Surrey Care Homes
"The relationship is more than the contract, it’s the partnership approach which ensures the issues are addressed well before they become difficult to resolve. Both organisations maintain a very straightforward approach to managing the contract and the partnership. This has been key to the success of the project. I think you have to work that way to get the best from this kind of partnership."
Graham Lindsay, Assistant Executive Director, Surrey County Council Adults and Community Care
The first PFI contract for the provision of long term residential care homes was signed by Surrey County Council in March 1998. Under this partnership arrangement the Council transferred 17 homes, providing care to almost 800 older people, to the new Service Provider, Anchor Homes.
The PPP Forum interviewed Graham Lindsay (Assistant Executive Director, Surrey County Council Adults and Community Care), Jon Stanley (Area Manager, Anchor Homes), Rosemary Lindsay (Contracts Manager, Surrey County Council Adults and Community Care) and Christine Conroy (Area Support Home Manager).
Graham: "The council owned and managed 33 care homes in total. It was recognised that in order to meet future Registration requirements and manage the changes in the way care is now provided, a number of homes would need significant capital investment. The Council did not have the level of capital required so it was necessary to look at all the options for the future."
Jon: "When the homes were built, they were designed to meet the needs of the residents that were receiving care at that time. The average age of residents has risen in recent years and therefore dependency levels are now higher. This means the type of accommodation needed is vastly different and the new builds and refurbished designs take this into account."
The scheme had a capital investment requirement of £29 million. The net present value of the scheme is in excess of £150 million for the 20-year service contract, with an approximate total value in excess of £350 million.
Graham: "At the time the Council wanted to ensure an adequate supply of good quality residential care. A review was undertaken to look at the investment needed and what investment options were available to the council. Owing to the potential changes in capital financing the council took the decision to look at PFI. It appeared to be a financially attractive proposition. Once the decision was made to follow the PFI route a full EU tendering process was undertaken.
Given the uncharted territory of PFI in social care, the outline business case was prepared alongside the proposals for a preferred procurement route. We were unsure whether we were going to get approval for the scheme until quite late on in the procurement process. Council officers worked with organisations like 4Ps but it was as much of a learning curve for them as it was for the council.
In my view the main benefit of the PFI route was that right from the start we needed to have a clear understanding of the scope of the project, what it was the Council was trying to achieve, how to engage stakeholders, how to consult, who the Council’s partners were etc. Sharing as much information as possible with partners was key to a successful outcome. Extensive early meetings were held, even before Anchor was chosen as our preferred bidder, full presentations were made to bidders to say this is what our project is about, this is what we’re trying to achieve, and this is what we would be looking for from potential partners."
Jon: "It was important to work as partners right from the beginning and we put a lot of effort into making sure we had joint consultation sessions and there were joint newsletters coming from the Council and Anchor Trust. Council officers visited the homes jointly with Anchor representatives and talked to the residents, relatives and staff during the time leading up to the actual transfer."
Eight of the homes were refurbished and nine were rebuilt over a five year programme. The buildings were delivered on budget and ahead of schedule despite encountering some unusual problems.
Jon: "A badger set was discovered on one of the sites and they’re protected so we had to reroute a lot of the fences and be careful not to disturb it. Other site anomalies had to be overcome such as shared utilities and caretaking facilities."
Christine: "The improvement in the environment is significant. We now have all single rooms many with ensuite facilities. This has had a significant impact on the quality of life of the residents."
Jon: "The building work proved to be challenging for both staff and residents. Transitional arrangements were put in place and carefully managed to ensure minimum disruption to daily life and routine."
Christine: "I was a manager of a home that was being demolished and we had to be relocated for a year and then move back to the new building. We undertook a great deal of consultation with residents and relatives, taking into account the residents choices for the new accommodation. We asked them about colour schemes, furniture, fabrics etc that they would like. The plans for the new builds were displayed in the public areas of the homes."
In all, 693 staff were transferred from the Council to the Anchor Trust under TUPE.
Jon: "A large amount of work was undertaken with the transferred staff on Anchor’s mission statement and values, and the type of care that would be provided. This work focused on Anchor’s care planning approach and what the residents would get from this partnership in terms of care and facilities. Staff were concerned about the change from public to private sector so processes and procedures were put in place to ensure a smooth transition under TUPE and other organisational changes were implemented. These involved regular two-way consultation processes with staff."
Graham: "We approached the project on the basis of very strong partnership working and it was helpful that PFI encourages that. I can remember sitting with lawyers for many hours trying to thrash out some of the finer details. Ultimately we recognised it was about striving for a contract that was mutually negotiated, mutually acceptable and pragmatic and workable.
Again, irrespective of whether it’s PFI, any partnership of this sort requires significant investment, particularly in time and effort, from the people leading the work. People like Jon from Anchor’s side, Rosemary from the Council’s side as the contract manager.
The Commission for Social Care Inspection (CSCI) is an independent body which regulates the care home industry. So we linked performance deductions to meting their requirements. If Anchor Trust doesn’t meet the required standards and CSCI take appropriate action, if that action is related to the to the performance elements of the contract then appropriate deductions will be made.
There is provision in the contract which means that should there be a legislative change that is solely aimed at providers of residential care services, Anchor Trust are able to put forward a case for sharing the cost of such a change.
The relationship is more than the contract, it’s the partnership approach which ensures the issues are addressed well before they become difficult to resolve. Both organisations maintain a very straightforward approach to managing the contract and the partnership. This has been key to the success of the project. I think you have to work that way to get the best from this kind of partnership."