To approve the development and implementation of a range of home care commissioning options, including an additional, open framework for the purchasing of commissioned home care services, to ensure sufficient quality and capacity is available in Herefordshire to support the eligible needs of adults to remain safe and independent in their own home.

That:

a) A range of commissioning options are explored, developed and implemented, subject to further governance as required, to complement the existing commissioned home care framework;

b) An additional, open framework for the purchasing of commissioned home care services can be introduced, following a competitive tender process, from November 2022; and

c) The corporate director for community wellbeing is authorised to take all operational and commissioning decisions necessary to implement the above recommendations

1. Do nothing. There are significant delays and challenges in meeting the increasing demand for home care provision, leading to some vulnerable people waiting long periods for packages of care, amid significant risk to their wellbeing. The existing framework alone is not currently sufficient to meet the demand and therefore doing nothing is not an option.

2. In-source provision of home care. This could address the challenge of providing commissioned care to some degree, particularly in rural areas and with complex cases. However, this option is not recommended as there would be significant challenges in the short term in recruiting and retaining sufficient staff to operate a sustainable service. In addition, such development would undermine the operational and financial viability of contracted providers.

3. Subcontract within the existing home care framework. This is a possibility within the existing framework arrangement. However, management fees would be applied and therefore this is unlikely to be a financially viable option. Additionally, capacity acquired through this form of subcontracting is likely to be limited.

4. Re-open and re-procure the existing framework. This would be disruptive to the market and there is a significant risk that existing framework providers would withdraw and the process could substantially weaken the framework.