Agenda and minutes

Select Committee - Commissioning
Tuesday, 4th February, 2014 2.00 pm

Venue: Swale 1, Sessions House, County Hall, Maidstone. View directions

Contact: Denise Fitch  01622 694269

No. Item


2.00pm - Karen Sharp, Head of Public Health Commissioning (KCC) pdf icon PDF 28 KB


(1)  The Chairman welcomed Karen Sharp to the meeting and invited her to outline to the Committee her role in supporting KCC, and to answer questions from Members of the Committee.


(2)       Karen stated that she been in post since June 2013, as her role is a relatively new position.  Public health has a £50m grant budget (increasing to £55m in 14/15) although KCC will spend far higher than this on a range of public health activities. The aim is to improve the health of the population, through a range of programmes including drugs and alcohol; sexual health; decrease inequalities and smoking with community intervention.  2 services have a budget of over £12 m each – Drugs and alcohol and sexual health. Currently, public health underperforms in health checks; infant feeding; and smoking cessation.  Hoped the wider determinants of KCC can help meet health outcomes  through examples such as  - delivery of sport, targeted intervention with vulnerable groups, education.


Karen has worked in KCC, the NHS and in the voluntary sector both as a commissioner and also in provider organisations in the voluntary sector.


Question – Following the closure of the MIU - minor injury unit, would it be possible to combine such services with those provided by public health, NHS and Community Groups?


(3)       Karen stated that although public health grants covered a wide range of services, Public health was not involved in the commissioning of MIU’s as it is the responsibility of the CCG’s. Better integration of NHS, CCG, Public Health, Social care  will happen through the evolving structures of the Health and Wellbeing Boards. These structures are still relatively immature but progressing well. As go forward will see more joint commissioning and outcomes.


Question – With a £50m budget, how much involvement does the Government have in stating how that amount was spent and where; and having taken over other contracts, was it possible to change more and adapt to KCC’s liking?


(4)       Karen explained that the public health grant came with conditions and was ring-fenced.  There are 4 mandated services and a broad public health  outcome framework crossing a range of services – but KCC decides the services to deliver these outcomes. KCC will need to demonstrate improvement in public health outcomes within the framework.

KCC is asked to assure that the grant is spent on what it is intended for, and provide assurance statements to ensure it is spent appropriately.


(5)       Some services that KCC has inherited were already underperforming.  Contracts were novated to KCC as part of transition. KCHT receives the highest spend (£20m.) to provide range of services, some are underperforming and none have gone to market. Part of the public Health team role is to separate out this contract and put services out to market to be competitively tendered over the next year. In the novated contracts there was detail about what service should look like, outputs but targets and outcome measures were not well detailed. Lot of work to prepare for  ...  view the full minutes text for item 13.


3.00pm - Ryan Campbell, CEO and Karen Tyrell, Director, Development and Marketing, KCA pdf icon PDF 17 KB

Additional documents:


1.            The Chairman of the Select Committee welcomed the Chief Executive Officer of KCA,  Ryan Campbell, and the Director of Development and Marketing, KCA, Karen Tyrell, to the meeting.


2.            Ryan and Karen had received questions and themes that the Select Committee were investigating in preparation for the meeting.  A copy of their response was included in the papers and considered by the Select Committee.


3.            Ryan began by explaining that KCA was a registered charity that provided drug and alcohol misuse and mental health services.  KCA provided some mental health services in Kent but no longer provided adult and drug and alcohol services sincenew contracts were awarded to different providers.  KCA provided a greater proportion of services outside Kent.  He advised that the competitive market had worked in KCA’s favour and its business had doubled in size through expansion.


4.            Grants could be seen as providing voluntary organisations with an inbuilt predisposition not to have to change or innovate – which eventually restricts services.


5.            Ryan advised that KCA’s experiences with KCC and commissioning were pretty good – even when they not won contracts- and without issue regarding procurement processes.  There was a tendency among providers to consider the commissioners as being good if they won a contract or the commissioner had a problem with them if they are unsuccessful in gaining a contract.


6.            There was little public information on commissioning nationally; so unable to equate whether KCC, as a commissioner, was good or bad or cost effective at as no measurement. But commissioning is expensive for external organisations and for KCC.


7.            Commissioning can be expensive, the principle part of which was unproductive in time and expensive to resource.  For example from 5 bids tendered for may win one contract. Subsequently the funding lost in failed bids had to be recouped within those contracts won.   If there was a way that this process could be streamlined reducing the cost, money would be available for more projects in the community.


8.            Ryan suggested that there had been a general unpleasantness since 2006 regarding the competition for contracts in the voluntary sector. KCA had 3-6 year contracts, which meant that a third of its business was at risk every year which was stressful as always looking down the barrel of a gun.  For some smaller organisations this could equate to 100% of their funding and their continued existence.


9.            Statistically, KCA and every provider will lose contracts, therefore there was a fast turn around to win contracts to keep the organisation running.  With shorter contracts the reality is that staff were TUPED every few years so it was difficult to retain loyalty amongst frontline staff that are continually swapped between providers.  Equally, senior staff could lose their jobs if they cannot maintain business levels so it was difficult to keep them motivated. 


10.         Ryan said that when he started in the voluntary service there was a friendlier environment which saw shared information and best practice across organisations.  Now information  ...  view the full minutes text for item 14.


4.00pm - Sean Kearns Chief Executive and Stephen Bell, Director of Business Development, CXK pdf icon PDF 17 KB

Additional documents:


(1)       The Chairman welcomed Sean and Stephen to the meeting and invited them to outline their roles and to answer questions from the Committee.

(2)       Sean stated that he had been the Chief Executive of CXK for the past three and a half years, this organisation had previously been called Connexions Kent and Medway.  This organisation had a long established relationship in Kent for delivering services firstly under GOSE (Government Office for the South East) and under contract to KCC from 2008.  Since 2012 CXK had procured contracts through the early intervention framework e.g. Parenting Services, Health & Wellbeing Services and a number of youth services e.g. detached youth service work. CXK merged with KCFN in April 2013 and are involved in a voluntary sector consortium delivering services to KCC. 

(3)       Stephen explained that both CXK and KCFN had similar backgrounds, KCFN was previously the Children’s Fund.  Kent was one of only two local authorities who had created a legacy from the Children’s Fund.  KCFN primarily contracted for participation and play work but had grown beyond that and had managed to grow services which had been a challenge in a recession.   KCFN recognised that they needed to work closer with Connexions and therefore formed a partnership. Both of these organisations were able to offer family based services which complemented each other, KCFN tended to focus on the younger age group whereas CXK focused on young people and adults.

(4)       Sean stated that CXK had obtained charitable status in 2008 and from that point they diversified their portfolio and aimed to provide a holistic offer around the family and supporting young people in readiness for training or the work market.

(5)       Stephen confirmed that both organisations had moved away from grant funding streams to commissioning, and had looked at how they could maximise their work in this environment.

Question – The services that you provide are discretionary?

(6)       Stephen stated that if local authorities focused solely on their statutory duty then they would be unsustainable as they would only be reacting to what was going wrong. It was essential that local authorities focused on the preventative agenda and there were cost savings to be made by local authorities from early intervention.

(7)       Sean explained that CXK are commissioned providers for KCC, some services are discretionary and some form part of a statutory duty. For example specifically in the Connexions Contract we undertake the Councils statutory duty to track, record and report to the DFE on the activities of young people aged 16-18  One of the challenges was that there was no clear barometer regarding statutory provision i.e. what and how much. 

Question – Why do you think that KCC not take a holistic approach to commissioning?

(8)       .Sean expressed the view that KCC did not have a mature commissioning process.  Officers needed to understand that they can explore beyond the specification in order to get innovation and creativity as well as accountability from commissioned services.  We supply a response to your tender  ...  view the full minutes text for item 15.