Cabinet Member decisions

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

Proposed decision:

 

APPROVE the proposed NHS Health Check programme model and agree to the commissioning of:

1.    NHS Health Check primary care delivery – 1 April 2026 – 31 March 2033, (up to five years with two additional one-year extensions)

2.    NHS Health Check Outreach Service - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

3.    NHS Health Check Training Provider - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

4.    NHS Health Check Quality Provider - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

 

 

Background

 

The statutory NHS Health Check programme was established in 2009 to improve cardiovascular health in the population by assessing risk factors, communicating opportunities for health gain and supporting people to make positive lifestyle changes that reduce risk of cardiovascular disease (CVD). The programme offers a free health check once every five years to eligible people aged between 40-74 years who do not have certain pre-existing conditions. Through a combination of blood pressure check, cholesterol test and lifestyle questions, the health check calculates a person’s risk of heart, kidney, stroke and diabetes problems. The health check advisor will then support them to consider positive lifestyle changes which could reduce this risk and make onward referrals for further support as needed.

 

The NHS Health Checks programme has been a national priority since responsibility for providing it passed from the NHS to Local Government in 2013. It offers the English health and social care system a proven opportunity to reduce the growing burden of non-communicable disease related to behavioural and physiological risk factors and therefore remains a priority area for both the Local Government and the NHS. It also reduces cost to the NHS and adult social care services by preventing people requiring treatment or ongoing support for CVD through prevention and early identification of those at risk.

 

The NHS Health Check programme is currently provided by Kent Community Health NHS Foundation Trust (KCHFT) under a partnership co-operation agreement and delivered via three main routes:

 

1.    contracts with GPs to deliver NHS Health Checks which accounts for approximately 84% (28,125) of all health checks provided in Kent.

2.    contracts with pharmacies to provide NHS Health Checks, however post COVID-19, recovery in this area has not been strong and pharmacies now deliver approximately 2% (570) of health checks compared to 11% pre-COVID.

3.    provision of NHS Health Checks for GP practices who do not engage in the programme and provide an outreach service delivering opportunistic checks in community settings. This provision accounts for approximately 14% (4,802) of all health checks.

 

In 2024/2025, the Kent NHS Health Check programme invited 95,308 of the eligible population, slightly exceeding our 20% target for the year, and supported 33,487 (35%) individuals to access an NHS Health Check.

 

Reason for the decision

 

Kent County Council (KCC) has a duty to provide the statutory NHS Health Check programme as per the Local Authorities (Public Health Functions and Entry to Premises by Local Health Watch Representatives) Regulations 2013. This legislation provides key regulations that must be adhered to by each Local Authority in the delivery of this programme including:

 

• Offering a check to each eligible person once every five years. 

·        Excluding those with a pre-defined medical condition from receiving a check. 

·        Recording a pre-defined list of medical information during each check. 

·        Providing people with a cardiovascular risk score and a range of information related to their health check results. 

• Reporting on invites sent and checks conducted. 

 

The NHS Health Check programme is currently commissioned under a partnership co-operation agreement between KCC and Kent Community Health NHS Foundation Trust (KCHFT). This partnership agreement is due to end on 31 March 2026, and such agreements are no longer permitted under the Provider Selection Regime legislation which came into force in January 2024. As a result, a decision needs to be taken regarding the future procurement routes for these services.

 

In addition, Public Health has undertaken a comprehensive review of services funded by the ringfenced Public Health Grant as part of the transformation programme, with the aim of improving future services and ensuring best value for money and service sustainability. The work completed as part of this programme has included stakeholder engagement; service user insights and options appraisals, as well as a robust peer review process of the preferred option. Other options considered but rejected during the options appraisal process included:

 

 

Option 1: Keep current service the same – the current service provides a universal offer, meets all statutory requirements and has been performing well against Key Performance Indicators. However, the service is not reaching those who really need it i.e. groups at highest risk of CVD, and invite costs are high and do not make best use of digital solutions. This represents a large proportion of the budget and leaving less available for actual delivery of checks. 

 

Option 2: Discontinue the service – this option was dismissed as a non-viable option as it would place KCC in breach of its statutory responsibilities.

 

Option 3: Revised model and specification – preferred option

The preferred option is to implement learning from the current service, into a revised model and specification that will better target those at higher risk of CVD. The proposal includes simplifying the oversight and management of the programme by directly contracting with the GP providers rather than through an intermediary provider (KCHFT). This will give greater oversight over delivery of the service, improved efficiencies and tighter budgetary control. All commissioning activity will adhere to ‘Spending the Council’s Money’ and relevant procurement legislation. Details of the preferred option are as follows:

 

§  Prioritise individuals at higher risk of CVD through targeted invitation.

 

§  Implement findings from engagement work (taking place in 2025/26) to employ the most effective method of inviting those at high risk of CVD, to increase their likelihood of attendance at their Health Check.

 

§  Continue to work with primary care as the main providers of NHS Health Checks, insourcing the contract management of the service so that KCC are contracting directly with primary care providers via a Direct Award B (as per Procurement Act 2023) The benefits of this approach include:

·             Fostering continuous competition throughout the lifecycle of the contract period, lending itself to better value for money.

 

·             An environment of continuous innovation and cost efficiency to be implemented throughout the lifecycle of the contract period, without the costs associated with recommissioning.

 

·             Contracting directly with primary care rather than via a third party brings us closer to communities so that we are better able to respond to local need and address health inequalities at pace.

 

·             Greater level of control and access to data and improved ability to audit performance.

 

·             Stronger local authority relationships with primary care to make the programme more efficient and streamline with other primary care contracts.

 

§  Work with the Local Medical Committee and individual GP practices to encourage full roll out of the programme, with flexibility for GP practices to contract on behalf of other practices within the Primary Care Network

 

§  Commission a NHS Health Check outreach service and a digital training offer for all Health Check advisors in line with current procurement regulations.

 

 

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

 

The NHS Health Checks (NHSHC) programme aligns with the Council’s ‘Framing Kent’s Future 2022-2026' strategy, supporting the following priority commitments: 

 

Priority 1: Levelling up Kent 

 

• To work with our partners to hardwire a preventative approach into improving the health of Kent’s population and narrowing health inequalities.  

 

• To see significant improvements in the economy, connectivity, educational attainment, skills and employment rates and public health outcomes in deprived communities in coastal areas so that they improve faster than the rest of Kent to reduce the gaps.  

 

Priority 4: New models of care and support 

 

• To reshape our commissioning practice to ensure we build strategic partnerships with our providers, through earlier engagement, more consistent and proactive commissioning practice, and a stronger focus on co-designing services.  

 

The model enhancements in this proposed decision further supports these priorities with a greater focus on narrowing health inequalities, through the prioritisation of key groups at higher risk of CVD and targeting of the outreach service.

 

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

 

This approach aligns with Securing Kent’s Future and the council’s Best Value Statutory responsibility, most notably point 4.6 of the strategy documents as this decision will prioritise best value considerations .

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 and social care system.

 

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

 

The NHS Heath Checks programme aligns to with the Kent and Medway Integrated Care Strategy, supporting the following priority commitments:

 

Shared Outcome 3: Supporting Happy and Healthy Living

 

·   Support people to adopt positive mental and physical health behaviours

 

·   Support people to live and age well, be resilient and independent

 

 

 

Shared Outcome 4: Empower People to Best Manage their Health Conditions

 

·   Provide High Quality Primary Care

 

 

Shared Outcome 5: Improve Health and Care Services

 

·   Improve equity of access to health and care services

 

·   Provide high-quality care

 

Financial Implications

 

These contracts would be funded entirely from the ring-fenced Public Health Grant with an estimated financial commitment for a seven -year contract of £15,210,647.

 

The tables below outline the estimated costs to KCC Public Health over the maximum contract term. Final costs will be subject to negotiations and procurement outcomes.

 

Table 1: Estimated Costs to KCC Public Health (NHSHC)

	Cost to KCCPublic Health (NHSHC)
Primary Care Delivery and Support	£14,013,037
Outreach, Quality and Training services	£1,197,610
Total Cost (5 years plus two, 1 year extensions)	£15,210,647

 

The Public Health Grant allocated to the County Council has increased each year since the Covid-19 pandemic. In the unlikely event that the grant in future years is insufficient to cover the contract value, further savings will be negotiated with contract holders across the transformation programme. 

 

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

 

I.        APPROVE the proposed NHS Health Check programme model and agree to the commissioning of:

 

1.       NHS Health Check primary care delivery – 1 April 2026 – 31 March 2033 (five years with two additional one-year extensions) 

2.       NHS Health Check Outreach Service - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

3.       NHS Health Check Training Provider - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

4.       NHS Health Check Quality Provider - 1 April 2026 to 31 March 2033 (five years with two additional one-year extension options)

 

II.       DELEGATE authority to the Director of Public Health?to take necessary actions, including but not limited to entering into required contracts or other legal agreements, as required to implement the decision.

 

III.      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.