Purpose

IMPORTANT: A decision notice was
previously published on the forward plan, however due to internal
governance and administration error, a decision to agree to proceed
to consideration of the proposals by the Council’s internal
Contract & Commissiong Board (which would make any
recommendations to the Corporate Director) was erroneously
published against the decision notice (PUBLIC HEALTH NURSING -
EXTENSION OF THE SECTION 75 AGREEMENT Key Decision Number
3323RES).
 
This notice is being published
via General Exception, so the error is transparently corrected. The
original error will remain published (Key Decision Number 3323RES)
however with an explanation, and link to the update decision and
full report – Key Decision Number 3323RESa):
 
SUMMARY
 
This report seeks approval to
extend the existing contract with Croydon Health Services (CHS) to
31 July 2027, which falls within the permissible period of the
Section 75 Agreement. 
To agree to taking advantage of the permitted extension allowance and extend the existing s75
Agreement arrangement with CHS to run until 31 July
2027. 
 
Total value for the requested
extension of August 2025 – July 2027 will be approximatively
£14m plus annual Agenda for Change (AfC) salary uplifts.
 
This report provides an update
on the contractual arrangements for services within the Public
Health Nursing programme.
 
This report recommends the
approval of the commissioning intentions and procurement strategy
detailed in this report, that are in line with Croydon’s
Tender and Contract Regulations and PCR 2015.  
 
The extension requested is to
work with the provider to implement the 0-19 model, whilst enabling
the Council to carry out a thorough, open and transparent tender
programme, leading to the award of a new contract in
2027. 
This programme of services has
not been subject to tender for some 10-years and is going through
transformation to ensure alignment with other strategic plans,
decisions and commissioning cycles, in particular, the
implementation of the Family Hubs Delivery Plan plus allowing for
the time required to carry out a 0-19 Health Needs Assessment and
recommissioning process.

Content

For the reasons detailed in the
report the Corporate Director for Adult Social Care and Health
AGREED:
 
To approve a permitted extension of the existing s75 Agreement arrangement
with Croydon Health Services Trust to run until 31 July
2027. 
 
To note the
total value of the extension:August 2023
– July 2027 (4-years) being £28,351,907 plus annual
Agenda for Change (AfC) salary uplifts and inflation rates at
approximately 2% per year.
 
To note that previous
years’ underspends have been reinvested by Public Health in
other Healthy Child programmes
 
2022/23: £483,363
underspend
2023/24: £531,893
underspend
2024/25: £1 underspend
due to CHS recruiting bank and agency staff
 
To note that the aggregated
spend, inclusive of the extension, remains within the overall
awarded contract value of £48.982m
 

Reasons for the decision

The extension requested is to
continue working with the provider to implement the 0-19 model,
whilst enabling the Council to carry out a thorough, open and
transparent review of the programme in the format of a Health Needs
Assessment, which will inform the specification for
2027. 
 
This programme of services has
not been subject to competitive tender for some 10-years and is
going through transformation to ensure alignment with other
strategic plans, decisions and commissioning cycles, in particular,
the commissioning arrangements for Croydon Best Start and the
implementation of the Family Hubs Delivery Plan plus allowing for
the time required to consider future commissioning intentions and
undertake required market shaping. 

 

Alternative options considered

Options

Advantages

Disadvantages

Risks & Mitigations

Option 1:
Agree to permitted extension,
taking this s75 Agreement to 31 July 2027
 
Revised 0-19 model – area
based – which included decommissioning FNP service and
replacing with an additional Enhanced Level to the Health Visiting
service
Recommended

·        
Jointly designed new model / new way of working to
address performance and the recruitment deficit.
·        
CHS engaged a new, experienced lead that implemented
changes, which had a noticeable impact, who led PHN through the new
way of working model.
·        
Working with a partner with a vested interest in
ensuring the quality-of-service delivery during this period–
reputationally and financially – continues to ensure the
Council can influence pace and scale, utilising established
channels.
·        
The new way of working implemented 01 April 2025
allows the Council to continue monitoring and reviewing service
delivery while the Health Needs Assessment is being carried out,
which will inform the model and specification for the 2026/7 tender
programme. 
·        
This new way of working offers nurses the
opportunity to work across Health Visiting and School Nursing,
which is a developmental benefit.
·        
Offering Croydon families the Enhanced HV Level
enables the Council and provider to develop the HV service, which
could be a recruitment attraction
·        
Joint working continues between CHS PHN and
Maternity Services.
 

Decommissioning FNP
resulted in two FNP nurses not being qualified to move to the
Health Visiting or School Nursing service.

 
 

The Council invested
resource and worked closely with CHS, offering support through the
decommissioning of FNP and implementation of the additional
Enhanced HV Level.

 

National staffing
challenges remain an issue

 

 FNP nurses offered the opportunity of training
and/or work in other areas

 

Mitigation –
maintained regular engagements with staff, assuring no redundancies
and ensuring that staff were aware of and felt included in the
process

Option 2:
Bring the service
in-house
 
Not
Recommended

Offering the Council greater
oversight of service delivery and better ability to be flexible and
responsive to strategic changes

·        
These programme of services cannot be insourced as
they provide services that are explicably commissioned to be
independent from the Council 
 
·        
Health visiting provides clinically based
services.  Not financially or
logistically viable to transfer these services
 

Making this programme of
services in-house would place the Council at significant risk and
does not provide independence

Option 3:
Do nothing
 
Not
Recommended

 

Not viable as the
current s75 Agreement expired 31 July 2023 and has included three
permitted two-year extensions (to 31 March 2028),
In order to ensure
that the revised model in place will secure delivery of these
services, an appropriate timeframe is required to carry out the
procurement process.

The current model is
not attracting or retaining staff, and it can be accepted that
maintaining the status quo will not improve matters

 

The Council would be
at risk of not meeting its statutory obligations to deliver the
Healthy child Programme.

 

It would undermine
its commitment to the best start in life for all children and the
delivery of linked programmes e.g. Family Hubs