Decision Maker: Cabinet Procurement and Insourcing Committee
Decision status: For Determination
Is Key decision?: Yes
Is subject to call in?: No
1. To agree an award of the City and Hackney Stop Smoking Service contract to Provider A for a period of up to five years (3+1+1) from the 1st of July 2024. The total value of the contract will be a maximum of £5,698,595. This will be made up of up to £3,583,700 in core service spending (An average of £716,740 per year). There will also be up to £500,000 of central government funding to be allocated towards Optional Additional Work Packages and up to £339,978 per annum of additional central government funding to support local stop smoking services (as described in section 6.1 of the report).
Reason(s) For Decision
5.1 This report seeks to confirm the award of a contract for =a new Stop Smoking Service based on a redesigned service model and specification including an insourced service element.
5.2 This option would seek to incorporate the latest evidence and best practice guidelines, as well as insights that have been gathered from resident and stakeholder engagement and data analysis. For completeness the changes proposed for the new service are detailed below.
5.2.1 Incorporate the latest guidance from NICE including lowering the age threshold from 18 to 12, continuing to offer behavioural support plus medication (now including nicotine-containing e-cigarettes for over 18s only) as the most effective way to support smokers to quit, with support tailored to the specific needs of individual smokers
5.2.2 Integration/alignment of community and hospital-based stop smoking and tobacco dependency treatment service pathways.
5.2.3 Strengthening and extending ongoing support for people to reduce risk of relapse and remain ‘smokefree’.
5.2.4 Increase access to harm reduction approaches for those motivated to reduce their tobacco use but not yet ready to quit in one go.
5.2.5 Specify a revised model for the City element, including new activity targets (and corresponding adjustment to the City contribution to the service budget - see savings section 7), as well as additional capacity provided through the virtual Stop Smoking London portal (available through membership of the London Smoking Cessation and Tobacco Control Programme, funded separately).
5.2.6 Insourcing of an enhanced community engagement function, through recruitment of a dedicated officer to be hosted by Hackney Council. It is proposed this would be a PO7 post and the budgeted amount for this is £80,000 per annum, which is included within the £800,000 financial envelope for this service detailed in the business case. This community engagement officer will work alongside the contracted provider and develop close partnerships with key local high risk/high prevalence communities, building on the successes of the Public Health Community Champions programme. This partnership approach will aim to ensure the service is flexible to the wider needs of priority groups, helping to deliver on the new service's priority objective to reduce inequalities in tobacco related harm. The full scope of work for the insourced community engagement officer will evolve in response to community and service needs, but is expected to include:
· working with the service provider to build capacity in community organisations to deliver stop-smoking advice directly
· supporting the co-development of tailored communications and targeted outreach to promote the service
· building/strengthening relationships between high risk/prevalence communities and the service provider to maximise responsiveness and reach of the service
· gathering insight from people in these communities to support ongoing service improvement and co-design to better meet the needs of smokers in City and Hackney.
5.2.7 Inclusion of a ringfenced outreach and engagement budget of £50k per year, to fund community partners to support the work with priority groups described above. This fund is part of the overall service budget and would be held and distributed by the provider. The provider will be required to work in close partnership with the insourced community engagement officer to co-design an approach for allocating this funding that is proportionate, fair and transparent.
5.3 Since the start of the existing service in 2018, new guidance has been published by National Institute for Health and Care Excellence (NICE) on preventing smoking uptake, promoting quitting and treating dependence. Reprocuring this service with a redesigned service model allows us to take account of this guidance, as well as wider system changes such as those implemented through the NHS Long Term Plan, as well as more recent government announcements to achieve a ‘smoke free generation’. Procuring a redesigned service will ensure the new Stop Smoking Service is responsive to these changes in the wider policy and delivery context.
5.4 This proposed new service would replace all existing provision (including community outreach, GP and pharmacy based Stop Smoking Services) and integrate with new NHS tobacco dependency treatment pathways. The new service proposals will build on learning from the coronavirus pandemic in seeking to work in partnership with the voluntary and community sector; co-designing and implementing a flexible service offer that meets the needs of those who would benefit the most, within communities where tobacco harms are high but uptake of local Stop Smoking Services has historically been low.
5.5 The evaluation and co-design work has considered options for taking an holistic approach to supporting people to address multiple health risks and address wider needs that affect people’s smoking behaviour. It has considered the most appropriate delivery model for achieving the priorities for the new service (such as a single integrated service, lead provider network or multiple contract lots and insourced provision).
5.6 Following a detailed benchmarking exercise, it was confirmed in the Business Case Report that the budget for the new service, whilst including the new/enhanced elements outlined above, can be reduced (see savings proposals in section 7).
5.7 Following a number of central government announcements both prior to and during the tender being opened, this service has been designed to be flexible to the allocation of additional streams of central government funding. These streams include the Stop to Swap scheme, financial incentives for pregnant smokers and, most recently, the additional funding for local Stop Smoking Services announced by the Prime Minister in early October 2023 (see section 6.1.1)
Alternative Options (considered and rejected)
5.9 Option 1 - End the service at the currently scheduled end date of 30/06/2024 and do not commission a new Stop Smoking Service
This option would allow for savings to the Council, however in doing so it would end a vital service for the tens of thousands of smokers living locally and would, therefore, have a detrimental impact on population health and risks increasing health inequalities in City and Hackney. This option does not take account of the significant health harms caused by smoking in the local context:
· smoking is the primary cause of premature death and preventable illness in England - one in two long term smokers will die from a smoking-related disease
· the annual societal costs of smoking in Hackney are estimated at over £100m each year (equivalent data are not available for the City)
· according to data from the Annual Population Survey in 2021, smoking prevalence in Hackney amongst adults (age 18+) was 14.2%, higher than our 15 ‘statistical neighbours’ (again, equivalent data are not available for the City).
Whilst ending the service would release short-term savings, it should be noted that stop smoking interventions are the most cost effective (often cost ‘saving’) of all public health interventions and have the greatest impact on reducing health inequalities (along with domestic violence prevention).
5.9 Option 2 - Reprocuring the Stop Smoking Service based on the current service model and specification
The current Stop Smoking Service performs well for those who use it. Hackney’s outcomes ranked 3rd out of 16 in 2020 when compared to its statistical neighbours for both “smokers setting a quit date” and for “self-reported successful quits at 4 weeks”. Hackney’s performance against these national smoking indicators is also consistently above the England average.
However, the service has been less successful in attracting referrals from some high risk groups and high prevalence communities (including pregnant/post partum women, smokers from the Turkish/Kurdish community and those in routine and manual occupations). A re-designed service that is more responsive to the wide-ranging needs of City and Hackney’s diverse smoker population will help to reduce stubborn inequalities in service uptake.
5.10 Option 3 - Recommission a new Stop Smoking Service based on a (wholly outsourced) redesigned service model and specification
This option allows for the incorporation of a number of improvements to the service model (see section 5.2) and ensures that the service is up to date with the latest guidance from NICE and the wider policy context(see section 5.3).
Whilst this option considers the latest evidence and insight available for City and Hackney, this fully outsourced Stop Smoking Service model does not give full regard and commitment to the Hackney Labour Manifesto 2022-26 to review all outsourced services, with a view to bringing them in-house. A fully outsourced option would exclude some of the key advantages to insourcing particular elements of this service, as detailed in section 5.2.6.
Publication date: 06/02/2024
Date of decision: 05/02/2024
Decided at meeting: 05/02/2024 - Cabinet Procurement and Insourcing Committee