |
Name: |
Jenny Knight |
Tel: |
01273 293081 |
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Email: |
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Ward(s) affected: |
All |
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FOR GENERAL RELEASE
1. PURPOSE OF REPORT AND POLICY CONTEXT
1.1 Following approval at Procurement Advisory Board on the 19th April 2021 this paper provides an overview of the proposed Mental Health Supported Accommodation remodel and re-procurement and seeks approval to proceed with a joint BHCC and CCG procurement process.
2. RECOMMENDATIONS:
2.1 That the Committee grants delegated authority to the Executive Director of Health & Adult Social Care (HASC) to take all necessary steps to
(i) Procure and award contracts for five (5) years for the provision of a joint mental health supported accommodation pathway with a council contribution of £330,000.00 per annum.
(ii) to approve an extension to the contract referred to in 2.1(i) for a period or periods of up to two years in total if it is deemed appropriate and subject to available budget.
3. CONTEXT/ BACKGROUND INFORMATION
The Mental Health Pathway:
3.1 Brighton & Hove City Council in partnership with NHS Brighton & Hove Clinical Commissioning Group (CCG) commission three Mental Health Supported Housing services in Brighton and Hove (Shore House, Sanctuary Star, and Route One) and a floating support service (Southdown Support).
These services form part of the Mental Health Supported Accommodation Pathway which offers a range of accommodation with different levels of support for people with mental health needs in Brighton and Hove.
3.2 The current accommodation is as follows:
· Shore House; 20 units of shared accommodation with high level support - CCG funded
· Sanctuary Star; 32 units of shared accommodation with medium level support – CCG funded
· Route One; 60 units of shared and self-contained accommodation with medium to low level support – BHCC funded
· Southdown Support: Floating Support to those with mental health support needs living in independent accommodation – BHCC funded
Current Model
3.3 Higher levels of supported accommodation are offered to people who need it most with people moving into medium or lower supported accommodation, and then on to independent living when they’re ready. The services provide support for people with the aim that residents move on to more independent living within approximately two years.
The services are accommodation-based with support for people with mental health needs. They work proactively with people in their recovery and provide personalised and flexible support to build confidence, resilience, and the skills needed for independent living.
The support provided includes assistance with:
· Managing mental health issues
· Medication management
· Maintaining a safe living environment
· Preparation for independence
· Daily life skills
· Help to find and access other services in the city
· Support with alcohol and drug issues
· Suicide prevention
· Prompting with personal care
· Accessing welfare benefits, preventing and managing debt, and managing money
· Support with physical health and nutrition
· Accessing work and learning opportunities
· Support to build a positive social network and engage in the wider community
Medium Mental Health Supported Accommodation (Route One):
3.4 Brighton & Hove City Council commissions the medium to low level supported accommodation service for individuals with mental health support needs. The contract for 60 units of self-contained and shared accommodation with support is provided by Brighton Housing Trust. The contract which commenced on the 1st June 2016 was originally due to end on the 31st May 2021. Due to Covid-19 the procurement has been delayed and the contract has been extended until 1st September 2022.
3.5 The contract has been extended in conjunction with the CCG commissioned mental health supported accommodation to allow for a full consultation and joint procurement process of all three supported accommodation services which form part of the mental health accommodation and support pathway.
Procurement Timeline:
3.6 Brighton & Hove City Council and NHS Brighton & Hove Clinical Commissioning Group are working together on the remodelling of the mental health accommodation pathway. The following is an overview of the timeline for the consultation and procurement process.
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Action: |
Timeline: |
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Develop Engagement Plan
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Nov’ 20– Jan ‘21 |
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Health & Equalities Impact Assessment
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Nov – Dec ‘20 |
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Commission 3rd party to undertake service user consultation
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December 2020 |
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Service user and Stakeholder Consultation
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Jan-Mar ’21 |
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Procurement Advisory Board
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April 2021 |
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Focus groups & Feedback on consultation
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Apr-May ‘21 |
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Development of the Model and Service Specifications
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Apr – July ‘21 |
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H&ASC Committee
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8th June ‘21 |
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Market Engagement
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Jul – Aug’21 |
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Tender Open
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September 2021 |
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Tender Evaluation
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November 2021 |
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Mobilisation of Services
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Feb ’22 – Sept ‘22 |
A project group is overseeing the consultation, model development and tender process for the three services.
Finance:
3.7 The 20/21 service budgets and contributions are outlined below:
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BHCC Contribution per annum 20/21: |
CCG Contribution per annum 20/21: |
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BHT Shore House |
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523,389 |
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Sanctuary Star |
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359,269 |
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BHT Route One |
300,000 |
29,531 |
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Southdown Floating Support * |
£111,622 (for 20% of the service allocated to mental health) |
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*recently re-tendered
Current Cost per unit per annum:
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Accommodation |
Cost |
Units |
Per unit per annum |
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Shore House (High) |
523,389 |
20 |
£26,169 |
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Sanctuary Star (Med) |
359,269 |
32 |
£11,227 |
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Route one (Med – Low) |
329,531 |
60 |
£5,492 |
The proposed budget for the council contribution to the supported accommodation pathway is £330,000. This is an increase of £30,000 per annum to take into account the rising costs of running a supported accommodation service from the previous tender in 2016.
4. ANALYSIS & CONSIDERATION OF ANY ALTERNATIVE OPTIONS
4.1 Consideration has been given to providing the service in-house. The current service offers 60 units of self-contained and shared accommodation spread out over eight separate buildings. If the contract were to be delivered in-house the council would need to provide 60 units of accommodation ready for occupation at the commencement of the contract.
Any accommodation service run in-house would generate significantly less housing benefit revenue. Local authorities housing benefit rate is capped but a third sector provider offering supported accommodation can claim a higher rate helping to cover housing management costs, cleaning and repairs and maintenance. This would mean any service run by the local authority would be significantly less financially viable.
Initial calculations for providing this contract in-house show that the cost would be approximately £0.200m higher than the current contract price. These calculations exclude any office space, relevant premises costs and additional management resource that will be required. The calculations assume that existing staff would transfer to Council contracts and NJC grades.
5. COMMUNITY ENGAGEMENT & CONSULTATION
5.1 The Council and CCG are
committed to benefits of co-production and as such have engaged
with service users, providers and other stakeholders to inform this
re-procurement
In December 2020 the group appointed Mind, the mental health charity to carry out a consultation with current and ex-service users via survey and one to one interviews. Online surveys have also been carried out with stakeholders and referrers via the engagement HQ website. A full report has been provided by Mind into the outcome of the consultation (see appendix 1). The group has also undertaken some workshops with professionals and current service providers.
The consultation process coupled with a review of current services and their outcomes, data on referrals and waiting lists and the conclusions of previous reports including the Sussex Health & Care Partnerships Mental Health and Housing Strategic Plan, the Multi Agency Discharge Event and the HACT Report on Housing & Mental Health highlighted a number of areas of focus for the retender;
Accommodation:
· Better quality accommodation.
· More self-contained accommodation – shared accommodation not suitable for many people including those with high needs, vulnerable people and women.
Support:
· Safeguarding concerns for both vulnerable people and women in shared high support accommodation.
· Staffing levels in high and med support insufficient for the levels of complexity of need.
· Staff training and therapeutic interventions needed for more complex clients.
· Better integration between clinical services and supported accommodation
· Better transition into supported accommodation and between supported accommodation services.
· Mixed view of move on targets (18-24 months) with professionals concerned they are not achievable and possibility destabilising, and the Mind report concluding that they are mostly achievable.
· Shared accommodation – issues for residents with others behaviour, substance misuse, levels of staffing overnight.
· The need for flexible provision which can quickly increase and decrease support to individuals based on their changing needs.
The following gaps were identified within the current provision:
· Demand outstrips supply leading to delayed discharge and waiting lists.
· Move on from the pathway can be slow due to a lack of available independent accommodation.
· There is a lack of mobility accessible accommodation
· There is a lack of provision for women with complex needs and vulnerable people with higher support needs due to shared accommodation being unsuitable
· Those with complex needs are currently being placed in residential accommodation or high cost placements.
· Lack of accommodation for young people aged 18-25 with co-existing mental health and substance misuse including young women with Autistic Spectrum Condition (ASC).
· Difficulty in accessing supported accommodation for forensic discharge (those with mental health and a history of offending behaviour).
6. CONCLUSION
The Proposed Model:
6.1 If approved Brighton & Hove City Council and the CCG intend to develop a new supported accommodation pathway to address some of the issues identified in 5.1. This procurement will seek to provide:
· An increased level of self-contained accommodation with specific provision for women with complex needs and vulnerable individuals.
· A flexible level of support within the accommodation service which can increase and decrease to meet client needs without them having to move accommodation.
· Improved integration with secondary mental health services.
· A higher level of support in high needs accommodation with increased levels of overnight staffing to allow the placement of those with complex needs including dual diagnosis.
· Therapeutic interventions and trauma informed support through well trained staff.
· Greater flexibility in the length of stay in the accommodation based on individual needs.
· The commissioning of the CCG commissioned Mental Health Crisis House will take place within the same procurement.
6.2 The procurement will not meet all of the gaps identified through the consultation and review process, with a similar financial envelope and the commissioning of increased staffing levels, flexible support and more self-contained accommodation the procurement will inevitably result in a lower number of units commissioned.
6.3 The exact make-up of the units will be determined through the specification and tender process and will depend on the size and type of accommodation which providers are able to offer. We would expect to see mixed services containing flexible levels of support which allow people to remain in their accommodation while the support flexes to meet their needs but with the aim that support will reduce over time. The following is an example of the number of units which the tender will aim to achieve.
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Total number of hrs per service user per week |
Number of Units |
Approximate Cost |
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High |
20 |
25 (increase of 5) |
£675,000 |
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Medium |
11 |
20 (decrease of 12) |
£240,000 |
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Medium to Low |
2-8 hours (flexible based on need) |
54 (decrease of 6) |
£330,000 |
6.4 The retender process will provide a safer environment with better outcomes and reduced numbers of people either being turned down for placements due to their level of need and reduce the number of people stepping up from supported accommodation into residential placements.
6.5 Not all areas that were identified as part of the consultation will be resolved by this procurement for example the provision of a commissioned service for 18-25 year olds with complex needs will be looked at as part of a separate commissioning project with the CCG.
7. FINANCIAL & OTHER IMPLICATIONS:
Financial Implications:
7.1 For context, the spend on the mental health accommodation pathway in financial year 2020/21 is outlined in paragraph 3.7 with £0.412m funded by Brighton & Hove City Council and £0.912m funded by Brighton & Hove CCG.
For the Council, the contracts are within the Health & Adult Social Care directorate and the proposed new contracts for 2021/22 totalling £0.442m is within budget. The budget for this procurement is £0.330m per annum.
The Council is experiencing financial challenges and is subject to annual government financial settlements which can impact on the availability of funding. However, it is anticipated that financial resources will be available to enable the commissioning of the services detailed above.
Finance Officer Consulted: Sophie Warburton Date: 14/05/2021
Legal Implications:
7.2 The Care Act 2014 sets out a range of statutory duties for Local Authorities, including a number related to the prevention agenda. It requires all Local Authorities to, “work in partnership to provide, or arrange services, facilities, resources, or take other steps, towards preventing, delaying or reducing the development of needs for care and support”. The Health and Social Care Act 2012 sets out the legal duties of the Department of Health, Public Health, Clinical Commissioning Groups and NHS bodies to reduce health inequalities. As such it requires local health and social care bodies to address health inequalities. The HWB is required to promote integrated working amongst health and social care services.
The proposed procurement is in line with the Local Authority’s duty to promote the wellbeing of its residents requiring support for their mental health.
Lawyer Consulted: Nicole Mouton Date: 18/5/21
Equalities Implications:
7.3 Brighton & Hove City Council has developed a joint Health & Equalities impact assessment with the CCG for this tender process. This has identified a number of areas to be addressed as part of the tender including accommodation and support for women and vulnerable people and mobility accessible accommodation. These will be addressed as part of the development of the specifications for the procurement.
7.4 All commissioned services are monitored on their policies and practice in relation to equalities. Service users and staff are interviewed as part of the review process and complaints regarding discrimination and hate crime are reported to Commissioners. Demographic data on both referrals and acceptances into the service are monitored. We ensure that all services have relevant policies and procedures in place and that staff training includes good quality training around equalities issues.
Sustainability Implications:
7.5 The commissioned service would give due consideration to sustainability encouraging the use of public transport among staff and using sustainable materials and ensuring recycling.
Brexit Implications:
7.6 None identified.
Any Other Significant Implications:
Crime & Disorder Implications:
7.7 There are no crime and disorder implications from this procurement process.
Risk and Opportunity Management Implications:
7.8 There are risks associated with the procurement process which are as follows
· There is a risk that we will not receive any bids for the tender however this is being mitigated by market engagement prior to the tender process and engagement with stakeholders and existing providers.
· There are risks associated with a new provider being successful in the tender process. This would require the movement of vulnerable service users into new accommodation with a new provider. This risk is being mitigated by a long mobilisation period to allow for engagement with service users and support to move. Staff are entitled to TUPE so they would transfer with clients and support the transition maintaining a consistency of support.
Public Health Implications:
7.9 The aim of this procurement is to continue to develop and improve supported accommodation services for individuals with mental health needs. The newly commissioned services should have a positive impact on the health and wellbeing of the individuals accommodated within it.
7.10 Services are commissioned not only to support residents with their mental health needs but also support them with their wider health, including substance misuse, healthy living and skills for independent living such as shopping and healthy eating.
Corporate / Citywide Implications:
7.11 This procurement will meet the corporate priorities of ‘increasing healthy life expectancy and reducing health inequalities’ by providing a service which helps people manage their mental health and prevents hospital admission. The services will also ‘support people to live independently’ by providing support to those who are able to move onto greater independence and eventually into their own tenancies.
7.12 This procurement will also supports the aims of the Sussex Health & Care Partnerships Mental Health and Housing Strategic Plan 2020 which aims to ‘Deliver the ambition to create new integrated models of supported housing for people with multiple and complex needs thereby reducing the need for inappropriate out of area placements and residential care’
SUPPORTING DOCUMENTATION
Appendices:
1. Consultation findings about Mental Health Supported Accommodation in Brighton and Hove by Mind