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RESOLVED:
 
1. 
To agree an award of the City and Hackney Stop Smoking
Service contract to Provider A for a period of up to five years
(3+1+1) from the 1st of July 2024. The total value of the contract
will be a maximum of £5,698,595. This will be made up of up
to £3,583,700 in core service spending (An average of
£716,740 per year). There will also be up to £500,000
of central government funding to be allocated towards Optional
Additional Work Packages and up to £339,978 per annum of
additional central government funding to support local stop smoking
services (as described in section 6.1 of the report).
 
Reason(s) For
Decision
 
5.1  This report seeks to
confirm the award of a contract for  =a new Stop Smoking Service based on a
redesigned service model and specification including an insourced
service element.
5.2  This option would seek to
incorporate the latest evidence and best practice guidelines, as
well as insights that have been gathered from resident and
stakeholder engagement and data analysis. For completeness the
changes proposed for the new service are detailed below.
5.2.1  Incorporate the latest guidance from NICE
including lowering the age threshold from 18 to 12, continuing to
offer behavioural support plus medication (now including
nicotine-containing e-cigarettes for over 18s only) as the most
effective way to support smokers to quit, with support tailored to
the specific needs of individual smokers
5.2.2  Integration/alignment of community and
hospital-based stop smoking and tobacco dependency treatment
service pathways.
5.2.3  Strengthening and extending ongoing support
for people to reduce risk of relapse and remain ‘smokefree’.
5.2.4  Increase access to harm reduction approaches
for those motivated to reduce their tobacco use but not yet ready
to quit in one go.
5.2.5  Specify a revised model for the City
element, including new activity targets (and corresponding
adjustment to the City contribution to the service budget - see
savings section 7), as well as additional capacity provided through
the virtual Stop Smoking London portal (available through
membership of the London Smoking Cessation and Tobacco Control
Programme, funded separately).
5.2.6  Insourcing of an enhanced community
engagement function, through recruitment of a dedicated officer to
be hosted by Hackney Council. It is proposed this would be a PO7
post and the budgeted amount for this is £80,000 per annum,
which is included within the £800,000 financial envelope for
this service detailed in the business case. This community
engagement officer will work alongside the contracted provider and
develop close partnerships with key local high risk/high prevalence
communities, building on the successes of the Public Health
Community Champions programme. This partnership approach will aim
to ensure the service is flexible to the wider needs of priority
groups, helping to deliver on the new service's priority objective
to reduce inequalities in tobacco related harm. The full scope of
work for the insourced community engagement officer will evolve in
response to community and service needs, but is expected to
include:
· 
working with the service provider to build capacity in community
organisations to deliver stop-smoking advice directly
· 
supporting the co-development of tailored communications and
targeted outreach to promote the service
· 
building/strengthening relationships between high risk/prevalence
communities and the service provider to maximise responsiveness and
reach of the service
· 
gathering insight from people in these communities to support
ongoing service improvement and co-design to better meet the needs
of smokers in City and Hackney.
5.2.7 
Inclusion of a ringfenced outreach and
engagement budget of £50k per year, to fund community
partners to support the work with priority groups described above.
This fund is part of the overall service budget and would be held
and distributed by the provider. The provider will be required to
work in close partnership with the insourced community engagement  officer to
co-design an approach for allocating this funding that is
proportionate, fair and transparent.
5.3  Since the start of the
existing service in 2018, new guidance has been published by
National Institute for Health and Care Excellence (NICE) on
preventing smoking uptake, promoting quitting and treating
dependence. Reprocuring this service
with a redesigned service model allows us to take account of this
guidance, as well as wider system changes such as those implemented
through the NHS Long Term Plan, as well as more recent government
announcements to achieve a ‘smoke free generation’.
Procuring a redesigned service will ensure the new Stop Smoking
Service is responsive to these changes in the wider policy and
delivery context.
5.4  This proposed new service
would replace all existing provision (including community outreach,
GP and pharmacy based Stop Smoking Services) and integrate with new
NHS tobacco dependency treatment pathways. The new service
proposals will build on learning from the coronavirus pandemic in
seeking to work in partnership with the voluntary and community
sector; co-designing and implementing a flexible service offer that
meets the needs of those who would benefit the most, within
communities where tobacco harms are high but uptake of local Stop
Smoking Services has historically been low.
5.5  The evaluation and
co-design work has considered options for taking an holistic approach to supporting people to address
multiple health risks and address wider needs that affect
people’s smoking behaviour. It has considered the most
appropriate delivery model for achieving the priorities for the new
service (such as a single integrated service, lead provider network
or multiple contract lots and insourced provision).
5.6  Following a detailed
benchmarking exercise, it was confirmed in the Business Case Report
that the budget for the new service, whilst including the
new/enhanced elements outlined above, can be reduced (see savings
proposals in section 7).
5.7  Following a number of
central government announcements both prior to and during the
tender being opened, this service has been designed to be flexible
to the allocation of additional streams of central government
funding. These streams include the Stop to Swap scheme, financial
incentives for pregnant smokers and, most recently, the additional
funding for local Stop Smoking Services announced by the Prime
Minister in early October 2023 (see section 6.1.1)
 
Alternative Options
(considered and rejected)
 
5.9  Option 1 - End the service
at the currently scheduled end date of 30/06/2024 and do not
commission a new Stop Smoking Service
 
This option would allow for savings
to the Council, however in doing so it would end a vital service
for the tens of thousands of smokers living locally and would,
therefore, have a detrimental impact on population health and risks
increasing health inequalities in City and Hackney. This option
does not take account of the significant health harms caused by
smoking in the local context:
 
· 
smoking is the primary cause of premature death and preventable
illness in England - one in two long term smokers will die from a
smoking-related disease
· 
the annual societal costs of smoking in Hackney are estimated at
over £100m each year (equivalent data are not available for
the City)
· 
according to data from the Annual Population Survey in 2021,
smoking prevalence in Hackney amongst adults (age 18+) was 14.2%,
higher than our 15 ‘statistical neighbours’ (again,
equivalent data are not available for the City).
 
Whilst ending the service would
release short-term savings, it should be noted that stop smoking
interventions are the most cost effective (often cost
‘saving’) of all public health interventions and have
the greatest impact on reducing health inequalities (along with
domestic violence prevention).
 
5.9  Option 2 - Reprocuring the Stop Smoking Service based on the
current service model and specification
 
The current Stop Smoking Service
performs well for those who use it. Hackney’s outcomes ranked
3rd out of 16 in 2020 when compared to its statistical neighbours
for both “smokers setting a quit date” and for
“self-reported successful quits at 4 weeks”.
Hackney’s performance against these national smoking
indicators is also consistently above the England average.
 
However, the service has been less
successful in attracting referrals from some high risk groups and
high prevalence communities (including pregnant/post partum women, smokers from the Turkish/Kurdish
community and those in routine and manual occupations). A
re-designed service that is more responsive to the wide-ranging
needs of City and Hackney’s diverse smoker population will
help to reduce stubborn inequalities in service uptake.
 
5.10  Option 3 - Recommission a new Stop
Smoking Service based on a (wholly outsourced) redesigned service
model and specification
 
This option allows for the
incorporation of a number of improvements to the service model (see
section 5.2) and ensures that the service is up to date with the
latest guidance from NICE and the wider policy context(see section 5.3).
 
Whilst this option considers the
latest evidence and insight available for City and Hackney, this
fully outsourced Stop Smoking Service model does not give full
regard and commitment to the Hackney Labour Manifesto 2022-26 to
review all outsourced services, with a view to bringing them
in-house. A fully outsourced option would exclude some of the key
advantages to insourcing particular elements of this service, as
detailed in section 5.2.6.