NHS Lincolnshire ICB published a procurement opportunity in November 2022 for domiciliary care services (homecare) funded through Continuing Healthcare (CHC). 

The ICB currently purchases CHC homecare from over 70 providers, largely under spot purchase arrangements.  Under this arrangement there is no obligation for a provider to support a person who needs a care package, leading to an inconsistency in how quickly our patients can access high quality care in their own homes.  This also means that there is inconsistency in quality and lack of understanding and insight of the quality of services and disparate delivery of training and approaches to support care staff.

By using a smaller number of providers, we believe that patient experience will be improved as providers will need to fulfil all packages of care associated with one of seven geographic zones and in a timely way and to deliver that care in line with specified quality standards.  This will allow patients to be discharged from hospitals more quickly and individuals in the community to access care in a timely way.

The aim of this procurement is to improve the consistency and standards of the quality care for people across the whole of Lincolnshire, as while we know there are some very good examples of care provision across the county, we also know there is currently significant variation and some gaps in county-wide provision.   We also want to improve responsiveness to requests for homecare through a more straightforward delivery model.

We believe having arrangements in place with a smaller number of providers will improve the consistency of care, patient experience and staff recruitment and retention across Lincolnshire as a whole. 

This procurement relates to domiciliary care services funded through the NHS Lincolnshire ICB’s Continuing Healthcare Service, not adult social care which is run by Lincolnshire County Council.

We have worked with Lincolnshire County Council and system colleagues throughout the procurement but want to emphasise that this procurement exercise does not relate to the social care packages that individuals receive, which are funded by Lincolnshire County Council.  

As with all NHS procurements, the procurement process was held in strict accordance with the Public Contract Regulations 2015 and The National Health Service (Procurement, Patient Choice and Competition) (No.2) Regulations 2013 (the “Regulations”).  The Regulations set out how the procurement process must be conducted and involves the publication of an Invitation to Tender (ITT), the evaluation of tenders received against evaluation criteria published in the ITT, moderations, and award decision. 

Multiple Market Engagement events were held both face-to-face and virtually to gather views and feedback to help shape and inform the commissioning intentions and potential procurements going forward. 

Details of, and invitations to, these events were shared with all current providers by email on 25 May and advertised on both Find a Tender and Contracts Finder websites.   The events were held on 8 June 2022, 15 June 2022 and 20 July 2022.  

Following this, two further virtual sessions were held on 9 November 2022, during which it was explained how to access the procurement documents through a procurement portal and what the ICB would be looking for in the submitted tender responses and therefore what bidders might want to consider.

All providers were informed and invited to the Market Engagement events in June, July and November.  The tender opportunity was also advertised on the government website and was accessed by over 60 providers.

In accordance with guidance on procurement, bidders are invited to respond.  We are only allowed to communicate with bidders through a formal process based around the procurement portal. This is designed to prevent unfair advantage to any of the bidders that are responding to the tender.

This restriction on communication applies through the evaluation and moderation process and through to recommendation of award to successful bidders.  Once an award recommendation is in place, successful and unsuccessful bidders are notified.  There is then a 10-day statutory standstill period where again regulations do not allow us to communicate with any bidders as that may be seen to influence the outcome of the tender other than through formal routes. 

Tenders were evaluated against a wide range of pre-determined Pass/Fail and scored evaluation criteria which was outlined within the Invitation To Tender (ITT) documentation. 

The four providers for Lincolnshire are:

• Cera Care
• Complete Care
• AMG
• Annicare

The contracts have been procured by NHS Lincolnshire ICB and cover the seven zones across Lincolnshire.  It does not cover North or North East Lincolnshire which falls under the remit of NHS Humber and North Yorkshire ICB. See map.

The evaluation of submitted bids was carried out by a panel made up of representatives from the NHS Lincolnshire ICB and their advisors. This was in accordance with the published award criteria and weighting for this tender.  By publishing the award criteria prior to the evaluation, it ensures that all bidders understand how their bids will be evaluated in an open, transparent, and fair way.

All of the four providers are registered with the Care Quality Commission (CQC) under Section 10 of the Health and Social Care Act 2008.  The ICB have confidence through our processes that each provider is capable and can provide high quality care. 

Three providers are rated as ‘good’ with the Care Quality Commission.  One provider awarded the contract is currently rated as ‘requires improvement’ by the CQC for its Lincoln Branch.  This rating was determined at a visit by CQC in 2016 and the report states that this was in part related to a previous provider.  The awarded provider has provided assurance through its tender response that it will deliver the services in accordance with the specification.

Whilst we expect the new providers to be fully operational by the 1^st April 2023, this is not the same as them delivering 100% of the provision from that date, rather they must be ready and capable to do so. This will be a carefully managed and phased development that will grow incrementally over time. The providers have the option to sub-contract care packages out to other providers, but this is at their discretion.

There are currently 84 people in the county who receive CHC funding, and whose care is managed through this contract.

There are another 143 people currently receiving Fast Track Funding and these individuals will continue to receive care from their current provider until their next review at the minimum.  At present all fast-track packages are reviewed at 12 weeks. 

This procurement process will not affect people who hold Personal Health Budgets via Direct Payments or packages individuals may have with the Mental Health, Learning Disability and Autism team.  If an individual has a combination care package (i.e. consisting of a notional budget with an agency and a direct payment for a personal assistant) only the notional part of the care package could be impacted.

Whilst we cannot comment on individual cases specifically, we will be liaising with individuals, their families, and carers affected in the coming months to discuss all options and ensure they continue to receive the best possible care.   The NHS Lincolnshire ICB is committed to ensuring that any transition of care is managed safely.

Moving existing care packages to new providers will take place gradually over the next 6 months, as we need to understand on a case-by-case basis how best to manage this for the person and for the current provider, to ensure good care provision is maintained throughout as any change takes place.   No changes will be made without first speaking with the person in receipt of care, their families, and carers.

Care staff may have a right under the TUPE (Transfer of Undertakings (Protection of Employment) Regulations 2006) to transfer to a new provider.  However, this is a matter for discussion between care staff, the current provider and new provider.

The NHS Lincolnshire ICB have only asked current providers to consider whether TUPE would apply.  Where care staff are eligible and wish to TUPE to a new provider, this means that carers will remain supporting the existing packages of care.

Please be assured anybody already receiving end-of-life fast track care will stay with their current care provider and will not be moved across unless indicated by their 12-week review.

From Monday 3^rd April onwards new patients eligible for Fast Track Funding that require end-of-life care will be referred to the four new providers for their care package. 

As is standard practice, all packages of care are reviewed and assessed at regular intervals.  Over the next 3-6 months, all individuals potentially affected by this change will undergo a review which could lead to a phased transition of their care package.  

We want to retain high quality, eligible staff within the Lincolnshire system, wherever possible. We would welcome the opportunity to work with any providers who feel our support in making this happen would be helpful.

Everyone will continue to have choice in how their needs and objectives are met from their personal care and support plan. 

Some people may choose to have a Notional, Direct Payment or Third-Party arrangement through a Personal Health Budget.  However, if they choose to have an agency to meet some or all of their needs, the choice of which agency is commissioned remains with the NHS Lincolnshire ICB.  This has always been the case and is standard practice.  There may be exceptional circumstances, but these will be reviewed on a case-by-case basis.