Cabinet Member for Public Protection PP03 (11/12) Key Decision: Approval to Commence Procurement of Drug and Yes Alcohol Treatment Services. Part I July 2011 Report by the Interim Director Joint Commissioning Unit Electoral Division(s): N/A Executive Summary The Drug and Alcohol Team (DAAT) purchase a number of services which support people with drug and alcohol problems in gaining access to treatment and support in their recovery from addiction to substances. A number of the services that are currently delivered are due to be retendered. The West Sussex DAAT Partnership are planning to procure a range of specialist drug and alcohol treatment services some of which will be locality based and some of which will be county wide. These will also include prison drug and alcohol treatment services at HMP Ford. The proposal is to commence a tender process for the award of contracts for the provision of services to these client groups. Funding will be from the existing budget sources for these services. Recommendations 1. That approval is given to commence a tender process to procure Young People s and Adults Drug Treatment Services in the community and prison drug and alcohol treatment services at HMP Ford in August 2011 in order to have services in place for February 2012 for the community based services and April 2012 for the prison drug treatment services. 2. That the Executive Director Finance and Resources be delegated to let contract/s for community based services for 2 years 2 months with a possible extension for a further 2 years with an annual value of up to 1.023m (maximum of 4.262m over the course of the contract, including extension period). 3. That the Executive Director Finance and Resources be delegated to let the contract for HMP Ford prison drug and alcohol treatment services for a period of 3 years with a possible extension for a further two years, with an annual value of 0.364m (maximum of 1.820m over the course of the contract, including extension period). 1 Background 1.1 A range of drug and alcohol services is commissioned across West Sussex to support those in need of reducing or ceasing their misuse of substances. These services have been commissioned under a range of different contracts.
1.2 The Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life identifies that the approach will be to offer every support for people to choose recovery as an achievable way out of dependency. Over the next four years there is a determination to break the cycle of dependence on drugs and alcohol and the wasted opportunities that result. The solutions need to be holistic and centred around each individual, with the expectation that full recovery is possible. 1.3 The investment made in the drug treatment system over the last decade has built capacity and enabled people to access treatment for a sufficient period of time to bring about substantial health gains. We now need to make the same progress in treating those with more severe alcohol dependence and to become much more ambitious for individuals to leave treatment free of their drug or alcohol dependence so they can recover fully. 1.4 West Sussex DAAT Partnership fully support these aims and intend to create a recovery system that focuses not only on getting people into treatment and meeting process-driven targets, but getting them into full recovery and off drugs and alcohol for good. 1.5 The proposed procurement is the first opportunity that West Sussex DAAT will have had to clearly set out this ambition within contracts. The vision of the Recovery Partnership, part of the wider structure of the DAAT, has over the past two years been promoting this recovery ambition and vision and through collaborative work with the Royal Society of Arts has been driving forward innovative projects supporting the notion of recovery in our communities in West Sussex. 2 Discussion 2.1 As the Service and Funding Agreements for all of the existing services cease either at the end of January 2012 or in the case of the prison drug treatment services, the end of March 2012, action must be taken to ensure that there is continuity of service to ensure access to essential treatment. In line with legislation and the Council s Standing Orders it is a requirement to tender for these services beyond this date. An open tender is the most appropriate method. This will ensure that a transparent, equitable and fair procurement process is completed and the successful bidder will provide optimum value for money. 2.2 Recent market consultation has identified that there are a number of providers in the market place who would be either able to deliver all of the services themselves under one contract or by sub-contracting or going into partnership with another provider. Currently four separate suppliers deliver the contracts. 2.3 It is intended that one contract will be let for the adult and young people s drug and alcohol treatment services to be delivered either by a single or multiple suppliers. It is also intended that one contract be let for the prison drug and alcohol treatment services to be delivered either by a single or multiple suppliers.
2.4 In West Sussex, the West Sussex Young People s Substance Misuse Service (WSYPSMS) is currently delivered through a contract with Crime Reduction Initiatives (CRI). The clinical prescribing element of the young people s service is delivered through a small contract with Sussex Partnership Trust via their Children and Adult Mental Health Services (CAMHS) contract. 2.5 The Adult Drug and Alcohol Treatment Services that operate in Crawley are currently provided through a contract with Addaction and the services that operate in Bognor and some of the services provided in the Chichester district are delivered through a contract with Crime Reduction Initiatives, an independent sector service provider. 2.6 Additionally a specialist counselling service is delivered that provides weekly counselling for people who need time limited 1:1 counselling. This is provided by an organization called Sussex Alcohol and Substance Misuse Service (SASS). 3 Proposals 3.1 The young people s and adults treatment service contracts would be for 2 years and 2 months with provision for possible extension for up to two years with an annual value of up to 1.023m (maximum of 4.262m over the course of the contract, including extension period.) Prison drug treatment services will be for a period of 3 years with a possible extension for a further two years, with an annual value of 0.364m (maximum of 1.820m over the course of the contract, including extension period.) 3.2 The services which are to be procured include: A county wide young persons substance misuse service, a specialist community substance misuse service, providing care planned interventions aimed at alleviating harm caused by a young person s substance misuse A county wide specialist counselling service for adults who require a structured counselling intervention to address issues relating to their drug and or alcohol misuse Non clinical drug and alcohol treatment locality services in Crawley, Bognor and Chichester providing open access and structured treatment interventions to support recovery Drug and alcohol treatment services at HMP Ford Prison. These will provide clinical and non clinical treatment interventions 3.3 These services are non-clinical services with the exception of the young person's service and the Prison Drug Treatment Services which have clinical or prescribing elements to the service provided. Clinical services within the adult community based treatment services are delivered through an existing contract which is not being tendered at present.
3.4 All of the above contracts with the exception of the Prison Drug treatment System will expire on the 31st January 2012. New services must be in place to provide seamless service provision commencing from the 1st February 2012. The Prison Drug Treatment Services must be in place by the 1st April 2012. 3.5 The aims of the retendering exercise are to provide continuity of the above services. The exercise provides the opportunity to enhance current services towards a nationally recognised model that has as it vision and objective, the development of recovery orientated services, as set out in the Drug Strategy, 2010. 3.6 Prison Drug and Alcohol Treatment services are not being delivered at present. An interim contract to deliver clinical service provision at HMP Ford has been awarded to Crime Reduction Initiatives and will commence on 1st September 2011 and run until March 31 st 2012. Funding commitment for this is from the current DH budget allocation to Integrated Drug Treatment System (IDTS.) The procurement that is proposed will supersede this contract and another that is already in operation that provides structured psychosocial interventions and support. This contract was previously commissioned through the National Offender Management Service (NOMS) and is the former Counselling, Assessment, Referral, Advice and Throughcare (CARAT s) drug and alcohol treatment programme, delivering psychosocial interventions. The combination of two sources of funding, delivering clinical and psychosocial interventions, will secure an integrated service to the prisoner from the 1st April 2012. The recovery focus also extends to people accessing treatment services in prison and the service model at HMP Ford will have a strong focus on recovery ambition. 3.7 Within the proposed service model of all of the services being retendered there will be a strong emphasis upon the following: accessibility and location of service delivery, the importance of effective engagement with the customer and the use of peer mentors, now more commonly referred to as Recovery Champions or Coaches who provide less formal support to people in treatment, but who provide optimism that successful recovery can be achieved. These elements of service delivery will form part of the commissioned service specification. 3.8 Within the service delivery required there will also be a strong emphasis on early intervention and engagement, in respect of gaining quick access to treatment but also in respect of the inclusion of family and significant other/carer support as an integrated part of service delivery. The service model requires a strong partnership approach which is in part supported through the DAAT Recovery Partnership Group (DAAT RPG). There will be an expectation that the services will work in an integrated way towards a whole person centred recovery supporting customers with issues that also cause drop out from treatment such as housing and lack of social and community support or relapse after exit. Targeted support will be provided to people who are in recovery and who need support to access educational opportunity, employment or other vocational services. 3.9 A shift away from considering treatment services in isolation is necessary. The work of the DAAT Partnership has already begun to shape
4 Consultation this vision of recovery in conjunction with and complimentary to treatment service delivery. This procurement will further shape this vision and support a shift in the culture of service delivery away from a solely medical model. 4.1 A working group is being set up with representatives from the DAAT Partnership including Police, Integrated Offender Management, Family and Friends Network and active involvement from a Recovery community group. 4.2 The DAAT Board has endorsed the procurements for adult drug and alcohol treatment services. 4.3 Consultation regarding young people s service provision has been with children s trust partners through the Children s Trust Substance Misuse Group (CTSMG) that reports to the Children s Trust Strategy Group (CTSG) and includes membership from West Sussex County Council s Youth Service and specialist children s services, Community Safety, NHS West Sussex, the Police, the districts and boroughs, the voluntary sector, the Youth Offending Service and the West Sussex Parenting Commissioner. 4.4 The HMP Ford Prison Drug and Alcohol Treatment Services Board endorses the prison drug and alcohol treatment procurement and is establishing a representative stakeholder consultation group to agree the detail of the service model and specification which will include consultation with offenders. As this procurement will be completed later than the other procurement this activity is not as advanced as the young people and adult community drug treatment service modelling. 4.5 The provision of the retendered services has been discussed with the Sustainability Team, and a Sustainability Appraisal completed which has informed the design of the new service. 4.6 In respect of both procurements it is planned that customers or serviceuser representatives will be included on the panel that evaluates tenders. 4.7 Subject to the recommendations being agreed, the staff involved will be consulted on the implications of the changes, which are likely to involve TUPE transfers for a number of staff. 5 Resources Implications and Value for Money 5.1 Current spend on the existing services equates to 1,387,480 per annum. In round terms this is made up of the following: County wide young people s services (including CAMHS service)- 262,470 Adult Drug and Alcohol Treatment services (Crawley) 391,230 Adult Drug and Alcohol Treatment services (Bognor/Chichester) - 280,260 County wide specialist counselling services - 89,500
Prison drug and alcohol treatment services - 364,020 5.2 We will seek efficiencies from this procurement and, through the award of one contract for the community based services, expect a reduction in management costs. 5.3 A competitive tender process will be conducted which will require technical assessment against a detailed service specification. The service specification will be developed against evidenced demand for the service. Performance after contract award will be measured against key indicators and a spectrum of outcomes evidencing successful exit from the treatment system and successful entry into education, employment and more stable housing. There are a range of mechanisms which will measure this performance including the NTA s Treatment Outcomes Profile and a localised Recovery Outcomes Framework. 5.4 Advice suggests that the most effective duration of contracts is to offer a 2yr and 2 month contract (commencing 1st February 2012, ending 31st March 2014) with provision for up to a two year extension, one year at a time. This aligns with potential retendering of the main county wide clinical services contract. The prison procurement will be awarded from the 1st April 2012 for three years with provision for extension up to 2 years. 5.5 Funding for the prison services comes from the joining together of national funding streams at a local level. There are two allocations for adult prisons: The first amount is for clinical drug treatment, previously known as Integrated Drug Treatment System (IDTS). The funding for this has historically come from the Department of Health (DH). The second allocation is for non-clinical substance misuse interventions, and comprises former Counselling, Assessment, Referral, Advice and Throughcare (CARAT s) drug and alcohol treatment programme. This represents funding that had previously come from the Ministry of Justice to National Offender Management Service (NOMS). Both sources of funding, from NOMS for CARATS, and the DH funding for IDTS, will be combined and DAAT will become responsible for commissioning these through one single pot of funding from DH. 5.6 Taken together, these allocations provide the opportunity to realise the vision of a locally commissioned, recovery-focused prison based treatment system described in the Green Paper Breaking the Cycle and the Prison Drug Treatment Strategy Review Group report chaired and published by Lord Patel in November 2010. It also marks the final step in achieving the one pot for one purpose concept, by bringing together funding streams and making them available to local partnerships to commission the full range of provision necessary to support individuals along the full course of their recovery. These allocations for prison drug treatment services will transfer from the PCT to the Joint Commissioning Unit under a variation to the Section 75 Agreement. 5.7 Following work with the Department of Health and the Home Office, the National Treatment Agency developed a Value For Money Tool Kit in 2010. This can be applied to Local Authorities which, for the first time,
identifies the costs and benefits of drug treatment. The costs and benefits are applied to the Spending Review period (2011-15) and can be seen in Appendix B Substance Misuse Cost Benefit Analysis summarised as applicable to West Sussex. 5.8 In 2010 the National Treatment Agency (NTA) analysed the long term results for those entering the treatment system four years ago (41,475 people). This included analysing crime data over this period and matching those arrested for drug related offences with those in the treatment system during this period. This is the first long term study of its kind. 5.9 There is strong evidence to suggest that sustained recovery from addiction was found for almost half (46%) of those discharged from the treatment system during 2005-6. 55% of those who left the treatment system during this period did not return to the treatment system for the subsequent four years. 5.10 Almost half of those discharged from the treatment system did not have any further drug related contact with the criminal justice system during the subsequent four years. For those who did re-offend after leaving the treatment system 65% went back into treatment. Comparisons were made for those leaving treatment during 2006-7 and showed significant similarities in long term outcomes. A MORI Poll found that over three quarters of the public believe that drug treatment is a sensible use of taxpayers money. They particularly rated that the greatest benefit was that it makes their communities safer and reduces crime rather than it improves a drug users well being. The benefit of localised expenditure in West Sussex is detailed from 3.1 in Appendix B Substance Misuse Cost Benefit Analysis 5.11 Resources are required to administer the tender and procurement process and to evaluate the bids. This is a necessary investment to ensure that the process complies with legislation and with the Council s Standing Orders. This will be drawn from existing resources and there is no requirement for additional resources. 5.12 There is potential for economies of scale through the procurement processes. Currently the demand for the services outweighs the supply and in some cases there are waiting lists for the current services. In light of these considerations, economies of scale will potentially increase the level of service for the same budget commitment rather than reduce the budget. 5.13 Undertaking a tender process will promote competition that will ensure that bids are evaluated against both quality and cost and therefore Best Value is achieved. 5.14 No inflationary uplifts on the contract will be offered. A Payment by Results model is proposed and this will increase likelihood of increased capacity and quality of service delivery and return on investment. 6 Risk Management Implications
6.1 One risk is that the tender process fails to provide a bid which can be selected and thus deliver the service. This risk will be mitigated by advertising widely. Third Sector and Independent Sector providers alike are notified of where to look for tender opportunities. Interest registered for and attendance at a market consultation event, held in June 2011, would appear to indicate that there is interest from the market. 6.2 If a successful provider cannot be selected the process will ensure that this is known approximately 2 months in advance of the current arrangements ending. This situation would lead to the working group and legal services determining the most appropriate course of action to prevent a gap in service. 6.3 In any tender there is a risk of legal challenge. This will be mitigated through legal and procurement advice on the process and ensuring that all bidders are treated fairly and scored and evaluated in the same way. 6.4 The majority of the funding for these services is external and provided through the NTA and DH, and reaches the County Council through the PCT. These resources are predominantly subject to transfer through the existing Section 75 agreement or are proposed to be transferred under the first variation to the Section 75 agreement. 7 Customer Focus Appraisal 7.1 A Customer Focus Appraisal (CFA) has been undertaken and is attached at Appendix A. The issues identified by the CFA are addressed and included in the design of the service and integrated into the contract and the specification of requirements for the new service. 7.2 As part of the County Council s Equality Duty it is essential that the tender and the resulting contracts ensure that the services are delivered in a way that endeavours to eliminate discrimination, enable equality of opportunity and fosters positive relations for those with the protected characteristics described in the legislation. 8 Crime and Disorder Act Implications 8.1 This proposal includes support for offenders and ex-offenders and this will not be reduced as a result of its inclusion in the tender process. Integration of service delivery should produce opportunities to enhance service capacity to meet growing demand. Getting people off substances reduces violent crime, acquisitive crime and crimes of possession and supply. It also reduces vulnerability to becoming a victim of crime. 9 Human Rights Act Implications 9.1 The positive duties under Articles 2 (right to life) and 3 (prevention of inhuman and degrading treatment) as well as the duty to have regard to the right to private family life and home are all engaged by the responsibilities which these services meet to those directly in need and the wider community. Service design and contract management will need to ensure these obligations are met.
Crispin Atkinson Interim Director Joint Commissioning Contact: Emma Fawell, DAAT Commissioning Manager, ext 82633 Appendices: Appendix A: Customer Focus Appraisal Appendix B: Substance Misuse Treatment Investment Cost Benefit Analysis Background Papers The Drug Strategy 2010: Reducing Demand, Restricting Supply, Building Recovery: Supporting People to Live a Drug Free Life Green Paper Breaking the Cycle The Prison Drug Treatment Strategy Review Group report chaired and published by Lord Patel in November 2010