Issue details

Proposed Decision

That the Cabinet Member for Adult Social Care and Public Health agree to recommission the East and West Kent Drug and Alcohol Service

Reason for decision

Kent County Council has a statutory responsibility as a condition of its Public Health Grant to provide specialist Substance Misuse Services aimed at reducing the harm caused by drugs and alcohol and to improve the health and wellbeing of the people of Kent. 

The two contracts under the Adult Kent Drug and Alcohol Services are due to expire on 31 January 2025 and therefore a key decision is required to plan for beyond this date.

Background

The provision of drug and alcohol services aligns with local and national strategies. 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) as well as the improvement of the local treatment and recovery system as outlined in the Kent Drug and Alcohol Strategy, 2023-2028.

The proposed decision supports Securing Kent’s Future 2022-2026 under Objective 3: Policy choices and scope of Council’s ambitions, by evaluating the statutory minimum requirements in order to create efficiencies.

Nationally, drug and alcohol services support the Government’s 10-Year Drug Strategy ‘From Harm to Hope’ (2021). The strategy is supported by a grant, the level of which has been confirmed for three years, whilst the remaining seven await confirmation. Kent has supported the implementation of the national strategy by investing this money into existing contracts.

The two contracts that make up the Adult Kent Drug and Alcohol Treatment Services in Kent, both of which are due to end on 31 January 2025, are:

·       West Kent Adult Drug and Alcohol Service (Tunbridge Wells, Tonbridge & Malling, Maidstone, Gravesend, Dartford, Sevenoaks) - delivered by Change, Grow, Live (CGL). The contract commenced on 1 April 2016 until 31 January 2025

·       East Kent Adult Drug and Alcohol Service (Swale, Canterbury, Thanet, Dover, Folkestone and Hythe and Ashford), delivered by Forward Trust. The contract commenced on 1 May 2017 until 31 January 2025

Options

Kent County Council (KCC) Public Health is leading a transformation programme designed to improve service delivery to communities, particularly targeting underserved communities. The transformation work aims to ensure that services are efficient, evidence-based, deliver outcomes and best value.

Nationally, the drug and alcohol services support the 2021 10-Year Drug Strategy and associated investment linked to national objectives of improving numbers in treatment, continuity of care from prison to community, quality of treatment and reduction in drug and alcohol related mortality. The grant funding cannot be used to prop-up core service delivery and must be used for additional activity.

The service delivers various interventions in order to meet the objectives including:

·         Psychosocial support on both a group and one-to-one basis, utilising techniques such as motivational interviewing and cognitive behavioural approaches.

·         Clinical interventions include prescribing for detoxification, opiate substitution therapy, and relapse prevention medications

·         Harm reduction, including screening for blood borne viruses, vaccinations for hepatitis B, provision of needle exchange and Naloxone (used to quickly reverse an opioid overdose)

·         Access to community or inpatient detoxification, and to community or residential rehabilitation

As a result of the additional investment from Central Government to sustain these national strategic objectives, Kent is in receipt of £11,424,253 investment via a number of Office for Health Inequalities and Disparities (OHID) grants over the period April 2022 to March 2025. A condition of the additional OHID grant funding is that local authorities maintain their investment into the local substance misuse treatment and recovery system from their public health grant at or above the levels reported in 2020–21. Therefore, whilst it was possible to consider efficiencies as part of the transformation, any savings made need to remain invested in the services.

An options appraisal was developed which considered a range of changes to the service delivery model, based on collaboration with key stakeholders and people with lived experience.

The preferred option identified was to procure Kent Adult Drug and Alcohol Services under the new Provider Selection Regime, with an enhanced service specification, underpinned by collaboration with stakeholders and people with lived experience. The contracts for both East Kent and West Kent will be in place from 1 February 2025 to 31 January 2029 (four years with two additional two-year extension options).

Due to uncertainty as to whether OHID grant funding will continue post-March 2025, all enhancements made will be within the financial envelope of the Public Health Grant.

Suggested changes include:

• Refining pathways for 18-25 year olds so it is clear which service supports this cohort, depending on their circumstances
• Specifying pathways for children impacted by someone else’s substance use. Adult and young persons’ services working together to identify these young people, develop pathways, and deliver joint interventions, thus expanding the impact on families.
• Clearly set out the offer for vulnerable groups, including the need for women-specific groups, particularly amongst those who may have experienced trauma
• Outline the need for improved tier 4 pathways; tier 4 services include inpatient detoxification and residential rehabilitation. There is a need for Kent services to have a uniform approach and to ensure vulnerabilities are accounted for, such as those who are rough sleeping.

Advantages include:

• The opportunity to draw upon local and front-line expertise when identifying potential service improvements
• Increased buy-in of all stakeholders as a result of collaboration
• Focus on achievable improvements, such as defining efficient pathways
• Anticipated changes to the specifications are ones that can happen within the current financial envelope

Options considered but rejected included:

·         Keep current service the same - no change/ do nothing - the drug landscape has changed since the current service was tendered; it is important that services are fit for purpose and meet people’s presenting needs and therefore this was a non-viable option

·         Discontinue/ decommission the current service - Decommissioning the service was concluded as a non-viable option that would place KCC in breach of the Public Health grant conditions.

·         Split the service in two – one focusing on detox and treatment and the other focusing on recovery - it was deemed that this would add confusion to an already complex system within Kent.

·         Bring pharmacy contracting responsibilities in-house - established relationships are already in place with providers, bringing pharmacy provision in-house risks limiting the pool of available pharmacies, which in turn may create a barrier for people in terms of access.

·         Stop using fixed premises and move to a co-location model – it is important that drug and alcohol services have a physical presence in accessible areas in order to provide drop-ins and needle exchange. Removing this presence risks missing opportunities to help people at the point they are motivated to seek support.

Procurement

As of 1 January 2024, the recommissioning of drug and alcohol services falls under the new Provider Selection Regime (PSR) for procuring health care services in England by organisations termed relevant authorities, including NHS bodies and Local Authorities.

The PSR was introduced under the Health and Care Act 2022 with the intent to: introduce a flexible and proportionate process for deciding who should provide health care services; provide a framework that allows collaboration across systems; ensure that all decisions are made in the best interest of patients and service users.

Following approval of the key decision, a PSR-compliant procurement process will be run to select suppliers for the new service.

Financial Implications

Public Health estimate a financial commitment as below for each contract according to the recommended length of each contract:

·       The estimated financial commitment of £43,461,175.80 for an 8-year contract for the East Kent Drug and Alcohol Service.

·       The estimated financial commitment of £30,291,915.85 for an 8-year contract for the West Kent Drug and Alcohol Service.

The exact figures will be subject to factors such as costs of medications, pharmacy costs and staff retention for highly specialised roles. All funding will come from the Public Health Grant.

Additional OHID grant funding is only currently confirmed until 31 March 2025. Should this funding be extended beyond that point, it will be treated as a contract variation and will be in addition to the above estimated values and will require the providers to deliver additional activity.

A key decision (22/00041) has already been taken to accept and deploy the additional OHID grant money received, therefore a further decision would not be required for deployment of further OHID funding.

Legal Implications 

Under the Health and Social Care Act 2012 [8], Directors of Public Health (DPH) in upper tier (UTLA) and unitary (ULA) local authorities have a specific duty to protect and enhance the population’s health.  

KCC commissions these services as part of its statutory responsibilities and as a condition of its Public Health Grant. Kent Drug and Alcohol Services aim to reduce the harm caused by drugs and alcohol and improve the health and wellbeing of the people of Kent. The local authority’s Public Health Grant requires the Authority to “have regard to the need to improve the take up of, and outcomes from, its drug and alcohol misuse treatment services.”

The recommissioning of these services will fall under the Provider Selection Regime (PSR) introduced under the Health and Care Act 2022.  Appropriate legal advice will be sought in collaboration with the Governance, Law and Democracy team and will be utilised to ensure compliance with relevant legislation; the Provider Selection Regime is still in its infancy and so commissioners will be working closely with this team as well as the Commercial and Procurement Team.