1

MIDDLESBROUGH COUNCIL

Report Title:Future of Health Visiting, Family Nurse Partnership and School Nursing Services in Middlesbrough

Executive Member for Public Health: Cllr Michael Thompson

Director: Kevin Parkes, Executive Director, Economic |Development and Communities

Date: 14 July 2015

PURPOSE OF THE REPORT

  1. This paper outlines the future plans for the delivery of Health Visiting, Family Nurse Partnership and School Nursing Services in Middlesbrough.
SUMMARY OF RECOMMENDATIONS
  1. It is recommended for the Executive to:
  2. Approve for a six month contract from 1 October 2015 to 31 March 2016 for health visiting and family nurse partnership service to be drawn between the Council and South Tees Hospital Foundation Trust (STHFT) to ensure service continuity whilst a procurement exercise is carried out.
  3. Approve the plans to procure an integrated Healthy Child Programme (HCP) 0-19 service that combines health visiting, family nurse partnership and school nursing services to be in place for 1 April 2016.
  4. Approve the contingency plan for transferring the delivery of the health visiting, family nurse partnership and school nursing services in-house in the event of market failure and for this arrangement to be in place for 1 April 2016.

IF THIS IS A KEY DECISION WHICH KEY DECISION TEST APPLIES?

It is over the financial threshold (£150,000) / 
It has a significant impact on 2 or more wards / 
Non Key

DECISION IMPLEMENTATION DEADLINE

  1. For the purposes of the scrutiny call in procedure this report is

Non-urgent / 
Urgent report

If urgent please give full reasons

BACKGROUND AND EXTERNAL CONSULTATION

National Context

  1. Health Visiting, Family Nurse Partnership and School Nursing Services are part of a national public health programme, the Healthy Child Programme (HCP) which is aimed at improving health and well-being outcomes for children and young people. The programme provides arobust evidence based framework, and sets out good practice and standards for prevention and early intervention services. The HCP is divided into two programmes: the 0-5 HCP which covers the early years up to age five, delivered by health visiting teams and Family Nurse Partnerships and the 5-19 HCP which covers children and young people between the ages five to 19, delivered by the school nursing service.
  1. The Health and Social Care Act 2012 led to primary care trusts and strategic health authorities being abolished on 1 April 2013. The statutory functions for these organisations were transferred to three commissioning organisations namely: Clinical Commissioning Groups (CCGs), NHS England and local authorities.
  1. Since April 2013, Local Authorities have been responsible for commissioning 5-19 HCP, except healthcare delivery in special schools commissioned by the clinical commissioning groups and school based immunisations commissioned by NHS England. The commissioning responsibility for Health Visiting (HV) and Family Nurse Partnerships (FNP) is currently with NHS England but will transferto Local Authorities from 1st October 2015.

Middlesbrough’s Health Visiting and Family Nurse Partnership service (0-5 HCP)

  1. The Health Visiting and Family Nurse Partnership service is commissioned by NHS England Area team and delivered by South Tees Hospital Foundation Trust (STHFT). The service is delivered across South Tees and covers Middlesbrough and Redcar and Cleveland.From 1 October 2015, the commissioning responsibility for Health Visiting and Family Nurse Partnerships will transfer from NHS England to Middlesbrough Council. To commission these services, Middlesbrough Council will receive a financial allocation of £1.35m for 2015/16 (the remaining half year) and £2.7 million annually as part of the public health grant.
  1. The financial value of this contract means that it falls under the Light Touch Regime of the new Public Contract Rules and therefore requires a procurement exercise to have the services in place when the commissioning responsibility transfers from the NHS to the Councilon 1 October 2015. However, as the service needs to be operational from 1 October 2015, there will be not be sufficient time for the Council to review the service and undertake a full procurement exercise.
  1. It is therefore recommended for the Council to enter into a six month contract with South Tees Hospital Foundation Trust (STHFT) to ensure service continuity whilst a procurement exercise is carried out. There is potential for legal challenge from otherproviders and the market, however the risk is low due to most councils taking this approach nationally.

Middlesbrough School Nursing Service (5-19 Healthy Child Programme)

  1. The 5-19 HCP is jointly commissioned by Middlesbrough Council, Redcar and Cleveland Council and NHS South Tees Clinical Commissioning Group. The service is delivered by South Tees Hospital Foundation Trust. Whilst the service works across Middlesbrough and Redcar and Cleveland, it is split into distinct teams for each local authority area.
  1. The full contract value for the South Tees School Nursing Service is £1,758,921 made up of £933,508 for Middlesbrough Council and £852,413 for Redcar and Cleveland Council.

Procurement and market failure for school nursing service

  1. Following a detailed service review and extensive stakeholder consultation in 2014, Middlesbrough Council and Redcar and Cleveland Borough Council in partnership with South Tees Clinical Commissioning Group (CCG) went out to tender for the provision of a Healthy Child Programme (HCP 5-19 years) across South Tees. The closing date for tender submissions was 9 January 2015 and there were no bids submitted.
  1. The market failure presented a risk of having no service provider to deliver the school nursing servicewhen the existing contract expired on 31stMay 2015. Following negotiations with STHFT, the contract for school nursing services has been extended by 10 months to 31 March 2016 with a 10% financial uplift to the existing contract value. The contract extension allows the Council to re-tender for an integrated service for 0-19 Healthy Child Programme that combines health visiting, family nurse partnerships and school nursing.
  1. The Council will also develop an integrated specification for a 0-19 public health service that combines health visiting, family nurse partnerships and school nursing services. The opportunity to integrate public health nursing provision from the antenatal period up to 19 years, coordinate the prevention and early intervention services and align to the Council’s children and young people’s services.

OPTION APPRAISAL/RISK ASSESSMENT

  1. The following options were considered in determining the future of the health visiting, family nurse partnerships and school nursing services in Middlesbrough.

a)Option 1 – Accept market failure and put no further provision in place;

b)Option 2 – In-house delivery by the Council of health visiting, family nurse partnership and school nursing service;

c)Option 3 – Re-procure a 0-19 Healthy Child Programme combining health visiting, family nurse partnership and school nursing service; and for the service to be in place 1 April 2016.

  1. Following a detailed options appraisal it is recommended for the Council to re-procure a 0-19 Healthy Child Programme to be in place 1 April 2016. The proposed procurement approach will be competitive procedure with negotiation, recognizing the long-term nature of the contract and the complexities associated with an integrated service offer. The Council expects the formal tender process to commence in August 2015 and a detailed procurement plan has been developed.
  1. Prior to this and recognizing the recent market failure of the school nursing tender in January 2015, an extensive market engagement and consultation process has been developed to stimulate the market. Market engagement events are planned for 14 and 16 July 2015 providing potential providers to meet with the Council and discuss the proposed bid. The event will give the Council a good indication of the market for these services.
  1. Given the recent market failure of the school nursing tender in January 2015, it is also recommended for the Council to have a contingency plan in place for in-house delivery of the services from 1 April 2015. A project team has been established to develop a robust project plan for bringing the health visiting, family nurse partnerships and school nursing services in-house. The project team has identified the following work streams to progress actions in relation to information governance, clinical governance and safeguarding, ICT and systems, workforce, estates and service model development.
  1. The Council is working very closely withRedcar and Cleveland Council who are bringing delivery of their school nursing services in-house from 1 September 2015 and health visiting and family nurse partnership on 1 April 2016.

FINANCIAL, LEGAL AND WARD IMPLICATIONS

Financial

  1. The funding for the health visiting, family nurse partnerships and school nursing services will be from the Middlesbrough Council’s public health grant. Future public health allocations for local authorities beyond 2015/16 have not yet been confirmed. Public Health England will be conducting a consultation on future funding levels and the final allocations will be confirmed by December 2015. These allocations will also include the funding for health visiting and family nurse partnerships beyond 2015/16.
  1. On 4 June 2015, the Chancellor announced that £200m in-year efficiencies during 2015/16 will be made to the public health grant allocations to local authorities. Whilst the details for how this will be implemented have not yet been released, if the target was applied uniformly this would be a 7.4% (£1,169,000) reduction for Middlesbrough Council’s 2015/16 allocation. Department of Health have announced that they will be carrying out a consultation on the implementation of these in-year efficiencies in the summer of 2015.

Legal Implications

  1. The Council has a statutory responsibility for improving the health and well-being of its population. This responsibility includes the healthy child programme 5-19 and will from the 1 October 2015 include the commissioning responsibility for Healthy Child Programme 0-5.
  1. The financial value of the Health Visiting and Family Nurse Partnerships contract means that it falls under the Light Touch Regime of the new Public Contract Rules and therefore requires a procurement exercise to have the services in place when the commissioning responsibility transfers from the NHS to the Council on 1 October 2015.
  1. There is a risk of legal challenge from other providers on the Council entering into a six month contract with the existing provider, South Tees Hospital Foundation Trust (STHFT). However, the risk is low given the national timescales for the transfer of commissioning responsibilities which means that most councils nationally will not have sufficient time to carry out full procurement processes and ensure service continuity on 1 October 2015.
  1. Depending on the final outcome of the procurement process, if the health visiting, family nurse partnership and school nursing services are transferred to Middlesbrough Council for in-house delivery TUPE will apply and the Council will have to abide by employment law in the transfer of staff and assets.

Ward Implications

  1. The Healthy Child Programme (0-19) is delivered to all children and young people and families across the town.
RECOMMENDATIONS
  1. It is recommended for the Executive to:
  1. Approve for a six month contract from 1 October 2015 to 31 March 2016 for health visiting and family nurse partnership service to be drawn between the Council and South Tees Hospital Foundation Trust (STHFT) to ensure service continuity whilst a procurement exercise is carried out.
  2. Approve the plans to procure an integrated Healthy Child Programme (HCP) 0-19 service that combines health visiting, family nurse partnership and school nursing services to be in place for 1 April 2016.
  3. Approve the contingency plan for transferring the delivery of the health visiting, family nurse partnership and school nursing services in-house in the event of market failure and for this arrangement to be in place for 1 April 2016.
REASONS
  1. The Council has a statutory responsibility for improving the health and well-being of its population. This responsibility includes the healthy child programme 5-19 and will from the 1 October 2015 include the commissioning responsibility for Healthy Child Programme 0-5.
BACKGROUND PAPERS

No background papers were used in the preparation of this report.

AUTHOR: Edward Kunonga, Director of Public Health

TEL NO: 01642-728020

______

1