The Cabinet Member for Adult Social Care and Public Health is proposing to take a decision to:
1. Extend the current NHS Health Check System contract by six months to end on 31 March 2024.
2. Commence a formal procurement activity in June 2023 for a new NHS Health Check System contract to start on 1 April 2024, for an initial period of 5 years with the option of two 12-month extensions.
3. Delegate authority to the Director of Public Health to award a new contract and take relevant action, including, but not limited to, finalising the terms, entering into a contract and other legal agreements, as necessary to implement the decision.
Reason for the decision:
Kent County Council (KCC) has a statutory responsibility to provide the NHS Health Check programme which is delivered by Kent Community Health Foundation Trust (KCHFT), General Practitioners (GPs) and Pharmacy.
Delivery of this programme has been challenging since COVID-19 and there are opportunities to deliver the service differently. A review has commenced which will look at both the clinical and cost effectiveness of the programme and make recommendations on the future service and contracting model.
An IT system is required to facilitate effective delivery of the programme, including data capture, the invitation process and national reporting. KCC has contracted with Health Diagnostics since 2018 and the current contract comes to an end on the 30 of September 2023, following previous extensions.
To allow time for the review to conclude, a further six months extension is needed for the system, meaning the contract will come to an end in March 2024.
The NHS Health Check system supports the councils’ legal responsibilities to deliver the NHS Health Check programme. It is recommended for the council to conduct a competitive procurement in June 2023 and award the contract following this compliant process.
Local authorities are mandated to provide the NHS Health Check programme via The Local Authorities Regulations 20131.
The NHS Health Check programme benefits from a suitable system as it supports:
· Provision of a set of standardised tests to provide a Cardiovascular Disease (CVD) risk score for the patient.
· Education around risk factors for common long-term conditions and promotion of a healthier lifestyle via a one-to-one health conversation with a medical professional.
· Prevention and earlier detection of disease which can improve the quality of life and outcomes for the patient as well as saving money for the wider health system and reducing demands on staff resource.
· Referrals to the appropriate service including healthy lifestyle services and the patient’s general practice to ensure the patient commences the appropriate pathway to improve their situation.
The system will ensure the eligible population is invited, assist with the operational processes, including user experience, secure data capture of confidential information, and monitoring of the performance. It will ensure that the programme is provided effectively, and it supports KCC to meet its statutory obligations of delivering the NHS Health Check Service and reporting outcomes to Office of Health Improvement and Disparities (OHID).
Options (other options considered but discarded)
Decommission the service - Decommissioning the service was concluded as a non-viable option as the system supports the mandated NHS Health Check Programme. Not providing a system for providers of the NHS Health Check and requesting that they revert to other methods (such as using paper forms, manual reporting and invoicing) was deemed a not suitable option. It would move away from an automated approach, risking increased errors and losing the structured, logical, and standardised approach to providing consistent NHS Health Checks across the county. This option would likely put KCC at reputational risk, Primary Care may disengage with the programme or request additional funding and furthermore, the outreach team delivered by KCHFT would need to find other solutions in facilitating the NHS Health Check.
Hybrid model – Commissioners looked at whether systems already in place in Primary Care can be used to meet the requirements. This would involve using various Integrated Care Board systems to facilitate the NHS Health Check, such as EMIS. Analysis suggested that this could cause fragmented commissioning, with different systems having to be updated to meet the needs of the requirements. The cost modelling for these upgrades and additional time needed for staff to collate the data showed that it would be more costly to commission in this way and KCC would have less control when changes are needed.
How the proposed decision supports the Council’s Strategy 2022-26:
This system contributes to ‘Priority 1: Levelling up Kent’ of the Framing Kent’s Future Our Council Strategy 2022-2026 as it supports the NHS Health Check programme, which is a preventative approach into improving the population health.
This system will also contribute to ‘Priority 4: New Models of Care and Support’ as the data that is collected through the system can be used to support commissioning and decision making to support those who are in most need of a health check.
The yearly value for a system is variable as it depends on the number of licenses made available, volumes and the type of invitations sent (text/letter). Part of the contract costs includes a payment which is passed through to a mail house service to pay for postage and packaging of the invitation letters as well as text messaging invitations.
Current extension and requested extension to current service.
The estimated costs of the requested six-month extension will be £166,369. This consists of £109,750 for the system and the remainder for invitation costs.
New Commissioned Service
The service period has been recommended to span an initial term of five years followed by two optional 12-month extensions, dependant on satisfactory performance being met and the requirement still being relevant.
The estimated budgetary commitments throughout the contractual lifespan equates to £2,672,378.
Efficiencies and cost saving will be made throughout the life of the contract depending on effectiveness of pilots and the outcome of the review.
Extension: Additional legal advice has been sought in relation to the contract extension and is set out below:
“KCC is relying upon Regulation 72(1)(b) of the Public Contracts Regulations 2015 (“PCR 2015”) to make this contract extension of 6 months. The conditions of Regulation 72(1)(b) are met in that a contract extension is required for economic and technical reasons, a change of provider any sooner would cause significant inconvenience and/or a substantial duplication of costs for KCC and the value of the contract extension does not exceed 50% of the contract value. A modification notice will be published accordingly in compliance with Regulation 72(3) PCR 2015.”
Procurement: Local authorities are mandated to provide the NHS Health Check programme via The Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013. This competitive tendering exercise will enable a system to be in place and facilitate all aspects of the NHS Health Check programme, enabling Kent to remain compliant with these regulations. Public entities, including KCC, are bound by the Public Contract Regulations 2015 (PCR). PCR have been and will be applied throughout the procurement process.
In consideration of the above, should the decision be agreed, officers will inherit delegated authority via the Officer Scheme of Delegation, to proceed with all the necessary steps to procure an NHS Health Check system including the advertisement, management of a competitive tendering exercise, and award of the contract.
An Equality Impact Assessment has been created which identified that the system will need to conform with Accessibility Regulations 20182, which will form part of the tender requirements and is a current requirement of the system. Once a provider has been awarded the contract, commissioners will review the EQIA and work with the supplier to ensure that appropriate action is taken to place to reduce any barriers of using the system.
Data Protection implications:
A Data Protection Impact Assessment (DPIA) screening tool has been completed and the recommendation was for a full DPIA to be completed for the service once a successful provider is identified. Overall, there are no anticipated data implications associated with this activity because there will be no significant change to the existing service, nor to the data collected and shared.
Decision type: Key
Reason Key: Expenditure or savings of more than £1m;
Decision status: Recommendations Approved
Division affected: (All Division);
Notice of proposed decision first published: 13/03/2023
Decision due: Not before 11th Apr 2023 by Cabinet Member for Adult Social Care and Public Health
Lead director: Dr Anjan Ghosh
Department: Social Care, Health & Wellbeing
Contact: Sam Lain-Rose, Digital Lead (Digital Inclusion & Capability) Email: Sam.Lain-Rose@kent.gov.uk.
The proposed decision was considered and endorsed by the Health Reform and Public Health Cabinet Committee on 16 March 2023.
Financial implications: As above
Legal implications: As above
Equalities implications: As above