Issue details

Proposed decision: Recommission the Kent Drug and Alcohol Inpatient Detoxification 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 the people of Kent. 

The current contract under the Kent Drug and Alcohol Inpatient Detoxification Service is due to expire on 31 March 2026 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 are designed to achieve best value and align to the Council’s Strategic Statement. They support residents that need help, work with care providers and the NHS to ensure that the care system is more sustainable, and work towards the improvement of the local treatment and recovery system as outlined in the Kent Drug and Alcohol Strategy, 2023-2028.

Nationally, drug and alcohol services support the Government’s 10-Year Drug Strategy ‘From Harm to Hope’ (2021). The strategy is supported by a Drug and Alcohol Treatment Recovery and Improvement Grant (DATRIG), the level of which has been confirmed for four years, whilst the remaining six await confirmation. One of the conditions of receiving DATIRG funding is that Local Authorities MUST be part of an Inpatient Detoxification (IPD) Consortium (although it is not currently known whether this will remain a condition of receiving funding in future years). Kent County Council lead on the Kent Consortium, under which this contract sits. Current members of the Consortium are Kent County Council, Surrey County Council, Oxfordshire County Council, and Medway Council.

The current consortium receives priority access to two beds within a nine-bed unit. Priority access is defined as having access to the next bed from the two beds purchased that becomes vacant at the site (subject to need and meeting the referrals criteria). Where there is a wait list from spot purchasing authorities, authorities in the consortium have access to the bed before the spot purchasing authority up until the total number of bed nights within the allocation has been reached.

The contract for the Kent Drug and Alcohol Inpatient Detoxification Service is currently delivered by Kent and Medway Partnership Trust (KMPT) via Bridge House, an Inpatient Detoxification Service in Maidstone.

Options

An options appraisal was developed and the preferred option identified was to procure the Kent Drug and Alcohol Inpatient Detoxification Service under the Provider Selection Regime (PSR) via a consortium arrangement. This is the preferred option of all consortium members. The contract will be in place for an initial period from 1 April 2026 to 31 March 2029 with the option to extend for up to two additional one-year periods, ending no later than 31 March 2031, which is in alignment with the 10-Year Drug Strategy.

Advantages include:

·         Supporting sustainability of local provision by purchasing a set amount of bed nights in advance

·         Local provision reduces travel time and logistical barriers for patients and their families, making it possible for Kent drug and alcohol service providers to transport patients to and from the facility, and to visit patients during their stay to carry out recovery planning.

·         Patients are able to attend for aftercare support, which is more feasible for a facility located within the county

Options considered but rejected included:

·         Let the contract come to an end when it expires on 31 March 2026 and return to spot-purchasing bed nights. Decommissioning the service comes with a risk that OHID will keep to the grant conditions which state that Local Authorities MUST be part of an IPD Consortium in order to receive the IPD element of the DATRIG funding. Spot-purchasing means Kent County Council would no longer have priority access, which could result in longer waiting times for Kent residents.

·         Discontinue the current arrangement and invest any remaining funds in the existing Hampshire Consortium (this is a separate consortium arrangement, led by Hampshire County Council, which Kent County Council is already a member of). This would require patients to travel to Fareham and would mean there is no local inpatient detoxification provision.

·         Join another Consortium nearby, such as West Sussex. Whilst this would provide an option closer than that offered through the Hampshire Consortium, it would not offer the convenience of a Kent-based facility.

Regardless of which option was explored, there would be no major changes to the specification as the service model only requires inconsequential refinements.

Note: each consortium group member (Surrey, Oxfordshire, and Medway) will be following their own governance processes to enable the continuation of the consortium arrangements.

Procurement

The recommissioning of the Kent Drug and Alcohol Inpatient Detoxification Service falls under the 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:

The funding for this contract would be from OHID additional grant funding, the Drug and Alcohol Treatment and Recovery Improvement Grant (DATRIG), should this continue beyond March 2026. The funding is linked to the 10-year national drug and alcohol strategy ‘From Harm to Hope’ and would constitute a continuation of the activity currently funded by the existing OHID grant.

The financial commitment will be circa £2,452,191 for a 5-year contract for the Kent Drug and Alcohol Inpatient Detoxification Service (three years with two additional one-year extension options), however, the contract will reflect only the money available through known grant funding at that time.

The above values reflect the potential for a year-on-year increase in the cost of bed nights (set by the provider) and the potential to increase the number of bed nights each consortium member (Kent, Surrey, Oxfordshire and Medway) may purchase. Annual allocations will be agreed subject to availability of the grant and in line with demand.

Should the funding not be continued, or grant conditions are amended, the current contract could be allowed to end and Kent drug and alcohol services will return to spot-purchasing bed nights on an ad-hoc basis, using any funding already allocated within the existing contracts (covered under key decision 24/00055). This would represent a reduction in activity as no additional funding would be available, and would not support market sustainability, best value, or national policy).

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, provided it is received on similar terms and conditions.

Legal Implications:  

Under the Health and Social Care Act 2012, Directors of Public Health (DPH) in upper tier (UTLA) and unitary (ULA) local authorities have a duty to take such steps as they consider appropriate for improving the health of people in their area and such steps can include providing services or facilities designed to promote healthy living (whether by helping individuals to address behaviour that is detrimental to health or in any other way).  

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 this service 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.