Agenda item

Report of Corporate Director for People

Councillor Woodings, Portfolio Holder for Adult Social Care and Health, introduced the report.

Roz Howie, Programme Director for Public Health, presented the report and stated the following:

(i)  the World Health Organisation (WHO) defines sexual health as a state of physical, mental, and social well-being in relation to sexuality. It is not merely the absence of disease, dysfunction, or infirmity. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence;

(ii)  sexual health is an important area of public health. Most of the adult population of England are sexually active and access to quality sexual health services improves the health and wellbeing of both individuals and populations. The government in 2013 set out its ambitions for improving sexual health in its publication, a framework for sexual health improvement in England. In December 2021, the government published an action plan towards ending HIV transmission, AIDS and HIV-related deaths in England 2022 to 2025. The government is committed to improving sexual and reproductive health (SRH) in England, including access to SRH services, and will set out plans to do so.

(iii)  sexual health is not equally distributed within the population. Strong links exist between deprivation and STIs, teenage conceptions and abortions, with the highest burden borne by women, men who have sex with men (MSM), trans community, young people, and people from ethnic minority backgrounds. Similarly, HIV infection in the UK disproportionately affects gay, bisexual and other MSM, and black African populations. Some groups at higher risk of poor sexual health face stigma and discrimination, which can influence their ability to access services. Despite the increased provision of remote and online services improving access for some, it should be recognised that some will be excluded or may be disadvantaged by these approaches (2020 data on internet access revealed 5% of the adult population of Great Britain had not used the internet in the last 3 months and 16% of the population does not use a smartphone for private use).

(iv)  offering a mixture of face-to-faceand online servicesis required to meet the needs of different population groups. Services and modes of delivery should be designed to meet the needs of local populations and work to reduce inequalities in both access and health outcomes;

(v)  the consequences of poor sexual health are preventable and include unplanned pregnancies, infections including HIV, cervical and other genital cancers, pelvic inflammatory disease and infertility, psychological consequences, stigma, and poorer educational, social, and economic opportunities. There are notable inequalities in access and outcomes in relation to SRH which must be addressed if meaningful improvements in population outcomes are to be achieved;

(vi)  from April 2013, Local Authorities have been responsible for commissioning specialist integrated sexual health services (ISHs) including testing and treatment for sexually transmitted infections (STIs), the provision of HIV Prophylaxis (PrEP) and provision of the full range of contraception advice and provision;

(vii)  it is recognised that the specialist ISHS is only part of a range of the provision that will need to be provided to meet the sexual health needs of the local population. Services delivered by primary care, third sector and community- based organisations form an essential part of any local sexual health system. Local Authority (LA), NHS England and Improvement (NHSE/I) and Integrated Care Board (ICB) commissioners are expected to work collaboratively to map service user pathways and plan services according to population need. The need for NHS organisations and local authorities to work more closely and to collaboratively commission SRH services was restated in the green paper Advancing Our Health: Prevention in the 2020s;

(viii)  Health and Wellbeing Boards will play a key role in ensuring that the services and care their communities receive is seamless. They will undertake a joint needs assessment (JSNA) to identify the current and future health and social care needs of the local community as well as local assets. Based on this they will develop Joint Health and wellbeing strategies (JHWBs) to agree their joint priorities for local action. Both JSNAs and JHWNs will inform the ICB, NHS and LA commissioning. Sexual Health has a clear role to play in improving health and reducing health inequalities and therefore must be considered;

(ix)  the existing Integrated Sexual Health Service (ISHS) was commissioned by Public Health in Nottinghamshire County and Nottingham City Councils as it was deemed that there were several benefits to this approach, namely:

·improving patient experience;

·driving efficiency;

·improving local partnerships;

(x)  a collaborative agreement was entered into between the two parties describing how the Councils will jointly work together and the roles and responsibilities of each partner organisation and to outline accountability arrangements, financial contributions, and dispute resolutions for the period April 2016-31 March 2024. This will be the approach again for recommissioning of the services for the period 1 April 2024 – 31 March 2031. A second collaboration agreement has been drawn up between Partner Organisations;

(xi)  the aim, through the recommissioning programme, is to secure the provision of open access, comprehensive sexual health services which meet the current and future sexual health needs of all our population, whilst addressing avoidable health inequalities. Subject to approval of the report, an ISHS will be commissioned to be delivered from April 2024 onwards.

Resolved to

(1)  approve spend of up to a total value of £31,956,785 from the ring-fenced Public Health Grant funding, conferred under s31 of the Local Government Act 2003, on commissioned ISHS’s during the period 1 April 2024–31 March 2031;

(2)  delegate authority to the:

(a)  Director of Public Health to enter into a second collaborative agreement with Nottinghamshire County Council for the recommissioning of ISHS’s;

(b)  Director of Public Health, in consultation with the relevant Portfolio Holder, to agree the service model for commissioning of integrated sexual health services against the entire budget available, through applying the insight and commissioning recommendations developed within the strategic commissioning review;

(c)  Director of Public Health to undertake ajoint competitive procurement procedure (to be led by Nottinghamshire County Council)for tendering of, evaluation, selection and approval and awarding the contracts for the services listed below:

(i)  comprehensive sexual health services including most contraceptive services and all prescribing costs, but excluding GP additionally provided contraception;

(ii)  sexually transmitted infections (STI) testing and treatment, chlamydia screening and HIV testing;

(iii)  sexual health aspects of psychosexual counselling;

(iv)  specialist services, including young people’s sexual health, teenage pregnancy services, outreach, HIV prevention (through PreP pre-exposure prophylaxis), sexual health promotion and services in schools, colleges and pharmacies.

Reasons for recommendations

(i)  A collaborative agreement was entered into between the two parties describing how the Councils will jointly work together and the roles and responsibilities of each partner organisation and to outline accountability arrangements, financial contributions, and dispute resolutions for the period April 2016-31 March 2024.

(ii)  This will be the approach again for recommissioning of the services for the period 1 April 2024–31 March 2029. A second collaboration agreement has been drawn up between Partner Organisations.

(iii)  All the funding for integrated sexual health services commissioned by Nottingham City Council sits under ring-fenced grant conditions (Public Health Grant), for which the Director of Public Health is accountable, and the resource must be stewarded in line with these conditions. The Director of Public Health is the appropriate designate for approving the commissioning model in line with clinical governance standards to meet population needs.

(iv)  The current contract for integrated sexual health services ends March 2024, and the recommendations refer to spend approvals and reflect the procurement timeline and process to enable the contract to be awarded within the deadline.

(v)  A commissioning review of sexual health services in Nottingham and Nottinghamshire has been undertaken. This included a joint needs assessment, a number or pre-market engagement events and reviews of procurement options and provider models. The procurement exercise for new services needs to be completed by autumn 2023, to allow for service mobilisation in 2023/24 with a view to starting April 2024. Spend approval is being sought for commissioned services under a 3+2+2year contract.

(vi)  An option appraisal was undertaken to determine the most appropriate procurement route (see background information section - papers) therefore competitive procurement procedure with negotiation under Regulation 29 of the PCR 2015 was determined to be the best option (Recommendation 3).

Other options considered

None - as the current contracts cease on 31 March 2024, without re-commissioning there would be no commissioned services and a lack of provision, with Nottingham City Council neglecting its duty to in respect of these services and putting Nottingham at significant disadvantage for the delivery of integrated sexual health services for its residents.