Agenda Item 03 Enclosure CKWCB/12/101
Report To: Date:
Title of Report:
Cluster Board 3rd April 2012
Request to seek approval to implement the outcome of the commissioning review of the Inpatients Service at HMP Wakefield through a competitive tender procurement process
FOI Exemption Category: Open
Report Author and Job Title: Executive Summary:
Ann Ballarini, Executive Director of Commissioning and Service Improvement
Danny Alba, Commissioning Programmes Manager This paper is a formal request to the Board for approval to implement the new delivery model through a competitive tender procurement process, as an outcome of the commissioning and service review of the Inpatients Service at HMP Wakefield. Wakefield CCE has reviewed and recommends that the full business case (FBC) goes forward to the Cluster Board for approval. Value of the contract to let is a maximum of ÂŁ400,000 per annum / ÂŁ1,200,000 for 3-year contract. Tender will run from second week of April and the provider who wins the contract will commence service delivery from 1st April 2013. Current provision by the prison is not fit-for-purpose as assessed by independent reviews undertaken during 2011; Risk to delivery of the project is that the resource available may not prove attractive for the market although market analysis / shaping for this area of provision indicates there is existing interest from the market; Risk potential is political interest in the tender and potential adverse publicity due to the high profile of Wakefield Prison but mitigation is that the procurement process will be carried out in full compliance with EU Procurement Law and commercial-in-confidence; and Risk to delivery of the project is the considerable business change required at the prison but mitigation is robust project management and also the new service will be augmented by
telemedicine and enabled by the safeguards contained within the new NHS standard contract. Legal Implications:
To comply with Cluster Standing Orders and Standing Financial Instructions procurement of contracts must comply with UK legislation, in particular: Public Contracts Regulations 2006; Human Rights Act 1998; Data protection Act 1998; and Freedom of Information Act 2000. Other relevant legal implications are that new provision must operate within the constraints and protections of the: NHS Standard Contract; Prison Act 1952; and Mental Health Act 1983 and 2007. Makes provisions for intermediate care which fills the existing gap between primary care and secondary care; Improved health of prisoners through better clinical management of long-term conditions leading to a reduction in the health inequality gap; Improved patient safety for prisoners, including improved safety of staff, with a reduction in serious incidents and no incidence of ‘never events’, through improved access to better healthcare; Developed integrated care pathways enabling seamless care between primary, intermediate and secondary care and between health care and custodial care; Delivers against the NHS Outcomes Framework 2012/13; specifically: domain 2- enhances quality of life for people with long-term conditions – enhancing quality of life for people with mental illness; domain 4 - ensuring that people have a positive experience of care especially improving people’s experience of out-patient care and improving experience of care for people with mental illness; and domain 5 - treating and caring for people in a safe environment and protecting them from avoidable harm; and Properly governed healthcare provision to provide sub-acute care and intermediate care which is ‘care closer to home’.
No TUPE issues as HM Prison Service staff (prison officers) are not liable for TUPE under National Offender Management Service (NOMS) rules.
Outcome of Equality Impact Assessment:
No group(s) adversely affected.
PCT/Prison Bilateral Partnership; Prisons Quality Board; Planned Care CCU; NHSWD SMT; Wakefield Alliance CCE; and Cluster Board
It is recommended the Board: i.
Approves the implementation of the new service delivery model as an outcome of the review of the Inpatients Service at HMP Wakefield through a competitive tender procurement process.
Purpose of Report The purpose of this report is to inform the Board of the outcome of the review of the Inpatients Service at HMP Wakefield and to seek approval to implement the new service delivery model through competitively tendering the service through a procurement process. The value of the contract to let is a maximum of £400,000 per annum / £1,200,000 for 3-year contract. The tender would run from the second week of April with the contract being awarded in September/October but leaving a further five to six months to mobilise the service due to the high security operating environment with the successful bidder commencing service delivery as from 1st April 2013. Wakefield CCE met on 27th March 2012 and reviewed the FBC and recommends that it goes forward to the Cluster Board for approval.
Context and Project Delivery From 2004 through to 2006, responsibility for commissioning prisoners’ health transferred from the Home Office (now National Offender Management Service (NOMS) which is an agency of the Ministry of Justice (MoJ)) to the Department of Health (DH). At an operational and local level this meant the transfer of commissioning responsibility from HM Prison Service to the local Primary Care Trust (PCT) was effected for the two Wakefield prisons, i.e. HMP Wakefield and HMP & YOI New Hall, to Wakefield West PCT on 1st April 2005 (latterly NHS Wakefield District but now prison health commissioning is the responsibility of NHSCKW ‘direct commissioning’ and destined for the NHS Commissioning Board (NHS CB)). The two prisons that we are responsible for commissioning health services for are very different: HMP Wakefield is a large, high security prison for men (located near to the city centre of Wakefield), and HMP & YOI New Hall for girls and women (located in Flockton, halfway between Wakefield and Huddersfield). This paper specifically focuses on the development of health services at HMP Wakefield. HMP Wakefield is a prison with particularly challenging health problems and with its growing older population the case for change is ever more pressing. A key area for development is the hospital wing known as the Inpatients Service; the strategic case for change and the background to this is set out in subsequent sections of this paper. Governance for local prison health commissioning is organised and managed as a commissioning programme within NHSCKW Programme Management Office’s (PMO) Commissioning Development portfolio. Key commissioning decisions are taken by the PCT/Prison Partnership which is a bilateral commissioning partnership relationship between the Executive Director of Commissioning and the respective Prison Governor. NHSCKW is the responsible commissioner but takes commissioning decisions in partnership with the respective prison. The PCT/Prison Quality Board oversees all quality assurance aspects of prison commissioning. The development of the new service delivery model for HMP Wakefield’s Inpatients Service and proposed tender of the clinical health provision component of the service has been managed through robust project delivery by the PMO. The first step was to make the strategic case for change and then to develop the business case. The table below sets out the key project stages and milestones and the respective approvals process for the project.
Project delivery: Project stage
Strategic case for change
Key milestone dates September 2011(completed)
Development of outline business case (OBC) Development of project initiation document and initial plan Development of delivery strategy
January 2012 (completed) January 2012 (completed)
Risk assessment and mitigation Development of procurement strategy Design and construct of new delivery model Intention to undertake competitive procurement OBC supported OBC supported FBC supported with a recommendation to the Cluster Board that the FBC is approved Request for approval to competitively tender Procurement process
December 2011 (completed) January 2012 (completed) th 27 January 2012 (completed) th 27 January 2012 (completed) th 8 March 2012 th 20 March 2012 th 27 March 2012
Readiness for service Establish operational service Operational review and benefits realisation review
Approvals / governance PCT/Prison Quality Board and PCT/Prison Partnership PCT/Prison Partnership project delivery by the PMO
January 2012 (completed)
Planned Care CCU NHSWD SMT Wakefield Alliance CCE
3 April 2012
Second week of April (if approved) through to September/October 2012; Early 2013 1 April 2013
Background HMP Wakefield is a high security dispersal prison for men and provides healthcare in an environment where security is the primary concern. It holds category A and B prisoners. The operational capacity at the time of the health needs assessment (August 2011) was 740 including approximately 100 Category A and 10 High Risk Category A prisoners. A significant proportion of the population is prisoners convicted of violent and/or sex offences and the prison has a growing older population. The Inpatients Service has a Prison Service type-3 classification which means the prison is required to provide 24 hour healthcare provision. Inpatients has the capacity to hold up to 15 prisoners whose medical and custodial care is both complex and varied and cannot be provided on ordinary wing location. These include prisoners with longterm conditions, substance misuse issues, sub-acute physical health problems, end of life needs, rehabilitation needs, and mental disorder.
The funding stream for this area of commissioning comes from Offender Health, which is a directorate of the DH, which deploys allocations to those PCTs with prisons in their patch. The resource envelope for this tender will be from the re-engineer of service provision and funded from the existing baseline allocation for HMP Wakefield. The telemedicine provision will be funded by Regional Innovation Fund (RIF) monies. NHS Wakefield District (NHSWD) receives a ring-fenced allocation to commission primary care and in-reach secondary care provision for the prisoner population of HMP Wakefield. Going forward this will be ‘direct commissioning’ by the NHS CB. Prisoners’ hospital secondary care will be funded by the local Clinical Commissioning Group (CCG). Commissioned service provision currently leaves a gap in terms of intermediate care, falling between primary care and secondary care provision for the prisoner population. The new service delivery model aims to address this gap. Another key driver supporting the case for change is the necessity to reduce secondary care activity which results in high hospital escort and bedwatch costs when prisoners are admitted to the local hospitals. This problem is further compounded by public safety issues when high security prisoners have to be taken to hospital. A key benefit of the new delivery model for the Inpatients Service is that it will facilitate earlier planned discharge from hospital back to prison as the new Inpatients Service would have the capability and capacity to provide sub-acute / step-down / intermediate / rehabilitative care to bridge the gap between prison primary care and hospital acute secondary care. Inpatient prisoners will be clinically supervised and rehabilitated with the aim of returning to ordinary wing location as soon as possible. The strategic case for change is made by two key reports: Clinical Quality Risk Assessment Report (Elliott, NHS Wakefield District 2011) and Independent Review of Inpatients (Russell, NHS Doncaster, 2011). Both reports highlight serious failings of service delivery at HMP Wakefield which include risks to patient care in terms of quality and poor clinical governance. However, Andrew Russell’s independent report did recognise the unique benefit of retaining an inpatients service at the prison and recommended that the Inpatients Service be retained but substantially redesigned and provision by a suitable healthcare provider. The clear focus for the clinical health care provider would be to deliver professional clinical medical and nursing care and treatment within a framework of robust and professional clinical governance ensuring quality outcomes are achieved for this patient cohort. As a consequence of these reports’ outputs the PCT/Prison Partnership initiated a project to take the recommendations forward with the redesign of the service delivery model and subsequent tender of the service being the key outputs. The OBC was initially circulated to the Planned Care Clinical Commissioning Unit (CCU) for comment on 8th March and following this a report and the FBC went to the Wakefield CCE on 27th March that has made the recommendation to the Cluster Board to approve the FBC.
Commissioning Review and New Service Delivery Model There are four key outputs arising from the commissioning review. These are the: Design and construct of the new service delivery model for the Inpatients Service; Procurement of the clinical health component (value = £400,000pa / £1.2million for 3 year contract) of the Inpatients Service; Service delivery re-engineer of the custodial care component (value = £306,000 for a 1 year contract with HMP Wakefield who we already contract with for this); and Procurement of a telemedicine managed service to augment the Inpatients Service and mitigate some of the challenges surrounding the considerable business change involved (value = £59,058).
Key Risks Current provision by the prison is not fit-for-purpose as assessed by independent reviews undertaken during 2011; Risk to delivery of the project is that the resource available may not prove attractive for the market although market analysis / shaping for this area of provision indicates there is existing interest from the market; Risk potential is political interest in the tender and potential adverse publicity due to the high profile of Wakefield Prison but mitigation is that the procurement process will be carried out in full compliance with EU Procurement Law and commercial-inconfidence; and Risk to delivery of the project is the considerable business change required at the prison but mitigation is robust project management and also the new service will be augmented by telemedicine and enabled by the safeguards contained within the new NHS standard contract.
Contracting Issues Procurement of the clinical health component of the Inpatients Service will be tendered using the new NHS Standard Community Contract. Please note that we have secured approval from NHS North of England (NHSNE) to vary the standard 1 year contract duration to enable us to tender a contract of 3 years duration. Clearly, the value of the contract means we will run the tender in accordance with Public Procurement Rules and NHSCKW Standing Financial instructions, i.e. ‘formal tendering procedures must be applied where the estimated whole life costs exceeds £50,000’. The service re-engineer of the custodial care component (value of new contract with HMPW £306,000 will be for 1 year only at this stage) will be with HMP Wakefield as the existing provider of this element of custodial care provision and also using the new NHS Standard Community Contract through a contract variation. We have to contract with HMP Wakefield for the custodial care element of provision because the High Security Directorate of the Prison Service is mandated to run all high security hospital escorts and bedwatches and of course is responsible for the day-today management and custody of its prisoners. This is actually desirable as well as essential because to facilitate good clinical healthcare provision the healthcare provider would need the prison’s operational support in terms of custodial and security supervision due to the nature of the high security prison environment.
Benefits Appraisal The key benefits include both ‘health benefit’ and ‘financial benefit’: Health benefits Makes provisions for intermediate care which fills the existing gap between primary care and secondary care; Improved health of prisoners through better clinical management of long-term conditions leading to a reduction in the health inequality gap; Improved patient safety for prisoners, including improved safety of staff, with a reduction in serious incidents and no occurrence of ‘never events’ through improved access to better healthcare; Developed integrated care pathways enabling seamless care between primary, intermediate and secondary care and between health care and custodial care; Properly governed healthcare provision to provide sub-acute care and intermediate care which is ‘care closer to home’; Delivers against the NHS Outcomes Framework 2012/13; specifically: domain 2enhances quality of life for people with long-term conditions – enhancing quality of life for people with mental illness; domain 4 - ensuring that people have a positive experience of care especially improving people’s experience of out-patient care and improving experience of care for people with mental illness; and domain 5 - treating and caring for people in a safe environment and protecting them from avoidable harm; Improved quality of healthcare delivery to deliver optimal sub-acute and intermediate care provision including meeting the Transforming Community Services (TCS) key indicators, i.e. ‘care closer to home’, ‘health and wellbeing’, ‘rehabilitation’, ‘long-term conditions’, and ‘end of life care’; Improved care delivery by the appropriate professionals with the required qualifications, experience and clinical supervision/governance arrangements; Improved integrated case management for individual prisoner-patients for improved continuity of care across the prison and local health systems; and Better aligned health, social and custodial care delivery to meet the holistic needs of high security prisoners. Financial benefits Decrease in hospital escorts and bedwatch activity by keeping prisoners in prison wherever possible through commissioning a fit-for-purpose intermediate care inpatients service and augmenting this with an innovative telemedicine solution to help drive costs down; Enabling a speedier return from hospital back to prison because hospital consultants will have greater confidence in the healthcare provision available at the prison so will look to discharge prisoners earlier from hospital than they previously would have done thereby reducing acute bed costs and bedwatch charges; and More efficient allocation of health, social and custodial resources, i.e. clear, unambiguous and quantifiable profiles to deliver a best-value service making the most from scarce financial resources.
Project Key Milestones A project management approach is adopted to implement the commissioning / service review. Key high level project milestones are: Strategic assessment – September 2011(completed); Business justification – January 2012 (completed); Delivery strategy – January 2012 (completed); Comment re: OBC – 8th March (by NHSWD Planned Care CCU); Support for OBC – 20th March (by SMT); Recommendation to the Cluster Board to approve the FBC – 27th March (by Wakefield Alliance CCE); Request for approval to competitively tender – 3rd April 2012 (by Cluster Board); Procurement process – second week April through to September/October 2012 (if approved); Readiness for service – early 2013; Implementation of new service – 1st April 2013; and Operational review and benefits realisation appraisal – June 2013.
Recommendations It is recommended the Board: i.
Approves the implementation of the new service delivery model through a competitive tender procurement process as an outcome of the review of the Inpatients Service at HMP Wakefield.
Danny Alba, Commissioning Programmes Manager 3rd April 2012