Decision Maker: Cabinet Procurement and Insourcing Committee

Outcome: For Determination

Is Key Decision?: Yes

Is Callable In?: Yes

Date of Decision: March 3, 2025

Purpose:

Content: RESOLVED:   1.  Agree to award the Commercial Sex Workers Service contract to the Homerton Healthcare NHS Foundation Trust for an initial period of 5 years with 1+1+1 years as an extension option. Commencing on 1st April 2025, the total cost of the contract will be a maximum of £2,710,128. 2.  Agree to award the NHS Health Checks and Sexual Health Enhanced Service contract to the City and Hackney Integrated Primary Care Community Interest Company (formally known as City and Hackney GP Confederation) for an initial period of 5 years with 1+1+1 years as an extension option. Commencing on 1st April 2025 the total cost of the contract will be a maximum of £4,160,000. 3.  Agree to award contracts for the “Public Health Pharmacy Services - Sexual and Reproductive Health Services” to 47 community pharmacists operating in City and Hackney (list of pharmacies to be awarded can be found in Appendix 5). Commencing on 1st April 2025 the total cost of the proposed contracts will be £1,280,000 (additional pharmacies may meet the requirement to be issued a contract, in which case they will be within the authority of the Director of Public Health to approve). 4.  Agree that any further pharmacies that meet the requirements to be issued a contract are awarded under the delegated authority of the Director of Public Health.   Reasons For Decision   1.  In accordance with the Council's governance process, a contract award report articulating the recommendations for contract award is a requirement.   2.  Commissioning of the Primary Care Based Services and Commercial Sex Workers Service supports the local authorities ability to deliver against the five main sexual health Public Health Outcomes  Framework measures:   ·  under 18 conceptions ·  chlamydia detection rate  ·  new STIs diagnosis (excluding chlamydia in the under 25s) ·  prescribing of long-acting reversible contraception (LARC) excluding injections (females aged 15 to 44) ·  people presenting with HIV at a late stage of infection   3.  The commissioning of health checks plays a crucial role in meeting the council's mandate to improve public health and well-being within its community. Health checks are a vital aspect of preventive healthcare, aiming to identify health risks early, encourage healthy lifestyles, and prevent the onset of chronic diseases that can burden both individuals and the healthcare system. NHS Health checks will support the delivery of the following Public Health Outcomes  Framework measures: ·  healthy life expectancy, inequality in life expectancy and disability free life expectancy ·  diabetes diagnosis rate ·  % of the eligible population who receive a Health Check ·  mortality rate from cardio vascular disease   4.  Primary care based enhanced services (Community Pharmacies, GP enhanced sexual health and NHS Health Checks)   Community Pharmacies   5.  The provision of Public Health services which include an enhanced service for sexual health. The services provided by pharmacies will contribute to an improvement in the sexual and reproductive health and wellbeing of people in the City of London and Hackney with a particular emphasis on young people.   6.  The principal aims of this Service are:   ·  To increase the access to and use of condoms by sexually active young people (aged under 25 years).To achieve high screening rates for Chlamydia and Gonorrhoea in sexually active young people. ·  To improve access to treatment of Chlamydia and other Sexually Transmitted Infections (STIs) for sexually active young people. ·  To increase access to Emergency Hormonal Contraception (EHC) for all women, non-binary persons and transgender men who have had unprotected sex. ·  To reduce the number of unplanned pregnancies in the client group. ·  To refer clients, especially those from inclusion communities groups, into mainstream contraceptive services. ·  To increase the knowledge of risks associated with STIs. ·  To refer clients who may have been at risk of STIs to an appropriate service. ·  To reduce inequalities in sexual health outcomes, in line with the aims of the City & Hackney sexual and reproductive health strategy and action plan.   Enhanced Sexual Health Services -  GP   7.  GP practice led sexual and reproductive health services. Specifically, GP practices will be required to:   ·  Ensure sexual and reproductive services are accessible to City and Hackney GP patients, in particular to those who are at a higher risk of unwanted pregnancies and poorer sexual health outcomes. ·  Provide a LARC service that is widely promoted and easily accessible, providing convenient and timely appointments to encourage take-up, including through self-referral. ·  Provide services for the prevention, detection and management of STIs. ·  Provide Chlamydia screening in line with the National Chlamydia Screening Programme (NCSP). ·  Provide data which can be used to determine and address health inequalities amongst the population. ·  Contribute to the implementation of the City & Hackney Sexual and Reproductive Health Strategy and Action plan, 2024-2029. ·  Contribute to place and neighbourhood based partnership working in sexual and reproductive health.   Enhanced GP Services - NHS Health Checks   8.  The Local Authority is mandated to make provision for the NHS Health Checks programme provided for eligible residents. 9.  The NHS Health Check programme aims to improve the health and wellbeing of adults (aged 40-74 years) through the promotion of early awareness, assessment, and management of the major risk factors for CVD – risk factors that are associated with premature death, disability and health inequalities in England. 10.The programme objectives include: ·  To promote and improve the early identification and management of the individual behavioural and physiological risk factors for vascular disease and the other conditions associated with those risk factors. ·  To support individuals to effectively manage and reduce behavioural risks (smoking, alcohol, diet and physical activity) and associated conditions through information, and evidence based behavioural and clinical interventions. ·  To help reduce inequalities in the distribution and burden of behavioural risks, related conditions and multiple morbidities.   11.Commercial Sex Worker Service (Open Doors)   12.Sex workers have specific sexual health needs with those street sex working often having additional complexities and vulnerabilities from dependent alcohol and drug use, increased rates of domestic abuse, mental health needs, homelessness and violence. 13.Supporting clients through outreach and drop in to access drug and sexual health treatment services, harm minimisation, overdose prevention and exit street based sex working are all key outcomes from the service provided across City and Hackney. 14.A specialist service has enabled a trusted relationship to be established with this vulnerable group and both sexual health and substance use needs to be effectively addressed.     . 15.Specifically, the service aims to:   ·  improve the sexual wellbeing of on-street and off street Commercial Sex Workers (CSW) through the provision of targeted and tailored sexual health outreach services, ·  ensure CSWs have access to clinical harm reduction advice, information and interventions around substance use via smooth referral pathways, joint working and integrated service provision, and multi-agency coordination of care, ·  increase uptake of specialist and mainstream clinical sexual health and mental health services by on-street CSWs, ·  reduce the risk of sexual ill-health of those who use on-street commercial sex services and onward transmission of HIV and STIs to the general population, ·  encourage behaviour change to exit CSW to reduce the associated social and health burden borne by this population and the general population, ·  increase access and uptake of mainstream services for CSW by removing service barriers.   Alternative Options Considered and Rejected   Option 1-  End the services at the currently scheduled contract end dates and do not commission all or any of the services   This option was considered and rejected because whilst not commissioning the full range of services outlined may provide a saving in year one, costs in future years would significantly rise as residents access services out of area who will then recharge for the cost of provision.   In addition to this, both sexual health services and NHS Health Checks are included as legally mandated services for local authorities to commission. Not providing these services would open up the authorities to legal challenge and breach the conditions of the ring-fenced public health grant.   Option 2 - Re-procure the current services via a competitive procurement process.   This option was considered and rejected because opting for a procurement route other than via direct contract award would be contrary to the local and national strategic direction of increasing partnership working with the local NHS.   There are also no other providers who can deliver this service due to the nature of the commissioning arrangements of these NHS services.   Option 3: Insourcing   This option was considered and rejected because the GP Enhanced Sexual Health and the NHS Health Checks are delivered within the GP practices, and both services require access to registered patient data. Insourcing will require significant system changes to be able to access patients' records/data which may not be possible, or are likely to take many years and significant discussion to achieve. The Council does not have the infrastructure in place or data sharing agreement to access the information necessary to provide an insourced service.   Open doors is a highly specialised service which requires formal clinical expertise and clinical supervision.  Neither LBH nor the City of London Corporation has the required professional staff nor structures to undertake this.   Insourcing would increase costs, delays, impact negatively on local partnership working and may not be achievable in terms of data sharing.   Consequently, the proposed services to be commissioned cannot be insourced in the future.   The full options appraisal can be found in Appendix B.   Hackney Council’s Sustainable Procurement and Insourcing Strategy (SPIS) approved by the Cabinet in November 2024 confirms that all services should be reviewed for insourcing inline with the insourcing-outsourcing hierarchy described in the Strategy.  The hierarchy recognises the importance of NHS and VCS partners and it should be noted that all the services described in this report are delivered by local NHS organisations (acute trust, GP practice or local pharmacy) based in Hackney and the City of London.