Agenda item

[To be introduced by the Cabinet  Member for Health and Wellbeing. Report of the Director for Public Health] The report will seek agreement for the Council  to be part of the London wide procurement process. The report will seek approval of  the London Procurement Strategy and request delegation of the decisions  for awarding contracts to the Leader of the Council.

Councillor Morton returned to the meeting.

The Cabinet Member for Health and Wellbeing introduced the report which set out the re commissioning of a modernised network of sexual health services able to meet London’s challenging sexual health issues.

RESOLVED

1.    To approve the Council’s participation in a London wide procurement for a web-based system to include a ‘front-end’ portal joined up partner notification and home/self-sampling, to be led by one Council on behalf of the Councils in the LSHTP.

2.    To approve the Council’s participation in a sub-regional procurement strategy for re-procurement of a contract for GUM and CaSH services. Participating Councils in the sub region include Barnet, Camden, City of London, Haringey, Hackney, Enfield and Islington.

3.    To note that the Leader has agreed to take responsibility for approving the awards of the contract for the web-based system to be procured in accordance with paragraph 3.1 and of the contract for GUM and CaSH services to be procured in accordance with paragraph 3.2.

4.    To note that the Leader has agreed to take responsibility for approving the new collaborative commissioning model for the Council to participate in London-wide cross charging once this has been developed in accordance with the proposals in paragraphs 4.11 of this report.

5.    To note the progress made in developing options for the future commissioning and procurement of GUM and CaSH services and the named inclusion of the Council in the Prior Indicative Notice (PIN) and Official Journal of European Union Notice (OJEU) for procurement of these services at the sub regional level as part of the strategy referred to in paragraph 3.2.

6.    To approve an extension of the Council’s current contract with Whittington Health NHS Trust for provision of an integrated GUM and CaSH service to residents of the borough for a further 18 months from 1st April 2016 until 30th September 2017 subject to an option for the Council to terminate the contract after 31^st March 2017 on 1 month’s notice.  The contract value for the period of extension will be pro rated based on a full year rate of £2,582,000. 

Reasons for decision  

Approval was being sought on the recommendations outlined in 3.1-3.5 across all 28 LAs participating in the LSHTP. They have been agreed by both the LSHTP board chaired by Mike Cooke, Chief Executive of Camden Council and the London Association of Directors of Public Health.

Haringey residents have high rates of sexually transmitted infections and although now reducing have had high rates of teenage pregnancy. This suggests that, although costly, sexual health services for Haringey residents need to be more effective.  The Council wants to support residents to make healthy choices and to have better sexual and reproductive health.

The LSHTP recommendations are underpinned by a business case, which demonstrates the imperative to transform the commissioning of sexual health services in London, rather than just gradual transformation or making no change. The business case is based on a detailed needs assessment, a survey completed by 24 provider NHS Hospital Trusts, provider interviews, 8 workshops, and a survey of 1,377 service users. In addition work was completed in three sub groups of the LSHTP board exploring clinical requirements, financial benefits/models and procurement strategies. Haringey Council officers are participating at every level of the LSHTP from sub groups to the programme board.

Paragraphs 4.5 to 4.11 below identify the reasons for the recommendations relating to procuring a web based front end for London;  participating in a north central London sub regional procurement; delegating authority for progressing the commissioning of relevant services and finally continuing to cross charge for activity within the LSHTP 28 boroughs;  

 Web based front endCommissioning a web based innovation will allow Londoners to explore on line, different sexual health service options and if the requirement is for a clinic, make an online appointment, see Figure 1. The  results of a customer survey suggest, given better options, 15% of clinic users will opt to switch to a non clinic based service i.e. order a home testing kit or find a local pharmacy. The advantages of procuring this service on a London wide basis includes being able to offer extensive choice of London clinics, cost advantage from scale and will enable a high profile marketing strategy to persuade customers to switch from telephone to on line booking.

Figure 1 – web based system as a process

North central London sub regional procurement of GUM and CaSH services The London LAs are proposing a sub regional model of commissioning which networks across the capital. The rationale for this is outlined below and highlights a balance between the ability to procure local services to meet residents’ needs with a higher degree of cost and quality control obtained through larger contracts, thus gaining economies of scale.

Benefits - The sub region model creates the opportunity to co-commission local services with partner LAs and to be able to influence services in other sub regions where Haringey residents go for services. The aim is to have consistency across London.

There are significant benefits for providers in operating across a larger sub regional network in terms of best use of estates, economies of scale for service overheads and the offer of a work environment that would be attractive to high quality clinical staff.

LAs too would achieve economies of scale on back office and transactional costs.

Delegating authority In terms of delegated authority it is recognised that it would not be timely for all 28 LAs across the sub regions to return to their Cabinets for award of contracts within the sub regions. The schedule for contracts starting in April 2017, when the existing agreements expire, is already ambitious and must be kept to if providers are to be given sufficient time to execute the new contracts.

Cross charging - Residents will continue to be free to access GUM services across London. The aim is that Haringey will be invoiced by each provider across London for these services at the same price agreed for the host sub region, i.e. there will be a single price negotiated for the whole of London by each sub region based on a standard service design. With external legal support, Commissioners will identify and develop a new collaborative commissioning model to facilitate cross charging in this way across London that minimises bureaucracy, as further explained in this report and particularly in paragraphs 6.22 to 6.25. 

Alternative options considered

Officers across the 28 boroughs have Reviewed 3 main options for commissioning the sexual health services.

·                         Option 1: Do nothing. Current system remains unchanged.

·                         Option 2 (described in section 4): Develop a network system based on 4 sub regions.

·                         Option 3: LAs to focus on the development of a local service model that includes GUM reducing dependence on central London services.

Option 1: The current system remains unchanged - Under this option Councils would continue with the current arrangements and undertake any redesign and procurement activity as locally determined. The main advantage of this model is that it does not create any change in provision for residents and the additional commissioning time entailed by Option 2.

The key disadvantage of this option is that it will not improve access for residents who are now experiencing long waiting times at GUM clinics and inflexibility around opening times. For commissioners there would be no shift in the challenging position of negotiating price and quality annually with multiple NHS Trusts. These Trusts are well aware that they hold a powerful negotiating position with LAs outside of their host area and often hold a non negotiation position.

The current situation is financially unsustainable. Growth in activity and costs in GUM provision could mean Councils having to make savings to other key public health services to fund statutory open access services.

Option 3: LAs to focus on development of a local service model reducing dependence on central London services - In this model LAs would continue to agree GUM services for their own area. The individual LAs could work together via a 28 borough wide sexual health cross charging network arrangement to ensure there is a forum where common issues can be addressed. Benefits include enhanced local control and potentially greater scope to reshape local service provision away from central London and less complex collaborative arrangements than in Option 2. Where this option falls short is because of the movement of residents across London and the risk of LAs acting ‘out of sync’ with each other on price or  allowing their local GUM providers to introduce additional capacity, thus pulling in more business into that high price clinic. In addition this option will reduce the scope for individual commissioners to drive the change and efficiencies offered within option 2.

Risks – A full risk assessment exists at both LSHTP board and within the sub region.  Key issues are highlighted below:  

The key risks to achievement of timescales are linked to the complexity of partnership working and scale of change required across London under the recommendation.   Some of this is mitigated by having LA Cabinets agree to delegate authority. 

The new model will require ‘channel shift’ for some customers to a greater on- line offer, this may be challenging particularly for those who are not used to on line booking. There will be a proactive communication strategy to support customers with this change.

The LSHTP does aim to reduce capacity in GUM clinics and this is likely to lead to service changes as people are directed to community or enhanced GUM clinics.

The savings forecasted are dependent on some new form of tariff and this must stretch beyond north central London sub region.