Purpose

Reason for the decision
 
Public Health are
undertaking a comprehensive review of Public Health funded services
as part of a transformation programme. The programme of work is
complex and many of the contracts expire at the same time. This is
because they form part of a partnership with Kent Community Health
Foundation Trust (KCHFT).
 
The proposal is to extend the KCHFT partnership so that the
transformation work can continue, in a way that does not
de-stabilise, service delivery, workforce and minimises the impact
to staff, residents and providers. It also allows time for
interdependencies and joint commissioning to be fully
considered.
Background
 
The
purpose of the Public Health Transformation programme is to improve
future services, with the following aims: 

-     
Delivering best value and to spend the Public Health
Grant in a way that delivers the biggest impact.

-     
Improving services for Kent residents, targeting
people who need services the most, with services being informed by
evidence, joined up and aligned internally and with other related
services.

-     
Ensuring that services are fit for the future,
sustainable and responsive to need. This includes managing changes
in demand, ensuring provider capacity and capability, being
insights led, responding to societal changing trends and utilising
new technology. Focusing on prevention, reducing health
inequalities.
 
The
programme is reviewing twenty-one Public Health funded service
areas simultaneously to help explore options for integration,
efficiency and maximising impact. Many of the services in the
review expire at the same time as they form part of an overarching
partnership contract with Kent Community Health Foundation Trust.
This includes many mandated services such as health visiting and
sexual health. The partnership was put in place in March
2017[1] and has supported the delivery
of a number of shared objectives such as; influencing public health
systems, reducing health inequalities, delivering innovation and
improving efficiency.

Performance and quality of service delivery during the partnership
has been very good, with KCHFT consistently meeting set targets
(targets that are regularly reviewed). Many of the services
delivered by KCHFT are specialised services.
 
The
recommendation is to put in place a twelve-month extension for the
partnership to support the delivery of the transformation
programme.
 
A
partnership extension would help to:

Minimise risk of destabilising the workforce; these are
specialist roles and as the end of the contract approaches staff
may choose to move organisation. The change of service model and/or
supplier needs to be carefully managed.
Maximise interdependencies – this is a complex programme
with many interdependencies and sufficient time is needed to
explore and consider these in full. For example, HIV commissioning
which is currently part of this service but funded by NHSE (NHS
England) and due to transfer to the ICB (NHS Kent and Medway
Integrated Care Board).
Allow
time to balance resources of Public Health and Integrated
Commissioning staff in KCC across a number of recommissioning
programmes.
Develop comprehensive business cases for alternative and
financially costed service models.
Develop understanding and application of new procurement
legislation by taking a stagged approach across the
transformation.
Build
further insights (both service user insights and insights with
underserved communities who do not currently access services, but
may benefit from accessing services)
Build
engagement with existing providers and other providers in the
market and help to shape commissioning models.

 
The partnership
extension would help ensure service stability, whilst fully
exploring alternative service delivery options and putting new
contracts in place. During the transformation work, some services
would not use the full twelve-month extension. New, staggered
contract start dates would be put in place for services. Some
services (substance misuse) are likely to start new contracts in
January 2025, because there is little change in delivery and
greater clarity on model. Other services may start new contracts
later in the year, because they want to align with external
commissioning opportunities or because there are opportunities to
deliver the services differently by competitive procurement or
insourcing.
Any
substantive service change or updates required prior to the next
partnership agreement decision would be managed via fresh
decisions. 
 
The
proposed twelve-month partnership extension would include contract
break clauses.
 
All
parties will remain committed to delivering efficiencies and
financial savings in the extension year in line with current terms
to ensure best value. KCC will closely monitor expenditure
alongside performance. 
 
It is
important during the Public Health Transformation programme review,
not to de-stabilise the existing supplier, KCHFT. KCHFT delivers a
number of services for both KCC and the Kent and Medway ICB
(Integrated Care Board), therefore it is important for KCC and the
wider health system to ensure this supplier and any potential
change, is managed carefully in order to not disrupt KCC’s
services and also services provided by KCHFT for the ICB. There is
an extremely limited choice of alternative providers in the
market.
 
 
Options (other options considered but discarded)

 
The alternative
options, considered but disregarded include: -
 

1)   
Option 1 - Re-procuring services and putting in
place new contracts for 1st April 2025. This option has
been dis-regarded because there would be little time and officer
capacity to ensure services offer the best value and will not allow
time to explore alternative service delivery models. With the
extension, the service and the workforce will, as a result, not be
de-stabilised and service quality will not be
compromised.

2)   
Option 2 – Contracting outside of the
partnership This option is not considered suitable in the
short-term as the partnership offers Kent, high quality, stable
services within a financial envelop that offers value for money,
operating within a partnership. The risk of discontinuing these
services in the partnership, at this time, could have an adverse
impact on the provider, their workforces and quality.
 
 
Supporting KCC’s
Strategy
Securing Kent’s
Future
This
approach aligns with Securing Kent’s Future and the
council’s Best Value Statutory responsibility.

Public
Health services are preventative services with evidence of good
Return on Investment and can help. reduce demand into other KCC
services and across the health system.

Extending the two current partnerships for twelve months,
ensures that transformation can take place in a way that minimises
potential risks (and associated costs) and takes advantage of
future service options that will provide the best value for Kent
and its residents.  It supports the
following objectives: -
 

Objective 4 – Further transforming the
operating model of the Council
 
The
transformation programme offers the opportunity to review Public
Health services and to ensure services are efficient, offer best
value and are sustainable.
 
 
Framing Kent’s
Future
The Transformation Programme aligns with KCC’s ‘Framing
Kent’s Future’ and in particular: -
 

Levelling up Kent – Public Health services
will remain focused on reducing health inequalities across the
county and where needed most.

New models of Care and Support – the Public
Health transformation programme will review existing services and
ensure they are efficient and sustainable.

 
The
transformation programme also supports the NHS Kent and
Medway  Integrated Care
Board.
 

Procurement legislation

Integrated
Commissioning have sought internal and external legal advice on the
matter of extending the partnership due to the new and untested
nature of the new PSR procurement regulations. The advice received
is detailed below.
On the basis that the
main subject matter of the KCHFT agreement is healthcare services,
and providing that the agreement was entered into pursuant to
regulation 12(7) of the Public Contracts
Regulations 2015 (PCR), the agreement falls
to be treated as an agreement for healthcare services for the
purposes of the Health Care Services
(Provider Selection Regime) Regulations 2023
(“PSR”).
 
The PSR regulations
provide a few grounds for making a contract modification without
having to follow a new PSR procurement process. Depending on the
confirmation of the contract values involved, Regulation 13(1)(d)
of the PSR provides a ground to rely upon for the agreement to be
extended provided that the terms of the extension would not render
the contract materially different in character and the cumulative
change in the lifetime value of the contract since it was entered
into or concluded would be less than 25% of the lifetime value of
the original contract when it was entered into or
concluded.
 
It should be noted
that if relying upon this ground, the Council must submit a notice
of the modification for publication on the UK e-notification
service in relation to the agreement, within 30 days
of the modification as the extension is worth more than
£500,000.
 
 

[1]
Issue details - 19/00064 - Kent County Council and Kent Community
Health NHS Foundation Trust collaborative partnership - delivery
and transformation of Public Health services

Decision

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

 

(a) 
EXTEND the Kent
Community Health NHS Foundation Trust (KCHFT) partnership for
twelve months, from 1st April 2025 to 31st
March 2026, to support the Public Health Service Transformation
programme; and

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