Agenda item

[Report of the Director for Public Health. To be introduced by the Cabinet Member for  Finance and Health.] To seek approval to extend and vary the contract from 1 April 2017 for one year.

The Cabinet Member for Children and Families introduced the report which sought agreement to the extension of the existing 0-5 year old public health services contract along with a variation to the services deliverable under the contract. The contract included the provision of the health visiting service and the family nurse partnership programme and it was proposed to add to this coordination and delivery of the HENRY Programme.

The Leader highlighted the real progress made by the Council and Public Health team in moving to a universal model and being able to provide this service.

RESOLVED

1. To approve, in accordance with Contract Standing Order CSO 10.02.1(b), the following variation to the Council’s health visiting and family nurse partnership services contract with the Whittington Health NHS Trust.

2. Subject to the variation to the contract specification referred to in paragraph below, the extension of the contract by 1 year at a cost of £4,832,029.

3. A variation to the contract specification to include a requirement to coordinate and deliver the HENRY Programme and to reduce the required capacity of the family nurse partnership programme.

Reasons for decision

Extending the contract will allow time to fully implement the national evidence based ‘4, 5, 6 model’ (see section 6.2). The service has already implemented the 4 levels and the 5 mandated contacts and plans are already underway for the implementation of the 6 high impact areas^[1].

The variation within the contract will be a revision to the specified services in two respects. Firstly, a requirement for co-ordination and implementation of the HENRY Programme will be added. This is a successful behaviour change programme for families focussing on healthy eating. The public health team has co-ordinated this programme for the last 3years. It is now part of the health visiting team’s mandatory training and will support implementation of one part of the 6 high impact areas – healthy weight.

The other variation to the specification will be to reduce the required capacity of the family nurse partnership programme. This is necessary as demand has reduced due to the fall in teenage pregnancies.

The contract extension will align the duration of the health visiting service and the family nurse partnership programme contract with that of the school nursing service contract. This will provide the opportunity to procure an integrated 0 – 19 year old service in the future.

Operationally, the 0-5 public health service is integrated within the wider offer for children and families and is embedded within the wider health pathways for children, young people and their families.

In Haringey, the CCG’s commissioned children’s community health services (except children’s community nursing) are provided by Whittington Health NHS Trust. These are part of a block arrangement through the NHS standard contract.

Alternative options considered

Currently across the country NHS organisations are the main providers of health visiting services and the family nurse partnership programme. A number of Councils have gone out to market following the transfer of commissioning responsibility to local authorities in October 2015. This has led to mixed results as the market is under developed. As a result many Councils have either extended service provision with their current provider beyond the recommended ‘sunset clause’^[2]. One Council in London has brought the service ‘in-house’, and others have placed them within their section 75 partnership arrangements with their Clinical Commissioning Groups (CCG).

Historically the provision of 0-5 public health services has been through the standard NHS local community providers.Since the transfer of responsibility for commissioning the 0-5 public health services to local Councils in October 2015, this position remains largely unchanged across the 32 London boroughs as 98% of all 0-5 public health services are delivered by the standard NHS community providers.

The children and young people services commissioned by Haringey Council and Haringey CCG provided by the Whittington Health NHS Trust are part of an integrated service offer therefore for the Council to procure one part of the overall children, young people and their family service provision from a different provider could destabilise the pathways in place for our families, leading to fragmentation and compromise the stability of the provider to deliver services and achieve the required outcomes for children, young people and their families. Moreover, there is a very limited market for these types of children’s community services, which is already evidenced in Haringey. For example, in 2015 Haringey public health team tendered the school nursing service. Despite there being good market engagement initially with 8 expressions of interest from providers, only 1 bid was submitted which was from the incumbent provider Whittington Health NHS Trust.

Haringey’s experience is not dissimilar to that of other Councils. A recent scoping exercise by the London Association of Directors of Public Health found that for 0 – 5 year old public health services:

-      90% have extended their existing contracts since the commissioning transfer providing time to consider new commissioning models e.g. 0-19 year old services,

-      some Councils entered into section 75 arrangements with their local CCGs as a vehicle to facilitate an integrated service model (3 boroughs) and

-      10% went out to tender in 2016, 1 borough received no bid submission at the end of the tender process and plans to bring the 0-5 service “in-house”.