Public Health Commissioning 2014/15 Provider Briefing Events September 2014

1. Public Health Commissioning 2014/15 Provider Briefing Events September 2014

2. Today’s Agenda • Welcome & Introductions • Public Health • Vision • Commissioning • Drug & Alcohol Services • Sexual Health • NHS Healthchecks • Smoking Cessation • Procurement • Proposed Tender Process • Information on Tendering • Timetable • Questions & Answer Session • Demonstration of the E-Tendering System

3. Context • Public Health responsibilities transferred to Local Authority on 1st April 2013 • There is a strong organisational commitment to ensure the integration of Public Health functions across the Council • That means Public Health services need to adopt and comply with Council governance, constitution and EU Procurement Rules • Creates greater opportunities for providers to support the wider council Health and Wellbeing services

4. Vision for Public Health in Herefordshire • Protect and improve the health and wellbeing of residents in Herefordshire and reduce health inequalities • Contribute to the Council’s Priorities of - Keeping children and young people safe and give them a great start in life and Enabling residents to live safe, healthy and independent lives • Support the Department’s vision to enable residents to live safe healthy and independent lives , maintaining service provision to those with need within the available resource

5. Commissioning Context We will look at our commissioning from a health and wellbeing perspective through the life course • Starting well: Give Every Child the Best Start in Life • Developing well: Enable all children and young people to maximise their capabilities and control over their lives • Working Well: Create fair employment and good work for all • Living well: Create a safe environment to build strong healthy communities and strengthening ill health prevention • Ageing well: Ensure people receive the care and support they need across the life course

6. Public Health Commissioning Principles • Commissioning evidence-based services based on local needs to improve public health outcomes for local people • Adopting a holistic approach which encompasses the whole of the local health and wellbeing economy • Broadly looking at framework approaches • Equity of Access • Proportionate tendering exercises and qualification criteria dependent on complexity • Cost effectiveness and Clinical Effectiveness • Supplier Diversity and Support Local Economy where we can • Promote Positive Behaviour Change • Encourage partnerships and joint ventures to maximise benefits of volume linked to price reductions and capability of market • Flexible contracting

7. What does this mean to those who wish to provide services? • These changes create opportunities for all of us to think differently • We are interested to hear from a range of providers, clinical professionals, communities, voluntary groups who want to provide these services • Procurement activity – Some challenging timescales

8. Services to be Tendered • Drugs & Alcohol • Sexual Health • Health Checks • Stop Smoking

9. Drugs and Alcohol – Current Status • Contract for treatment provision, primarily delivering assessment, medication for opiate addiction and keyworking • Limited capacity for treating alcohol addiction • Counselling contract for people with drug issues • Contract for support for family members • Contract for young people’s substance misuse treatment

10. Drugs and Alcohol It’s a bit like…

11. Drugs and Alcohol – Future Model Professor Strang’s report Medications in Recovery: Re-orientating Drug Dependence Treatment 2012

12. Drugs and Alcohol – Recovery Focused Model

13. Drugs & Alcohol Future Scope of Services • Recovery focused, peer led, family orientated drug and alcohol treatment service • Social interventions that help people regain and gain skills that will help them reconnect with their families, gain employment and maintain a stable home • Services will be targeted towards those at greatest risk of harm to themselves, their families and the local community • Increased emphasis on proactive early intervention and prevention • Assertive outreach to vulnerable substance misusers • Assertive case management of people who have the greatest physical and mental health problems associated with their substance misuse.

14. Drugs & Alcohol Proposed Commissioning approach • We are considering using a lead contractor model. • Contracts will be combined where appropriate and resources diverted from overheads to meeting gaps in existing provision.

15. Sexual Health – Current Status Currently Provision is made up by: • C-Card Condom Distribution • Primary Care LARC contraception (IUD/IUS/sub-dermal implant) • Secondary Care Specialist contraception/GUM Clinic • Testing/LAB • Pharmacies – Emergency Hormonal Contraception

16. Sexual Health

17. Sexual Health Future Scope of Services • STI testing and treatment and contraception including: Contraception, including implants and intrauterine contraception including all prescribing costs – but excluding contraception provided as an additional service under the GP contract. • STI testing and treatment, chlamydia screening and HIV testing and sexual health specialist services, including young people's sexual health and teenage pregnancy services, outreach, HIV prevention and sexual health promotion work, services in schools, colleges and pharmacies

18. Sexual Health Proposed Commissioning approach • To provide an effective integrated sexual health system which includes Department of Health Levels 1, 2 & 3 plus a local level ‘0’ to provide county wide Health Promotion activities.

19. Health Checks – Current Status • Current practice is to offer Health Checks through GP surgeries to 1/5th of the total eligible patients (approximately 61,500) each year using index birthdates to ensure that all patients are invited once every 5 years (c. 12,300 invitations per year). •  The most striking service gap is the difference in actual uptake 49% and the aspiration of 75%. As this is a reporting requirement within the Public Health Outcomes Framework it is essential that this aspect is addressed as a priority is any service restructure.

20. Health Checks – Future Model The aim of the programme is to identify individual risk of vascular disease (heart disease, stroke, diabetes, kidney disease and certain types of dementia) in the local population aged 40-74, for those not already diagnosed and provide appropriate advice and interventions to reduce or manage that risk. Recommendations/Proposals • Improve access by providing invitees with a more flexible (in terms of time and place) appointment system. • Invite a range of providers to tender to provide Health Checks in a variety of settings

21. Stop Smoking – Current Status • Currently a range of providers working to service level agreements provide the service • The service supports smokers to quit by offering behavioral support and pharmacotherapy (through Pharmacy). • Interventions are delivered by a stop smoking advisor, who has received stop smoking service training that meets the published NCSCT (National Centre for Smoking Cessation and Training) standards for one-to-one and/or group support. • Each quit programme is 12 weeks and progress is assessed at 4 weeks and 12 weeks post quit date • Providers are paid for successful outcomes only; success being measured at set quit date, 4 weeks and 12 weeks post quit date. Providers are offered a higher tariff payment for successful outcomes in pregnant smokers.

22. Stop Smoking – Challenges This approach means that: • The Service has experienced a consistent decline in number of people accessing the service • The majority of stop smoking advisers complete this work as a small part of their main jobs which limits the capacity to make an impact. • The majority of support given to smokers (98%) is by individual behaviour counselling; one to one delivery reduces the potential to increase the number of quitters receiving the service when compared to group support.

23. Stop Smoking – New Model • Improve access – • Increase number of service providers- any qualified provider (e.g. voluntary/community organisations, dentists , ) • Increase option of sites to access stop smoking support e.g. workplaces, secondary care) • Increase access in areas where we know that there are high numbers of smokers • Improve performance of practitioners • Improve options for treatment - Markedly increase group and drop-in support availability • Make use of underpinning technology

24. Other Services – Next Steps • All Public Health commissioned services will be undergoing a review • New approaches and initiatives will be considered in line with the Commissioning context and principles discussed earlier • The programme of procurement, of which these services are the first, will be further developed and rolled out

25. Potential Tenders The services currently undergoing a commissioning review with the most appropriate approaches to market under consideration are: • Physical Activity • Obesity Services • Child Health

26. The Tender Process Wayne Welsby Head of Commercial Services

27. The Tender Process • Needs to comply with EU Treaty rules and principles of transparency, proportionality, equal treatment and non-discrimination. • It is the formal process used by the Council to award contracts. • Questions asked within the tender pack provides the Council with confidence that organisations are suitably qualified for the opportunity and asks questions on how the requirements will be fulfilled. • The objective is to identify most suitable bidder(s) with whom to contract.

28. Proposed Procurement Process The Council’s aim is to use a RESTRICTED(two stage) process this involves the the completion of:- • A Pre-Qualification Questionnaire (PQQ) • An organisation’s business status and capacity • Only need to complete one PQQ for any Public Health service • Will ask to indicate services interested for the Council to gauge interest at this stage: is for information only • Invitation to Tender (ITT) • An organisation's ability to deliver specific services • How an organisation’s will deliver those services

29. What is in the PQQ? “BASIC DETAILS OF YOUR COMPANY” • We want to know who we are dealing with e.g. company name, parent company details, VAT registration. “BUSINESS AND COMPANY STANDING” • These are statutory questions which all public bodies must ask. • Public Services Contracts Regulations 1993 (www.legislation.gov.uk). “INSURANCE” • We seek (proportional) insurances for our protection should something go wrong. “FINANCIAL INFORMATION” • We need evidence of solvency and to evaluate financial risk including over reliance.

30. What is asked in the PQQ? Contd.. “EQUAL OPPORTUNITIES”, “ENVIRONMENTAL MANAGEMENT” AND “QUALITY ASSURANCE” • The Council operates these policies and it seeks to work with organisations sharing same values and controls. “HEALTH & SAFETY”, “EQUALITY & DIVERSITY” • The Council complies with H&S and E&D legislation. • Through its policies and procedures, it seeks to contract with organisations matching its aspirations. “REFERENCES” • Purchasers need to validate claims. References are a test of capability and capacity. • Proof often sought from more than one client.

31. How is the PQQ Assessed? The are 3 types questions are • Informational • Not assessed but providers still need to provide. • Name, address, company registration etc. • Mandatory • Pass/Fail questions • Scored • Questions are scored The PQQ will explain how bidders will be invited to the next stage for each specific service

32. What is in the ITT? “Service Specification” • Details what is required for the specific service. • Background to service & Herefordshire specifically “Terms and Conditions” • By returning a tender bidders will be agreeing to this document. “Pricing Schedule” • This will be specific to each service. • All elements must be priced as required. • Do NOT amend. “Provision of Service Information” • These will be service specific. • Bidders need to answer the questions given.

33. PREPARE AND SUBMIT YOUR RESPONSE • Tenders are evaluated based on content not ‘gloss’. • Note the evaluation methodology and focus on key elements • Answer the question asked not the question you want it to be • Check if response requires an attachment. • Check if responses permit attachments. • Keep responses concise and to limits where specified (may be a page) • Use affirmative language not conditional phrases (“subject to”, “however”, “might” etc.).

34. Completing the ITT “PLAN YOUR RESPONSE • Early on thoroughly read tender documents (including T&C’s). • If the tender is unclear, seek clarification. • Know the tender timetable and deadlines. • Plan for sub-contractor input to your tender response. • Know how to respond (labelling, formats, attachments and templates).

35. How Will the Bids be Evaluated? Whilst a standard approach is followed to evaluate tenders, this will be adapted to meet the needs of each procurement process. For this set of tenders: • Tenders will be first checked to make sure that they are compliant. • Compliant tenders will then be evaluated individually by specialists who will then meet to agree a consensus score. • There will be a scoring regime against which evaluators will mark tenders: this will be shared with bidders. • Tenders will be evaluated on a MEAT (Most Economically Advantageous Tender) basis combining quality and price. • Evaluator comments are captured throughout the process and bidders will be fully debriefed on the reasons for the scores.

36. Responding to Tenders PREPARE AND SUBMIT YOUR RESPONSE • Prepare your own checklist and tick-off what you have completed. • Do not leave uploading documents until the last minute. • Can upload as elements completed: can be changed up to the closing date & time. • Keep up-to-speed with the Council’s tender amendments and responses through the e-tendering portal, Proactis.

37. Ten Top Tips on How to Tender • Read the documentation thoroughly and understand what is required. • Understand the Council; aims, priorities, commissioning principles. • Don’t be put off – if in doubt ask! (via Proactis) • Do answer in full, do not assume anything is obvious or “goes without saying”, particularly if you are a current supplier as we can only evaluate what’s in the Tender. • Don't include publicity or promotional material in your submission unless you are asked to do so • Make it clear which question your answer refers to – clearly number and cross reference. Help the evaluation team to make the right decisions. • Note the evaluation criteria and weightings and ensure extra care given to key questions. • Be clear on your pricing model - state any assumptions you made when pricing (e.g. availability of resources, timing etc) • Do ask for feedback if you are unsuccessful, it will help you with the next tender. • Be clear on your pricing model - state any assumptions you made when pricing (e.g. availability of resources, timing etc) • Complete and return the documentsby the date and time given.  Check that you have signed everything you should have. • Do ask for feedback if you are unsuccessful, it will help you with the next tender.

38. Next Steps

39. The Procurement Timetable

40. Where can I find Tender Opportunities? • Register on Proactis, our e-Tendering Portal:- https://tenders.herefordshire.gov.uk/SupplierPortal/ • Its free to register • Easy to search for Opportunities • Technical Support is available • The core communication channel for procurement

41. Question and Answer Session

42. Thank you for Coming