Table of contents
- Introduction
- A commissioning work programme for 2022/23
- Performance and assurance
- Service delivery models - Common themes
Introduction
Purpose
This document sets out the commissioning intentions of Torbay Council’s Public Health department in 2022/23.
Context
Throughout 2020/21 and 2021/22, the need to respond to the COVID Pandemic necessitated routine health and social care services, commissioned either by Local Government or the NHS, be delivered in a way that both sought to mitigate the risks of COVID, by way of changes to delivery models, but also respond to the need to deploy colleagues to work directly on the pandemic response.
As a result, the way in which Torbay Council Public Health commissioners applied scrutiny and contractual obligations on our providers had to adapt; working with partners to ensure those service model mitigations put in place (i) met or exceeded national guidance on ‘essential services’; and (ii) focused on safeguarding and protecting care provision for the most vulnerable.
The Public Health Team went through a radical reshaping during 2020/21; reflecting the new COVID functions needed, and the wealth of new staff that were required to meet emerging priorities, some of which are outlined in this document. There does however remain the four overarching arms overseen by our senior management team; Public Health Knowledge and Intelligence, Health Protection and the COVID Outbreak Response Team, Healthcare Public Health and Health Improvement (including commissioning) functions.
Background to Public Health duties and funding
The Health and Social Care Act 2012 (effective 1 April 2013) gave upper tier local authorities duties both to improve the health of their populations as well to directly deliver, or arrange the provision of, some specialised healthcare services that previously had been the responsibility of the NHS.
There is a requirement to appoint a Director of Public Health (DPH), who as a statutory chief officer holds a leadership role spanning health improvement; health protection; and PH support to NHS commissioning bodies.
Working through Public Health England, the Department of Health & Social Care (DHSC) provides Local Authorities with a ring-fenced grant to fulfil these duties. Whilst the overarching aspiration of the Public Health Team in Torbay is about primary prevention; tackling health inequalities; and intervening to alleviate ill-health are broader than the prescribed functions we hold, we are mandated to:
- Take steps to protect the health of the local population.
- Ensure NHS commissioners receive the specialist PH advice they need.
- Provide or arrange the provision of open-access sexual and reproductive health services, the National Child Measurement Programme (NCMP), NHS Health Checks, and 0-5 PH services (including Health Visiting).
Public Health is also responsible for commissioning a range of other services including drug and alcohol services and healthy behaviours services such as smoking cessation and weight management programmes.
Torbay’s public health ring-fenced grant for 2021/22 was £9,808,929, or £70.9 per head of population (estimated as 138,431). The ring-fenced grant for 2022/23 will be £10,084,463, which will mean a £276,000 increase on 2021/22. However, it is currently unclear whether any additional responsibilities should be inferred from the grant conditions circular statement:
The grant will be ringfenced for use on public health functions. This may include public health challenges arising directly or indirectly from COVID-19
Public health ringfenced grant 2022 to 2023 - GOV.UK
Since 2015/16, Torbay has seen an increase in its grant of 2.9% (in cash terms) from a baseline of £9,802,000. Considering inflation, this is a real-terms reduction in income.
National drivers
From October 2021 the responsibilities of Public Health England have been split between the new UK Health Security Agency and a Department for Health and Social Care-based Office for Health Improvement and Disparities (OHID). This necessitates new ways of working from local Public Health Teams, alongside a need for adaptations because of the role of Local Authorities, and their DsPH, in the emerging Integrated Care Systems; driving joined-up local planning of services. The Comprehensive Spending Review has seen the government consider its priorities across all spending areas for the coming years; the outcome for the public is positive in that it will maintain the grant level in real terms until 2024/25, but this does not reverse the relative static growth since 2015/16 which has not considered the increases in costs and trends in population growth.
There is also potential changes in legislation potentially being released in 2023. The proposed amended procurement legislation could free up the local authority in terms of ‘red tape’ to make it easier for a wider range of bidders to be involved in procurements. The NHS Provider Selection Regime could provide a regulatory framework for the award of healthcare contracts by local authorities (and NHS commissioners) that sits outside the formal public procurement regime and means that those contracts will not need to be procured in accordance with the rules in the Public Contracts Regulations 2015 or their successor legislation.
A commissioning work programme for 2022/23
It will be apparent to all that COVID has had a detrimental effect on the health and wellbeing of the population, both directly (as a potentially fatal communicable disease) and indirectly; through disrupting the delivery of routine healthcare as well as people’s ability or determination to call upon the care they needed.
We know the impact of COVID on routine care, in the context of Public Health commissioned services, has been that fewer episodes of care have been delivered than would have been expected in an average year. As a result, Torbay’s Public Health Team is initiating a programme of work which will intend to mitigate the risks of these missed opportunities, focussing on those most in need, whilst attempting to ‘catch up’ on interventions through novel and alternative modes of delivery over the coming period to end 2023/24.
Whilst vital that we work to stabilise our current services; seek to ‘catch up’ with those provisions lost because of COVID; and initiate programmes to reengage with previous and reach out to new service users – we must also begin work to:
- Enable and support service recovery from the impact of COVID, whilst at the same time ensuring services can continue to respond to the pandemic as needed to safeguard service users, staff, and the wider population.
- Understand the impact of COVID on our populations, and work to reflect the identified, needs, vulnerabilities and inequalities within the future shape of service delivery.
- Work through a process of reviews, in light of COVID, to ensure that going forwards our future services reach the right communities, families, and individuals; and are delivered in the right way to meet people’s needs.
- Prepare for, and begin where necessary, the process of securing best placed providers to deliver our services in the future, working to local needs and priorities whilst observing national guidance and policy directives.
The following outlines our core intentions, in relation to our commissioned services, for 2022–2023 and should be read in that context.
Performance and assurance
Our contract management regime
- Develop clearer lines of accountability by embedding contract management into a single function, working closer with centralised contract management colleagues to provide excellent contract management services.
- Clarify and streamline performance and risk reporting from services and develop and maintain Contract Operations Manuals to provide consistent and coherent processes for manging contracts going forward.
- Orientate provider partners on, and begin formal initiation of, our revised contract management structure.
System stability
- Continued scrutiny of provider mitigations, where COVID pressures persist, ensuring the most vulnerable are prioritised.
- Return to more standard contract review systems and processes of quarterly monitoring, focussing on business as usual as well as supporting providers with their development and recovery plans.
- Work with provider organisations to review business continuity plans in light of COVID, both in relation to ‘lessons learned’ of their business response to the pandemic and continued barriers to delivery as a result.
Procurement pipeline
- Review contract status of commissioned services, establishing a timetable of key contract decision points through to 2027/2028.
- Working alongside our colleagues in the Procurement, Contracting and Commissioning Team, develop a procurement pipeline, to inform our commissioning intentions in future years.
- Work with the procurement team specifically to ensure team and individual work programmes reflect any critical dates/plans.
Service delivery models - common themes
Work with partners to develop an innovative digital offer, using technology to improve interaction and engagement with people around direct service delivery.
Digitise and modernise services:
- Review and learn lessons from innovative solutions put in place to mitigate the impact of COVID.
- Retain and develop further those elements proven to work.
- Reshape or remove any processes that are not cost and time effective or are barriers to service user access.
Consider revisions to delivery models, ensuring they
- Champion prevention and continue to meet the specified needs of Torbay’s residents.
- Reflect co-production from the start, specifically service user voices and collaboration with commissioning partners.
- Have been evaluated in terms of impacts on equality; ability to meet a return to pre-COVID levels of demand; and continued value for money.
Reflect on the outcome of the governments Comprehensive Spending Review and its implications on those services that
- Are statutorily required to provide or commission.
- Are considered critical in relation to preventing or intervening in harm and/or health protection.
- Have outcome goals related to primary prevention/ behaviour change intervention.
Covid recovery programme:
- Work with provider partners to stabilise services; return to average delivery levels; and increase provision where feasible, to prevent further deterioration of our position and to support the delivery of the recovery programme wherever possible.
- Adapt the programme in light of any continued disruption to routine services, because of COVID, and its implications on the recovery programme.
- Monitor capacity to deliver, and evaluate the impact of, the recovery programme.
Children and young people
Torbay’s 0 to19 service
Universal and targeted integrated services and support to children, young people and families across Torbay aged 0 to 25.
Contract holder: Torbay and South Devon NHS Foundation Trust (in partnership with Action for Children and Children’s Society (Checkpoint) Torbay)
Contract term: 2019/24 (plus extensions)
Key priorities:
- Year 4 Commissioning priorities
- System:
- Early help pathways across 8 to 25 years SEND (Special Educational Needs and Disabilities).
- Governance and integration in Local Authority and across Integrated Care System.
- Joint Commissioning programmes of delivery across the Children's Partnership.
- Data and Intelligence “My health My School” and Interactive JSNA for Children and Young People specifically.
- Service/Interventions:
- Children and families obesity pathways and system development.
- Emotional Health and Wellbeing
- Child development.
- Complexity in families and consistency in service
- Vulnerability Pathway.
- System:
COVID Impact (Emerging Health Needs); working with commissioned services and wider partners to understand the impact of COVID on children’s health and wellbeing and to implement appropriate, joined-up approaches to address these.
Primary Care Services
Provide a range of specific community services as part of the wider public health system including Long-Acting Reversible Contraception, NHS Health Checks, stop smoking, supervised consumption, and needle exchange services
Contract holder: All GP Practices and Pharmacies in Torbay
Contract term: 2021/23 (plus extensions)
Key priorities:
- Embed the primary care contracts recently reprocured.
- Work with Primary Care (PC) to recommence delivery of the standard NHS Health Check offer and continue to monitor activity.
- LARC (Long-Acting Reversible Contraception) investment and catch-up provision (see SRH section too).
- Work with Local Pharmaceutical Committee (LPC) colleagues to understand the benefits and implications to public health of the pharmacy component of the Treating Tobacco Dependence pathway (commissioned via the NHS).
- Continue the iterative developments in relation to needle exchange services in response to any additional drug treatment monies.
- Prepare the providers for the transition of commissioning of supervised consumption services to the emerging Multiple Complex needs Alliance.
Torbay Healthy Lifestyle Services
Practical support to aid people wanting to engage in healthier lifestyles including quitting smoking, losing weight, and becoming more physically active. It also screens people for smoking and alcohol in the hospital using volunteers and trains health professionals in Making Every Contact Count (MECC) and Connect 5. Brief advice is also offered about emotional health and wellbeing, oral health, alcohol reduction, diet, and nutrition.
Contract holder: Torbay and South Devon NHS Foundation Trust
Contract term: 2022/23
Key priorities:
- Torbay Council will continue to invest in lifestyles services, with particular focus on the following:
- Working with the provider to assist them in identifying and delivering services to the populations and areas most in need. This will inform the procurement of the Lifestyles services in 2022.
- Continue to contribute to the delivery of the Devon Tobacco Control Alliance.
- Further develop the Treating Tobacco Dependency pathway to offer continued support to people after they start their stop smoking journey as a hospital inpatient or after giving birth.
- Develop workstreams around smoking in pregnancy.
- Form an integral part of the community stop smoking offer alongside pharmacy and primary care.
- Design and deliver an alternative weight management service for children and families that is based upon the THRIVE model and review alternative models of weight management service delivery.
- Evaluate the additional funding received for adult weight management in 2021/22 to improve and further develop any additional weight management services in 2022/23.
- Continue working with NHS commissioning and primary care to support the mobilisation of their digital NHS Weight Management Programme.
- Awareness and focus on the growing problem of type 2 diabetes.
- Supporting and contributing to implementing and delivering Torbay on the Move priorities.
Drug and alcohol misuse and dependence
Offers specialist clinical treatment and behaviour change approaches to support individuals across Torbay struggling with drug and alcohol use. Currently, there are 736 people accessing a range of interventions, including pharmacological treatment and residential care. The programme includes harm reduction services such as needle exchange and the provision of naloxone to reduce drug deaths and harm.
Contract holder: Torbay and South Devon NHS Foundation Trust (in partnership with Devon Partnership Trust)
Contract term: May 2022 to Feb 2023
Key priorities:
- Multiple Complex Needs procurement programme.
- Review and respond to the impacts of the new National Drug Strategy.
- Final reporting and closure of the 2021/22 Universal Drug Grant.
- Planning and preparedness for the supplementary substance misuse treatment and recovery grant (SSMTR) including:
- reviewing and refreshing the 2018 Rapid Needs Assessment,
- Assessing and responding to a review of substance misuse commissioning capacity.
- Undertake an Inpatient consortia review and develop a 3-year plan.
- IPS implementation.
- DPH annual report focusing on alcohol and its harms.
- Consider findings of the Dame Carol Black Review, alongside the current service delivery model and how it will respond to them.
- Work with Office for Health Improvement and Disparities (OHID) and the South West alcohol and drugs commissioners' network to develop a regional workforce development strategy to maximise recruitment and retention within specialist substance misuse provider services.
- Support the production of a Diamorphine Assisted Treatment business case and the strategic review of homeless and substance-related deaths.
Sexual and Reproductive Health (SRH)
Offering non-clinical workforce training, community-based prevention interventions, condom distribution for 13-24 years old and contraceptive care and the testing & treatment of sexually transmitted infections, SRH services are available through GPs; Community Pharmacies; and our specialist integrated clinics across Torbay, which are open to anyone present in our local authority area.
Contract holder: Northern Devon Healthcare NHS Trust (integrated sexual and reproductive health)
Contract term: 2018/23 (plus 1+1 extensions)
Contract holder: The Eddystone Trust (sexual health and HV prevention)
Contract term: 2021/23
Contract holder: Northern Devon Healthcare NHS Trust (Condom distribution)
Contract term: 2021/23
Key priorities:
- Vulnerable People: review the service model, considering COVID response, to ensure it is accessible to Children and Young People, vulnerable adults, and others who may be affected by its new ways of working.
- Sexual Health: ensure delivery of a catch-up programme in light of a 37% (1324) reduction in new genitourinary medicine (GUM) attendances having been carried-out in 2020/2021.
- Reproductive Health: ensure delivery of a catch-up programme, given the significant disruption to the provision of long-acting reversible contraceptive methods throughout 2020/2021 and 43% (1088) fewer intrauterine device (IUD) and subdermal implants (SDI) interventions across all settings in 2020/21.
- Prevention: work with partners to embed the routine offer of HIV pre-exposure prophylaxis (PrEP) within harder-to-reach groups, and to initiate purposeful promotion of good sexual health practices.
- Incentivising Faculty of Sexual and Reproductive Healthcare training to Primary Care to support Primary Care LARC recovery.
- Open-book contract management systems and processes implemented.
- Sector-Led Improvement (SLI) programme work for PrEP seeking to understand the needs of underserved groups across the South West.
- Development of resident-initiated digital registration offer for under 25s condom distribution (C-Card).
- Insight work to understand sexual and reproductive health prevention needs of 16–25-year-olds (C-Card). Developing refreshed Health Needs Assessment and local strategy during 2022/23.
- To assess and forward plan arrangements for future service models as all contracts are due to expire in 2023.
Miscellaneous services funded from the public health grant or other local authority sources
Key priorities:
- Progress the decommissioning of the Crowdfunder Project across Torbay Council.
- Conclude and implement the procurement of the Online Emotional Mental Health and Wellbeing Service alongside Devon Clinical Commissioning Group, Devon County Council and Plymouth City Council.
- Continue to consolidate, performance manage and effectively procure the administration of the small grants portfolio across Public Health, Adult Social Care and Governance.