Content

RESOLVED:
To agree a Contract Variation of
£5m for the City and Hackney Integrated Drug and Alcohol
Service (existing value £24m) commencing in April 2023 with
all additional activity to be delivered by the end of March 2025.
The revised maximum contract value including variation will
be  £29m.
 
Reason(s) For Decision
 
1. 
Substance Use and its
associated harms have become a significant focus for Central
Government over the past two years, in part due to the publication
of two reviews of substance use across the UK by Dame Carol
Black.
 
2. 
This has led to an
increased number of national strategic approaches to tackling drug
related harms, including publication of an overarching ten year
drug strategy and increases in funding, via grants, to help better
meet the needs of local residents using drugs.
 
3. 
The London Borough of
Hackney (LBH) has been identified as a specific strategic partner
for a number of these funding streams by Central Government, with
drug harms across the borough having risen over the last ten years
alongside an overall reduction in the capacity and funding of our
substance use treatment provision.
 
4. 
In order to reduce
levels of unmet need across the borough we have accepted
invitations to apply for this grant funding, and have utilised this
money to increase treatment capacity and diversity of offer from
our core substance use service (delivered by Turning Point). We
have also worked to develop our approaches through funding of other
services with low or no representation in our substance use
treatment system.
 
5. 
Single Tender Actions
are being used to procure most of these services due to:
· 
The novel nature of
the organisations
· 
Lower levels of
funding requirements
· 
Guidance from Central
Government
· 
Lack of an existing
contract between the authority and the services regarding this
specific delivery
 
6. 
This report is
presented to the Cabinet Procurement and Insourcing Committee to
approve a contract variation of £5,000,000 for the delivery
of community drug and alcohol treatment.
 
7. 
This paper details the
necessity of our existing substance misuse service receiving this
funding, as well as  the steps taken to
meet the principles of decision making, best value duty and to flag
future risks to service delivery
 
8. 
What follows is a
brief overview of the three relevant grant funding streams LBH
have/are to receive and how they align to both local and national
strategy.
 
The Rough Sleepers Drug and Alcohol
Treatment Grant:
 
9.  This funding
aims to improve substance use treatment and health outcomes for
people with substance use issues who are experiencing homelessness,
aiming to reduce drug related deaths.
 
10.  The application period and
lead time between approval and delivery 
for the first phase (Q4 2020/21 and all of 2021/22) was limited.
Despite this, stakeholder engagement with partners was conducted
(Appendix 1), with ongoing engagement throughout the process of
preparing and submitting the bid.
 
11.  Local Authorities were not
informed at the start of the programme that there would be further
funding and need for RSDATG delivery. Commissioners were informed
of the continuation in March 2022, covering FY 22/23 and
23/24. 
 
12.  Application for funding was
opened in June 2022, to be submitted by July 2022.
 
13.  Further Stakeholder
engagement was conducted, with consensus arising regarding access
to wider ranges of clinical services, further Adult Social Care
input and increased peer support. 
 
14.  The successful
application for the second phase meets this by:
· 
Increasing staff and
resources for the core substance use service (delivered by Turning
Point)
· 
Additional funding to
develop and increase staff within the LBH Supporting Transition and
Empowering People Service (STEPS)
· 
A specialist Social
Worker within LBH ASC
· 
Grant funding to a
wider range of existing local services.
 
15.  Project
ADDER:
 
16.  This programme was
initiated by the Office of Health Improvement and Disparities
(OHID, previously Public Health England) in early 2021 aiming at
system wide development work to address drug related
harms.
 
· 
Specific outcomes of
the programme are to:
· 
Reduce drug-related
death
· 
Reduce drug-related
offending
· 
Reduce the prevalence
of drug use
· 
Achieve sustained and
major disruption of high-harm criminals and networks involved in
middle market drug/firearms supply and importation
 
17.  The  high profile programme acts as a
‘trailblazer’ for Central Government’s 10 year
drug strategy. In line with this the Metropolitan Police team
covering Hackney also received significant funding.
 
18.  Much like RSDATG,
funding has also been confirmed and awarded a year at a time, with
both short application periods and rapid timescales between
approval and delivery.
 
19.  In the first year
the City and Hackney Public Health team were awarded
£900,000.  In the second and final
year of the project (2022/23) £1,198,306.00. Due to
underspend this funding will also cover an additional quarter of
delivery (Q1 23/24).
 
20.  Stakeholder
consultation was undertaken to understand gaps in the treatment
system, and to develop solutions to delivering against these
gaps.
 
21.  As part of this a
number of smaller, community based, organisations were identified
as being good partners in system expansion. Additionally Turning
Point were identified as requiring increases in their teams in
order to work with a higher number of individuals, better connect
to prisons for releases into the community and to undertake
increased levels of outreach.
 
22.  Unlike the RSDATG,
only a small amount of grant reprofiling has been necessary in the second
year.
 
23.  Supplementary
Substance Misuse Treatment and Recovery Grant
(SSMTR):
 
24.  This grant funding
is directly aligned to the 10 year drug strategy with the
investment seeking to reach ambitious targets by 2025. The funding
is significant and is likely to continue for multiple years.
Despite this, and again much like RSDATG and ADDER, the turnaround
periods from confirmation of funding available through to delivery
are short.
 
25.  2023/24 funding was
confirmed on 16 Feb 2023, and 24/25 funding is currently
indicative. We have been awarded 
£1,490,000 in the first year, with indicative funding at
£2,890,000 in the second year. 
 
26.  Application for
23/24 funding started in late Feb, with submissions to be made
March 10th. Delivery of some aspects commenced in April 2023. We do
not know about the second year’s funding, but it is likely
that the Central Government delivery mechanism will be similar next
year.
 
27.  As we were asked to
prepare for this funding we have re-engaged with partners to
understand the current need across the substance use system.
Through consultation, including through five themed stakeholder
engagement workshops, it has been agreed that in the first year we
will continue services started as part of RSDATG and ADDER as well
as increase salaries (to aid staff retention) and bring further
peer led provision into the borough.
 
28.  If the Office for
Health Improvement and Disparities (OHID) are in agreement with
this plan, further funding will be awarded to Turning Point to
continue the work they started with earlier grant funded
opportunities, as well as to increase salaries.
29.  We have not yet
finalised a plan of delivery for the second year, which will be
developed jointly through the new multi-agency Combating Drugs
Partnership, though we believe it is likely we will continue
services delivered as part of year one.
 
30.  The significant
increase in the potential figure to be awarded to LBH from 24/25
onwards will be discussed throughout the coming year with partners,
as well as Central Government. It is likely that a significant
portion of this funding may need to be awarded to the City and
Hackney Recovery Service or distributed through an appropriate
procurement process.
 
31.  As the SSMTR is part
of the vehicle for change aimed at with the ten year drug strategy,
we are expecting further funding to continue beyond 23/24 and
24/25, but this is uncertain.
 
32.  City and Hackney
Recovery Service  and increased funding;
reasons and options
 
33.  As detailed above,
all decisions regarding system wide need have been made in
consultation with partners. In these consultations consensus has
driven our funding applications and consequent service
delivery.
 
34.  The extremely
limited time between confirmation of funding and delivery start
date for 23/24 has created severely limited options for procuring
services in a timely manner. Additionally, without confirmation of
24/25, we are unable to initiate a procurement process for that
year.
 
35.  Further to this, a
procurement process that results in a new and different provider
alongside the existing service  would
create substantial risks for service clients, due to the resources
required to overcome technical limitations; it would also create
substantial unnecessary duplication of costs. Examples
include:
· 
Supporting wider
partners/clinicians to understand the complexity of having multiple
providers would be difficult and introduce risks of inappropriate
or delayed referrals risking safety and quality of care.
· 
New, duplicated
infrastructure would be needed for a new provider such as
managerial and administrative staff, as well as other costs in
service delivery (such as premises, equipment, IT, storage and
procurement of consumables etc.)
· 
Mobilisation would
need to be done at a speed incompatible with the single year time
frames.
· 
Data management would
be difficult. There would be no shared data management resource,
data sharing would be challenging to develop and as a current data
controller Turning Point would need to operate within
organisational and legal information governance frameworks that
make sharing confidential data complex.
· 
Institutional
safeguarding concerns due to increased mobilisation times and data
challenges. A more disjointed system would increase the challenges
of responding effectively to safeguarding concerns.
36.  These constraints
mean that the existing City and Hackney Recovery Service provider
is the only viable main provider of substance use services. A
contract variation of £5m will provide the flexibility to
provide the additional services required for 23/24 and
24/25.
 
37.  Funding forecast
breakdown is outlined below. The newly created City and Hackney
Combating Drugs Partnership (CDP) has agreed to 23/24  delivery, with the likelihood agreed services will
continue into 24/25. Additional services to be awarded, and the
potential need for reprofiling other
funds from the grant envelope, will be agreed by the CDP during
23/24. This will be in line with OHID and Central Government
timelines.
 
38.  Value for money and
quality have been assured through a thorough benchmarking process,
both locally and nationally.  Locally,
benchmarking has been conducted with neighbouring commissioners and
services, and nationally OHID benchmarks all budget templates and
only signs off on budgets which meet their value for money and
quality thresholds.  Further quality
assurance is conducted quarterly through contract monitoring with
the provider. 
 
39.  The recommended
contract variation is an indication of how the grant funding, with
the increase in staff, improved pay and conditions, and increased
treatment capacity and quality impacts the overall contract value
of this commissioned service.
 
40.  Additional funding
breakdown
 
41.  Below is a
provisional breakdown of the services to be delivered covering the
period 23/24 and 24/25.
 
42.  A significant
contingency management cost is reflected due to the large increase
indicated in funding in 24/25, as well as to enable reprofiling of any underspend across the overall
grant envelopes mid-year.

Intervention
 
 

Total forecast spend for Turning Point FY
23/24-24/25
 

Funding Stream

Senior Recovery Worker

£55,125.00

SSMTRG

Non Medical
Prescriber

£135,198.00

SSMTRG

Additional recovery workers

£462,462.80

SSMTRG

Through the Gate Workers

£167,727.00

SSMTRG

Clinical Psychologist

£63,245.00

SSMTRG

Addictions Psychiatrist

£194,040.00

SSMTRG

Peer Mentoring Programme

£26,201.00

SSMTRG

Naloxone increases

£33,708.00

SSMTRG

Increased Dispensing Costs

£106,090.08

SSMTRG

pay increases

£457,400.16

SSMTRG

Dual Diagnosis Strategic Manager

£228,456.00

RSDATG

Dual Diagnosis Outreach Worker

£450,000.00

RSDATG

Trauma Aware Pathway navigator

£160,512.00

RSDATG

Data Coordinator

£64,174.00

RSDATG

Business Support Officer

£56,967.60

RSDATG

Nurse

£109,480.00

RSDATG

Alcohol Nurse

£109,480.00

RSDATG

General Practitioner

£20,000.00

RSDATG

Women's Healthcare Assistant

£44,804.40

RSDATG

Senior MH Practitioner / CBT Therapist

£52,962.40

RSDATG

Clinical supervisions

£11,040.00

RSDATG

Dual diagnosis training

£35,992.00

RSDATG

Contingency Management

£14,000.00

RSDATG

ADHD assessments

£16,000.00

RSDATG

Fibroscanner
Lease

£42,000.00

RSDATG

NMP Nurse

£123,308.00

RSDATG

Contingency

£1,759,626.56

SSMTRG

 

 

 

Total

£5,000,000.00

 

 
 
Alternative Options (Considered and
Rejected)
 
 

Reasons for
Rejecting

Reasons for
Rejecting

Reasons for
Rejecting
 

Complete a full procurement process for each
new allocation of grant funding

Completing a full procurement process takes a
minimum of 6 months and if a new provider was appointed a further 6
month mobilisation period would be
required, leaving little time to demonstrate impact.

Unable to demonstrate  impact within the
timeframe.

 

Risks not meeting the grant agreement, and money being
withdrawn.

 

Risks any new service experiencing teething problems in
mobilisation and establishing clear
joint working protocols, jeopardising
safety of individuals accessing service.

Insourcing

Wherever possible existing insourced services
have been awarded grant funding: STEPs, Young Hackney Substance Use
Service and Adult Social Care.
 
The adult community drug and alcohol service
is a hugely complex service, requiring a clinical team, a
consultant psychiatrist and at present 90 Recovery Workers, it is
therefore too complex to insource, and especially in such short
timeframes.

Insourcing has been
achieved wherever possible.
 
The adult service is
too complex for insourcing and other technical reasons stand in the
way of bringing an additional provider of services into the
authority area.
 

Do nothing, and do not accept the grant
funding

Given the dire need for funding this option
would leave a desperately underfunded community treatment system
unable to respond to the increase in drug related deaths and poor
treatment outcomes.

Risks the very
health and wellbeing of residents and fails to demonstrate the very
real difference this money can and is making.