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RESOLVED:
1. 
To agree to extend the current contract for Clinical
Sexual Health Services with the Homerton Healthcare Foundation Trust from 1st
August 2025 to 31st March 2026 at a value of £2,533,333 with
an option to extend for up to a further year at a value of
£3,800,000 per annum.
2. 
To agree to extend the contract for the Sexual and
Reproductive Health(SRH) in-reach and out-reach nurse, which was
originally awarded as a variation to the Clinical Sexual Health
Services contract, from 1st April 2025 to 31st March
2026, at a value of £87,793 per annum.
 
Reasons For
Decision
 
Following  key
decision AHI S378 detailed work has been undertaken with The
Homerton to prepare for recommissioning
of the clinical Sexual Health Service using Direct Award C,
commencing 1st August 2026.
 
A significant area of focus has been in
relation to the financial sustainability of the service model and
current service configuration.
 
SHL, the London wide online sexual health
testing service, has successfully transferred a significant amount
of testing from clinics to an online provider with lower costs per
test. Whilst this has provided significant cost savings to councils
it has impacted on the financial viability of service provision
from clinics.
 
The costs of providing in clinic services have
also changed and, as the Public Health grant has not kept up with
inflationary pressures, additional increasing provider efficiencies
have been required.
 
The initial joint work from October to January
identified that more substantial service redesign work will be
needed in order to ensure the Homerton
has a service configuration that is financially sustainable to
allow them to enter into an eight year contract of 5+1+1+1.
 
In addition the London Sexual Health Programme
service specification is required for the 8 year contract as
services are commissioned on an open access basis for use by any
person across London and England. Without the service specification
it would not be possible to design the local service confident that
there will not be major changes needed in how services are to be
provided. The service specification is now not timetabled to be
available until April 2025.
 
Extending the existing contract, would also
allow for the London Sexual Health Programme London wide open book
exercise work programme which will assist in providing reference
costs to compare the Homerton’s
current costs and ensure that local service models are based on the
best possible information.
 
The SRH Nurse provision improves access to
sexual and reproductive health services for young residents in both
Hackney and the City of London by
· 
identifying  and
establishing  new locations to provide
clinical services to young residents aged 11-18 or up to 24 with
particular vulnerabilities
· 
supporting the Super Youth Hub pilot ‘HealthSpot’ by the provision of clinical
‘in-reach and ‘out-reach’ services at youth
locations.
· 
Improving the pathways between schools, colleges and other youth
settings into clinical services.
· 
Contributing to the development and/or delivery of Sex and
Relationship Education (RSE) in education settings by adaptation of
resources, training for school staff, direct delivery, and/or
capacity building within the Young Hackney Health and Wellbeing
team.
 
An extension to this current offer will enable
this work to be embedded within the core clinical contract.
 
Hackney and the City of London continue to
have very high levels of need for sexual health services as
evidenced by high rates of STIs and unwanted pregnancies. This is
due to a combination of our local demographics including a young
population, larger proportion of global majority communities and a
relatively large population of men who have sex with men who have
higher recorded sexual health needs, higher incidence of STIs and
high uptake of services at sexual health clinics.
 
Hackney has a young population with 62% of
residents under the age of 40 with the highest uptake of sexual
health services at clinics in those aged 22 to 40.
 
Young people in Hackney bear the burden of
chlamydia infection, with a proportionally high burden of disease
among young black men of Caribbean heritage.
 
Many inequalities and disparities in sexual
and reproductive health outcomes, as well as access to and uptake
of services, are tied to age, sex, sexual orientation and
ethnicity, with links to socio-economic deprivation.
 
The local City and Hackney clinical sexual
health services not only treat sexual ill health but also provide
for sexual good health through encouraging preventative approaches
e.g. provision of PrEP, encouraging
condom use, vaccinations, partner notification and sit alongside
the sexual ill health prevention services as detailed in key
decision AHI S392.
 
Alternative Options
Considered and Rejected
 
Options Appraisal
 
Option 1 –
Extend the current contract until 31st March 2026 with a further
option to extend for up to a further year
 
This option would enable the required service
redesign work to take place and any formal consultation which may
be necessary or desirable.
 
The proposed redesign work will ensure that
the service model meets the needs of the population taking into
consideration that sexual health services have experienced
significant increases in demand for services as well as increased
rates of sexually transmitted infections, alongside, like many
providers, increased costs due to inflationary pressures and pay
awards.
 
An extension would also allow the London
Sexual Health Programme to deliver the updated London service
specification (expected by the end of April 2025) which is
anticipated to add further clarity to areas for cross charging such
as young people, partner notification, chemsex and psychosexual issues
 
The open book exercise work programme can be
undertaken providing reference costs to compare the Homerton’s current costs and ensure that
local service models are based on the best possible
information.
 
Option 2 –
Proceed to competitive full market procurement
 
This option considers re-procuring the
clinical services through a full competitive process rather than
extending the current contract
 
The new procurement regulations for clinical
services implement changes which place a greater emphasis on the
need to collaborate, integrate and reduce the need for competitive
procurement
 
Opting for a full market procurement would be
contrary to the local and national strategic direction of
increasing partnership working with the local NHS.
 
This option would not allow time for the local
service configuration to be redesigned, nor the results from the
Open book process to inform future commissioning.
 
Option 3 - Continue
with CPIC decision agreed in October 2024 and seek to award 5+1+1+1
using direct award C from August 2025
 
The Homerton have
confirmed that the current service model is not financially
sustainable as it is operating at a very significant deficit of
income compared to current expenditure.
 
This option would not allow sufficient time
service transformation, the open book exercise to be undertaken nor
the publication of the London service specification
 
Option 1 is the
preferred option.