Cabinet
Subject: Ageing Well Services
Date of meeting: 18 July 2024
Report of: Cabinet Member for Adult Social Care, Public Health and Service Transformation
Contact Officer: Name: Director Public Health
Email: Corporate Director: steve.hook@brighton-hove.gov.uk
Report author: David.brindley@brighton-hove.gov.uk
Ward(s) affected: (All Wards);
Key Decision: Yes
Reason(s) Key: Expenditure which is, or the making of savings which are, significant having regard to the expenditure of the City Council’s budget, namely above £1,000,000 and Is significant in terms of its effects on communities living or working in an area comprising two or more electoral divisions (wards).
1. Purpose of the report and policy context
1.1 This report seeks cabinet approval to commission Ageing Well Services for the city for a further six-year period (4 +2).
1.2 The Ageing Well service began in 2019 and the existing contract runs until 30th March 2025.
1.3 This service supports delivery of the four overarching outcomes of the council plan (see also section 3.23). Ageing Well is an investment in our Voluntary Community and Enterprise Sector (VCSE) and will deliver value for money; a systematic review on the return on investment of public health interventions, demonstrated that for every £1 invested in public health, £14 will subsequently be returned to the wider health and social care economy[1]. It will enable people to continue to live healthy, happy, and fulfilling lives by promoting better health and wellbeing and support people as they age. The service will provide easily accessible and welcoming information and advice, and the support people need, which, will in turn reduce and delay the need for Adult Social Care services. Ageing Well is a key element in the public health programme to make Brighton & Hove an age and dementia friendly city.
1.4 Ageing Well is a key service in the delivery of the Brighton & Hove Joint Health & Wellbeing Strategy (HWBS) ambitions for Brighton & Hove to be a place where people can age well and be supported to reduce loneliness and social isolation.
1.5 It will reduce the risk of falls for older people where more people will be helped to live independently in the community by services that connect them with their communities.
1.6 Ageing Well has strong links and working relationships with other local services delivering on the HWBS outcomes, including the Carers Hub, BHCC Healthy Lifestyles Team and Adult Social Care, Social prescribing, and the NHS Falls Prevention and Memory Assessment services.
1.7 Continued investment in Ageing Well supports the Local Authorities public health duty responsibility for improving the health of our local population and supports improvement on several key public health outcomes from the Joint Strategic Needs Assessment [2].
1.8 Ageing Well is a Public Health and NHS universal prevention service open to anyone in the city aged 50 and over and not just those in receipt of Care Act support. It is delivered by a partnership of 11 CVS organisations. Its aims are to reduce social isolation and loneliness, promote good health and wellbeing, prevent ill health, and enable people to remain independent. The service does this by providing a broad programme of services, support, and activities, including befriending, physical activity, social and cultural groups, information and advice, and activities for people from LGBTQ and BRM communities. All activities are accessible via a Single Point of Contact (SPOC) which is accessed by freephone or email. The phone line is staffed by people and there are no automated options.
1.9 Ageing Well has delivered well on the objectives, and there has been a significant year-on-year increase in the numbers of people accessing the service; the total number of people accessing Ageing Well support has grown from 4,818 in the first year of delivery to 14,466 during year five, a 200% increase.
2. Recommendations
2.1 Cabinet approves the procurement of Ageing Well services for a further six-years (four + two)
2.2 Cabinet agrees to delegate authority to the Corporate Director of Housing, Care and Wellbeing to carry out the procurement and award of a contract for a Brighton & Hove Ageing Well Service with a term of six years (four + two)
3. Context and background information
3.1 The population profile of our city is changing; according to the 2021 census, the overall population of our city has only increased by 1.4% (3,800), since 2011, but:
· The 65+ population has increased by 9.5%.
· There are 20% more adults aged 65 to 77 (4,341), and
· 32% more adults aged 48 to 62 (13,826)
3.2 13,875 residents aged 66+ (38%) live alone, which is significantly higher than in the South-East (30%) and England (31%)
3.3 There are approximately 9,271 older people living in income deprivation in our city (2019), 18.7% of all people aged 60 or over. This is the second highest proportion in the South-East region.
3.4 The population of our city is getting older and for many of our residents that will come with increasing health and care needs. Without action to support our population to age well and improve the lives of local people by supporting them to live healthier for longer and making sure they have access to the best possible services when they need them[3], we will see significant increases in demand for health and social care services.
I. Background
3.5 The Ageing Well service has been jointly commissioned by BHCC and NHS Sussex Integrated Care Board (ICB) since 2019.
3.6 Under their public health duties, Local Authorities are responsible for improving the health of their local population. Ageing Well supports improvements in the following public health outcomes:
· Inequality in life expectancy at age 65.
· Healthy life expectancy at age 65.
· Loneliness: % of adults who feel lonely often or always or some of the time.
· Social isolation: % of adult social care users who have as much social contact as they would like.
· Social isolation: % of adult carers who have as much social contact as they would like.
· % of physically active adults.
· Emergency hospital admissions due to falls in people aged 65 and over.
3.7 Previous model of support to age well in the city consisted of 19 separate grant contracts, for varying amounts and activities, spread over 12 different Voluntary, Community, Sector Enterprise (VCSE) organisations.
3.8 In 2018 health and social care partners ended the above grants and tendered for a new citywide ‘Ageing Well’ service with a single point of contact.
3.9 The contract was awarded to a ‘lead provider’ - Impact Initiatives - who are responsible for sub- contracting partners (initially 7 now 10).
3.10 Contract duration 4 years + 2 - contract expires March 31st, 2025.
3.11 The 11 Ageing Well partners (appendix 1) offer a wide programme of services and activities which are all accessible via the SPOC. Activities available include centre- based groups & activities, befriending, Information and advice, Multi-cultural activities, LGBTQ specific activities, nutrition support, and psychosocial Activities for people living with dementia. The service also delivers an annual two-week Ageing Well festival to celebrate ageing. The SPOC links people up with the right support for their circumstances. It can be accessed by the individuals themselves, or by their carer’s, or by health and care professionals.
3.12 Overall, the service has performed consistently well over the life of the contract and the benefits of having an integrated service to support people as they age, with access via a single ‘front door’, was clearly demonstrated through the pandemic. The service was able to flex delivery through a combination of telephone, postal, online and doorstep support and became the central point for food and meal support for anyone aged 50+.
3.13 The total number of people accessing Ageing Well services has grown from 4,818 in the first year of delivery to 14,466 during year five, a 200% increase.
3.14 The annual value of the contract is £757,957, which breaks down as £452,957 from the public health ringfenced grant and £305,000 from the NHS Better Care Fund.
II. Recommission
3.15 We are proposing to commission Ageing Well for a further six years (4 + 2) through an open tender process.
3.16 BHCC will run the procurement and award the contract.
3.17 Commissioners believe this proposal can offer a high level of social value and this is reflected in 25% of the quality scoring being for social value.
3.18 The maximum value of the new contract will be £3,317,742 (£552,957 pa) over a six-year period.
3.19 The funding will come from BHCC public health grant (£452,957) and NHS Better Care Fund (£100k).
3.20 As there is reduced NHS funding and no inflationary uplift during the current contract period, we will not be looking to make savings from this procurement, and so the recommended quality/cost scoring ratio is 80/20.
3.21 Commissioning Ageing Well will support the council’s four strategic priorities set out in its Council Plan 2023-2027, focusing on the following outcomes:
· Outcome 1: A city to be proud of - grow a diverse and sustainable city economy by ensuring that CVS delivery partners in Ageing Well attract funds from outside the city to invest in the service, and work in partnership with both the local private and public sector to deliver a low carbon and circular economy.
· Outcome 2: A fair and inclusive city - engagement and collaboration, fight discrimination and embrace diversity, and work to reduce inequality, Ageing Well will work in collaboration with system partners, residents and public and private sector partners to ensure access to support is delivered equitably and fairly across the city, and identify and engage with groups most at risk of a decline in their health & wellbeing, and who face intersectional barriers, to ensure they are able access support.
· Outcome 3: a healthy city where people thrive - enable people to live healthy, happy and fulfilling lives, and provide joined up services and ensure everyone has access to the information, advice and services they need, Ageing Well will ensure people across the city have opportunities to age well and maintain and improve their physical and mental health and wellbeing, and that access to information, advice and support are easily accessible, and that inequalities of opportunity to participate are reduced. Ageing Well will be a beacon for our age and dementia friendly programme and all partners will be signed up to the BHCC age and dementia friendly business accreditation scheme.
· Outcome 4: A responsive council with well-run services - meeting the needs of our residents and other customers, Ageing Well will be a welcoming and inclusive service, maintaining the fully staffed single point of contact freephone number for those who are not online.
III. New Service aims and objectives.
3.22 Reduce loneliness and social isolation, promote good health and wellbeing, and support people to remain independent.
3.23 Connect people aged 50 and over to primary prevention activities which improve and maintain their health & wellbeing.
3.24 Provide a citywide service proportionate to need and tackle inequalities.
3.25 Work to ensure there is an equitable delivery/offer of service activities across the city and address any gaps.
3.26 Outreach and engage with those identified as being most at risk of a decline in their independence and wellbeing.
IV. New Service Delivery
3.27 The new service will build on the best elements of the existing service and maintain the current identity. The name of the service will remain ‘Ageing Well to continue to build brand awareness in the city. Ageing Well will continue to be a citywide service open to anyone aged 50+, with a focus on older adults most at risk of a decline in their health and wellbeing.
3.28 Ageing Well will:
3.29 Reduce pressure on Health and Care services by offering upstream prevention support to keep people well and independent.
3.30 ‘Make Every Contact Count’ by proactively identifying people in contact with the service who need specialist health and care support and take positive action to link them with appropriate local services.
3.31 Be an Age and Dementia Friendly service. All partners will be required to sign up to the BHCC age and dementia friendly business recognition scheme.
3.32 Deliver the annual two week Ageing Well festival.
3.33 Offer meaningful volunteering opportunities for adults aged 50+.
3.34 Involve older adults in the design and delivery of the service, utilising the rich experience of peopled age 50+ in our city.
3.35 The new service will deliver ‘a connection hub’, and ‘evidence-based activity provision to support health & wellbeing’.
3.36 The Ageing Well Connection hub will:
3.37 Have a single point of contact which is accessible to both professionals and members of the public, providing information, signposting, and support.
3.38 Offer a clearly accessible advice service.
3.39 Engage and work with people in local communities and communities of interest to promote Ageing Well and ensure support is accessible and meets the needs of those most at risk of a decline in their health and wellbeing.
3.40 Pilot innovative methods to capture equalities monitoring information.
3.41 Work with the developing Integrated Community Teams (ICTs) to build clear pathways into Aging Well support for patients and clients who would most benefit e.g. those at risk of frailty.
3.42 Work with providers across the city to ensure there is equitable provision of primary prevention support for people aged 50+ in Brighton & Hove.
3.43 Represent and advocate for the needs of people aged 50+ at strategic partnership steering groups and boards in Brighton & Hove.
3.44 Provide and coordinate a volunteer ‘buddy’ programme. The role of the volunteer buddies will be to support and connect people aged 50+ lacking confidence to access primary prevention activities. Note this programme will not accompany people to health and care appointments.
3.45 Activities delivered directly by Ageing Well will be provided equitably across the city, proportionate to need. Where gaps or over provision are identified the service will flex delivery in response.
3.46 Activities must be easily accessible by public transport and participants supported to access this transport with clear information.
3.47 Ageing Well will offer a range of evidence-based leisure, physical, cultural, and social activities which will improve and maintain independence and support health & wellbeing. These activities will operate under the following categories and headings:
4. Analysis and consideration of alternative options
4.1 We have analysed the following three options and have come to the conclusion that option 2 is the preferred route.
4.2 Option 1 – End current contract and take no further action.
4.3 As outlined in the context section of the report, Brighton & Hove has an increasing older population, and, with the migration of older people to coastal and rural areas, as outlined in the Chief Medical Officers report of 2023 [4], this trend is likely to continue, bringing with it, for some, increasing frailty, multiple debilitating or degenerative conditions, discomfort, and loneliness.
4.4 Without an Ageing Well service, supporting people to age well and retain optimum independence, the demand for health and social care services, in the home and in residential and hospital settings, will increase, and the Local Authority will be at risk failing in its public health duty to improve the health of its local population.
4.5 Option 2 – Open Tender for single contract (preferred)
4.6 Commissioning Ageing Well will support the City Council to meet the needs of their ageing population and offer value for money and delivers integration of health and social care in a way that supports person-centered care, sustainability and better outcomes for people and carers.
4.7 Universal prevention services such as Ageing Well are effective at supporting people to age well and can reduce demand and spend on local authority services, for example The Adult Social Care Access Point can reduce the need for Care Act Assessments by diverting appropriate customers to Ageing Well support at an early stage. As referenced earlier for every pound spent on public health services there is a return on investment of £14.
4.8 There are significant internal benefits in managing a single point of contact and one contract. This model also facilitates the potential bidding option of a lead provider working with smaller sub-contractors, opening up access to specialist expertise.
4.9 A price cap will be used, in response to the reduced funding for the new contract. Therefore, an 80/20 Quality/Price split is proposed, as there will be little variation in the prices of submitted bids.
4.10 Option 3 – Split service into smaller pots
4.11 Prior to the current contract, the services were fragmented under a number of smaller grants. This resulted in duplication of costs and contract management was spread very widely across a large number of providers. Returning to this model is not deemed practical and would result in a larger portion of the contract value being used for overheads of the individual organisations.
5. Community engagement and consultation
5.1 The following engagement and consultation activities have helped support and shape the Ageing Well proposal:
· In early 2024 the 11 Ageing Well delivery partners combined to conduct a ‘Lived Experience Engagement’ survey seeking the views of both customers of Ageing Well and older people who are not engaging in support. This survey was conducted both online and through paper versions and a total of 351 responses were received.
· Age UK Brighton & Hove, LGBTQ Switchboard, and Time to Talk Befriending have all carried out service user engagement in the past year and shared results and reports with the BHCC commissioner.
· All 11 current Ageing Well partner organisations were consulted on future Ageing Well commissioning plans at 1:1 meetings with the public health commissioner during February and March 2024.
· An Ageing Well market engagement event to consult on our plans was held on June 6th, 2024, and attended by representatives from 17 local voluntary sector organisations.
· The cabinet lead member Councillor Burden and Ageing Well policy lead Councillor Galvin were consulted on the 31/05/24, and the procurement lead member Councillor Robinson was consulted on the 10/06/24.
6. Financial implications
6.1 The proposal to commission Ageing Well for a further six years through an open tender process is anticipated to cost £3,317,742 (£552,957 pa) over a six-year period. This is within budget with funding coming from:
· BHCC public health grant £453k
· Better Care Fund £100k (NHS contribution).
Name of finance officer consulted: Louise Hoten Date consulted: 20/06/24.
7.1 Council is required to comply with all relevant procurement legislation in relation to the procurement and award of contracts above the relevant financial thresholds for services, supplies and works. The Council’s Contract Standing Orders will also apply.
Name of lawyer consulted: Daniel Mattess Date consulted: 20/06/24.
Note that the Council has determined that care experience should be treated as a protected characteristic, and this is reflected in the Equalities Impact Assessment template and guidance notes.
8.1 An Equalities Impact Assessment was completed when this service was first tendered in 2018. This is currently being refreshed and will be complete to go out with the tender documents. The EIA will inform targeting of priority groups for the new service.
9. Sustainability implications
9.1 Three areas in the checklist were identified as having potential positive impacts; these are:
· Sustainable economy: Ageing Well will provide volunteering and employment opportunities for residents in Brighton & Hove.
· Sustainable transport: Activities provided by Ageing Well must be easily accessible by public transport and information on bus numbers, times and stops etc. provided to attendees.
· Sustainable procurement: The commissioner has completed the Specification-writing Tool for Environmental Procurement (STEP) for the Ageing Well commission and will work with the procurement lead to produce matching questions to include in the tender.
10. Health and Wellbeing Implications:
10.1. Ageing Well is a health & wellbeing service and will enhance positive Impacts by ensuring there is equitable access across the city to health & wellbeing support, and, by targeting and engaging with those groups of people most at risk of a decline in their health & wellbeing.
10.2. No negative impacts were identified.
11. Procurement implications
11.1. The procurement lead member was consulted on 10/06/24 and was supportive of the proposals.
11.2. The proposed route to market is an open tender, awarding a contract to a single organisation. This route provides access to the opportunity for all suitable providers, allowing for competition and evaluating the bids to find the most economically advantageous tender.
11.3. The tender will comprise of an 80/20 split, with 80% being weighted to quality and 20% to price. As a price cap will be in place it is expected that there will be minimal variation to the submitted bids, therefore a focus on quality is preferred.
11.4. Social Value will form 25% of the quality evaluation, providing further opportunity for securing positive impact on local priorities, with clear commitments to outcomes for: -
· A diverse, fair and inclusive city meeting the needs of those at risk of decline in health and wellbeing.
· Resilient communities, involving older adults in the design and delivery of services including volunteering opportunities and buddying.
· A prosperous city, delivering partnerships and collaboration opportunities in Brighton & Hove.
11.5. These services fall within the ambit of the Light Touch Regime of the Public Contracts Regulations 2015 for purchasing social care services and other specific services which exceed the relevant lifetime contract value threshold of £630,540.
11.6. The LTR provides more flexibility and freedom in the procurement approach with emphasis on the principles of fairness, transparency, and equal treatment.
12. Crime & disorder implications:
12.1 There are no crime and disorder implications.
13. Conclusion
13.1 Commissioning the city’s Ageing Well service will support the four overarching outcomes of the council plan, and delivery of the Joint Health & Wellbeing Strategy Ageing Well ambitions and outcomes.
13.2 Commissioning public health prevention support can enable our population to age well, is cost effective, and can reduce demand on health and social care e.g. by diverting customers to Ageing Well support and reducing the need for Care Act Assessments.
13.3 Ageing Well has delivered on its objectives and its reach and impact have grown over the course of the contract period as evidenced by the significant year on year increases in the numbers of people accessing. A partnership approach to delivery also creates economies of scale & delivers added value.
13.4 We are now seeking cabinet approval to commission Ageing Well Services for a further six years.
Supporting Documentation
Appendices
1. Ageing Well current providers
[1] Masters R, Anwar E, Collins B, et al. J Epidemiology Community Health 2017;71:827–83
[2] https://www.brighton-hove.gov.uk/joint-strategic-needs-assessment-jsna
[3] Improving Lives Together https://www.sussex.ics.nhs.uk/wp-content/uploads/sites/9/2023/07/Improving-Lives-Together-Shared-Delivery-Plan.pdf
[4] Chief Medical Officer’s annual report 2023: health in an ageing society