Soft Market Testing Questionnaire

SCHPH00181Staffordshire Healthy CommunitiesService

THIS IS NOT A CALL FOR COMPETITION

1.Introduction

Staffordshire County Council (SCC) wishes to transform its health improvement and lifestyle commissioning model to reduce demand and the flow of Staffordshire citizens into Health and Social Care provision. This will require a focus on maintaining an active and healthy population whilst providing appropriate support to individuals who are over 50 yearsold, in communities which have the poorest health and are at greatest risk of requiring Health and Social Care.

  1. Target Population

We are currently scoping the potential to utilise risk stratification tools to identify at risk people. In the absence of such tools we have attempted to model the potential target population to provide an estimate of the ‘at risk’ population.

2.1 Target Population Modelling

Based on data availabilityat a Lower Super Output Area (LSOA) level, a number of indicators have been tested for their relationship with rates of funded long-term Health and Social Care users aged 65 and over (excluding those living in care homes). Eightindicators showed a relatively good statistical relationship with long-term state funded Health and Social Care users (Appendix 1). These indicators were used to develop a Health and Social Care needs index for Staffordshire.

Using this index,52 LSOA areas have been identified within which 27,600 adults aged 50 years and over are considered to be at increased risk of entry into Health and Social Care (Appendix 2).

It should be noted that the target population may change in response to any risk stratification tools that can be utilised locally which will ensure more effective targeting of the service.

  1. NHS Health Checks

The Healthy Communities Service will be expected to deliver the NHS Health Check programme on behalf of SCC. The NHS Health Check programme aims to prevent heart disease, stroke, type 2 diabetes and kidney disease, and raise awareness of dementia both across the population and within high risk and vulnerable groups.

The NHS Health Check is made up of three key components: risk assessment, risk awareness and risk management. During the risk assessment standardised tests are used to measure key risk factors and establish the individual’s risk of developing cardiovascular disease. The outcome of the assessment is then used to raise awareness of cardiovascular risk factors, as well as inform a discussion on, and agreement of, the lifestyle and medical approaches best suited to managing the individual’s health risk.

The programme has also been designed so that the majority of the NHS Health Check, including the tests and measurements required for the risk assessment, can be delivered in different settings. The NHS Health Check can be carried out locally in any suitable location and by a suitably qualified Professional. Links would need to be made with local GPs to ensure patient information is transferred securely.

One of the programme’s objectives is to reduce health inequalities. Local Authorities may tailor the delivery of the programme to achieve this. Although Local Authorities have a duty to offer the NHS Health Check to all eligible peoplePublic Health England supports approaches that prioritise invitations to those with the greatest health risk. A recent review of NHS Health Checks in Staffordshire highlighted:

  • Residents in their sixties are more likely take up their offer of an NHSHealth Check for confirmation they are healthy and well. This compares to younger ages who do not attend their NHSHealth Check as they may perceive themselves to not be at risk due to their current health status and age.
  • Those in high areas of deprivation are not engaging with the programme.
  • Analysis showed both mortality and hospital admissions were higher where NHS Health Check uptake rates were low.

Based on this learning we envisage that the Healthy Communities Service will deliver a targeted NHS Health Check programme to the target population (Section 2.1). This programme will be required to increase uptake of NHS Health Checks particularly among the 50 – 60 age group and in the 60 plus age group who maybe in ill-health but not known to GPs. The programme will also ensure all NHS Health Checks are good quality.

3.1 NHS Health Check Current Uptake

Table 1.0 shows the number of NHS Health Checks being offered and uptake levels during 2015/16in Staffordshire and within identified target areas (see section 2) for those aged 50—74 years.

Table 1.0

Total 50-74 population / Estimated eligible 50-74 population / Number offered a NHS Health Check / Number who received a NHS Health Check
Staffordshire / 275,516 / 192,861 / 16,856 / 9,586
Targeted Areas / 21,403 / 14,982 / 1,593 / 631
  1. Referrals

The NHS Health Check will be a referral route into the Healthy Communities Service. It is envisaged that the service will also provide relevant assessment and referral training to a range of front lineworkers, linking in where possible to existing training. For example, Lets Work Together and Making Every Contact Count ( ). The development of a risk assessment checklist and referral forms and pathways will be required.

  1. Intervention

A review of the evidence in relation to what approaches can help to reduce the demand on or delay entry into Health and Social Care has moved the thinking from purely behavioural delivery to one which is bespoke and can flex between behavioural and practical support according to individual need.

The Healthy Communities Service will need to build on local assets and skills within the community to help citizens help themselves and one another and connect individuals to wider community networks and programmes. There will be three levels of support requiring different degrees of input as follows:

  • Universal Offer (Available to most) Not in Service scope

This will include a wider digital offer that is capable of risk assessing (including the provision of digital NHS Health Checks), together with enabling access to a wider range of information and acting as a community navigator, which signposts citizens to a range of support / services and; community capacity building.

  • Targeted Support (Available to targeted populations -Some)

Providing behavioural interventions to individuals from identified geographical hotspot areas to reduce preventable risk factors that result in poor health e.g. stopping smoking, improving poor diets, increasing physical activity levels and social prescribing aimed at reducing loneliness and social isolation.

  • Bespoke Targeted Support (Available to individuals in targeted population with high needs - few)

Identifying individuals, who are showing signs of struggling to cope, agreeing support required using an asset-based approach and providing personalised coaching and practical skills to promote independence and resilience e.g. malnutrition and dehydration prevention, home-based activity to increase mobility and ability to maintain activities of daily living, social prescribing and befriending.

  1. Healthy Communities Aims and Predicted Outcomes

The aim of the Healthy Communities Servicewill be to prevent or delay citizens entering state funded Adult Social Care. This will be achieved by:

  • Reducing lifestyle risk of falls in citizens at greater risk of falling / with a history of falls.
  • Improving social connectedness and reducing loneliness.
  • Preventing strokes through tailored lifestyle interventions (targeted at individuals at greater risk of or following stroke / Transient Ischaemic Attacks).
  • Reducing lifestyle (mobility / fluid intake) risk factors associated with individuals at greater risk of Urinary Tract Infections (UTI) / with a history of UTIs.
  • Supporting better health and wellbeing in the early stages of dementia through providing lifestyle support.

6.1 Individual level outcomes

  • Individuals who move from at risk of fall to no risk
  • Individuals who reduce their loneliness or social-isolated score following intervention
  • Individuals who successfully stop smoking at 12 weeks, self-report
  • Individuals malnourished or at risk of malnutritionwho demonstrate stable weight (for those whose pre to initial assessment measure shows weight loss) or have gained weight (for those whose pre to initial assessment weight was stable) at 12 weeks.
  • Obese Individuals who achieve 5% reduction in body weight at 12 weeks
  • Individuals who increase their physical activity score following intervention
  1. Current Prevalence

Table 2.0 shows the current prevalence of indicators relevant to the Healthy Communities Service in Staffordshire and within identified targeted areas.

Table 2.0

Indicator / Prevalence / Number of individuals from targeted areas
Staffordshire / Targeted areas
Smoking 50+ / 8.4% / 16% / 4400
Obesity 50+ / 27% / 32% / 9188
Malnourished* 65+ / 10% / 10% / 1400
Physically Inactive
50+ / 34% / 40% / 11,468
Falls * 65+ / 35% / 35% / 4800
Lone Pensioner Households / 12.6% / 15.1% / 5443

*Based on estimates and applied to population figures.

  1. Potential Delivery Model

The potential delivery model for the Healthy Communities Service is by a hub and spoke(see 8.1 below).It is envisaged that this approach will allow the prime provider to build on existing assets within the identified community and enter into formal agreements (for example a partner agreement, sub-contract or grant) with a diverse range of providers to meet the outcomes of the service.

8.1Healthy Communities Potential Delivery Model

  1. Proposed payment structure

The estimated annual budget identified to deliver the Healthy Communities Service is between £1.4 million - £1.6millionper annum.

It is anticipated that approximately 50% (£700,000 - 800,000) of the Contract value will be fixed and approximately 50% (£700,000 - £800,000) will be Payment By Results (PBR).

The proposed payment system will involve a combination of fixed and PBR payments. The ‘fixed’ component of the Contract will be paid as long as the Service is delivered in accordance with the Contract and Specification. Whereas, the PBR components will be linked to the number of successful outcomes delivered. A minimum target for individual successful outcomes (as detailed in section 6.1) is likely to be detailed in the Specification based on local need. In order to maximise the efficient use of the public resource providers will be asked to detail the number of individual outcomes they can deliver within this financial limit.

  1. Timescales and estimated budget

It is proposed that the Healthy Communities Service commences on 1st April 2018.

  1. Purpose of Document

The responses submitted as part of this soft market testing questionnaire is to seek the market’s views on the development of a local model, the capacity of the market to deliver these services, and the level of interest in this proposed procurement activity.

  1. Process

This Soft Market Testing (SMT) document contains a series of questions that we would like you to answer, submitting your written responses by 12 noon Tuesday 13th June 2017.Please send your response to the email address shown at the end of this page. If you have any queries with regards this exercise these should also be addressed to the contact name shown below.

Your responses will not be scored in any way. This is an information gathering exercise and is not a pre-qualification process. This SMT exercise does not form part of any subsequent formal procurement process.

Your responses will be used by the Council’s project team, in commercial confidence, to inform the service specification, relevant schedules and Contract.

Please try to limit the size of your response to each question to ensure that it is brief and to the point. Please ensure that you clearly state any assumptions made when responding.

You must carefully consider the use of phrases such as “in confidence” or “commercially sensitive” when responding since they will not necessarily protect your organisation’s information from disclosure under the Freedom of Information Act 2000. In respect of any information submitted by your organisation which is considered to be commercially sensitive, you should clearly identify such information as “commercially sensitive”.

Completion of the following questions will not infer any advantage upon individual organisations, as stated above this is an information gathering exercise only.

Completed questionnaires should be returned via email to;

Sarah Lynn (Category Manager)

Telephone: 01785 854645

Email:

Targeted Population

Approach/model

  1. How do you see this service fitting alongside and complementing (not duplicating) existing care pathways, programmes and services that are currently delivered in Staffordshire?

If you are currently unaware of existing pathways, programmes and services delivered in Staffordshire, please provide a response based on your experience of other areas.

  1. Do you agree with the proposed delivery model detailed in section 8?

Yes / No
If yes, please state why you agree.
If no, please suggest how it could be done differently and what benefits the alternative approach would bring for service users, providers and/or SCC.
  1. Based on the proposed hub and spoke model and identified LSOA areas.How many spokes do you think would be required to support delivery across targeted areas? Alternatively, if you feel the service could be delivered via a different approach please provide details of the approach

Risk Stratification/identification of target population

  1. Based on the proposed model, how would you utilise new or existing risk stratification/identification tools to ensure effective targeting of services?
  1. Who would administer assessment tools and refer into the service?What are the potential links to existing front line training sessions in Staffordshire?For example, Let’s Work Together, Making Every Contact Count.

Delivery

  1. Current NHS Health Check research highlights that people in areas of deprivation are less likely to take up an offer of an NHS Health Check.

How do you think this element of the service could be delivered to ensure these populations engage?

  1. We envisage utilising an asset-based, rather than deficit-based, approach to the Healthy Communities Offer. How do you see this being achieved?
  1. Based on the proposed model, how do you see the bespoke offer being delivered and what level/skill mix of staff would be required?
  1. Howwould you ensure a seamless client journey for clients with multiple needs accessing community interventions?

Costs

  1. Do you agree with the proposals detailed within the proposed payment structure?

Yes / No
If no, please suggest how it could be done differently and what benefits the alternative approach would bring for service users, providers and/or SCC.
  1. How can the service demonstrate increased efficiencies through the lifetime of the Contract?

Outcomes

  1. Based on the existing prevalence levels detailed in section 7. Please indicate the number of outcomes against each individual outcome indicator that you think could be delivered against the contract value?

Individuals who move from at risk of fall to no risk following 12 week intervention
Individuals who reduce their loneliness or social-isolated score following intervention
Individuals who successfully stop smoking at 12 weeks, self-report
Individuals malnourished or at risk of malnutrition who demonstrate stable weight (for those whose pre to initial assessment measure shows weight loss) or have gained weight (for those whose pre to initial assessment weight was stable) at 12 weeks.
Obese Individuals who achieve 5% reduction in body weight at 12 weeks
Individuals who increase their physical activity score following intervention
  1. Do you feel the individualoutcomes are suitable based on the aims detailed in section 6?

Yes/ No
If no please provide alternative outcomes and potential ways to measure
  1. Do you foresee any difficulty in providing evidence to support delivery of individual outcomes detailed in section 6.1.

Yes/ No
If yes please provide alternative measures.

General Information

  1. We are looking for informal expressions of interest in these services at this stage in order to establish the level of market interest. Would your organisation be interested in bidding for these services?

Yes / No – delete as appropriate

If yes how would you bid for the work? Please select one of the following;

As a sole provider
Prime contractor with sub-contractors
Prime provider with sub-contractors
As a consortium
Sub-contractor to a main provider/contractor
Other please explain

If NO - We would be interested to know why organisations may not be interested in bidding for these services. Please provide more detail below if you are able to share this information.

  1. Please use this opportunity to provide any other feedback or outline any other requirements that need to be considered/included.

Your organisation

Name of organisation:

Point of Contact:

Email address:

SCC may contact the organisation to seek clarity on responses received or to further discuss responses submitted as part of this questionnaire.

Which services does your organisation currently deliver?

Appendix 1 Indicators which showed a relatively good statistical relationship with long-term state funded Health and Social Care users

  • Income Deprivation Affecting Older People Index (IDAOPI), 2015
  • People aged 50 and over with no cars or vans in household, 2011
  • Emergency (unplanned) admissions, 2015/16
  • Risk of loneliness index (Office for National Statistics modelled data)
  • People aged 65 and over with a limiting long-term illness, 2011
  • People who feel a bit unsafe or very unsafe walking alone after dark (Mosaic modelled data)
  • People who visit their GP more than once a month (Mosaic modelled data)
  • People who do not exercise (Mosaic modelled data)

Note: The indicators do not demonstrate a causal relationship.

NB: some indicators which were identified as being triggers for entry into social care form the evidence base or stakeholders have not been included due to lack of (robust) data availability at LSOA level, for example, bereavement, stroke prevalence, people with urinary tract infections and incidence of falls.

Appendix 2: Map showing Risk of Adult Social Care Needs Index

Data compiled and analysed by Insight, Planning and Performance

Risk of Health and Social Care Needs Index: areas at very high risk

LSOA / Ward name / Local authority
E01029346 / Brereton and Ravenhill / Cannock Chase
E01029349 / Cannock East / Cannock Chase
E01029350 / Cannock East / Cannock Chase
E01029354 / Cannock North / Cannock Chase
E01029355 / Cannock North / Cannock Chase
E01029356 / Cannock North / Cannock Chase
E01029359 / Cannock South / Cannock Chase
E01029360 / Cannock South / Cannock Chase
E01029388 / Hednesford North / Cannock Chase
E01029404 / Western Springs / Cannock Chase
E01029407 / Anglesey / East Staffordshire
E01029409 / Anglesey / East Staffordshire
E01029410 / Anglesey / East Staffordshire
E01029427 / Eton Park / East Staffordshire
E01029437 / Horninglow / East Staffordshire
E01029447 / Shobnall / East Staffordshire
E01029448 / Shobnall / East Staffordshire
E01029453 / Stapenhill / East Staffordshire
E01029468 / Winshill / East Staffordshire
E01032898 / Burton / East Staffordshire
E01029492 / Chadsmead / Lichfield
E01029496 / Chasetown / Lichfield
E01029499 / Curborough / Lichfield
E01029527 / Summerfield and All Saints / Lichfield
E01029535 / Audley and Bignall End / Newcastle-under-Lyme
E01029538 / Bradwell / Newcastle-under-Lyme
E01029547 / Chesterton / Newcastle-under-Lyme
E01029548 / Chesterton / Newcastle-under-Lyme
E01029553 / Cross Heath / Newcastle-under-Lyme
E01029554 / Cross Heath / Newcastle-under-Lyme
E01029555 / Cross Heath / Newcastle-under-Lyme
E01029560 / Holditch / Newcastle-under-Lyme
E01029566 / Knutton and Silverdale / Newcastle-under-Lyme
E01029588 / Ravenscliffe / Newcastle-under-Lyme
E01029599 / Thistleberry / Newcastle-under-Lyme
E01029604 / Town / Newcastle-under-Lyme
E01029666 / Perton Lakeside / South Staffordshire
E01029691 / Common / Stafford
E01029692 / Coton / Stafford
E01029715 / Highfields and Western Downs / Stafford
E01029725 / Coton / Stafford
E01029727 / Manor / Stafford
E01029734 / Penkside / Stafford
E01029763 / Biddulph East / Staffordshire Moorlands
E01029766 / Biddulph East / Staffordshire Moorlands
E01029809 / Leek North / Staffordshire Moorlands
E01029827 / Belgrave / Tamworth
E01029834 / Bolehall / Tamworth
E01029835 / Castle / Tamworth
E01029845 / GlHSCote / Tamworth
E01029849 / Mercian / Tamworth
E01029859 / Stonydelph / Tamworth

Data compiled and analysed by Insight, Planning and Performance