Meeting: Cabinet	Date: 19 April 2022

Wards affected: All

Report Title: Multiple Complex Needs Alliance – Contract Award Decision

When does the decision need to be implemented? 19 April 2022

Cabinet Member Contact Details: Councillor Jackie Stockman – Cabinet Member for Adults and Public Health, Email: jackie.stockman@torbay.gov.uk. Councillor Christine Carter – Cabinet Member for Corporate and Community Services, Email: christine.carter@torbay.gov.uk. Councillor Swithin Long - Cabinet Member for Economic Regeneration, Tourism and Housing, Email: swithin.long@torbay.gov.uk

Director/Divisional Director Contact Details: Lincoln Sargeant - Director of Public Health, Email: Lincoln.Sargeant@torbay.gov.uk. Joanna Williams – Director for Adults and Community Services, Email: joanna.williams@torbay.gov.uk. Tara Harris – Divisional Director Community and Customer Services, Email: Tara.Harris@torbay.gov.uk

1.	Purpose of Report

1.1	The MCN (Multiple Complex Needs) Alliance is a local authority commissioning programme seeking to improve the system response and outcomes for people needing support with drug & alcohol issues, domestic violence, and homelessness. An open procurement has now been completed for three separate Lots to work under an Alliance Agreement. This Alliance Agreement involves working to a shared budget envelope, with a focus on partnership working. It commits providers to work towards a financial painshare/gainshare model.

1.2	The purpose of this report is to gain Cabinet approval to award a contract to suppliers for:

Lot 2 (Drug and Alcohol Treatment).

Lot 3 (Domestic Abuse).

1.3	Lot 1 (Homeless support) is unable to be awarded at this time. Further information regarding this specific lot is outlined in Appendix 2 to protect commercial confidentiality.

2.	Reason for Proposal and its benefits

2.1	SLT and Cabinet approval was given in January 2020 to proceed with commissioning a Multiple Complex Needs (MCN) Alliance as an alternative commissioning approach to single service procurement for the adult drug and alcohol service, domestic abuse and sexual violence service and the homeless hostel provision. This has been enacted, with the award recommendations identified for Cabinet decision.

2.2	The key benefits to commissioning this Alliance at a delivery level are that people can access support more easily, have a better experience and achieve better outcomes than commissioning services individually.

2.3	The Alliance model delivers an integrated understanding of people’s needs and response to these, including early identification and response to emerging issues by the Alliance composition of Suppliers and Commissioners working together under an Alliance framework.

2.4	Anticipated financial benefits of the MCN Alliance include better financial decisions for the system; efficiencies from better integration of services; and better positioning for national Government and other bid opportunities, which increasingly require a system response between partners within an area.

2.5	The MCN Alliance will help build safer communities by enhancing the system response to domestic abuse and sexual violence by bringing the service into an integrated Alliance. In addition, it will better support people with a drug and alcohol dependency which will contribute to reducing alcohol and drug related concerns amongst residents and visitors.

2.6	The MCN Alliance will support the corporate and community strategic aims by supporting vulnerable people and their families which is supporting Torbay residents to thrive. This is central to addressing inequalities in Torbay, being and integral aspect to Turning the Tide on Poverty. In addition, it will contribute to ensuring Torbay becomes the premier resort in the UK.

3.	Recommendation(s) / Proposed Decision

3.1	That Cabinet authorise the awarding of places on the MCN Alliance and subsequent award of service contracts for the entire duration of the initial term of the Alliance;

3.2	That Cabinet authorise the lot-specific recommendations contained in Exempt Appendix 1; and

3.3	That the recommendation as set out in paragraph 13.4 of Exempt Appendix 2 be approved and accordingly the Chief Executive be authorised to make the associated changes to this service provision.

Appendices

Appendix 1: Lot-Award Recommendations (Commercial in Confidence)

Appendix 2: Homeless Hostel Contingency Options (Commercial in Confidence)

Supporting Information

1.	Introduction

1.1	SLT and Cabinet approval was given in January 2020 to proceed with commissioning a Multiple Complex Needs (MCN) Alliance as an alternative commissioning approach to single service procurement for the Adult Drug and Alcohol Service, Domestic Abuse and Sexual Violence Service and the Homeless Hostel provision.

1.2	Work done prior identified there was significant overlap in demand these services by adults and families with multiple and complex needs. It also found that commissioning these services in silos caused inefficiencies from inter and intra-agency discoordination, duplication, and failure demand.

1.3	With little systemic change since, services remain complicated to navigate for users and providers alike and often not able to provide an adequate whole-person response for someone living a complex life and/or with multiple needs.

1.4	The MCN Alliance addresses these challenges by delivering a contracting mechanism for providers and commissioners to work together to achieve shared goals and improve outcomes holistically. It provides a more integrated understanding of people’s needs and response to these, including early identification and response to emerging issues by the Alliance composition of Suppliers and Commissioners working together under an Alliance framework.

2.	Options under consideration

2.1	From an overall Alliance standpoint, two options have been considered. The recommended option is to continue with the MCN Alliance and award places on the Alliance framework. This is the option for which a cabinet decision is being sought.

2.2 The alternative option would be to abandon the Alliance procurement and not award. Realistically, this would result in a decision to abandon the MCN Alliance delivery model.

2.3	Further options in relation to the Homeless Hostel specifically are detailed in Appendix 2 due to commercial sensitivities.

3.	Financial Opportunities and Implications

3.1	The Council’s indicative Funding Envelope for the initial term (from 01/02/23 – 31/03/27) of the Alliance is £12,974,341, as advertised within the tender. This is broken down as £503,941 for Year 1 (01/02/23 - 31/03/23) and £3,117,600 per annum each year thereafter (Years 1 & 2 are fixed).

3.2	Indicative budgets for each Lot were advertised (based upon incumbent contract value) for pricing submissions. However, the agreement of each annual service budget within the overarching envelope will be the responsibility of the Alliance.

3.3	In practical terms, the domestic abuse and sexual violence service will also have access to additional grant monies from the Department of Levelling-Up, Housing and Communities (DLUHC) for new safe accommodation obligations under the Domestic Abuse Act 2021. Funding will depend on the amount received from DLUHC annually, but indicatively bidders were told to plan for an additional £140,000 p/a in their pricing submission.

3.4	Drug and alcohol treatment will benefit from increased funding as part of the Government’s new Drug Strategy. While the scope of this funding allocation is wider than just the MCN Alliance, a significant proportion will be allocated to the MCN Alliance to increase the numbers in treatment and the quality of support provided as per the conditions of this grant.

3.5	The setting of the funding envelope does not preclude the Alliance or its individual members (including the Authority) leveraging other sources of funding to maximise achievement of Alliance objectives.

3.6	The Alliance agreement encourages partners to work towards a Gainshare/Painshare regime: providing meaningful incentives to exceed minimum performance and deliver improvements that benefit the alliance and persons using services holistically.

3.6	The budgetary implications of the recommendation for Lot 1 are outlined in Appendix 2 due to commercial sensitivities.

4.	Legal Implications

4.1	The MCN Alliance provides the vehicle to discharge the following duties in Torbay:

- The Public Health Ring-Fenced Grant condition of having regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services.

- To secure accommodation for statutorily homeless people.

- To provide accommodation-based support to victims of domestic abuse and their children in refuges and other safe accommodation under The Domestic Abuse Act 2021

5.	Engagement and Consultation

5.1	In June 2018, SLT authorised a programme to explore the feasibility and scope of a Drug and Alcohol Treatment system redesign using an alliance commissioning approach. As part of this Healthwatch Torbay were commissioned to carry out an independent consultation with adults with substance misuse issues. A key finding from this work was the desire from service users for more accessible, integrated services that addressed their needs holistically.

5.2	Further engagement with service users with a variety of presenting needs was held in 2019 with service users and other key agency stakeholders: this included informal drop-in discussions about experiences and ideas at a community venue, as well as a service user forum. This found there was a keen appetite for service co-design among those with lived experience. Another key finding was that active outreach and engagement in environments in which they can already be found and feel comfortable in are preferred (i.e., ‘come to us’). This will inform the approach to service co-design during mobilisation.

5.3	The Alliance will be responsible for developing a service model informed by the breadth of stakeholders, including (but not limited to) people with current lived experience of services and their families; people in recovery; statutory partners such as Police, Probation, and the NHS; the community, voluntary and social enterprise sector. This will commence during the mobilisation phase, post-award.

6.	Purchasing or Hiring of Goods and/or Services

6.1	Social value requirements have been scored within tender submissions on a quantitative and qualitative basis, using the National Themes, Outcomes and Measures (TOMs) methodology in relation to social value.

7.	Tackling Climate Change

7.1	Full climate change impact scoping, including a Carbon Neutral Impact Assessment will be developed during mobilisation of the Alliance. There is nothing at this stage indicating that the proposals will have an adverse impact upon the climate. There is a potential opportunity to reduce energy consumption via the colocation of teams and reducing estate.

8.	Associated Risks

8.1	There are risks in not proceeding with the awarding of places in the MCN Alliance. Foremost among these is the risk to service continuity and the Authority’s ability to meet its statutory obligations on homelessness, domestic violence and drug and alcohol treatment from February 2023. Not awarding would necessitate going back out to market again as soon as possible on a standalone basis. This option is uncertain in outcome as there is no guarantee new bids would be submitted, placing the continuation of statutory services at serious risk.

8.3	There are also significant opportunity costs associated with not being able to re-design services using an alliance commissioning approach. Long-standing inefficiencies such as avoidable failure demand will continue to persist and opportunities for medium-term cost savings via initiatives such as co-location and cross-skilling which much harder to achieve outside of an Alliance structure and common budget.

8.4	A key risk associated with proceeding is that the prospective Alliance partners are unable to form an effective relationship and governance structure during the mobilisation, due to a lack of appetite to take on shared risk and/or external pressures. Findings from the market engagement and subsequent tender evaluation indicate this has a low likelihood of materialising, at least severely enough to undermine the Alliance as a whole.

9.	Equality Impacts - Identify the potential positive and negative impacts on specific groups

Positive Impact	Negative Impact & Mitigating Actions	Neutral Impact
Older or younger people	Those engaged with the services who have contact with children and young people and present a risk to these will be more actively engaged with to ensure young people are safeguarded.	The service is not specifically commissioned to deliver services to U18s and older adults. Therefore, these are not directly affected by this proposal.
People with caring Responsibilities	A need to support the carers of those who experience drug & alcohol issues will continue and will work to broaden all services within scope of the alliance. By designing a system that will be easier for individuals and their significant others to use there will be a positive impact on the levels of stress and frustration that may be experienced in navigating a complex system with multiple hand off points.
People with a disability	The services will continue to make themselves accessible to customers with disabilities. The services will need to consider any differing engagement, access and support needs people have and where possible design services to take account of these.
Women or men	The services will continue to provide access to treatment & support services on a basis of need not gender. The service will give due regard to the emerging evidence base about the differing support needs of men and women who have experienced trauma and design services where possible to take account of these.
People who are black or from a minority ethnic background (BME) (Please note Gypsies / Roma are within this community)	Service design and delivery should be more flexible under the proposed changes meaning that any differing engagement, access, and support needs based on ethnic background can be more easily accounted and adapted for.
Religion or belief (including lack of belief)	Service design and delivery should be more flexible under the proposed changes meaning that any differing engagement, access, and support needs based on religion or belief can be more easily accounted and adapted for.
People who are lesbian, gay or bisexual	Service design and delivery should be more flexible under the proposed changes meaning that any differing engagement, access, and support needs based on sexuality can be more easily accounted and adapted for.
People who are transgendered	Service design and delivery should be more flexible under the proposed changes meaning that any differing engagement, access, and support needs based on gender identity and/or transition can be more easily accounted and adapted for.
People who are in a marriage or civil partnership	There is no differential impact: This should not affect the services delivered as relationships and marriage are not used to determine who receives this/these service(s).
Women who are pregnant / on maternity leave	Women who are pregnant or have small children will continue to be a priority group to access support. The service provision for pregnant women is a priority as pregnancy is often a catalyst for change and will continue to be a priority group due to the harm substance misuse and trauma during pregnancy can have on an unborn child. Services will continue to make themselves open and accessible, with established pathways between treatment and maternity services remaining in place.
Socio-economic impacts (Including impact on child poverty issues and deprivation)	The majority of service users will be from more deprived areas. This proposal focuses on commissioning, designing, and delivering services and the systems within which they operate, to become increasingly focused on improving the life chances and outcomes for some of the most deprived members of our community.
Public Health impacts (How will your proposal impact on the general health of the population of Torbay)	The proposal will positively impact on the general physical & mental health of the Torbay population by improving the lives of those seeking support & therefore contributing to the community within which they live. People accessing support in any services will experience improved outcomes in physical & mental health as well as improved occupational/employment opportunities, ability to maintain secure and stable housing, positive relationships.

10.	Cumulative Council Impact

10.1	None identified to date.

11.	Cumulative Community Impacts

11.1	The MCN Alliance has the potential to realise cumulative community impacts beyond the immediate scope of its commissioned services. Bringing together multiple providers into a single structure will enable them to better leverage other skills, expertise, and contacts from the wider support ecosystem (supporting agencies, voluntary and community sector etc.), as each party will bring its own network of support.

11.2	Commissioning these services as an Alliance also better prepares them for any increase in demand due to the deteriorating economic situation/cost of living crisis. Reducing failure demand, pooling resources and skills should allow for a more efficient deployment of resources over time and increased capacity.