Decision details

This OED follows on from the cabinet approval in September 2023 to tender a single Adult Social Care framework which gives delegated authority on framework spend. The BNSSG Learning Disability and Autism Development Team (hosted by BCC) is requesting approval to procure the model recommended within this report. This is part of the commissioning forward plan and in line with Bristol’s commissioning strategy and ASC transformation objectives.
The project will restructure the Learning Disability and Autism sector of the care market. At present, support for over 1,200 people with a learning disability and/or autism is ‘spot purchased’. That accounts for £73,337,485 p.a. or 35% of the total ASC purchasing budget. Spot purchasing care as individual needs arise has been shown to be an unsustainable method of procurement. It does not enable the availability of sufficient levels of service of adequate quality across all localities in Bristol. In addition, significant cost is built into each package to ensure provider sustainability. There is also insufficient service provision across the Care Ladder.
Adopting a more strategic approach will enable commissioners to take a proactive role in developing a sustainable local care market: a statutory requirement of councils with ASC responsibilities under the Care Act (2014). Data from the Local Government Association (LGA) and other sources suggest that due to insufficiencies of local supply, Bristol places proportionately more people with learning disabilities into residential care with no incentive for providers to step people down.
This model will bring benefits to citizens, service providers and Bristol City Council. Citizens will experience better consistency and choice in their care and support. There will be an improved incentivised approach to moving through the existing Care Ladder pathway for people with a learning disability and autistic people. Through this they will be able to access appropriate support and care at the right time, near to the place they call home. This will be achieved by the Strategic Partners working collaboratively with all key stakeholders enabling service users to seamlessly move up or down the Care Ladder when there is a change in their needs. Also, by concentrating new business through fewer key contracts that can be managed more effectively.
A Strategic Partner model was a key recommendation that 31Ten consultancy made in 2022 when they were commissioned to consider strategic commissioning approaches. This model aims to reduce the number of providers overall and work towards better value for money and a more sustainable market by commissioning at more sustainable rates than can be achieved through spot purchase. This will enable closer collaborative relationships between Strategic Partners and Bristol City Council. Partners will also have opportunities to expand their provision further and to develop place-based approaches locally.

Approval to procure the Strategic Partner model recommended on the Officer Executive Decision.

1) To remain with current contract arrangements
•This would limit choice and control for people to access services.
•Likelihood of more expensive off-framework spot purchasing
•Likelihood of more expensive out of county placements
•High volume of providers with less resource and input across commissioning
•Lack of market shaping
•Lack of robust quality assurance due to high number of providers vs resources
•Individuals remaining in the upper part of the care ladder (Lack of fluidity)