Decision details

Proposed Decision:

To approve the commissioning of the Sexual Health Services from 1 April 2026 up to no later than 31^st March 2031

Reason for the decision

Kent County Council (KCC) has a statutory duty to provide certain sexual health services as per Section 6 of The Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013. These include the three broad responsibilities of:

I.              Testing and treatment for sexually transmitted infections (STIs) excluding the treatment of Human Immunodeficiency Virus (HIV).

II.             Advice on, and reasonable access to a broad range of contraceptive substances and appliances.

III.           General advice and promotion of key messages to enable positive sexual health outcomes and to prevent ill sexual health.

STIs and unplanned pregnancies are significant contributors to poor health outcomes, and provision of these statutory services plays an important role in reducing the negative consequences and costs of ill sexual health.

Several sexual health service contracts are due to expire on 31 March 2026 and therefore a key decision is required to plan for beyond this date to ensure KCC is compliant with its statutory duties.

KCC is currently in a partnership arrangement with our East Kent and West Kent Integrated Sexual Health Service providers, however, due to changes in procurement legislation, this contractual option is no longer available and therefore the services need to be re-procured.

Background

The provision of sexual health services aligns with national strategies such as the Women’s Health Strategy for England by the Department of Health and Social Care (2022) and delivers to the Public Health Outcomes Framework, which aims to focus commissioned service delivery on areas which will have a positive impact upon public health outcomes for the population.

Locally, the provision of the services supports the Kent and Medway Integrated Care Strategy and delivers the recently published Kent Sexual Health Needs Assessment 2024

The sexual health service contracts in scope of this decision, which are due to expire on 31 March 2026, are:

·        West Kent Specialist Integrated Sexual Health Service including HIV treatment and care (Maidstone, Gravesend, Dartford, Tonbridge & Malling, Tunbridge Wells, Sevenoaks) – Provided by Maidstone and Tunbridge Wells NHS Trust (MTW). The contract commenced on 1 April 2019.

·        East Kent Specialist Integrated Sexual Health Service including HIV treatment and care (Swale, Canterbury, Thanet, Dover, Folkestone & Hythe, Ashford) – Provided by Kent Community Health NHS Foundation Trust (KCHFT). The contract commenced on 1 April 2020.

·        Psychosexual Therapy (Kent wide) – Provided by KCHFT. The contract commenced on 1 April 2020.

·        Community Pharmacy Sexual Heath Service (Kent wide) – Sub-contracted to Kent pharmacies by KCHFT. The contract commenced on 1 April 2020.

·        Online STI Testing service (Kent wide) – E-Bureau patient management team provided by MTW, the contract for testing kits and laboratory access is sub-contracted to Preventx by MTW. The contract commenced on 1 April 2019.

NHS England (NHSE) has had a long-standing statutory obligation to provide HIV treatment and care services. To promote a more integrated approach and seamless patient experience, KCC entered into a Section 75 agreement with NHSE to incorporate HIV treatment and care services into the KCC commissioned sexual health service offer. The agreement started in 2020 and has been renewed on an annual basis. In the financial year 2025/26, the statutory responsibility for commissioning HIV treatment and care services is transferring from NHSE to the Kent and Medway Integrated Care Board (ICB). KCC will continue to deliver a Section 75 agreement with the ICB to continue providing these services.

Options for re-commissioning sexual health services including the recommended option and discarded options

A comprehensive review of those services funded by the ringfenced Public Health Grant has been undertaken as part of a transformation programme. The programme has been designed toimprove service delivery to communities, ensure that services are efficient, evidence-based, deliver outcomes and best value.

An options appraisal was developed which considered a range of changes to the service delivery model, based on collaboration with key stakeholders, a peer review exercise, a public insights report and a review of the marketplace.

Preferred Option

The recommended option identified is to retain these services to ensure the council meets its statutory obligation, but to utilise the learning from the engagement with stakeholders to enhance delivery in future contracts, creating a more uniform and equitable approach to delivery across West and East Kent.

Future service model principles are:

• Enhanced integration within the existing services by aligning contracts to geographical areas and fostering collaboration between providers.
• Equitable service as service users receive the same service regardless of geographical area in the county.
• Value for money benefits demonstrated with focus on outcomes.
• Smoother service user pathways as psychosexual therapy and the E-Bureau function become embedded into the integrated service for the service user’s geographical provider.
• Opportunities for collaboration, sharing of best practice and fostering a whole systems approach.

Options considered but rejected included:

• Keep all current services the same – no change / do nothing – Whilst the services will mostly remain the same, a greater focus on consistency and integration in the geographical provider’s offers was deemed necessary to generate efficiencies and enhancements, hence the rejection of this option.

• Discontinue / decommission the services – Decommissioning the service was concluded as a non-viable option that would place KCC in breach of the Public Health grant conditions. KCC has statutory responsibilities to provide sexual health services.

• Add more to the service offer – do the maximum – Whilst this would be beneficial for Kent residents, there is no additional funding to enhance the service in a manner which requires more financial investment. As the service is meeting statutory obligations and performance expectations, further enhancements can be delivered by via efficiencies within the existing financial envelope.

The contracts for the service will run for a maximum of 5 years. Procurement and legal advice is being sought as to the permissible lengths of each of the contracts.

How the proposed decision supports the Framing Kent's Future - Our Council Strategy 2022-2026 

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).

How the proposed decision supports Securing Kent’s Future 2022 -2026: Securing Kents Future - Budget Recovery Strategy.pdf

The proposed decision supports Securing Kent’s Future 2022-2026 as a full review of options has been completed that included and prioritised best value, alongside ensuring our statutory minimum duty has been reviewed.

How the proposed decision supports the Kent and Medway Integrated Care Strategy

Kent and Medway Integrated Care Strategy

Sexual Health services, in collaboration with partners across the system, contribute to the Kent and Medway Integrated Care Strategy by supporting happy and healthy living for all through a preventative and early identification approach to STIs. Furthermore, this decision specifically will allow for greater focus on reducing health inequalities. Sexual health also supports giving young people the best start in life through health promotion and prevention elements of the contracts. Finally, services aim to empower patients and carers through the contributions to improvement in health and care services.

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

I.               APPROVE the proposed Sexual Health Services commissioning model and agree to the re-commissioning and award of contracts relating to Kent’s Sexual Health services effective from 1 April 2026 for a maximum of 5 years.

II.             AGREE that Kent County Council extend the Section 75 agreement with the Integrated Care Board and for KCC to commission HIV treatment and care services together in line with current arrangements.

III.            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.

IV.           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 contracts.

DELEGATE authority to the Director of Infrastructure in consultation with Director of Public Health to take relevant steps to resolve property matters in relation to implement this decision