Agenda item

(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 next year as want to go to market to comply with KCC, EU and open up the market.

(6)       £12m is the current budget for sexual health services. At market events collaboration of sectors – private, public, VCS, small was strongly encouraged. For some services the market is limited as these are clinical services, but have had proactive engagement and positive market events. The tender was broken into 7 lots, so was easier for smaller organisations to bid. Received number of collaborative bids and it was encouraging that the number of providers attending the market event was over 20.

Question – Will there be any Government testing?

(7)       Public Health England has provides performance dashboards, which provide bench marking. Services will regularly be subject to inspection from the Care Quality Commission. 

Question – Were there problems in contract management?

(8)       Contract management is very important to public health especially as it has inherited contracts, and there is a lack of confidence in the arrangements around novated contracts.

(9)       Resources used to contract manage needs to be balanced. We should commission outcomes and allow providers to decide the operational detail, and we should not incur heavy transaction costs through onerous performance management. We need to make contract management efficient and focused, and ensure it is not bureaucratic and taking up resource unnecessarily. However we need to be absolutely sharp about what is expected, pricing accordingly and only paying for what is delivered. The best example of contract management this year for public health is in the health checks contract. Improvements have been made and KCC has received a £700k credit note back from KCHT where it identified underperformance. The impact is that whilst there still underperformance, quarter 3 showed a 116% performance as opposed to 80% the previous quarter. This gives a clear message that we will pay for what is delivered and contract manage delivery closely.

(10)     To deliver more focus across the Council we should  extend contact management training, the more procurement can train commissioners in approach is useful. The Challenger event was excellent on this.

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Question – How important is the relationship between commissioning and CCG’s?

(11)     .  Public health has a statutory duty  to be represented on the CCG’s – from this we will automatically work together better to develop commissioning intentions. Relationships are key – in Public health many consultants are from PCT previously which often means they have good relationships with CCG colleagues and this enables joint work.  Barriers to joint working to be overcome include competing priorities against a backdrop of financial pressure.

Question – How dealing with under performance? How work with Voluntary sector? how support re PQQs?

(12)     Health checks is an example of where we performing better in who we invite – but not necessarily performing well in who attends  Need to shift this so can impact on behaviour. Real role for voluntary sector. E.g. go to local football club for checks (male unfit unlikely to go to GP surgery – need to think more locally about where target population may be and go to them).

(13)     A particular focus is the PQQ process, and the necessity for standard questions. We need to test financial viability as organisations need a turnover 4 x higher than the contract value, so some organisations would not be able to respond to invite.

(14)     Organisations need resource to be able to bid, it tends to be larger organisations with a big infrastructure that have a bidding arm within the company.

(15)     This Is a challenge as value of small organisations is huge in knowing community and flexing what they do – but have to ask for financial viability as need to ensure can deliver as if fail risk continuity of service Voluntary sector can build resource by being involved in projects an example is the  community chef programme– small but important work which gives real experience and leads to apprenticeships, now working to develop elsewhere by commissioning through the healthy living programme as have the infrastructure to assist them.

(16)     Sexual health has been broken into 7 lots from £100k to £3.5.m. are ways to work with VS/SME but KCC must balance ensuring continuity of services, as cant risk using provider without infrastructure to support.

(17)     One key issue is past experience – why do we not take account of this? Why not take previous performance into account in tendering.

Question – A large amount of contracts are not renewed.  Is it a question of re-tender at the end of each contract?

(18)     There is a legal framework to what should be retendered and when. Under performing contracts should be retendered.  If, at the end of a contract initial period, there are no significant issues with the operation of the contract and performance is high, and there was no budget pressure, then it is a good idea to think through the market process as decommissioning can increase instability in provision and disrupt workforce. However it is worth it if a) need to increase improvements to service and/ or b) there is budget pressure and need to look at different models.

Question – Has there been investment in mental health services to promote wellbeing.  Was there any liaison with the British Legion and similar organisations?

(19)     Preventative mental health money has been invested this year by KCC. This is for promotion of wellbeing to those that would not go anywhere near a service for example older men who might be isolated or depressed. The Vol untary sector has been awarded these projects through competitive tender  - were men had determined what the projects looked, i.e. The Mens Sheds programme received match funding from The Libor Programme. The British Legion and similar organisations are involved as national partners.

Question – Why are alternatives looked at, at the end of a contract.  What is the procedure for moving from one provider to another?

(20)     KCC works within KCC guidelines – sometimes a +1, +2year extension. Contracts have end dates. EU require competitively tendering to ensure best spend and services meet the needs of public.  

(21)To mitigate risk in transfer of contracts, different approaches can be used. For example sexual health is a large contract and KCC have allowed a 6 month period implementation period between award date and  implementation of the new contract. This allows time for good communication to stakeholders and service clients, and for the preparatory work to be done with the workforce for the new model.

Question – What is the impact of contracting with non NHS people/organisations?

(22)     Tendering in 13/14 has included awards to a number of organisations outside of the NHS. These contracts have been awarded to enterprises which offer a strong service model which they are keen to expand.  Services will always need to be clinically appropriate and this must be rigorously tested. There are lots of examples of clinical services delivered by Non NHS organisations for example drug and alcohol services across Kent.

Question – How many tenders have there been in public health in 3 months? -Who decided to commence the procedure? - 

(23)     Public Health Commissioning decides in consultation in various meetings. Commissioning has been aligned with the Public health business plan in 13/14. If the contract amount is over £1m, it is submitted to the Procurement Board; if it was below £1m it is agreed with divisional management team and  budget partners. 

Once tenders were received, who made the decision? – A Panel which includes representation from Commissioning and Procurement Board; and budget partners. 

What member involvement was there? - Graham Gibbens, Cabinet Member signs off. The investment in mental health was discussed at Corporate Board. Different models have been discussed at Cabinet Committee. Public health members and deputies were invited to the sexual health stakeholder event.

How many were a statutory obligation? – 1, the others were discretionary and went to the appropriate Board.

Was there any criteria applied to discretionary tenders? – A range of performance indicators in relation to the outcomes in the Public health framework.

(24)     The Chairman thanked Karen for helping the Committee with their work and for answering questions from Members.