Purpose

The purpose of the report was to seek approval for the future commissioning and delivery model for substance use services across South Tees from April 2027.

Decision

ORDERED that Executive::

1. Approve Option 1: development of a shared South Tees leadership, governance, clinical, specialist and support functions team, which was to be aligned with the existing Recovery Solutions Middlesbrough service and a mirrored, in-house Redcar & Cleveland Recovery Solutions care coordination service.
2. Approve Middlesbrough Council leading on behalf of the Public Health South Tees a procurement process in line with the Public Selection Regime (PSR) to award a new South Tees Recovery Service.

AGREED that Executive note there would be no material changes to the existing Middlesbrough frontline Recovery Solutions model, which had demonstrated positive benefits; proposed changes related primarily to the creation of shared South Tees specialist, governance and support functions.

Reasons for the decision

 REASONS

A South Tees-wide system removed duplication, improved pathways and consistency, and strengthened outcomes.

The recommended option:

•         maximised value for money through cost-neutral shared structures and reduced duplication;

•         enabled reinvestment into frontline capacity and lived experience roles within existing, ringfenced funding;

•         provided the ability to absorb the 2027/28 DATRIG funding reduction with no impact on current capacity;

•         improved data visibility and performance management;

•         enhanced workforce resilience and retention;

•         protected local area capacity and focus;

•         enabled integration with social care and partner services;

•         removed reliance on external providers for core clinical delivery, while retaining the benefits of specialist recovery provision.

Alternative options considered

OPTIONS

Option 1 (recommended): In-house Recovery Solutions teams in both local authority areas with South Tees shared functions in a specialist team.

Benefits:

•         improved efficiency and value for money;

•         shared clinical governance and resilience;

•         improved data access and integration;

•         flexibility to swiftly adapt to changing local needs.

Challenges:

•         perceptions of local authority delivery (service user perspective) and/or loss of individual local authority control;

•         potential workforce concerns;

•         TUPE process for Redcar & Cleveland Recovery Solutions service.

Option 2: In-house Recovery Solutions teams without shared structures.

Benefits:

•         retained complete local control for each local authority.

Challenges:

•         duplication of leadership, governance, clinical and other elements;

•         reduced efficiency and value for money;

•         harder to deliver within timescales.

This option had not been recommended as it would have required duplication of several management, governance and specialist functions across both authorities, reducing opportunities for efficiency, resilience and service standardisation.

Option 3: Procure an external provider to deliver Redcar & Cleveland care co-ordination and clinical service.

Benefits:

•         less resource-intensive for the Council;

•         specialist provider expertise.

Challenges:

•         higher costs due to management fees, therefore less frontline investment;

•         reduced direct control over performance information and service adaptation compared to an in-house model;

•         risk of ‘off-the-shelf’ models not meeting local needs;

•         weaker integration with partners.

This option had not been recommended as it would have created additional complexity in service delivery and accountability arrangements without fully realising the benefits of either a fully integrated South Tees model or fully independent local services.

Option 4: Extend the With You contract and retain Recovery Solutions Middlesbrough.

Benefits:

•         least disruption of all options;

•         enabled maintenance of the existing Redcar & Cleveland THRIVE model.

Challenges:

•         negotiations with the current provider would have been required;

•         inability to fully realise the desired service model delivery;

•         unrealistic to achieve the same level of value for money as the recommended model;

•         reduced direct control over performance information and service adaptation compared to the in-house model.

This option had not been recommended as it would have limited opportunities to share expertise, resources and specialist functions across South Tees, resulting in lower resilience and significantly reduced value for money compared to the preferred approach.

Option 5: South Tees Integrated Public Health Service (fully shared service hosted by Middlesbrough Council).

Benefits:

•         single integrated substance use system across South Tees;

•         increased efficiency through shared leadership, governance, clinical oversight and support functions;

•         improved resilience through a larger workforce and wider skills mix;

•         consistent service model, policies, pathways and performance management across South Tees;

•         better use of resources and economies of scale;

•         stronger partnership working;

•         improved data integration, intelligence and reporting;

•         greater flexibility to respond to changing local needs.

Challenges:

•         requirement for formal partnership and hosting arrangements;

•         TUPE and workforce transition considerations;

•         need to maintain both authorities’ identities, visibility and responsiveness;

•         potential concerns regarding local accountability and decision-making;

•         alignment of existing commissioning arrangements, policies and governance processes;

•         requirement for clear financial and performance oversight arrangements.