Purpose

Proposed decision
 
To agree the
procurement and award of contracts of the Kent Young Persons Drug
and Alcohol Service.
 
 

Reason for decision
Kent
County Council has statutory responsibility as a condition of its
Public Health Grant to provide specialist Substance Misuse Services
aimed at reducing the harm caused by drugs and alcohol and to
improve the health and wellbeing of Kent’s
population. 

 
The
Kent Young Persons Drug and Alcohol Service is due to expire on 31 January
2025 and therefore a key decision is required to plan for beyond
this date.
 

Background
The
provision of drug and alcohol services aligns with local and
national strategies. Locally, the services support the levelling up
agenda and integrated model of care outlined in the KCC Strategic
plan 2022-26 (Framing Kent’s Future) as well as the
improvement of the local early prevention and treatment and
recovery system as outlined in the Kent Drug and Alcohol Strategy,
2023-2028.
 
The
proposed decision supports Securing Kent’s Future 2022-2026
under Objective 3: Policy choices and scope of Council’s
ambitions, by evaluating the statutory minimum requirements in
order to create efficiencies.

 
Nationally, drug and alcohol services support the
Government’s 10-Year Drug Strategy ‘From Harm to
Hope’ (2021). The strategy is supported by a grant, the level
of which has been confirmed for three years, whilst the remaining
seven await confirmation. Kent has supported the implementation of
the national strategy by investing this money into existing
contracts.
 
Details of the
contract are as follow:
 

-     
Kent Young Person Drug and Alcohol Service (Drug and
Alcohol Support for those aged under 25), delivered by We Are With
You (With You)

-     
Commenced on 1 January 2018 until 31 January
2025
 

Options
Kent
County Council (KCC) Public Health is leading a transformation
programme designed to improve service delivery to communities,
particularly targeting underserved communities. The transformation
work aims to ensure that services are efficient, evidence-based,
deliver outcomes and best value.
 
Nationally, the drug and alcohol services support the 2021
10-Year Drug Strategy and associated investment linked to national
objectives of improving numbers in treatment, continuity of care
from prison to community, quality of treatment and reduction in
drug and alcohol related mortality. The grant funding cannot be
used to prop-up core service delivery and must be used for
additional activity.
 
The
service delivers various interventions in order to meet the
objectives including:

·      
Support in the community (youth hubs, community
centres, cafes etc) offering advice and support with substance use
through a trauma-informed, harm reduction approach and psychosocial
interventions

 

·        
Support in schools, running early intervention harm
reduction groups and a preventative programme called RisKit, specifically for young people who engage in
risk taking behaviours, including substance use
 

·        
Re-Frame which works with Kent Police to identify
young people, who come to the Police’s attention for Class B
and C drug possession (excluding those where intent to supply is
suspected) and works with the young person as an alternative to
criminal proceedings, to educate them around substance use, with
the intention of reducing their future offending.
 

·        
The Sunlight Project which is a pilot aimed at
supporting 7-11 year olds impacted by someone else’s
substance use via a self-esteem / resilience building programme
delivered in schools
 
As a
result of the additional investment from Central Government to
sustain these national strategic objectives, Kent is in receipt of
£11,424,253 investment via a number of Office for Health
Inequalities and Disparities (OHID) grants over the period April
2022 to March 2025. A condition of the additional OHID grant
funding is that local authorities maintain their investment into
the local substance misuse treatment and recovery system from their
public health grant at or above the levels reported in
2020–2021. Therefore, whilst it was possible to consider
efficiencies as part of the transformation, any savings made needed
to remain invested in the services.
 
An
options appraisal was developed which considered a range of changes
to the service delivery model, based on collaboration with key
stakeholders and young people with lived experience.

 
The
preferred option identified was to procure Kent Young Persons Drug
and Alcohol Service under the new Provider Selection Regime, with
an enhanced service specification, underpinned by collaboration
with stakeholders and young people with lived experience. The
contract will be in place from 1 February 2025 to 31 January 2027
(two years with two additional extension options, one for two years
and the second for one year).

 
Due to
uncertainty as to whether OHID grant funding will continue
post-March 2025, all enhancements made will be within the financial
envelope of the Public Health Grant. Suggested changes
include:

Refining pathways for 18-25 year olds so it is clear which
service supports this cohort, depending on their
circumstances
Specifying pathways for children impacted by someone
else’s substance use. Adult and young persons’ services
working together to identify these young people, develop pathways,
and deliver joint interventions, thus expanding the impact on
families.
Education around County Lines; this is a particular issue in
Kent due to the proximity to London. Education from the provider
may act as a preventative measure.
Added
reporting of opportunistic smoking quits; there is not currently a
stop smoking offer for those under the age of 18 in Kent. The
service is positioned well to deliver stop smoking advice as part
of Making Every Contact Count (MECC).

 
Advantages include:

The
opportunity to draw upon local and front-line expertise when
identifying potential service improvements
Increased buy-in of all stakeholders as a result of
collaboration
Focus
on achievable improvements, such as defining efficient
pathways
Anticipated changes to the specifications are ones that can
happen within the current financial envelope

 
 
Options
considered but rejected included:

 

-     
Keep current service the same - no change/ do
nothing - The drug landscape has changed since the current service
was tendered; it is important that services are fit for purpose and
meet the young person’s presenting needs and therefore this
was a non-viable option

 

-     
Discontinue/ decommission current service -
Decommissioning the service was concluded as a non-viable option
that would place KCC in breach of the Public Health Grant
conditions.

 

-     
Combine the service with adult services – the
offer for young people is distinct from that offered to adults and
requires expertise and specialist knowledge i.e., delivering drug
education and harm reduction in a way that is tailored
appropriately. It was felt that combining the services ran the risk
of diluting the offer.
 

-     
Alignment with the Children and Young People (CYP)
service transformation; the decision was made to proceed separately
due to the imminent contract end dates for the Young Persons
service. Implications and opportunities as part of the CYP
transformation will be considered in due course.
 

Procurement
 
As of 1
January 2024, the recommissioning of drug and alcohol services
falls under the new Provider Selection Regime (PSR) for procuring
health care services in England by organisations termed relevant
authorities, including NHS bodies and Local Authorities.
 
The PSR
was introduced under the Health
and Care Act 2022 with the
intent to: introduce a flexible and proportionate process for
deciding who should provide health care services; provide a
framework that allows collaboration across systems; ensure that all
decisions are made in the best interest of patients and people with
lived experience.
 
Following approval of the key decision, a PSR-compliant
procurement process will be run to select suppliers for the new
service.
 

Financial Implications

 

The funding for this contract would be funded
entirely from the Public Health Grant and, should OHID confirm
additional grant funding beyond March 2025 linked to the 10-year
national drug and alcohol strategy ‘From Harm to Hope’,
this would be used for additional activity within the contract. The
additional grant-funded activity could include a continuation of
activity currently funded by the existing OHID grants but
innovation would also be considered, should funding
allow.

 

The estimated financial commitment  for a five year contract for the Kent Young
Persons Drug and Alcohol Service is £4,099,533.88 This equates to an average
of approximately £820,000 annually.

 

The above values reflect a 1% per year annual uplift
to the contract (with the exclusion of the first year). The uplift
reflects the need to retain the workforce; services have highly
specialised roles and high, complex caseloads.
 

In terms of affordability, the annual increase in
the Public Health Grant is only generally known for the current
year, so it is not possible to know with certainty that there will
be sufficient Public Health Grant to fund the increase. If the
Public Health Grant increases prove to be insufficient then savings
will need to be delivered elsewhere in the programme.
 
Additional OHID grant funding is only currently confirmed until
31 March 2025. Should this funding be extended beyond that point,
it will be treated as a contract variation and will be in addition
to the above estimated values and will require the providers to
deliver additional activity.
 
A key
decision (22/00041)
has already been taken to accept and deploy the
additional money received, therefore a further decision would not
be required for deployment of further funding.

 

Legal Implications

 
Under
the Health and Social Care Act 2012 [8], Directors of Public Health
(DPH) in upper tier (UTLA) and unitary (ULA) local authorities have
a specific duty to protect and enhance the population’s
health.  
 
KCC
commissions these services as part of its statutory
responsibilities and as a condition of its Public Health Grant.
Kent Drug & Alcohol Services aim to reduce the harm caused by
drugs and alcohol and improve the health and wellbeing of
Kent’s population. The local authority’s Public Health
grant requires the Authority to “have regard to the need to
improve the take up of, and outcomes from, its drug and alcohol
misuse treatment services.”
 
The
recommissioning of these services will fall under the

Provider Selection
Regime (PSR) introduced under
the Health
and Care Act 2022.  Appropriate legal advice will be sought in
collaboration with the Governance, Law & Democracy team and
will be utilised to ensure compliance with relevant legislation;
the Provider Selection Regime is still in its infancy and so
commissioners will be working closely with this team as well as the
Commercial and Procurement Team.
 

Decision

As Cabinet Member
for Adult Social Care and Public Health, I agree to:
 

APPROVE the procurement and award of a contract for the Kent
Young Persons Drug and Alcohol Service effective from 1 February
2025 to 31 January 2027 (two years with two additional extension
options, one for two years and the second for one year)

 

DELEGATE authority to the Director of Public Health to take
relevant actions, including but not limited to, entering into and
finalising the terms of relevant contracts or other legal
agreements, as necessary, to implement the above decision

 

DELEGATE authority to the Director of Public Health, in
consultation with the Cabinet Member for Adult Social Care and
Public Health, the exercise of any extensions permitted in
accordance with the extension clauses within the contract.

 

CONFIRM that future Office for Health Improvement and
Disparities (OHID) grant funding (if received) be deployed against
this area of work in accordance with key decision
22/00041