Purpose

Proposed
Decision
 
That the Cabinet Member for Adult Social Care
and Public Health agree to recommission the East and West Kent Drug
and Alcohol Service
 

Reason for decision
Kent
County Council has a 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 the people of Kent. 

 
The two
contracts under the Adult Kent Drug and
Alcohol Services are 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 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.
 
The two contracts that
make up the Adult Kent Drug and Alcohol Treatment Services in Kent,
both of which are due to end on 31 January 2025, are:
 

·      
West Kent Adult Drug and Alcohol Service (Tunbridge
Wells, Tonbridge & Malling, Maidstone, Gravesend, Dartford,
Sevenoaks) - delivered by Change, Grow, Live (CGL). The contract
commenced on 1 April 2016 until 31 January 2025
 

·      
East Kent Adult Drug and Alcohol Service (Swale,
Canterbury, Thanet, Dover, Folkestone and Hythe and Ashford),
delivered by Forward Trust. The contract commenced on 1 May 2017
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:

·        
Psychosocial support on both a group and one-to-one
basis, utilising techniques such as motivational interviewing and
cognitive behavioural approaches.

·        
Clinical interventions include prescribing for
detoxification, opiate substitution therapy, and relapse prevention
medications

·        
Harm reduction, including screening for blood borne
viruses, vaccinations for hepatitis B, provision of needle exchange
and Naloxone (used to quickly reverse an opioid
overdose)

·        
Access to community or inpatient detoxification, and
to community or residential rehabilitation
 
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
2020–21. Therefore, whilst it was possible to consider
efficiencies as part of the transformation, any savings made need
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 people with lived experience.
 
The
preferred option identified was to procure Kent Adult Drug and
Alcohol Services under the new Provider Selection Regime, with an
enhanced service specification, underpinned by collaboration with
stakeholders and people with lived experience. The contracts for
both East Kent and West Kent will be in place from 1 February 2025
to 31 January 2029 (four years with two additional two-year
extension options).
 
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.
Clearly set out the offer for vulnerable groups, including the
need for women-specific groups, particularly amongst those who may
have experienced trauma
Outline the need for improved tier 4 pathways; tier 4 services
include inpatient detoxification and residential rehabilitation.
There is a need for Kent services to have a uniform approach and to
ensure vulnerabilities are accounted for, such as those who are
rough sleeping.

 
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 people’s presenting needs and therefore this was a
non-viable option

 

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

·        
Split the service in two – one focusing on
detox and treatment and the other focusing on recovery - it was
deemed that this would add confusion to an already complex system
within Kent.
 

·        
Bring pharmacy contracting responsibilities in-house
- established relationships are already in place with providers,
bringing pharmacy provision in-house risks limiting the pool of
available pharmacies, which in turn may create a barrier for people
in terms of access.
 

·        
Stop using fixed premises and move to a co-location
model – it is important that drug and alcohol services have a
physical presence in accessible areas in order to provide drop-ins
and needle exchange. Removing this presence risks missing
opportunities to help people at the point they are motivated to
seek support.
 

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 service
users.
 
Following approval of the key decision, a PSR-compliant
procurement process will be run to select suppliers for the new
service.
 

Financial Implications

 
Public
Health estimate a financial commitment as below for each contract
according to the recommended length of each contract:
 

·      
The estimated financial commitment of
£43,461,175.80 for an 8-year contract for the East Kent Drug
and Alcohol Service.

 

·      
The estimated financial commitment of
£30,291,915.85 for an 8-year contract for the West Kent Drug
and Alcohol Service.
 
The
exact figures will be subject to factors such as costs of
medications, pharmacy costs and staff retention for highly
specialised roles. All funding will come from the Public Health
Grant.
 
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 OHID grant money received, therefore a further decision
would not be required for deployment of further OHID 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 and Alcohol Services aim to reduce the harm caused by
drugs and alcohol and improve the health and wellbeing of the
people of Kent. 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 and 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 contracts for the East
and West Kent Community Drug and Alcohol Services effective from 1
February 2025 to 31 January 2029 (four years with two additional
two-year extension options), 

 

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