Agenda item

Report of Interim Corporate Director of Adult Social Care and Health

Cllr Corall Jenkins joined for this item and for the remainder of the meeting.

Helen Johnston, Consultant in Public Health, and Tracey Ford, Changing Futures Senior Systems Change Commissioning Manager, presented the report on the commissioning of Changing Futures services for Nottingham, 2025/26-29/30, highlighting the following points:

a)  the Changing Futures programme aims to improve outcomes for people experiencing Severe Multiple Disadvantage (SMD), working intensively with people who are the most vulnerable and with the most complex needs in our communities. Recipients of support will have a concurrent combination of at least three out of five key sources of disadvantage: homelessness, substance misuse, mental ill health, experience domestic/sexual abuse or violence, and connection with the criminal justice system;

b)  this decision authorises receipt of funding from NHS Nottingham and Nottinghamshire Integrated Care Board (ICB) Health Improvement and Innovation Fund (HIIF) through a Section 256 agreement between the ICB and Nottingham City Council, and approves the outlined service model for the commissioning of Changing Futures services from 2025/26-29/30 against that funding envelope.

During subsequent discussion and in response to questions from the Committee, the following points were made:

c)  Changing Futures is only able to work with individuals with the most complex needs, but through working and learning about what works with the most complex individuals, the programme can highlight system changes and enable improvements throughout the whole network of services, as well as bringing services into closer coordination;

d)  there had been concerns that the Changing Futures programme would not receive funding, despite being remarkably successful in Nottingham. The HIIF funding from the ICB us crucial for enabling that service to continue.

Resolved to:

(1)  approve receipt of £7,346,875 of ringfenced ICS Health Inequalities and Innovation Investment Funding (HIIIF) between 01 April 2025 to 31 March 2030 (£1,469,375 per year);

(2)  to delegate authority to Director of Public Health to;

  i.  enter into a Section 256 NHSA 2006 Agreement with the Integrated Care Board for the transfer to the Council of the HIIIF of up to £7,346,875 (£1,469,375 per year) from 01 April 2025 to 31 March 2030;

  ii.  approve the service model for the commissioning of Changing Futures services against the entire budget available;

  iii.  subject to prior Spend Control / s151 Officer approval:

a.  to spend £1,469,375 per year for the next five years on Changing Futures services and activity to 31 March 2030 as set out in the indicative budget at appendix A, including the extension of four specialist navigator contracts from 01 April 2025 to 31 March 2026;

b.  to procure, award and enter into two contracts for Changing Futures services and activity for three years from 01 April 2025, with an option to extend for a further two years from 01 April 2028 for (i) Main Delivery Service and (ii) Partnership Learning Hub;

c.  to enter into 1-year extensions of four specialist navigator contracts from 01 April 2025 to 31 March 2026.

Reasons for decision

e)  all of the funding for Changing Futures services commissioned by Nottingham City Council sits either under ring-fenced grant conditions (national Changing Futures grants from DLUHC and TNLCF) or partnership agreements (the ICB), for which the Director of Public Health is accountable, and the resource must be stewarded in line with these conditions;

f)  the current Changing Futures Main Delivery Service contract expires on 31 March 2025. As the funding for the services is now recurrent, the services must be competitively procured. Recommendation 2(3)(b) approves separating the services currently deliver under one contract into two lots and procure separately, under 3 + 2 year contracts. There is an expectation that the programme will attract additional funding over the next five years. The advertised contract values will therefore be in excess of the funding currently secured, to provide flexibility for additional capacity in those contracts; all additional funding will be subject to separate decisions to approve receipt and spend and procurement approach;

g)  four specialist navigator services designed to meet the needs of women and people from minority ethnicities experiencing SMD were competitively procured in 2023. One-year contracts were awarded from 01 April 2024, each contract has provision to be extended until 31 March 2026. The decision also seeks approval to utilise this extension provision. Separate decisions to approve will be needed for re-procurement of that service beyond 31 March 2026;

h)  the ICB funding includes a requirement for the provision of system and programme leadership. Recommendation 2 incorporates approval of the budget allocation for the programme staffing. A review of the staffing structure has been proposed to explore the most appropriate future arrangements, including the development of permanent roles.

Other options considered

i)  Do nothing. The current contracts have been aligned such that they cease on 31 March 2025. Without re-commissioning or extending, there would be no commissioned Changing Futures services and a lack of specialist, intensive provision for people experiencing SMD, with NCC failing to maximise the opportunity offered by the ICB’s HIIIF grant, and there would be no change of attracting additional funding through partners or a national programme. NCC would not fulfil its partnership role with wider preventative benefits, with a lack of benefit for Nottingham residents;

j)  reprocure all services, including the Specialist Navigators. This is not possible for operational and capacity reasons, and would represent a significant risk to the continuity of services. To minimise the risk around transition, the programme has recommended the option to extend existing agreements where provided for within existing contracts. These services are distinct from the main delivery contract, currently delivered by community organisations, run by and for the communities they represent;

k)  procure the main delivery service and the Partnership Learning Hub together. This is how the services are currently delivered, with the PLH sub-contracted by the main delivery provider. To separate the contracts gives greater accessibility to delivery for new partners to the Changing Futures programme. It also gives greater accountability for managing the service directly by NCC.