Decision Maker: Cabinet Procurement and Insourcing Committee

Outcome: For Determination

Is Key Decision?: Yes

Is Callable In?: Yes

Date of Decision: October 7, 2024

Purpose:

Content: RESOLVED to: 1.  Prevention and Promotion: Authorise Hackney Council to be included in the new North East London framework for community and voluntary organisations working in sexual health, HIV prevention and support. This will be commissioned and managed by London Borough of Newham for all North East London local authorities commencing in 2025. The value of services to be procured by Hackney Council via the four year framework would be a maximum of £875k ex VAT. 2.  Prevention and Promotion: Authorise Hackney Council to be included in the London HIV Prevention Programme commissioned by Lambeth LA for a further 4 years. Hackney Council’s contribution for this period will be a maximum of £200k ex VAT. 3.  Additional funding option: Across City, Hackney, London and nationally the need for sexual and reproductive health services is significantly increasing with rising rates of unwanted pregnancies, increasing number of terminations and increased rates of STIs. Significant cost savings have taken place across sexual health services and a number of leading agencies including the All Parliamentary Women’s and Equality Group, Local Government Association and Association of Directors of Public Health have been advocating for increased national funding for sexual health services. 4.  To enable rapid deployment of any additional (national government grant) funding that may be provided to local authorities, permission to include an option to increase the value of contracts by further sums allocated to the Council, currently estimated to be approximately a further 40%, as part of the procurement options. Any such option to increase contract values would be taken in line with internal governance to allow suitable oversight of the option but also rapid deployment in the event that additional funding is provided.     Reasons For Decision   Prevention and promotion: 1.  Preventing sexual and reproductive ill health by increasing sexual health literacy is a key strategic priority contained within the SRH strategy. 2.  Alongside work being undertaken by Young Hackney in schools and the youth hubs the voluntary sector has a key role in Increasing information on prevention methods such as condoms, PrEP, contraception, testing, treatment and partner notification. 3.  The recent needs assessment confirmed that significant sexual and reproductive health inequalities exist, with high levels of need  including for young people, gay and bisexual men and amongst specific global majority communities. 4.  City and Hackney has been party to an existing NEL framework for community and voluntary organisations working in prevention and support. This framework finishes in 2025. 5.  The London Borough of Newham, on behalf of all North East London local authorities, plans to recommission the framework in 2025.   The existing contracts to be procured under the framework are:   6.  Condom distribution to targeted communities - The service provides free condoms and lubricant, and information, to Hackney and City of London residents aged 18+ from black ethnic groups, as well as other ethnic minority groups, through targeted outreach and engagement 7.  HIV Preventative Services for adults (Lot 1) and HIV Preventative Services - families and children (Lot 2): The service provides people living with HIV, particularly newly diagnosed cases with a timely, personalised, time-focused package of support which promotes independence as well as emotional, physical and social wellbeing. It also includes community outreach and testing services. 8.  Project Community (Community Sexual Health Promotions service) - The aim is to prevent and improve poor sexual and reproductive health outcomes for individuals from high-risk communities 9.  Continuing to be a party to the framework provides City and Hackney with a number of benefits including: a) Making it easier for local C&H voluntary sector providers to be commissioned across NEL b) Increased efficiency by aligning the approach to contract and performance management c) Providing for economies of scale across NEL whilst retaining the focus on local areas. 10.In addition to the NEL framework, City and Hackney has been a long - standing member of the London HIV Prevention Partnership (LHPP), commissioned by Lambeth Council and provided by a wide range of voluntary partners, including East London based organisations, across London.  11.LHPP is a London wide partnership that aims to reduce HIV transmission and promote regular HIV testing as well as PrEP uptake across both gay and bisexual men and also heterosexual communities especially from global majority communities. 12.By taking a London wide approach the LHPP benefits from economies of scale especially in relation to social media based health promotions, outreach to venues (including those based in City and Hackney) that serve residents from across London, the UK and worldwide. 13.The contracts commissioned by Lambeth will need to be recommissioned in 2025/26 and permission is sought to confirm that City and Hackney will remain as a partnership member. 14.The overall outcomes for the prevention and promotion services will be: 15.Increase uptake of long-acting reversible contraception (LARC), including for disadvantaged or under-served communities 16.Increase the uptake of HIV testing, reduce late HIV diagnoses and preventing new infections 17.Ensure timely results and follow-up for all STIs and improve immunisation, to help to reduce the risk of onward infections 18.Ensure screening/identification and interventions for health and social risks such as domestic violence, child sexual exploitation, Female Genital Mutilation (FGM), and child and adult safeguarding, as part of local arrangements for pathways of care and support 19.Improve sexual health promotion, HIV prevention and uptake of sexual health interventions including LARC in key and vulnerable groups through targeted interventions and promotion, encouraging innovation 20.Monitor and improve the quality and experience of services for all users, including annual service user engagement plans.     Alternatives Considered and Rejected   Option 1 - End the services at the currently scheduled end date of and do not recommission services 1.  This option considers the implications of ceasing the delivery of prevention and promotion services. 2.  Under the Public Health ring-fenced grant conditions, sexual and reproductive health promotion services are not prescribed, but they are listed under the non prescribed (and, therefore, expected functions) and play a key role in reducing health inequalities, reducing the direct costs of providing for prescribed services e.g. testing and treatment of STIs. Not recommissioning services would lead to increased health inequalities, mortality and morbidity.   Option 2 - Not join the NEL Framework 3.  This option considers directly re-procuring the existing contracts directly rather than continuing to do so via a new framework 4.  A framework for HIV support across NEL was established in 2017 and has been effectively used to procure services for HIV support and prevention from local organisations 5.  City and Hackney has played an active role in establishing the new framework to ensure it meets local needs and will facilitate local, smaller organisations being commissioned more efficiently by a wider range of organisations e.g. NHS partners but also neighbouring authorities 6.  Not joining the NEL framework will put our local community organisations at a disadvantage and increases their administrative burdens when applying for contracts 7.  In the event that the framework does not deliver what is required for City and Hackney purposes we are not compelled to use it and at any point can choose to procure services directly   Option 3  - Do not continue with London HIV Prevention Partnership 8.  This option considers not continuing with London HIV Prevention Partnership (LHPP) 9.  This would be contrary to the Labour Party Manifesto which specifically includes a commitment to continue with this partnership arrangement 10.The partnership provides for significant economies of scale of working on HIV prevention at scale across London for both our gay, bisexual communities and also global majority communities. 11.Not continuing with the LHPP would lead to a reduction in the scale and reach of the London wide programme programme and be contrary to the key decision AHI S299.   Option 4  - Join the NEL framework and continue to be part of the London HIV Prevention Partnership 12.This option allows us to continue to realise the benefits of local providers whilst also realising economies of scale 13.This also provides for more efficient procurement of services by using a framework 14.Local providers and other specialist providers on the framework will allow Hackney to quickly and efficiently commission providers to meet existing and future needs for sexual health promotions   Option 5 - insourcing 15.These health promotion services are provided by community and voluntary sector organisations who are an integral part of local communities and provide value for money for the Council. Insourcing would potentially destabilise voluntary sector organisations by removing funding and staff which are central to their functions. 16.Many of the communities with the highest inequalities have long standing trusted relationships with local community organisations. It would be difficult, if not impossible, to replicate this if services were insourced.