Cabinet Member decisions

Reason for the decision

 

This proposal to expand Leigh Academy has been developed because the Kent Commissioning Plan 2024/28 indicates that there will be a shortfall in year 7 places in the Dartford and Swanley non-selective planning group.

 

To support KCC to mitigate against this shortfall, Leigh Academy agreed to increase its PAN from 240 to offer 270 places for September 2023, September 2024 and September 2025.

 

Following further discussions, Leigh Academy agreed to offer 300 places from 2026, subject to a physical expansion. This proposal seeks to facilitate the expansion by building a standalone block, and to enable various internal and external works.  The Trust, senior leadership team and governors of Leigh Academy agreed to consult on this proposal to permanently expand the school and enlarge the secondary provision within the school by the addition of 60 places per school year.

 

Leigh Academy, part of the Leigh Academy Trust (LAT), is a co-ed secondary school.  Following an inspection that took place in April 2023, Ofsted deems Leigh Academy to be a ‘GOOD’ school.

 

 

A decision is required now to allow internal modifications to Leigh existing building to be undertaken, which will allow the school to continue to admit an increased cohort from September 2024 and to begin work on external areas of the site.  The funding will also allow KCC to enter into a contract to undertake the requisite feasibility studies and design work for the main scheme to produce a new standalone block on site.  A separate decision will be taken by the Cabinet Member in due course to agree the overall funding of the scheme.  The estimated costs are explained below.

 

If no further action is taken in the longer term, Kent County Council will find it extremely difficult to provide sufficient secondary school places in the Dartford and Swanley non-selective planning group.

 

Background

 

Dartford Borough’s population is increasing with more families moving into the area and as a result, Kent County Council needs to add additional secondary school places to manage the increase in demand. One strategy for providing additional school places is to expand existing successful and popular schools.

 

The 2FE expansion is to be facilitated by internal alterations to the existing main school building, along with construction of a new teaching block at the front of the site to provide the level of accommodation required in accordance with BB103.  The existing tennis courts will be relocated to facilitate the construction of the new standalone block.  These internal and external works will be undertaken by LAT and the funding for the works will be passported to LAT from the CYPE Capital Budget, subject to a binding funding agreement being signed.  KCC will directly deliver the standalone block and related Highways mitigations, should they be required.

 

In order to accommodate the ongoing 2FE expansion, Leigh Academy have committed to an increased PAN in September 2024 (in line with September 2023), however this increased PAN requires an initial phase of internal alteration works to be undertaken to facilitate an increase in pupil numbers.

 

Any works undertaken by the Academy are to be overseen by the appointed KCC Consultant team.

 

Securing Kent’s Future

 

The 'Securing Kent's Future' strategy outlines the measures that KCC intend to take to ensure that Kent remains financially stable, now and long into the future.  It describes the statutory priorities, one of which being the statutory duty to ensure sufficient school places are available to any child or young person who requires one.  This duty applies to Special Educational Needs (SEN) provision, as well as mainstream settings.

 

This proposal is necessary for KCC to continue to deliver the statutory duty, in a cost-effective way, in line with the guidelines described in the Securing Kent's Future strategy. It will help to maintain KCC’s strategic role in supporting schools in Kent to deliver accessible, high quality education provision for all families.

 

The County Council’s Commissioning Plan for Education Provision in Kent 2024-28 is a five-year rolling plan which is updated annually.  It sets out KCC’s future plans as Strategic Commissioner of Education Provision across all types and phases of education in Kent. A copy of the latest plan can be viewed from this link:

 

https://www.kent.gov.uk/education-and-children/schools/education-provision/education-provision-plan

 

 

Financial Implications

 

Capital

 

The total cost of the expansion is estimated to be £10.5m, including both KCC and LAT spend which is to be allocated from the CYPE Capital Budget.   This sum has been included within the Basic Need Capital Programme that was recently agreed by Council. KCC will investigate whether other funding sources can be accessed, such as Community Infrastructure Levy, once full costs are known.

 

An allowance of up to £2,500 may be payable to the school, to outfit each new teaching room with appropriate ICT equipment, such as touch screens or projection equipment.  This will be met from the overall Capital allocation for this project.

 

Should the scheme not proceed through to completion, any costs incurred at the time of cessation would become abortive costs and are likely to be recharged to Revenue. This would be reported through the regular financial monitoring reports to Cabinet.

 

Revenue

 

The school would also receive funding for the additional pupils that it admits in line with the funding allocated to schools through KCC’s Schools Funding Formula.

 

As the scheme progresses, £6,000 per newly created learning space, would be provided towards the cost of furniture and equipment, such as tables, desks, chairs, cabinets and learning resources.

 

Both of these revenue allocations will be met from the Growth Funding provision held within the dedicated school's grant.

 

Human

 

The school will appoint additional staff as required; utilising revenue funding allocated through the Schools Funding Formula for these additional pupils.

As Cabinet Member for Education and Skills, I agree to:

 

I.          APPROVE the expansion of Leigh Academy by 2FE,

 

II.         AGREE to allocate £425,000, subject to a binding funding agreement, from the CYPE Capital Budget to the Leigh Academy Trust (LAT), to:

 

a.            enable design work for the essential internal and external works

 

b.            enable LAT to undertake essential internal modification works, during 2024.

 

III.        AGREE to allocate £975,000 from the CYPE Capital Budget, to enable KCC to undertake feasibility checks, design, plan, cost and tender for the project to construct      a new standalone block, from June 2024

 

IV.       DELEGATE authority to the Director of Infrastructure to, in consultation with the   Director of Education, enter into any necessary contracts or other legal agreements,           as required to implement this decision; and

 

V.          AGREE for the Director of Infrastructure to be the nominated Authority        Representative within the relevant agreements, with authority to enter variations as envisaged under the contracts.

Proposed decision

 

(i) REPROCURE contracts for the operation of 17 HWRCs and co-located WTS;

 

And subsequently,

 

(ii)       DELEGATE authority to the Director for Environment and Circular Economy, to take relevant actions to facilitate the required procurement activity; and

 

(iii)      DELEGATE authority to the Director for Environment and Circular Economy in consultation with the Cabinet Member for Environment, to take relevant actions, including but not limited to, awarding, finalising the terms of and entering into the relevant contracts or other legal agreements, as necessary, to implement the decision.

 

Reason for the decision

 

The option to reprocure the service is recommended by the Cabinet Member for Environment as this option will enable KCC to drive savings through economies of scale and be assured that it is paying the current market price for the service.

 

Background

 

As the Waste Disposal Authority, KCC has a statutory responsibility to arrange for the disposal of the controlled waste collected in its area by the waste collection authorities, and to provide places at which persons resident in its area may deposit their household waste and for the disposal of waste so deposited.

Contracts with FCC Environment Ltd and Commercial Services Kent for the operation, management and haulage services Household Waste Recycling Centres and co-located Waste Transfer Stations are due to expire on 31 October 2025.

 

Other Options considered but discarded

 

Option 1 - Do nothing. Discounted due to failure to meet statutory duties.

Option 2 – Extend with FCC and CSKL for 5 years, as per the current contractual terms. Discounted as this option is unable to demonstrate best value and does not test the market for potential economies of scale.

Option 3 – Extend with FCC and CSKL for 7 years. Discounted due to legal and procurement risk.

Option 4 - CSKL to operate all sites.  Discounted due to technical and operational risk and unable to demonstrate best value.

Option 5 - FCC to operate all sites. Discounted due to legal risk.

 

The commission of this contract will meet KCC’s Framing Kent’s Future 2022-2026:

Priority 3 – Environmental Step Change -Continue to work with our commissioning partners to create the infrastructure and jobs that enable us to reprocess waste materials and produce energy within the county, in order to maintain a closed loop local economy.

 

Securing Kent’s Future - Budget Recovery Strategy regarding the following outcomes:

 

Objective 2: Delivering savings from identified opportunity areas to set a sustainable 2024/25 budget and MTFP: Contract Review

 

Financial Implications

 

The current budget for 2024/25 is £13,344,800 which covers operational 17 sites.

 

Payable Exit fees and costs associated with procurement (£250k), demobilisation and remobilisation (£450k) are unbudgeted pressures.This will bring several sites up to an ongoing serviceable standard which may be required before they are handed over to a new provider to maintain.

 

These costs can be treated in several ways, KCC can either pay it at the close of the contract, it can be included in the procurement as a set up cost or amortised over a period of time but will remain a budget pressure

 

There is a risk to the delivery of MTFP savings during the procurement process, which will need to be managed with the incumbent contractors. Going forward these improvements may be included in the new contract specification and therefore can be priced and secured in open competition. 

 

A procurement process will enable KCC to be satisfied that it is paying the current market rate for these services and economies of scale may help to drive efficiencies in the service. However, there is no guarantee that the tendered price will be more attractive than the current price.

 

As Cabinet Member for environment I agree to:

 

(i) REPROCURE contracts for the operation of 17 Household Waste Recycing Centres and co-located Waste Transfer Services; And subsequently,

 

(ii) DELEGATE authority to the Director for Environment and Circular Economy, to take relevant actions to facilitate the required procurement activity;

 

(iii) DELEGATE authority to the Director for Environment and Circular Economy in consultation with the Cabinet Member for Environment, to take relevant actions, including but not limited to, awarding, finalising the terms of and entering into the relevant contracts or other legal agreements, as necessary, to implement the decision.

Proposed decision

That the Cabinet Member for Adult Social Care and Public Health:

a) APPROVE the changes to the Adult Social Care Charging Policy; and

b) DELEGATE authority to the Corporate Director Adult Social Care and Health to revise the Adult Social Care Charging Policy and to take relevant actions, including keeping the policy updated as necessary, to implement the decision

 

Reason for the decision

 

In line with the approved Budget Book, Kent County Council (KCC) is proposing to change its policy for charging for adult social care provided in a person’s own home or in the community. This means we are reviewing how much some people may have to pay towards the chargeable services that KCC provides or arranges, which include:

·       Care and support provided at home (for example homecare including supported living); and

·       Care and support provided in the community (for example daytime support).

 

This policy does not impact on people who live in and receive care and support in a residential care home.

 

We are proposing to stop disregarding the higher or enhanced rates of Attendance Allowance (AA), Personal Independent Payment (PIP) and Disability Living Allowance (DLA) when we calculate a person’s income (we already take into account the lower, middle or standard rates of these benefits).

 

This would mean that individuals in receipt of care who receive higher rate of these benefits would have more income taken into account in their financial assessment which would mean that they are likely to pay more for their care and support than they do currently.

 

We need to look at the amount of income we can generate by people contributing towards the cost of their own care. This is why we are proposing a change to the charging policy.

 

Background

 

KCC provide adult social care services to approximately 16,394 residents aged over 18 years old (data taken January 2024). Approximately 15,806 of these people receive chargeable social care services, this includes providing services like residential care and support and care in a person’s own home or in the community.

 

When people living in Kent need adult social care, as well as assessing their care needs, we also assess their income to decide how much they pay towards their care. This is known as means testing. Some people don’t pay anything, and the council picks up all of the cost, some people pay a contribution, and some people pay for all of their care (these people are known as full payers).

 

KCC sets out what and how people need to pay in the Adult Social Care Charging Policy.

 

KCC has already made substantial improvements and efficiencies to the way social care is delivered in Kent, alongside trying to limit the impact on the people that draw on care and support and help make the service sustainable.

 

Whilst KCC continues to strive to provide the best services we can, we continue to have the following growing pressures:

 

·       Significantly less government funding compared to nine years ago and we are expected to fund services through council tax contributions and income from other sources such as charging. The Revenue Support Grant (which includes adult social care as well as other council services) has reduced from £246.7m in 2013-14 (the first year of current funding arrangements) to £11.8m in 2024-25. There have been a number of separate social care grants which have been provided progressively since 2016-17 (not exclusively adult social care) which amount to £192.9m in 2024-25 but these grants have been provided in recognition of the pressures in social care and to fund improvements rather than replace the Revenue Support Grant reductions.

 

·       Increasing demand (an additional 1,152 people from March 2022-March 2023) for adult social care services, including people having complex care and support needs.

 

·       Significant annual increases in the National Minimum Wage (NMW) since 1999, which have impacted on the fees charged by care and other providers.

 

·       Continuing impact of inflation, which means we face growing pressures in the care market, including workforce challenges and rising costs for delivering care packages.

 

Options (other options considered but not taken forward)

 

Before deciding on the preferred proposal presented in the consultation, a number of options were considered:

Alternative option considered	Why the option has not been taken forward to consultation
Only apply the proposed change to people new to receiving care and support from KCC’s adult social care service from the date the new policy is implemented. This would mean that existing people receiving adult social care services would not have the higher or enhanced rates of disability benefits considered when KCC calculates a person’s income.	Whilst this would reduce the number of people impacted by the proposed change it would not be fair and equitable for all people who draw on care and support and does not reduce the current funding gap.
Introduce the policy in stages, no more than a £12 increase to anyone’s charge per year, for existing people who draw on care and support to give them time to adjust.	Whilst this would reduce the impact of the proposed change it does not reduce the current budget gap as quickly. This would also be quite challenging to administrate both manually and on the case management system.
An increase to the level of Disability Related Expenditure (DRE) for everyone from £17.00.	This would reduce the funding available for adult social care and increase the budget gap further and would be applied to all rather than just those who receive the higher and enhanced benefits.
Increase Minimum Income Guarantee for basic living expenses such as utility bills and food.	This would reduce the funding available for adult social care and increase the budget gap further.
Automatically review DRE for all individuals who could potentially be impacted.	This would have an incredibly significant impact on operational resources and would redirect resources away from frontline services.
Offer DRE assessments for all 3,784 individuals directly impacted.	This would reduce the funding available for adult social care and have a significant impact on operational resources.
Do nothing.	Due to the significant financial challenge being faced by KCC, if we do not raise additional income from this proposed change, then other options would need to be considered.

 

Our preferred proposal would reduce the funding gap for adult social care services in Kent in year. However, we recognise that these alternative options could help to lessen the impact on individuals.

 

How the proposed decision supports Framing Kent's Future - our council strategy 2022 to 2026

The proposed decision aligns with the ambitions set out in Framing Kent’s Future to place Kent on a sustainable footing for the medium and long term and also aligns with Objective 2 of Securing Kent’s Future to identify opportunities to set a sustainable budget and MTFP.

 

Financial Implications

 

The latest budget monitoring presented to Cabinet on 21 March 2024 shows £30m budget gap for 2023-24, of which £31.3m relates to the Adult Social Care and Health Directorate before management action and one-off use of reserves are considered. Members have agreed the immediate actions needed to reduce spending in the short term and have set the course for getting the council back to financial sustainability, securing the services that residents in Kent need the most.

 

Spending growth in KCC 2024-25 is £209.6m as stated in the 2024-25 budget. The net change to the budget is £113.9m (matched by funding increases through government grants, council tax, etc), leaving £95.7m savings which need to be found.

 

Of the above, the spending growth in Adult’s 2024-25 is £115.8m as stated in the 2024-25 budget. The net change to the budget is £61.7m (matched by funding increases through government grants, council tax, etc), leaving £54.1m in savings/additional income which needs to be found, of which this proposal is included within.

 

It has been estimated that the proposed change could raise approximately £3.5million. We would use this money to help reduce the funding gap so that we can continue to provide council services to those who need them. If this proposal is not implemented, then the income would need to be achieved elsewhere.

 

Equalities implications

 

An initial Equality Impact Assessment (EqIA) has been completed and can be found on the consultation webpage: www.kent.gov.uk/adultsocialcarecharging or upon request. This is a live document and will continue to be reviewed and updated following the consultation.

 

Age, disability, sex, race and carer’s responsibilities have been identified as having potential for negative impact if we were to implement the proposed change.

 

We have taken the following information from two sets of data, these are:

·     Young people drawing on care and support aged from 18 to 25, who are moving from children’s social care into adults’ social care.

·     Adults aged 18 and over drawing on care and support from adult social care.

 

In the data for young people, there are 612 active individuals who receive care at home, in the community or have a direct payment that may be affected.

 

In the data for adults, there are potentially 9,011 individuals who receive care at home and in the community that may be affected.

 

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

 

a)    APPROVE the changes to the Adult Social Care Charging Policy; and

 

b)   DELEGATE authority to the Corporate Director Adult Social Care and Health to revise the Adult Social Care Charging Policy and to take relevant actions, including keeping the policy updated as necessary, to implement the decision.

 

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 3^rd May 2019 and this agreement expires on 31^st 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 1^st 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.

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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.

 

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 1^st April 2025 to 31^st 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.

 

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 many of the contracts expire at the same time. This is because they form part of a partnership with Kent Community Health Foundation Trust (KCHFT).

 

The proposal is to extend the KCHFT 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: 

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

-      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.

-      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.

 

The programme is reviewing twenty-one Public Health funded service areas simultaneously to help explore options for integration, efficiency and maximising impact. Many of the services in the review expire at the same time as they form part of an overarching partnership contract with Kent Community Health Foundation Trust. This includes many mandated services such as health visiting and sexual health. The partnership was put in place in March 2017^[1] 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.

Performance and quality of service delivery during the partnership has been very good, with KCHFT consistently meeting set targets (targets that are regularly reviewed). Many of the services delivered by KCHFT are specialised services.

 

The recommendation is to put in place a twelve-month extension for the partnership to support the delivery of the transformation programme.

 

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.

 

The partnership extension would help ensure service stability, whilst fully exploring alternative service delivery options and putting new contracts in place. During the transformation work, some services would not use the full twelve-month extension. New, staggered contract start dates would be put in place for services. Some services (substance misuse) are likely to start new contracts in January 2025, because there is little change in delivery and greater clarity on model. Other services may start new contracts later in the year, because they want to align with external commissioning opportunities or because there are opportunities to deliver the services differently by competitive procurement or insourcing.

Any substantive service change or updates required prior to the next partnership agreement decision would be managed via fresh decisions. 

 

The proposed twelve-month partnership extension would include contract break clauses.

 

All parties will remain committed to delivering efficiencies and financial savings in the extension year in line with current terms to ensure best value. KCC will closely monitor expenditure alongside performance. 

 

It is important during the Public Health Transformation programme review, not to de-stabilise the existing supplier, KCHFT. KCHFT delivers a number of services for both KCC and the Kent and Medway ICB (Integrated Care Board), therefore it is important for KCC and the wider health system to ensure this supplier and any potential change, is managed carefully in order to not disrupt KCC’s services and also services provided by KCHFT for the ICB. There is an extremely limited choice of alternative providers in the market.

 

 

Options (other options considered but discarded)

 

The alternative options, considered but disregarded include: -

 

1)    Option 1 - Re-procuring services and putting in place new contracts for 1^st 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.

2)    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 and can help. reduce demand into other KCC services and across the health system.

Extending the two 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.

 

 

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

 

(a)  EXTEND the Kent Community Health NHS Foundation Trust (KCHFT) partnership for twelve months, from 1^st April 2025 to 31^st 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.

 

 

Reason for the decision

 

The outturn position for the Council needs to be noted by Cabinet.  The rolling forward of funds into 2024-25, the capital budget changes and the reserves drawdowns and realignments need to be agreed by Cabinet.

 

Background – Provide brief additional context

 

The report on the Council’s financial position as at the end of 2023-24 will be reported to Cabinet on 20 June 2024, which shows an overspend on the revenue budget of £12.4m.  The report provides detail of our revenue and capital outturn positions and how the revenue overspend is funded from reserves, which needs to be agreed by Cabinet.

 

Cabinet is also asked to agree revenue budget roll forwards, capital re-phasing, capital programme cash limit changes and reserves realignment.

 

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

 

Framing Kent’s Future (FKF), the KCC Strategic Statement, was approved at County Council in May 2022 and sets out the council’s ambition and strategic priorities until 2026. FKF acknowledged the significant financial and demand pressures the council would be facing over the coming four years, whilst concurrently delivering an ambitious agenda for Kent residents, businesses, and local communities. The Securing Kent's Future plans and this related Finance Monitoring report 2023-24 reflects the need to confirm a re-prioritisation of Council business within the framework of Framing Kent's Future - further details are set out within the “Securing Kent's Future” Cabinet report.

 

How the proposed decision supports Securing Kent’s Future

 

Securing Kent’s Future (SKF) acknowledges that given the significance of adults and children’s social care within the council’s budget, and that spending growth pressures on the council’s budget overwhelming (but not exclusively) come from social care, that the priority of delivering New Models of Care and Support must take precedence over the other priorities in Framing Kent’s Future.  This creates an expectation that council services across all directorates must collectively prioritise delivering the new models of care and support objective as a collective enterprise.

 

The Cabinet agree to:

 

a)    note the capital and revenue outturn position for 2023-24; and

b)    agree that £2.097m is rolled forward to fund existing criteria (as per Appendix 1); and

c)    agree that £0.675m is rolled forward to fund Member grants (as per Appendix 1); and

d)    agree the drawing down of £12.372m from Smoothing reserves to fund the 2023-24 overspend; and

e)    agree the £198.2m of capital slippage/re-phasing from 2023-24 will be added to the 2024-25 and later years capital budgets (as per Section 11 and Appendix 2); and

f)     note the review of the capital programme; and

g)    agree the proposed capital cash limit changes totalling £86.180m (as per Appendix 3); and

h)    agree the changes made as a result of the Reserves Review (as per Appendix 4)