Issue details

Proposed decision

To agree the procurement and award of contracts of the Kent Young Persons Drug and Alcohol Service.

Reason for decision

Kent County Council has 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 Kent’s population. 

The Kent Young Persons Drug and Alcohol Service is 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 early prevention and 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.

Details of the contract are as follow:

-      Kent Young Person Drug and Alcohol Service (Drug and Alcohol Support for those aged under 25), delivered by We Are With You (With You)

-      Commenced on 1 January 2018 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:

·       Support in the community (youth hubs, community centres, cafes etc) offering advice and support with substance use through a trauma-informed, harm reduction approach and psychosocial interventions

·         Support in schools, running early intervention harm reduction groups and a preventative programme called RisKit, specifically for young people who engage in risk taking behaviours, including substance use

·         Re-Frame which works with Kent Police to identify young people, who come to the Police’s attention for Class B and C drug possession (excluding those where intent to supply is suspected) and works with the young person as an alternative to criminal proceedings, to educate them around substance use, with the intention of reducing their future offending.

·         The Sunlight Project which is a pilot aimed at supporting 7-11 year olds impacted by someone else’s substance use via a self-esteem / resilience building programme delivered in schools

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 2020–2021. Therefore, whilst it was possible to consider efficiencies as part of the transformation, any savings made needed 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 young people with lived experience.

The preferred option identified was to procure Kent Young Persons Drug and Alcohol Service under the new Provider Selection Regime, with an enhanced service specification, underpinned by collaboration with stakeholders and young people with lived experience. The contract will be in place from 1 February 2025 to 31 January 2027 (two years with two additional extension options, one for two years and the second for one year).

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.
• Education around County Lines; this is a particular issue in Kent due to the proximity to London. Education from the provider may act as a preventative measure.
• Added reporting of opportunistic smoking quits; there is not currently a stop smoking offer for those under the age of 18 in Kent. The service is positioned well to deliver stop smoking advice as part of Making Every Contact Count (MECC).

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 the young person’s presenting needs and therefore this was a non-viable option

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

-      Combine the service with adult services – the offer for young people is distinct from that offered to adults and requires expertise and specialist knowledge i.e., delivering drug education and harm reduction in a way that is tailored appropriately. It was felt that combining the services ran the risk of diluting the offer.

-      Alignment with the Children and Young People (CYP) service transformation; the decision was made to proceed separately due to the imminent contract end dates for the Young Persons service. Implications and opportunities as part of the CYP transformation will be considered in due course.

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 people with lived experience.

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

Financial Implications

The funding for this contract would be funded entirely from the Public Health Grant and, should OHID confirm additional grant funding beyond March 2025 linked to the 10-year national drug and alcohol strategy ‘From Harm to Hope’, this would be used for additional activity within the contract. The additional grant-funded activity could include a continuation of activity currently funded by the existing OHID grants but innovation would also be considered, should funding allow.

The estimated financial commitment  for a five year contract for the Kent Young Persons Drug and Alcohol Service is £4,099,533.88 This equates to an average of approximately £820,000 annually.

The above values reflect a 1% per year annual uplift to the contract (with the exclusion of the first year). The uplift reflects the need to retain the workforce; services have highly specialised roles and high, complex caseloads.

In terms of affordability, the annual increase in the Public Health Grant is only generally known for the current year, so it is not possible to know with certainty that there will be sufficient Public Health Grant to fund the increase. If the Public Health Grant increases prove to be insufficient then savings will need to be delivered elsewhere in the programme.

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 money received, therefore a further decision would not be required for deployment of further 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 & Alcohol Services aim to reduce the harm caused by drugs and alcohol and improve the health and wellbeing of Kent’s population. 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 & 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.