Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

The purpose of this paper is:

1.1. To seek approval to tender for the Hampshire substance misuse treatment system as part of the implementation phase of the Substance Misuse Strategic Review.

1.2. To seek single tender approval to extend the existing substance misuse contracts to bring them into line with the proposed procurement process and commencement of the new treatment system.

1.3. This paper seeks to:

· set out the background and context to the re-commissioning of the Hampshire treatment system

· outline the project timetable for the procurement process

· set out the reason for single tender approval for the extension of existing contracts

· outline the financial implications arising from the re-commissioning exercise

2. Contextual information

2.1. Effective substance misuse services play a significant part in supporting the corporate priorities:

· Hampshire safer and more secure for all - by promoting treatment services and encouraging users (including known offenders) to take up treatment options there is a known correlation between numbers entering treatment and a reduction in crime rates.

· Maximising wellbeing - treatment and harm minimisation services have a significant impact on the health and wellbeing of individuals, their families, carers and communities.

2.2. A countywide strategic review of substance misuse services was launched during July 2008 and a formal consultation process, based upon a strategic review information pack took place between 2 October 2008 and 2 January 2009.

2.3. The desired outcome of the review process is to deliver the best possible configuration of drug and alcohol services in the county. These services will be effectively commissioned, properly contracted and monitored to meet needs and targets, and will be affordable within the available budget.

2.4. Further background and contextual detail is available in the Executive Member decision report: Approval of the next stage of the Substance Misuse Strategic Review - The Development Plan (following consultation) 26 June 2009.

3. Proposals for the Implementation Phase of the Substance Misuse Strategic Review

3.1. The procurement process will be supported by Corporate Procurement and a project initiation document (PID) has been developed for this project.

3.2. The implementation phase is summarised below and for a full version of the project plan see Appendix C.

Fig.1 : Key Milestones

	Milestone	Estimated Target Date	Status (Completed _)
1 2 3 4 5 6 7 8 9	Initial Project Plan for review Evaluation tool containing criteria, weightings and answer definitions, to assess responses at prequalification stage Adverts drafted and issued, seeking expressions of interest Prequalification questionnaire drafted and issued Prequalification evaluation results summary Evaluation tool containing criteria, weightings and answer definitions, to assess tender responses. Evaluation results summary (following evaluation of tenders and panels) Contract Award Service Commencement	21 09 2009 20 11 2009 16 12 2009 20 01 2010 18 02 2010 25 02 2010 18 05 2010 08 06 2010 01 12 2010	_ _

3.3. A tender process will be conducted to re-commission the Hampshire substance misuse treatment system. The proposals to tender are compliant with Hampshire County Council Standing Orders, and are subject to the European Union (EU) Procurement Directives (current regulations 31 January 2006) according to Part B services.

3.4. The new treatment system will be characterised by a single countywide model which will include services for criminal justice clients, drug clients and alcohol clients with a clear responsibility to respond to needs and address inequalities as a contractual requirement.

3.5. `Models of Care' (de facto National Treatment Agency, National Service framework) for both drug and alcohol users will be delivered via this integrated model and will offer all tier 2 and 3 modalities of treatment. Tier 4 provision, in-patient detoxification and residential rehabilitation will not be directly delivered by the new service provider(s).

Appendix D provides a full explanation of the services included in each tier. In brief these are:

· Tier 1 - Non substance misuse specific services

· Tier 2 - Open Access services

· Tier 3 - Structured community based services

· Tier 4 - Residential and specialist services

3.6. The revised tender timetable has meant that services currently contracted by the Drug and Alcohol Action Team (DAAT) and extended to 31 March 2010 now require an additional extension, to bring them into line with the new procurement timeline. Authority is requested to extend the applicable contracts to 30 November 2010.

3.7. The contract extension is requested on the basis of a single tender and the case for this approach is in line with the following criteria:

· it meets single tender criteria as an interim arrangement following the strategic review of services and whilst existing services are in transition.

Fig. 2 : Contracts Requiring Extension in line with the procurement of the integrated system

Provider	Service	Expiry Date	Extension Sought*
Cri	Open Access Shop Front & Aftercare (Winchester & Andover)	31.03.10	8 months
Phoenix Futures	Open Access Shop Front & Aftercare (Fareham, Gosport & East Hants)	31.03.10	8 months
Cranstoun	Drug Intervention Programme Team	31.03.10	8 months
Hampshire Partnership NHS Foundation Trust	Structured Community-based Interventions	31.03.10	8 months
Surrey & Borders NHS Foundation Trust	Structured Community-based Interventions	31.03.10	8 months
Portsmouth City PCT	Structured Community-based Interventions	31.03.10	8 months

*Note: "Extension Sought" shows minimum extension required and assumes that new treatment system will commence on 1 December 2010.

Fig. 3 : Contracts Requiring Extension which sit outside the integrated system

Provider	Service	Expiry Date	Extension Sought*
Parent Support Link	24/7 Carers Support Line & 1:1 Support	31.03.10	12 months
Portsmouth City PCT	"Baytrees" In-patent Detox Service	31.03.10	12 months

These services will be subject to a separate procurement process which will commence during 2010/11.

4) Impact and Implications

4.1 Legal

4.1.1 In preparation for the review, existing contracts that were due to expire during the period of the review were extended and those that extend beyond the period of the review will receive notice, to facilitate a process of commissioning to implement the findings of the review.

4.1.2 Advice and guidance has been sought from Hampshire's Legal Department and will continue to be sought during the tender and procurement process.

4.1.3 A tender process will be conducted and the award recommendations will be submitted to Legal Services for approval, in preparation for contract award.

4.1.4 The Transfer of Undertakings (Protection of Employment) Regulations 2006 (SI 2006/246) are designed to protect the rights of employees in a transfer situation enabling them to enjoy the same terms and conditions, with continuity of employment, as formerly. Where there is a transfer of the services to a new employer then these may apply to staff who are delivering contracted services within the current Hampshire treatment system.

4.1.5 The new treatment system will be commissioned using locally aligned budgets, rather than any local pooling arrangement.

4.2 Financial

4.2.1. The current DAAT-held Pooled Treatment Allocation funding into contracted substance misuse services has a value of £4.23m. However, due to the reduction in government grant*, known as the Pooled Treatment Budget (PTB), it is expected that approximately £3.38m will roll forward into the new integrated service.

* As a part of a review of spending, the Department of Health identified local efficiency savings of £50m per annum against national expenditure on the PTB by 2010/11. One of the means through which efficiencies will be delivered is to move from the formula based allocation towards allocations based on the number of individuals in effective treatment. By 2010/11 all areas will receive the same level of support from the PTB per person treated.

4.2.2. There are two key points relating to financial impact and implications:

· re-tendering / re-commissioning exercise will deliver the required efficiencies to ensure an ongoing balanced budget position. One-off funding of £323,000 is required in 2010/11 to cover the costs of maintaining existing frontline services during the commissioning and procurement of the new treatment system. The shortfall is being addressed as part of the Adult Services budget setting process for 2010/11.

· the carry forward of non-recurring funding across years has been approved by the Executive Member for Adult Social Care (decision report 26 June 2009), the DAAT partnership and by the National Treatment Agency

4.3 Impact Assessment

4.3.1 In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. The Hampshire DAAT diversity statement states that it is committed to securing genuine equality of opportunity, recognising the many differences between people and avoiding or overcoming discrimination, whether required by law or not, in all aspects of its activity by positively valuing different perspectives and skills.

4.3.2 The Hampshire DAAT ensures through its contracting and contract review processes that all service providers demonstrate equality of access to, and quality of treatment across, all groups of potential service users and that all services shall respond positively to the needs of diverse drug users, including cultural, religious, language, gender, sexuality, disability, age and communication need.

4.4. Human Resources

4.4.1. There are five full time equivalent (fte) Social Care staff, employed by Adult Services and supported by funding from the Hampshire DAAT Pooled Treatment Budget. These staff, together with a further seven social work posts funded by Adult Services form part of the current multidisciplinary community substance misuse teams providing structured treatment services in Hampshire.

4.4.2. As the future delivery of structured treatment services will form part of the tender process which will commence during 2009/10, there will be implications for all 12 fte staff employed by Adult Services. The Transfer of Undertakings (Protection of Employment) Regulations 2006 (SI 2006/246) may apply.

4.4.3 In response, Adult Services have commissioned a piece of work to review the impact of this whole system change, in order to clarify and redefine the social work role within the new treatment system. The affected staff group have been closely involved in the consultation process and are involved in this ongoing piece of work.

5. Recommendations

It is recommended that the Executive Member for Adult Social Care

approves:

5.1. The process outlined, to tender for the Hampshire substance misuse treatment system as part of the implementation phase of the Substance Misuse Strategic Review.

5.2 The extension of the existing substance misuse contracts to bring them into line with the proposed procurement process and commencement of the new treatment system.

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

Other Significant Links

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

A comprehensive Equalities Impact Assessment has been carried out.

The Substance Misuse Strategic Review process and the development of a new treatment system in Hampshire will build upon the current knowledge base, data evidence and activity in place (as described within the assessment), to improve access and engagement with the drug treatment system by groups of individuals who may be marginalised by virtue of a wide range of presenting needs.

The 2009/10 Adult Treatment Plan specifically prioritises BME; substance misusing parents; crack users; problematic drug users (PDU's) aged under 24, however, all groups should expect an improvement in the way their needs are met in a more holistic and integrated way.

It is proposed to undertake a regular review and update the Equalities Impact Assessment on an annual basis. Progress will be evidenced by an improvement in the knowledge base relating to marginalised groups, the available data evidence and documented activities in place.

In compiling this report account has been taken of the requirements of the Corporate Equalities Plan and Race Scheme. The Hampshire DAAT diversity statement states that it is committed to securing genuine equality of opportunity, recognising the many differences between people and avoiding or overcoming discrimination, whether required by law or not, in all aspects of its activity by positively valuing different perspectives and skills.

Hampshire DAAT ensures through its contracting and contract review processes that all service providers demonstrate equality of access to, and quality of treatment across, all groups of potential service users and that all services shall respond positively to the needs of diverse drug users, including cultural, religious, language, gender, sexuality, disability, age and communication need.

2. Impact on Crime and Disorder:

The County Council has a legal obligation under Section 17 of the Crime and Disorder Act 1998 to consider the impact of all decisions it makes on the prevention of crime.

The proposal in this report aims to improve the safety of vulnerable Hampshire residents and reduce the risk of crime occurring.

There are elements of the substance misuse treatment system that interface directly and indirectly with the criminal justice system and impact upon community safety across the county. In carrying out this strategic review we have been mindful of these links and have ensured that we have an overview of both the substance misuse strategic review and the community safety strategic review and have been involved in the development and detail of both reviews.

The strategic commissioning of an integrated drug and alcohol treatment system will contribute directly to the delivery of National Indicators NI15 - 18, 20, 30, 38, 41 & 42.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?

The re-commissioned treatment system will have regard to the accessibility of services to the client and will include the physical accessibility, i.e. proximity to public transport and the use of satellite provision to take the service into localities to reduce the burden of travel placed upon service users. An increase in local purchasing due to personalisation may also reduce carbon footprint through reduced travel.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?

As the procurement process develops, a requirement to consider the need to adapt to climate change, and be resilient to its longer term impacts will be taken into account in the detailed planning and development of the Invitation to Tender (ITT). Prospective service providers will be required to demonstrate that they have considered climate change in developing their service delivery model.

Service Definitions - By Tier

Tier 1 - Non Drug Treatment Specific Services

Tier 1 consists of services offered by a wide range of professionals (e.g. primary care medical services, generic social workers, teachers, community pharmacists, probation officers, housing officers, homeless persons units). Services work with a wide range of clients including substance misusers, but their sole purpose is not simply substance misuse. Tier 1 services may include:

· Access to full range of health, social care, housing and other services.

· Substance misuse screening, assessment and referral mechanisms to substance misuse services from generic, health, social care, housing and criminal justice services.

· Management of substance misusers in generic health, social care and criminal justice settings.

· Health promotion advice and information.

· Hepatitis B vaccination programmes for substance misusers and their families. Alternatively, if investments in vaccinations are made within Tier 2, 3 or 4 services, they can be recorded in the relevant grid.

Tier 2 - Open Access Services

Services within this Tier aim to provide accessible services for a wide range of substance misusers referred from a variety of sources, including self-referrals. The aim of the treatment in this Tier is to help substance misusers to engage in treatment without necessarily requiring a high level of commitment to more structured programmes or a complex or lengthy assessment process. Services include needle exchange programmes and other harm reduction measures, substance misuse advice and information services and ad hoc support not delivered in a structured programme of care.

Tier 3 - Structured Community Based Services

This Tier can be defined as providing services solely for substance misusers in a structured programme of care. Services include structured cognitive behaviour therapy programmes, structured methadone maintenance programmes, community detoxification, or structured day care (either provided as a drug-free programme or as an adjunct to methadone treatment). Structured community-based aftercare programmes for individuals leaving prisons are also included in Tier 3.

The principal expectation is that the substance misuser attending these services will have agreed to a structured programme of care which places certain requirements on attendance and behaviour (e.g. a certain number of days or hours attendance per week, review of programme is triggered if attendance is irregular).

Tier 4 - Residential and Inpatient Services

Services in this Tier are aimed at those individuals with a high level of presenting need. Services in this Tier include inpatient drug treatment, including detoxification and residential rehabilitation. Tier 4 services usually require a higher level of motivation and commitment from the substance misuser than for services in lower Tiers.