Agenda item

Report of Corporate Director for People

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

 

The report was jointly presented by Lucy Hubber (Director of Public Health), David Johns (Deputy Director of Public Health) and Matt Corder (Public Health Principal). The following was stated:

 

·  Nottingham City Council is responsible for improving the health and wellbeing of the local population. This responsibility, along with the overarching aim to increase healthy life expectancy, was made explicit within the Council’s Strategic Plan 2023-27 ‘People outcome – living well in our communities’;

 

·  the latest analysed data (June 2022) showed that healthy life expectancy for both men and women in Nottingham was significantly lower than the England average: with men living 5.7 years less in good health, and women 6.8 years less in good health. The risk factors which contributed most to the onset of disability and the foreshortening of life included smoking and tobacco, diet, nutrition, physical inactivity and alcohol and drug use;

 

·  Nottingham City Council commission services to reduce the prevalence and impact of these modifiable behavioural risk factors, such as tobacco use, physical inactivity and unhealthy diet. Historically, these had been commissioned as separate services and delivered by multiple service providers. Contracts for these commissioned services were due to end 31 March 2024 and a new offer of support was required to ensure health and wellbeing services met the current and future needs of local communities and delivered Best Value;

 

·  from April 2024, the Council intended to amalgamate a range of health improvement interventions into one service model, referred to as an Integrated Wellbeing Service (IWS). The Council would seek to commission a prime provider model, which would be responsible for delivering the service functions in an innovative, dynamic and flexible manner across Nottingham, ensuring Best Value with the following objectives:

 

o  maintaining and improving the health of Nottingham City residents;

o  preventing future ill-health and its negative impacts on the local population;

o  reducing future and existing pressures on local health and care services;

o  putting the service user at the centre of provision, in-line with the personalisation agenda;

 

·  the proposed IWS would provide a single-entry point to health and wellbeing support for residents wishing to address lifestyle and behavioural factors (such as smoking or weight management) whilst considering support and signposting around the wider determinants, such as emotional wellbeing and other factors that might be negatively impacting their health;

 

·  the service would take a life-course approach to prevention of ill-health, valuing the health and wellbeing of both current and future generations. The service would recognise the significant role the wider determinants of health play, and help individuals receive the support they required and related to the conditions which people are born, live, learn and work;

 

·  this would follow a sensitive and responsive local needs approach by working ‘with’ rather than ‘in’ communities. To that extent, the service would take an asset-based approach built on local need. The behaviour change service would be required to link with, and complement, the existing offers in the community and provide additional resources to further develop healthy communities and environments locally.

 

Resolved

 

(1)  to approve the procurement and award of a five-year contract, commencing on 1 April 2024, with an option to extend for a further five years (5+3+2), up to a maximum 10 years in total, for an Integrated Wellbeing Service, at a maximum total cost of £23,750,000;

 

(2)  to delegate authority to the Director of:

 

(a)  Public Health to approve the outcome of the procurement process and award contracts to the most suitable providers;

 

(b)  Governance and Legal, or their delegates, to sign the final contracts and agree extensions based on performance and budget availability.

 

Reasons for recommendations

 

1.  Health of the population

 

Recent data for Nottingham showed the need for a change of approach:

 

1.1  Healthy weight and physical activity

 

·  One in four children was overweight or obese when starting Primary School and that number became 2 in 5 amongst those starting Secondary School;

 

·  Almost seven in ten adults (66.9%) in Nottingham City were living with overweight or obesity and 28.4% of adults were living with obesity; significantly higher than the England average (63.5% and 25.3% respectively);

 

·  Just under one in four (24.1%) adults in Nottingham were inactive, comparable to the England average;

 

·  Four of the top five largest causes of (preventable) death and non-communicable diseases in Nottingham were directly or in-directly related to diet and physical inactivity;

 

·  In 2019/20, Nottingham recorded 3,145 hospital admissions per 100,000 where obesity was a factor, compared to a national rate of 1,869 admissions per 100,000; this was the 4th highest in England.

 

1.2  Smoking

 

·  While smoking rates were lower than they had been, the last three years had seen rates remain steady with a prevalence of 19.1% in 2021; significantly higher than the national average (13.6%);

 

·  Smoking was one of the largest causes of ill-health and early death in Nottingham. It had an impact on children and young people’s lives through pregnancy to adolescence, with 13% of pregnant women smoking at the time of delivery. This was significantly higher than the national average of 9.1%;

 

·  Nottingham was due to miss the Smoke Free 2030 target currently by 10 years.

 

1.3  Benefits of the proposed approach

 

·  The proposed service would provide holistic health and wellbeing support to Nottingham’s residents across the life-course. It would provide timely, flexible, and personalised support to enable residents to make positive and sustainable changes to health behaviours. This would include direct support alongside signposting to community or health and social care services. The service would provide support for residents who have a Nottingham City postcode and/or registered to a Nottingham City GP. The new service would benefit the wider health and care system. Living with obesity, being physically inactive, and smoking all added to health service costs as well as the cost of informal and formal social care;

 

·  In the proposed model, the Council contracts with a single organisation (or consortium) who had identified the best way to deliver services based on the needs of the local population. This may include the direct provision of services in combination with the sub-contracting of local providers. In the event of sub-contracting, the Council retains overall accountability for the commissioned service, while the prime provider held each of the sub-contractors to account individually;

 

·  This approach had several advantages for the Council, including clear and simple governance; access to external, subject experts; and best value. The model also provided the flexibility needed by providers to collaborate where it helped meet local need;

 

·  The model was currently out for consultation with Nottingham City residents and stakeholders. However, it would offer residents and health professionals making referrals a simpler route into a variety of digital, telephone and face-to-face services, with a recognisable Nottingham ‘brand.’ It would offer greater capacity and improved availability. Any provider would aim to ensure residents only had to tell their story once as they navigated the numerous services on offer;

 

·  The tender process would be used to ensure any service is designed for Nottingham residents and addresses local need. The social value providers’ offer to Nottingham City would also be scored as part of the tender process;

 

·  The service would support the Council’s statutory responsibilities. The Care Act 2014 required local authorities to ensure that residents who live in their areas receive services that prevent their care needs from becoming more serious, or delay the impact of their needs; have access to the information and advice they need to make good decisions about care and support; have a range of provision of high quality, appropriate services to choose from; and have an individual care plan to meet their needs. The Council (Public Health), also has a statutory responsibility to take steps to improve the health and wellbeing of the local population.

 

1.4  Commercial Oversight Board

 

·  The Commercial Oversight Board, made up of senior officers of the Council, had considered the Integrated Wellbeing Service and planned procurement;

 

·  The advice from the officers on that board was that the commercial strategy outlined for this service was the best option for the Council and recommend that the report proceed to Commissioning and Procurement Executive Committee. It was the professional opinion of the officers on this board that the proposed model provided the best outcomes for Nottingham citizens and would deliver Best Value;

 

·  Subject to approval by Committee, the next steps and key milestones were as follows:

 

open tender process	-	summer 2023 (date TBC)
awarding of contract	-	November 2023
mobilisation	-	December 2023–March 2024
service goes live	-	01 April 2024

 

Other options considered

 

1.  Continue to commission separate, individual health improvement interventions delivered across multiple service providers - This does not currently allow the providers to holistically address multiple health and behavioural factors simultaneously. Participants are supported with a single aspect of their health rather than addressing wider determinants and contributing factors impacting negatively on their overall health and wellbeing which often does not lead to sustainable change. Service users are currently expected to fit into existing services in this model, with limited flexibility in the delivery of interventions. As the aim of this proposal is to increase capacity, individual services would also exceed the Public Contract Regulations 2015 (PCR) thresholds requiring open and competitive tenders for each service. Therefore, this option has been rejected.

 

2.  Commission a provider collaborative of local health and wellbeing providers, led by a single, lead provider (place-based provider alliance) – the proposed service is above the PCR thresholds and thus requires a fair, open and transparent process to be undertaken that allows any economic operator (supplier) to participate. As such, legislation requires an open and competitive tender process which will include bids from a local collaborative.

 

3.  Provide the service in-house, through Nottingham City Council’s Sport and Leisure department (supported by Public Health as required) – This was explored as part of the development of the service model. Sport and Leisure colleagues have identified that they do not currently have the necessary skills and resources to deliver the full range of interventions the Integrated Wellbeing Service intends to offer. Discussions showed that the capacity and capability gap was significant and would lead to increased costs and significant delay in service development and impact on health outcomes when compared to procurement. This was confirmed by the Commercial Oversight Board who concluded that the proposed model provides the best outcomes for Nottingham residents and will deliver Best Value. Therefore, this option has been rejected.