Agenda item

Report of Corporate Director for Adult Social Care and Health

Tammy Coles, Public Health Principal, presented the report and stated the following:

a)  Nottingham’s substance use treatment and recovery system is funded primarily through the Ring Fenced Public Health Grant. Since 2021, additional grant funding has been allocated to Nottingham City Council by the Office of Health Improvement and Disparities, and confirmed until 31 March 2025 to support improvements in the quality and capacity of drug and alcohol treatment and recovery;

b)  the Office of Health Improvement and Disparities has allocated indicative grant funding for a further year for the period 1 April 2025 to 31 March 2026. These grants include the Drug and Alcohol Treatment and Recovery Improvement Grant, Inpatient Detoxification Grant and the Individual Placement Support Grant. The allocations remain indicative; and are still subject to Department of Health and Social Care and Treasury approvals and as such final allocations could vary. The Rough Sleeping Treatment Grant element of the Drug and Alcohol Treatment and Recovery Improvement Grant is confirmed;

c)  the Office of the Police and Crime Commissioner and the East Midlands Probation Service are commissioning partners, with their funding contributions paying towards the criminal justice pathway element of Nottingham City Council’s existing adult substance use service, Nottingham Recovery Network;

d)  the report requests approval to accept the substance use treatment grants for 2025/26, and the partnership funding contributions from the Office of the Police and Crime Commissioner and the East Midlands Probation Service, and approval to spend this funding on the existing substance use treatment and recovery services to meet the conditions of the grants.

Resolved to approve

(1)  receipt of, for the period 1 April 2025 to 31 March 2026:

(a)  the Drug and Alcohol Treatment and Recovery Improvement Grant and Inpatient Detoxification Grant from the Office of Health Improvement and Disparities, up to a maximum value of £4,851,019;

(b)  the Individual Placement and Support grant from the Office of Health Improvement and Disparities, up to a maximum value of £173,614;

(c)  up to £50,583 from the Office of the Police and Crime Commissioner, as a partner contribution to substance use services, to fund an out of court resolution worker to enable the delivery of diversionary and community caution activity in relation to substance use;

(d)  up to £113,000 from the East Midlands Probation Service, as a partner contribution to substance use services, to fund a 12-month extension of an existing criminal justice-specific programme to enhance the existing Dependency and Recovery offer to individuals in prison and on probation in Nottingham City;

(2)  spend of, during the period 1 April 2025 to 31 March 2026:

(a)  £5,285,275 on substance use services and activity, as per resolutions 1(a) to (d) above;

(b)  £97,059 Inpatient Detoxification Grant, through a consortium arrangement of additional inpatient detox beds within the East Midlands;

(3)  delegation of authority to agree the service model for the substance use services, against the total budget available, to the Director of Public Health.

Reasons for recommendations

a)  Nottingham’s alcohol and drug treatment and recovery system includes an integrated treatment and recovery service for adults, and services for children and young people and families impacted by substance use. These services are funded primarily through the ringfenced Public Health Grant. Additional grant funding has been previously allocated to Nottingham City Council by the Office of Health Improvement and Disparities to support improvements in the quality and capacity of drug and alcohol treatment and recovery. This grant funding has taken several different forms between 2021 and March 2025.

b)  Nottingham City Council was notified by the Office of Health Improvement and Disparities on 18 December 2024 of an indicative grant allocation for the period 1 April 2025 – 31 March 2026. In line with government policy, it has amalgamated several grants that support the drug and alcohol treatment and recovery agenda into a single Drug and Alcohol Treatment and Recovery Improvement Grant. The grants that will be consolidated are the Supplemental Substance Misuse Treatment and Recovery grant, the Rough Sleeping Drug and Alcohol Treatment Grant, and the Inpatient Detoxification grant. This has an indicative total allocation of £4,948,078, subject to Department of Health and Social Care and Treasury approvals and as such final allocations could vary of. Recommendation 1 is to accept the grants from the Office of Health Improvement and Disparities in their new format from 1 April 2025.

c)  For the grant period 1 April 2025 - 31 March 2026, an Individual Placement and Support grant will continue to be allocated to Nottingham City Council. This has an indicative value of £173,614. Recommendation 2 is to accept the Individual Placement and Support grant from Office of Health Improvement and Disparities.

d)  The Office of the Police and Crime Commissioner is a commissioning partner, with their funding contribution paying towards the existing criminal justice pathway element of Nottingham City Council’s existing adult substance use service, Nottingham Recovery Network. This specific funding from 1 April 2025 - 31 March 2026 is for a an out of court resolution worker to enable the delivery of diversionary and community caution activity in relation to substance use. There is an existing partnership agreement in place between Nottingham City Council and the Office of the Police and Crime Commissioner. Recommendation 1(c) is to accept the funding contribution to from the Office of the Police and Crime Commissioner.

e)  East Midlands Probation Service is a commissioning partner of with their funding contribution paying towards the criminal justice pathway element of Nottingham City Council’s existing adult substance use service, Nottingham Recovery Network. This specific funding, from 1 April 2025 - 31 March 2026 is for a 12 month contract extension for two existing posts to enhance the existing Dependency and Recovery offer to individuals in prison and on probation in Nottingham City. There is an existing MOU in place between Nottingham City Council and East Midlands Probation Service Recommendation 1(d) is to accept the funding contribution from East Midlands Probation Service.

f)  The additional Office of Health Improvement and Disparities funding referenced in 1.1 comes with specific grant conditions as to how it can be used, the use must be agreed with Office of Health Improvement and Disparities. The majority of the grant funding is used to support improvements in the quality and capacity of Nottingham’s drug and alcohol treatment services, with a small portion supporting commissioning capacity within the public health team. Recommendation 2(a) is to approve expenditure of £5,121,692 of the Office of Health Improvement and Disparities funding, £50,583 from the Office of the Police and Crime Commissioner and £113,000 from East Midlands Probation Service on the substance use grants and supporting activities, as agreed by Office of Health Improvement and Disparities and by the Office of the Police and Crime Commissioner and East Midlands Probation Service where appropriate.

g)  A condition of the Inpatient detoxification grant is a requirement that it is commissioned on a regional basis. The local authorities in the East Midlands have formed a commissioning consortium led by Nottinghamshire County Council. The Inpatient Detoxification Grant is allocated to Nottingham City Council based on local need but is paid by Office of Health Improvement and Disparities directly to the consortium lead. This arrangement has been in place since 2022. A Memorandum of Understanding is in place between Nottingham City Council and Nottinghamshire County Council who manage the contract. Inpatient bed use is allocated in proportion to funding to ensure value for money. Recommendation 2(b) is to approve expenditure of Nottingham City’s Inpatient Detoxification Grant funding allocation via the East Midlands consortia arrangements currently in place.

h)  All of the funding for substance use services commissioned by Nottingham City Council sits either under ring-fenced grant conditions (Ring Fenced Public Health Grant, Drug and Alcohol Treatment and Recovery Improvement Grant, and the Individual Placement Support grant), partnership agreements and MoUs, 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 service model for the substance use services against the entire budget available. Recommendation 3 therefore seeks to delegate responsibility to Director of Public Health to agree the service model for the substance use services against the entire budget available.

i)  The commissioning of substance use services comes under the Provider Selection Regime regulations, which came into effect in 2024. Under Provider Selection Regime regulations, it is permissible to add funding to existing contracts under specific circumstances. All of the funding streams discussed in this paper were identified as possible additions to the substance use contracts at the time of the tender for those contracts, therefore it is understood that these additions will be permissible under Provider Selection Regime Regulation 13 (1) (a) as modifications to the contract which were clearly and unambiguously provided for in the contract documents. 

Other options considered

a)  Do nothing – under this option there would be no receipt of the additional substance use grants for Nottingham. The money available for the substance use treatment and recovery system would reduce substantially downwards from the 2024/25 position. This option would significantly limit the ability to meet the outcomes targets for the delivery of From Harm to Hope, and there would be reputational issues associated with stepping outside of the national expectations from OHID. There would be a lack of benefit for Nottingham residents, and a contraction of the substance use workforce.

b)  Use the OHID grant funding to tender for new service providers rather than varying existing contracts.  All of the grant funding in this decision is solely for  2025/26 and the longer term funding offer for substance use treatment and recovery  is uncertain. It would not be viable to commission new services within that timeframe. The potential for further national grants was anticipated during the commissioning of current services and as noted in 1.9 the contracts were tendered in a manner to enable permissibility for these variations funded by the ringfenced national grant money for substance use treatment and recovery Therefore this option is not recommended.