021/2014: Co-commissioning of Custody Healthcare and Forensic Medical Examination Services – 10 December 2014

Executive Summary and recommendation:

1.1      Healthcare provision in police custody is currently commissioned by North Yorkshire Police (NYP).  However, the report by Lord Bradley in 2009 made the key recommendation that “The NHS and the Police should explore the feasibility of transferring commissioning and budgetary responsibility for healthcare services in police custody suites to the NHS at the earliest opportunity”.  The recommendations were accepted by the previous Government under the “Improving Health, Supporting Justice” delivery plan and have also been adopted by this Government.

1.2      North Yorkshire Police has been working with NHS England’s Local Area Team (LAT) commissioners in preparation for the subsequent transfer of commissioning and budgetary responsibility to the NHS, which is scheduled for April 2016.

1.3      The current contract for Custody Healthcare and Forensic Medical Examination (FME) services is due to terminate on 31^st January 2015, but has been temporarily extended to the end of the 2014/15 financial year.

1.4      Working together with NHS commissioners, and under the leadership of the joint NHS / NYP Police Healthcare Partnership Board, a detailed service specification for a co-commissioned replacement service for Custody Healthcare and FME services was drawn-up.  The aim of the procurement exercise has been to obtain a service that is:

• Cost-effective
• High-quality
• Promptly delivered
• Professionally conducted
• Accountable
• Tailored to match local needs

As a result of a rigorous procurement exercise, a potential provider (Leeds Community Healthcare) has been identified. A decision is therefore required to endorse the recommendation of the procurement panel.

Police and Crime Commissioner decision: Approved

Signature: 
Date: 10 December 2014
Title: Police and Crime Commissioner

Part 1 – Unrestricted facts and advice to the PCC

1. Introduction and background

1.1          Healthcare provision in police custody is currently commissioned by North Yorkshire Police (NYP).  However, the report by Lord Bradley in 2009 made the key recommendation that “The NHS and the Police should explore the feasibility of transferring commissioning and budgetary responsibility for healthcare services in police custody suites to the NHS at the earliest opportunity”.  The recommendations were accepted by the previous Government under the “Improving Health, Supporting Justice” delivery plan and have also been adopted by this Government.

1.2          A national programme was established to oversee the move towards co-commissioning of custody healthcare  with the NHS.  NYP is part of this process.

1.3          NYP has been working with NHS England’s Local Area Team (LAT) commissioners in preparation for the transfer of commissioning and budgetary responsibility to the NHS, which is scheduled for April 2016.  Agreement has been reached between the Home Office and the Department of Health for that legal and financial transfer.  However, the details of the value of the financial transfer have not yet been agreed between the government departments.

1.4          As the NHS are not an investigatory body, legal advice obtained by the national programme has articulated that the NHS cannot commission forensic-only ­services.  Therefore, the contract under new arrangements must be co-commissioned between the NHS and the Police and Crime Commissioner.

1.5          The current contract for Custody Healthcare and Forensic Medical Examination (FME) services with Medacs is due to terminate on 31^st January 2015.  However, agreement has been reached to temporarily extended this contract to the end of the 2014/15 financial year, allowing the new provider to commence operations at the start of the financial year.

1.6          Working together with NHS commissioners, and under the leadership of the joint NHS / NYP Police Healthcare Partnership Board, a detailed service specification for a co-commissioned replacement service for Custody Healthcare and FME services was drawn-up.  The aim of the procurement exercise has been to obtain a service that is:

• Cost-effective
• High-quality
• Promptly delivered
• Professionally conducted
• Accountable
• Tailored to match local needs

1.7          A rigorous procurement exercise was conducted.  At the conclusion of the assessment of responses submitted to the Invitation To Tender (ITT), no provider was selected due to concerns over the ability to deliver to the requisite quality criteria.  As a consequence, bidders were invited to submit a Best And Final Offer (BAFO).

1.8          An assessment of the BAFO responses was conducted, which focussed on:

• Service model
• Operating standards
• Strategy
• Implementation, mobilisation and Logistics

1.9          Through the assessment process, a potential provider, Leeds Community Healthcare (LCH), was identified.  LCH is an NHS Trust providing a range of community services for adults and children including community nursing, health visiting, physiotherapy, community dentistry, primary care mental health, smoking cessation and sexual health services.  LCH is also the provider of custody healthcare and FME services for West Yorkshire Police and South Yorkshire Police, and provides healthcare in several prisons throughout the region.

1.10       LCH’s bid outlines a proposal that both NYP and the NHS feel will achieve the time, cost and quality challenges set within the service specification.  It describes a nurse-led model of care, with Health Care Professionals (HCPs) embedded around the clock at the custody suites at York and Scarborough, with further 24hr provision shared between Harrogate and Northallerton custody facilities.  FME provision will be by an on-call system.

1.11       The assessment panel believe that LCH’s model presents the most cost-effective option within a strict quality framework.  That assessment was remitted to the joint NHS / NYP Police Healthcare Partnership Board on 27^th November 2014, which examined the proposal and endorsed the recommendation of the panel.

1.12       This co-commissioned service will provide significantly improved care for detainees in police custody, enhanced ability to gather forensic evidence to support criminal justice and improvements to care pathways that will support health improvements beyond detention.  This will contribute towards breaking the “revolving doors” cycle of offending associated with some mental and physical health deficits.

2. Matters for consideration

2.1.        The service will be co-commissioned by both the Police and Crime Commissioner for North Yorkshire (PCC) and the NHS Head of Health and Justice Commissioning for Yorkshire and the Humber.  This is desirable, given the shared interest in improving detainee safety and healthcare.  It is necessary as the NHS cannot commission forensic-only services (e.g. obtaining evidential blood samples).

2.2.        Financial responsibility for the contract will be borne by North Yorkshire Police until this is transferred to the NHS in April 2016.  At that point (and subject to agreement between the Home Office and Department of Health) the NHS will assume liability for the healthcare element, whilst North Yorkshire Police will retain ownership of forensic-only services.  The ratio of responsibility is estimated by the national programme to be approximately 95:5 respectively.

2.3.        Details of financial transfer from the police to the NHS are dependent on national agreement between the Home Office and Department of Health, and may not be known for some time.  However, it is anticipated that the Home Office will reduce police funding (“top-slice”) by an amount commensurate with the inter-departmental transfer.

3. Other options considered, if any

3.1.        A range of service delivery proposals were considered during the procurement process.  LCH’s submission has been assessed as being the most effective solution with the greatest potential quality outcomes.

4. Contribution to Police and Crime Plan outcomes

4.1.        The service will contribute to the Police and Crime Plan as follows:

• Reduce harm – by ensuring timely, high-quality healthcare is provided to detainees in the care of NYP
• Put people first – by delivering accountable, professionally conducted healthcare interventions
• Drive justice – by enhancing NYP’s capability to conduct professional forensic medical examinations to gather evidence
• Ensure we are fit for the future – by developing a co-commissioned service in collaboration with the NHS in anticipation of the requirement to do so from 2016 onwards
• Do more with less – by seizing the opportunity to address the “revolving doors” cycle of offending associated with many mental and physical conditions
• Police UK – by having the resilience of contracting with a healthcare partner that also provides services to West and South Yorkshire Police forces 

5. Consultations carried out

5.1.        The service specification for the contract was drawn up in a collaboration between North Yorkshire Police, the Office of the Police and Crime Commissioner, the NHS Commissioning Support Unit and NHS Local Area Team.

5.2.        Internal consultation has been conducted with police custody staff at all grades and with members of staff from the current provider.

6. Financial Implications/Value for money

6.1.        The contract value in Year 1 is £1,298,779.  In Year 2, where financial and legal responsibility transfers to the NHS, the contract value is £1,299,385.

6.2.        The process has been through a competitive tender managed by Regional Procurement and represents a cost-effective solution to the quality challenges set in the service specification

6.3        Chief Constables Chief Finance Officer Comments:

The contract value is some £320,000 pa more than the expected 2014/15 cost under the current contract, and some £220,000 more than the current annual budget provision for 2015/16 onwards (MTFP v45.1 – November 2014).  The additional costs will be factored into the next draft of the budget, and will increase the requirements for savings in future years.

7. Legal Implications

7.1.            The process has been through a competitive tender, managed by Regional Procurement in accordance with European Union procurement regulation.

7.2.            Having read this report and having considered such information as has been provided at the time of being asked to express this view, the Acting Force Solicitor and Head of Legal Services is satisfied that this report does not ask the PCC for North Yorkshire to make a decision which would (or would be likely to) give rise to a contravention of the law.

8. Equality Implications

8.1.            The process has been considered for any adverse equality implications.  None have been identified.

9. Human Resources Implications

9.1.        Consideration has been given to Transfer of Undertakings (Protection of Employment) Regulations, which are described in detail in the LCH proposal as part of the process during transition.

HR Comments

9.2.        There are no HR implications for NYP, as this relates to services provided, therefore any HR implications such as TUPE must be addressed by the service provider rather than NYP.

Public Access to information

The Police and Crime Commissioner wishes to be as open and transparent as possible about the decisions he/she takes or are taken in his/her name. All decisions taken by the Commissioner will be subject to the Freedom of Information Act 2000 (FOIA).

As a general principle, the Commissioner expects to be able to publish all decisions taken and all matters taken into account and all advice received when reaching the decision. Part 1 of this Notice will detail all information which the Commissioner will disclose into the public domain. The decision and information in Part 1 will be made available on the NYPCC web site within 2 working days of approval.

Only where material is properly classified as restricted under the GPMS or if that material falls within the description at 2(2) of The Elected Local Policing Bodies (Specified Information) Order 2011 will the Commissioner not disclose decisions and/or information provided to enable that decision to be made. In these instances, Part 2 of the Form will be used to detail those matters considered to be restricted.  Information in Part 2 will not be published.

Part 2

Is there a Part 2 to this Notice – NO       (please delete as appropriate)

If Yes, what is the reason for restriction – n/a