Issue details

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.