Agenda item

Report of Assistant Chief Executive, Director of Commissioning and Procurement, Director of Public Health and Director of Children’s Integrated Services

Chris Wallbanks, Strategic Commissioning Manager presented a report on the 0-5 Integrated Services Contract highlighting the following points:

(a)  The Council has a statutory responsibility to commission a range of public health services that protect and improve the health of the citizens and in 2015 the commissioning responsibilities for the 0-5 children’s public health services transferred to the local authority. Since this time the Council has been  working towards integrating these services with existing children’s delivery teams, removing boundaries and working holistically in order to help children get the best start in life;

(b)  Integration will improve the experience for children and for families offering services from pregnancy through to age 5 and will be influenced by practitioners and the needs of the families. It will also provide an opportunity to reduce duplication, increase flexibility and enable resources to be used more effectively;

(c)  a strategic commissioning review took place of all existing universal and preventative services jointly with the Nottingham CCG who commission the midwifery service. It is now possible to consider how collective services could be more closely aligned. It has also provided  a clear context for integration and provided an opportunity to design new pathways of support based on best practice.

(d)  Savings of 10% over three years have been identified through integration.

RESOLVED to:

(1)  Approve the integration of the existing public health contracts listed in the exempt appendix 1 and procure an organisation to deliver the integrated specification working in partnership with our internal Early Health Service with a view to potentially formalising the integrations through a contractual joint venture agreement. The details of this agreement, including any services in scope will be bought to committee to approve at a later date, following the appointment of the provider organisation;

(2)  Approve the budget to support the contractual value set out in exempt appendix 1. If the contractual values are over and above current indicative values a separate report will be presented for approval;

(3)  Delegate authority to the Director of Public Health in consultation with the Portfolio Holder for Adults and Health and Portfolio Holder for Early years to approve the outcome of the tender process and award the contract for 5 years, plus 2 years potential extension , plus a further 2 years potential 2 years extension (5+2+2).

Reasons for decision

Working to establish this integration of services will allow the existing provider to develop an innovative and flexible approach to delivering existing services, without historical boundaries or service divisions and be more responsive to  the needs of children and their families. 

The proposed integration of six public health contracts and their current value will reduce by a further 10% over the next three years, delivered through amalgamation and a competitive tendering process.

Local and national feedback has shown that families become frustrated having to give the same information to separate services and giving families numerous points of contact this leads to reduced the likelihood of effective engagement and duplication of work/information recording. Integration would ensure that all practitioners are working towards the same goals for families. This could not be realised through procuring separate services.

There will be increased opportunities for data sharing and planning around the family and the flexible approach allows resources to be used more effectively.

Long term benefits are expected of formal integration arrangement, these include: 

·  A single line managing structure to release capacity and resources

·  Use of one data collection system to facilitate data sharing and planning across different teams.

·  Pooling budgets to enable a more flexible approach

·  Sharing premises to promote co-location and potentially reducing costs

·  Undertaking skill-mix approach across the workforce to enable a more streamlined service with less duplication for families. This would mean one health worker working with a family from birth to aged 19 rather than transitions to different workers throughout that period.

Other options considered

Existing contracts are due to expire in March 2018 which would leave the Council in a position where it could not provide the statutory services it is require to leaving it open to challenge, and as such the option of doing nothing was rejected.

The 6 individual contracts could be re-procured independently, although this was rejected as it would maintain divisions between services which complicate the lives of families and their children. National feedback, supported by local feedback, showed that families became frustrated having to give the same information to a number of different services.  For this reason this option was rejected.

Another alternative option considered was to insource the children’s public health services. Due to potential risks relating to recruitment of staff and transfer of existing health staff to NCC terms and conditions this option was rejected. It would risk making recruitment to vacancies extremely problematic, and would risk unfair pay claims from staff.

Outsourcing the Early Help Teams was another alternative considered. There are a number of benefits to this option, but they are outweighed by the key risks relating to protecting existing staff. Stakeholders agreed that this option may be considered in the future if a trial period of integration proves to be effective and if contractual agreement protecting staff can be put into place. However at present this option has been rejected.