Purpose

Proposed
decision
 
The proposed decision is to extend the current
MTW (Maidstone and Tunbridge Wells NHS Trust) partnership contract
that is due to expire 31st March 2025 (for a period of 12 months to
31st March 2026), to support the work across the Public Health
Transformation programme.
 
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 some of the contracts expire at the same time because
they form part of a partnership with MTW (Maidstone and  Tunbridge Wells NHS Trust). The services delivered
by MTW are highly specialised and there is a limited market of
alternative providers.
 
The proposal is to
extend the MTW 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: -

1)   
Delivering best value and to spend the Public Grant
in a way that delivers the biggest impact.

2)   
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.

3)   
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.
 
Services that are in-scope are funded through the ring-fenced
Public Health grant (and do not draw on KCC core
funding). 

The
transformation programme brings many opportunities for example,
changing suppliers (on some services this may produce a saving),
consideration of bringing services in house, aligning commissioning
with external organisations, changing delivery model and delivering
potential savings by operating services differently.
 
MTW
entered into a Co-Operation Agreement with Kent County Council on
3rd May 2019 and this agreement expires on
31st March 2025.
 
MTW
provide KCC with West Kent sexual health services, HIV services and
online sexual health testing across the county.
The MTW
partnership was put in place in 2019 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. The partnership has enabled the successful
management of significant challenges including financial pressures.
It has supported stability for the workforce, in turn delivering
high quality services across Kent.
 
The
transformation programme is complex, with many interdependencies
such as ICB recommissioning, Family Hubs funding, OHID grants, as
well as cross-cutting themes that are common across services, such
as workforce training, quality and property.

Significant care is needed maintain statutory services delivered to
Kent residents, to ensure that the workforce is not destabilised
and to manage internal and external staffing resources associated
with the contractual partnership changes.

 
The
recommendation is to put in place a twelve-month extension for the
partnership.
 
The
benefits of taking this approach are that the work will progress
where it is possible to progress quickly, but where there are
details still to be worked through, due time and consideration are
given.

This approach will also ensure that Public Health and Integrated
Commissioning teams have the capacity to deliver the large-scale
transformation and that due diligence is taken in relation to the
new Healthcare procurement legislation (see legal
section). 
 
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.

 
Performance and quality of the services delivered by MTW are
currently good, with the provider meeting set targets (targets that
are regularly reviewed).
 
Sexual
Health services provide good return on investment (ROI), with LARC
(Long Acting Reversible Contraception) providing £13:£1
ROI and Online STI services delivering a £2.5:£1 ROI.
[1]
 
During
the extension year, all parties will remain committed to delivering
efficiencies and financial savings, in line with current terms to
ensure best value. KCC will continue to closely monitor expenditure
alongside quality and performance. 
 
The
proposed twelve-month MTW partnership extension will include
contract break clauses.
 
Any
service changes / updates required prior to the next partnership
agreement decision would need to be managed via new
decisions.
 
Options (other options considered but discarded)

 
The alternative
options, considered but disregarded include: -
 
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.

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. The services also ensure that we support
reductions in demand into other KCC services and across the health
system.

Extending the two (MTW and KCHFT) 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] Kent Public Health
Observatory 2023, based on national evidence.

Decision

As Cabinet Member for
Adult Social Care and Public Health I agree to: 
 
(a) 
EXTEND the MTW
(Maidstone and Tunbridge Wells NHS Trust) 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.