Decision Maker: Cabinet Procurement and Insourcing Committee

Outcome: Implemented

Is Key Decision?: Yes

Is Callable In?: Yes

Date of Decision: April 29, 2025

Purpose:

Content: RESOLVED: 1.  To agree to extend the current contract for Clinical Sexual Health Services with the Homerton Healthcare Foundation Trust from 1st August 2025 to 31st March 2026 at a value of £2,533,333 with an option to extend for up to a further year at a value of £3,800,000 per annum. 2.  To agree to extend the contract for the Sexual and Reproductive Health(SRH) in-reach and out-reach nurse, which was originally awarded as a variation to the Clinical Sexual Health Services contract, from 1st April 2025 to 31st March 2026, at a value of £87,793 per annum.   Reasons For Decision   Following  key decision AHI S378 detailed work has been undertaken with The Homerton to prepare for recommissioning of the clinical Sexual Health Service using Direct Award C, commencing 1st August 2026.   A significant area of focus has been in relation to the financial sustainability of the service model and current service configuration.   SHL, the London wide online sexual health testing service, has successfully transferred a significant amount of testing from clinics to an online provider with lower costs per test. Whilst this has provided significant cost savings to councils it has impacted on the financial viability of service provision from clinics.   The costs of providing in clinic services have also changed and, as the Public Health grant has not kept up with inflationary pressures, additional increasing provider efficiencies have been required.   The initial joint work from October to January identified that more substantial service redesign work will be needed in order to ensure the Homerton has a service configuration that is financially sustainable to allow them to enter into an eight year contract of 5+1+1+1.   In addition the London Sexual Health Programme service specification is required for the 8 year contract as services are commissioned on an open access basis for use by any person across London and England. Without the service specification it would not be possible to design the local service confident that there will not be major changes needed in how services are to be provided. The service specification is now not timetabled to be available until April 2025.   Extending the existing contract, would also allow for the London Sexual Health Programme London wide open book exercise work programme which will assist in providing reference costs to compare the Homerton’s current costs and ensure that local service models are based on the best possible information.   The SRH Nurse provision improves access to sexual and reproductive health services for young residents in both Hackney and the City of London by ·  identifying  and establishing  new locations to provide clinical services to young residents aged 11-18 or up to 24 with particular vulnerabilities ·  supporting the Super Youth Hub pilot ‘HealthSpot’ by the provision of clinical ‘in-reach and ‘out-reach’ services at youth locations. ·  Improving the pathways between schools, colleges and other youth settings into clinical services. ·  Contributing to the development and/or delivery of Sex and Relationship Education (RSE) in education settings by adaptation of resources, training for school staff, direct delivery, and/or capacity building within the Young Hackney Health and Wellbeing team.   An extension to this current offer will enable this work to be embedded within the core clinical contract.   Hackney and the City of London continue to have very high levels of need for sexual health services as evidenced by high rates of STIs and unwanted pregnancies. This is due to a combination of our local demographics including a young population, larger proportion of global majority communities and a relatively large population of men who have sex with men who have higher recorded sexual health needs, higher incidence of STIs and high uptake of services at sexual health clinics.   Hackney has a young population with 62% of residents under the age of 40 with the highest uptake of sexual health services at clinics in those aged 22 to 40.   Young people in Hackney bear the burden of chlamydia infection, with a proportionally high burden of disease among young black men of Caribbean heritage.   Many inequalities and disparities in sexual and reproductive health outcomes, as well as access to and uptake of services, are tied to age, sex, sexual orientation and ethnicity, with links to socio-economic deprivation.   The local City and Hackney clinical sexual health services not only treat sexual ill health but also provide for sexual good health through encouraging preventative approaches e.g. provision of PrEP, encouraging condom use, vaccinations, partner notification and sit alongside the sexual ill health prevention services as detailed in key decision AHI S392.   Alternative Options Considered and Rejected   Options Appraisal   Option 1 – Extend the current contract until 31st March 2026 with a further option to extend for up to a further year   This option would enable the required service redesign work to take place and any formal consultation which may be necessary or desirable.   The proposed redesign work will ensure that the service model meets the needs of the population taking into consideration that sexual health services have experienced significant increases in demand for services as well as increased rates of sexually transmitted infections, alongside, like many providers, increased costs due to inflationary pressures and pay awards.   An extension would also allow the London Sexual Health Programme to deliver the updated London service specification (expected by the end of April 2025) which is anticipated to add further clarity to areas for cross charging such as young people, partner notification, chemsex and psychosexual issues   The open book exercise work programme can be undertaken providing reference costs to compare the Homerton’s current costs and ensure that local service models are based on the best possible information.   Option 2 – Proceed to competitive full market procurement   This option considers re-procuring the clinical services through a full competitive process rather than extending the current contract   The new procurement regulations for clinical services implement changes which place a greater emphasis on the need to collaborate, integrate and reduce the need for competitive procurement   Opting for a full market procurement would be contrary to the local and national strategic direction of increasing partnership working with the local NHS.   This option would not allow time for the local service configuration to be redesigned, nor the results from the Open book process to inform future commissioning.   Option 3 - Continue with CPIC decision agreed in October 2024 and seek to award 5+1+1+1 using direct award C from August 2025   The Homerton have confirmed that the current service model is not financially sustainable as it is operating at a very significant deficit of income compared to current expenditure.   This option would not allow sufficient time service transformation, the open book exercise to be undertaken nor the publication of the London service specification   Option 1 is the preferred option.