EXERCISE ON REFERRAL SPECIFICATION 2018-2020(+1)

1.INTRODUCTION AND CONTEXT

1.1Thurrock Council wishes to commission a Service to deliver an Exercise on Referral (EoR) Scheme.

1.2Physical activity can play an important role in preventing and managing health conditions such as coronary heart disease, diabetes, obesity, musculoskeletal conditions and some cancers. It also has a positive effect on wellbeing and mood, providing a sense of achievement or relaxation and release from daily stress.[1]

1.3Obesity is a significant problem in Thurrock with 31.4% of adults measuring as obese (BMI 30+), and 70.3% as at least overweight.[2]32.7% of people in Thurrock are self-reported as inactive, taking part in no regular physical activity/exercise in a typical week.[3] Reduction of obesity, including increasing activity, is a key priority within the Thurrock Health and Wellbeing strategy.

1.4It is the aim of the EoR programme, to deliver improvements to the health and wellbeing of inactive people from specifically identified groups within Thurrock, where by exercise can improve current health conditions whilst also preventing further ill-health.

1.5The new EOR programme will form part of the council’s in-house Healthy Lifestyle Service.

2.AIMS

2.1The Provider will deliver a structured exercise programme in line with NICE guidelines, enabling GPs and other health professionals the opportunity to refer people who are sedentary or inactive and have existing health conditions or other factors that put them at increased risk of ill health. A formal agreement will exist between the referrer and the exercise project. The scheme will be based on NICE guidelinesas detailed below:

2.2The Provider will incorporate the core techniques outlined in recommendations 7–10 of 'Behaviour change: individual approaches' NICE Public Health Guidance 49[4]. This includes:

  • recognising when people may or may not be more open to change (see recommendations 8 and 9)
  • agreeing goals and developing action plans to help change behaviour (see recommendation 7)
  • advising on and arranging social support (see recommendations 7 and 10)
  • tailoring behaviour change techniques and interventions to individual need (see recommendation 8)
  • monitoring progress and providing feedback (see recommendations 7 and 10)
  • developing coping plans to prevent relapse (see recommendations 7 and 8).

2.3Achievement of the aims will generally be measured by the Provider’s performance as set out in the Key Performance Indicators in Appendix 1 to this specification.

2.4The Provider will collect data in line with the 'essential criteria' outlined in the NICE Standard Evaluation Framework for physical activity interventions, see Appendix 2.

3.KEY SERVICE REQUIREMENTS

3.1The Provider will deliver an appropriate range of physical activity options for inactive people, with specific health conditions, to enable them to work towards long term lifestyle change, and take control of their own health.

3.1.2The Provider will ensure there is a safe and effective environment for people to participate in physical activity – the “Participants”. The EOR programme must be based within Thurrock across a minimum of 3 venues which may include leisure centres, gym space, community hall space and outdoor space. Venue options must be accessible for local people to get toin terms of local transport, parking, including wheel chair access.

3.1.3The Provider shall ensure all staff across the Service receive the correct training for delivery of the programme and also receive Making Every Contact Count (MECC) training.

3.1.4The Service will have an impact on outcome Council’s Health and Wellbeing Strategy 2016-2021 on a number of the objectives including to reduce obesity and significantly improve the identification and management of long term conditions.[5]

3.1.5The key outcome targets for this Service are listed in Appendix 1: Key Performance Indicators and performance against these targets will generally be measured through the Key Performance Indicators and Data Returns set out in this contract in Appendix 2.

4.SERVICE DETAIL

4.1Referrals in and Timescale

4.1.1All referrals must come from the single point of access based within the Thurrock Healthy lifestyle Service (THLS).

4.1.2The Provider shall ensure there is a secure single point of contact – ie. phone number and email address forTHLSto refer clients into.

4.1.3The Provider shall ensure that clients referred into the service are contacted to arrange their initial assessment within 5 working days of the referral. Where the Provider is unable to reach a Participant by the 6th working day this must be reported on the 6th working day to THLS.

4.2Charges to Participants

4.2.1The Provider may apply a charge to Participants of up to £3 per session.

4.2.2The Council would like to make this programme inclusive and accessible for all eligible participants and appreciates the price charged may be a barrier to some. As part of the tender process, Bidders will detail their reduced/concessionary rates or additional benefits offer (such as a free 12 week programme).

4.3Initial Assessment and Programme Start

4.3.1Before embarking on the Programme a Participant must have an Initial Assessment. The Participant must complete a physical activity risk assessment and sign a disclaimer stating that they consent to have their information shared with their GP should there be concerns for the Participant’s health at any time throughout the Programme. If the Participant does not wish for their information to be shared with their GP, they cannot commence onto the Programme.

4.3.2The Provider shall supply a suitable accessible venue with private interview/ consultation rooms for Participants to attend for their assessment and follow up reviews.

4.3.3The Provider shall supply and maintain all relevant equipment necessary for the delivery of the assessment process, including weighing scales, blood pressure monitors etc.

4.3.4Should the Individual fail to attend (DNA) the Initial Assessment, they should be contacted and offered a further appointment date or a reason for their disengagement recorded where possible. DNAs should be referred back to the THLS.

4.3.5The Initial Assessment appointment shall include:

  • Height, weight, BMI
  • Blood pressure
  • Resting heart rate
  • A motivational assessment
  • An Emotional Wellbeing assessment
  • An exercise pathway assessment
  • An explanation of the Programme, including cost per session

4.3.6The Provider will place the individual on the relevant pathway that is appropriate to their individual needs and should be offered a place on the programme starting within 2 weeks of their Initial Assessment.

4.3.7The Provider must flag up with the Commissioner at the earliest possible point if the two weeks waiting time to start on a programme becomes unachievable due to demand.

4.3.8The Provider shall inform the Participant that the THLS may contact individuals after 6 months for follow-up. The Participants data would have already been collected at the referral stage.

4.4Eligibility Criteria

4.4.1The following individuals will be eligible to receive the Service, subject to the appropriate referral into THLS from the GP, Health Professional, or self.

  • Resident in Thurrock
  • Registered with a Thurrock GP (or who access Thurrock Health Services)
  • Age over 18
  • Have one or more identified long term condition
  • No contra-indications to exercise

4.5Exclusion Criteria

4.5.1Individuals with the following contra-indications (exclusion criteria) will be ineligible for the Service.

  • Unstable, changing and/or changes in patterns of or frequency of angina symptoms and symptom limits.
  • Resting systolic blood pressure > 180mmHg or resting diastolic blood pressure > 100mmHg
  • Significant drop in blood pressure during exercise
  • Uncontrolled tachycardia >100pbm
  • Severe or poorly controlled asthma/COPD
  • Conditions that may be aggravated by exercise – muscle, bone and joint conditions
  • Uncontrolled conditions, including diabetes and epilepsy
  • Ventricular/Aortic aneurysm
  • Uncontrolled arrhythmia
  • Febrile illness
  • Unstable/severe mental health problems

4.5.2The Provider will manage exclusion from the Service sensitively and in accordance with Section 4.6: Ineligible Individuals.

4.6Ineligible Individuals

4.6.1In accordance with the eligibility criteria (and exclusions) set out in Section 4.5 of this specification, there will be some instances when individuals referred are determined to be ineligible to receive any element of the Service.

4.6.2The Provider shall ensure that all ineligible individuals are treated according to the circumstances and within the highest standards of care required by the Council.

4.6.3Where the assessment demonstrates that the referred individual is already undertaking sufficient exercise so as to not need the Service, the Provider shall ensure they are signposted to appropriate alternative provision either delivered directly by the Provider or elsewhere within the borough.

4.6.4In cases where individuals self-present with a higher level of clinical need (or specifically meet the “exclusion” criteria set out in Section 5), they should be referred as appropriate to a suitable clinical service, or back to their GP.

4.6End of Programme

4.6.1At the end of a programme, Participants who have completed a minimum of 12 out of a possible 24 sessions within a 12 week period and received their end of programme assessment will be considered “Completers”.

4.6.2The Provider will carry out an end of programme assessmentwith the individual. This will take the form of a consultation session lasting approximately 15 minutes. The Provider will proactively refer onwards to other Public Health and/or Community or Primary Care Services as appropriate.

4.6.3The End of Programme Assessment shall include:

  • Height, weight, BMI
  • Blood pressure
  • Resting heart rate
  • A motivational assessment
  • An Emotional Wellbeing assessment
  • Feedback survey

4.6.4Where Participants are referred onwards to relevant alternative services this must be recorded and reported within the Data Returns.

4.6.5The Provider will either develop an outgoing “Feedback Survey” for use at the end of the programme or use one supplied by Thurrock Public Health. The format and content of the Survey will be agreed with the Commissioner prior to use.

4.6.6The Provider should offer Completers additional benefits such as free sessions or discounted gym membership to encourage long term health benefits.

4.6.7THLS will follow up participants who completed the programme at 6 months to establish whether they are still taking part in physical activity.

4.7Activity Programmes

4.7.1The Service will comprisea programme of activity lasting up to 60 minutes, twice weekly, on a group (pathway) basis. The groups will be comprised of Participants with similar conditions. Two levels of support are identified as follows:

4.7.2High support group:Individuals referred with the following conditions, Cancer (following treatment and remission), Coronary Heart Disease (CHD), Hypertension, Hypercholesterolemia, Diabetes Type 1, Diabetes Type 2, Respiratory Disorder, Bone, Joint or Mobility Problems, Neuromuscular referred to the medical pathway.

4.7.3Low support group:Individuals referred with Obesity (BMI 27+), Anxiety/ depression and mild to moderate mental health problems will be held on a regular basis, with the intention that Participants attend twice per week.

5.SERVICE GENERAL

5.1Data Requirements

5.1.1The Provider shall implement a suitable data recording/database system to provide and manage the referral process and collect all data returns for presentation to the Council in accordance with the requirements at Appendix 1 and 2 of this specification.

5.1.2The Provider will ensure that all relevant information sharing agreements are in place with GPs, THLS, and Health Providers (such as Basildon and Thurrock Hospitals, North East London Foundation Trust etc) in order that they have access to relevant information about Participants.

5.1.3The Provider shall ensure that referral and outcome information is shared with GPs and Health Professionals at all relevant stages in the pathway.

5.2General Staffing

5.2.1The Provider shall ensure that all staff are suitably trained; supervised and managed to deliver high quality and safe services. The minimum required is set out as follows, although these do not need to be full time roles:

5.2.2The Exercise Referral Instructor (Level 3): An exercise referral instructor’s role includes designing, monitoring, adapting and implementing exercise programmes for individual clients with a range of medical conditions.

5.2.3The Specialist Exercise Instructor (Level 4): The specialist exercise instructor is able to demonstrate that they have met the Level 4 National Occupational Standards in one or more medical areas.[6]

5.2.4In addition to specific service training, the Provider shall ensure that staff delivering the Service are trained inMECC and Brief Opportunistic Advice (BOA) and keep their qualifications up to date when further training updates are released.

5.3Safeguarding and Partnerships

5.3.1Safeguarding Children and Vulnerable Adults is a key priority for Thurrock Council. The Provider shall ensure safeguarding across the range of services delivered. In practice, this means as a minimum:

  • The Provider shall develop and maintain safeguarding policies for both children and adults that are acceptable to the Commissioner.
  • All Providers’ Staff in contact with Participants (including individuals deemed ineligible at the point of assessment) shall be trained to recognise and act appropriately upon the signs of potential abuse.

5.3.2The Provider shall report all relevant issues/concerns to the MASH (Multi-agency Safeguarding Hub (Children)) or Safeguarding Adults Board.

5.3.3The Provider will maintain efficient and effective multi-agency working relationships with allied services, agencies and stakeholders to enhance the quality of care delivered.

5.3.4Details of Thurrock safeguarding procedures and protocols can be found in Appendix 3.

5.3.5The Provider will practise effective information sharing with Thurrock MASH, adults and children’s social care, GPs, wider Local Authority services, secondary health service providers and other such agencies and organisations as deemed appropriate to safeguard the adult or child.

5.3.6The Provider will link with specialist providers where domestic abuse or any form of sexual violence is identified,see Appendix4.

5.3.7The Provider shall actively participate in local, regional and national networks, training, research and audit programmes where applicable.

5.3.8The Provider shall note that access to targeted services may require completion of a Common Assessment Framework (CAF) for submission to the Local Authority (LA). Other services may be universally accessible without referral to the LA.

5.4Communications

5.9.1The Provider will work with Thurrock Council Communications, THLS and Public Health to promote and encourage referrals into THLS single point of access.

5.5Complaints

5.5.1The Provider shall put in place a complaints system that is compatible with the Council’s Complaints Procedure, details of which are available at Details of any complaints and the remedial action taken, where appropriate, shall be shared with the Council’s Commissioner at the performance meetings.

6.PERFORMANCE MANAGEMENT

6.1Record and Data Management

6.1.1Provision of accurate up-to-date records is a key element of contract performance and the Council’s ability to ensure that the service is operating as expected to deliver the required outcomes. At all times the Provider shall comply with the requirements and best practice around the Data Protection Act.

6.1.2The Provider shall therefore provide and maintain the following records as set out in the Data Collection Spreadsheet attached at Appendix 2.

6.2Information Governance and Sharing

6.2.1The Provider will sign up to the Thurrock Council Data Sharing Protocol, comply with the Data Protection Act 1998 and gain written consent from Participant’s to share information with the THLS at the point of Initial Assessment..

6.2.2The Provider shall supply all information/data required by the Council within the timescales set out at the time, which will not exceed 45 calendar days, but may be required more urgently if there are legal or other constitutional requirements. There will be no charge made by the Service Provider for the provision of such information.

6.2.3At the end of the contract, or upon termination, whichever comes sooner the Service Providerwill transfer all data / records, whether in paper or electronic format, back to the Council.

Data Protection

6.2.4The UK government have now introduced the Data Protection Bill (replaces the Data Protection Act 1998) which enables the UK to continue as is once the UK exits the EU. The new Bill includes all the EU standards as set in the General Data Protection Regulations (GDPR) as well as some UK specific elements relating to Law Enforcement and National Security.

6.2.5The Provider will comply with all legislation and best practice regarding Data Protection, including the Data Protection Act 1998 (DPA), GDPR and Council Policies as set out in Appendix 5, and any updates to these that come into force during the term of the contract.

6.2.6The Provider will act as a ‘Data processor’ on behalf of the Council. Whilst Providers currently have certain responsibilities under the Data Protection Act, the new GDPR will bring increased responsibility and accountability for data processors, with the Information Commissioners Office (ICO) being given new powers to issue financial penalties against data processors that do not adhere to the guidelines.

6.2.7The Provider will ensure that it only sends confidential personally identifiable information to the Council and third party agencies via two specific methods of communication:

(a)By hand to the receiver of the information if this is paper based – documents should not be posted and should be passed directly to a member of staff and not left at any reception desk

(b)By utilising the ‘Leapfile’ programme that the Council uses for secure data transfer (or any future applications the Council may utilise in its place)

6.2.8Under no circumstances shall the Provider send personal and sensitive information to the Council or any other agency or Service via standard email. In cases where Council staff are not registered with this system the Service Provider must request that they gain access before sending information. Where the request is urgent and cannot wait for this to be put in place information must be provided verbally.

6.2.9Information can be sent to the Council via the website below:

Any deviation from this process will be viewed as a serious breach of this Contract.

6.2.10The Provider will collect and hold only relevant data under the ethos of ‘appropriate collection’.

Consent and Confidentiality

6.2.11The Service Provider will ensure:

  • Information shared with other agencies is on a need to know basis or when required to do so under the law or for the purposes of the protection of the Participant or of the public
  • Information is only shared when it is in the best interests of the individual
  • Provider staff follow information sharing guidance in accordance with the principles of the Data Protection Act 1998, the GDPR Regulations (EU/2016/679) and/or subsequent legislation which may come into force
  • Service user information is kept confidential except where there is a perceived or actual risk of harm which precludes this and/or it is required by law
  • Records are kept up to date and secure and there is a records management policy in place
  • Staff receive appropriate data protection training on a regular basis

6.2.12The Provider must gain written consent from Participants at the Initial Assessment to use their data for records for performance monitoring as set out in this specification and Participant consent to allow the Provider to contact the THLS, or the individuals GP, should there be a concern with the Participant’s health.