Agenda item

The Mayor and Executive Member for Adult Social Care submitted a report for Executive’s consideration.

The report sought approval to bring the specialist clinical/prescribing service for substance misuse into Middlesbrough Council, for delivery to commence 1 October 2023.

The current service provider ended their provision on 30 September 2023 and no other organisations submitted tender proposals following a procurement process. There was an absolute requirement to have the service in place. Therefore, there was a need for as much certainty as possible in order to mobilise a new service within such extremely challenging timescales.

It was imperative that essential elements, such as securing clinical staff, having a prescribing system and appropriate buildings to deliver the service from, were all in place. These were complex undertakings and required specialist knowledge from a broad range of individuals, teams and organisations.

The specialist prescribing service in Middlesbrough was currently contracted with Foundations Medical Practice. Historically this service had been delivered as part of a coterminous arrangement with the former South Tees Clinical Commissioning Group (CCG), now the North East and North Cumbria Integrated Care Board (ICB), who commissioned Foundations for primary care.

The ICB provided an enhanced service payment in relation to the Foundations patient group, which augmented the general medical element of service delivery. This, along with the Public Health and various primary care contracts, had historically made the service financially viable and ensured that the healthcare needs of an underserved population group had been more effectively met.

The service had been affected by the overall budget reductions to substance misuse with significant cuts to the funding since 2013. These impositions, on both the service and wider substance misuse model, had resulted in caseload sizes becoming dangerously high, which restricted the amount of support that could be provided to individuals who were reliant on the service.

OPTIONS

Appendix 3 of the report contained a detailed options appraisal.

However, in summary other potential decisions were considered but were not recommended for the following reasons:

1.    Do nothing – not a feasible option as the outcome would have resulted in no service provision on 1/10/23;

2.    Direct award of a contract to a suitable provider organisation – there were several major risks associated with this option, mainly regarding to the lack of certainty in this process within the already tight timescales. Other risks included:

i)     There had been no market interest in the tender. Therefore, this may not have yielded a suitable provider willing to take the service on;

ii)    Potential that the process would have failed during negotiations, which would have left no timescales to get alternative provision in place; and

iii)   Highly likely to have been a more costly option in order to secure a suitable provider and expected that the preferred delivery model would have had to be compromised;

iv)   Would have been a limited time solution and required taking the service back to the market in the near future – likely to have to have changed the model to secure a bid;

3.    Direct award of a contract to a Primary Care Network or GP practice – the risks outlined in option b. above also apply here. There is even less likelihood of securing a suitable provider from this sector, most crucially due to the lack of skills and experience within local primary care.

ORDERED

That Executive approve the specialist clinical/prescribing service for substance misuse be brought into Middlesbrough Council.

REASONS

Detailed reasons were provided in paragraphs 19 to 34 of the report, however in summary there was no option to risk having any break in service provision.

This would have resulted in serious risk of overdoses and deaths and would have had extremely negative consequences for a large number of extremely vulnerable people. This decision provided appropriate timescales to enable the future service to be planned, developed and implemented safely, in conjunction with relevant partners and stakeholders.