Subject: Weight Management Services Contract
Date of meeting: 10th January 2023
Report of: Executive Director, Health and Adult Social Care
Contact Officer: Name: Roisin Thurstan
Tel: 01273 290384
Email: Roisin.Thurstan@brighton-hove.gov.uk
Ward(s) affected: All
1. Purpose of the report and policy context
1.1 The purpose of this report is to describe the provision of Tier 2 Weight Management Services and to seek approval from the Adult Social Care and Public Health Sub-Committee to undertake a procurement process for the ongoing delivery of the Service at the end of the current Contract.
1.2 Tier 2 services are delivered by local community weight management services that provide community-based diet, nutrition, lifestyle and behaviour change advice, normally in a group setting environment. Normally people can only access these services for a limited time period, often only 12 weeks.
2. Recommendations
2.1 That the Adult Social Care and Public Health Sub-Committee delegates authority to the Executive Director, Health and Adult Social Care to procure and award a contract for Tier 2 Weight Management Services for a term of three (3) years with the optional extension of a further two (2) years and delegates authority to the Executive Director Health and Adult Social Care to grant that extension subject to satisfactory performance.
3. Context and background information
3.1 Background
3.1.1 Individuals living with obesity presents a major challenge to the current and future health of the local population. Higher Body Mass Index (‘BMI’) is associated with an increased risk of morbidity and mortality from a range of conditions including hypertension, heart disease, stroke, type 2 diabetes, and several cancers.
3.1.2 Lifestyle risk factors (including poor diet and lack of physical activity) operating together compound the risk of becoming an unhealthy weight. In Brighton and Hove, 58% of our population, aged 18 and over, are classified as overweight or obese. In 2019/20, this figure was 49.5%. Our National Childhood Measurement Programme (NCMP) data shows a decline of healthy weight children from 72% in 2018/2019 to 66% in 2020/21. Certain groups in our city have a significantly higher risk of an unhealthy weight, including those living with disabilities, living in more deprived areas of the city and those from Black and other ethnic groups. See appendix 1 for detail.
3.1.3 Evidence shows that weight management services can help people to adopt healthier behaviours, lose weight and improve their general wellbeing. Individuals that are overweight or obese, are at higher risk of developing serious health problems, including heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers. See Nice Guidelines. The recent COVID pandemic highlighted this risk as obesity increased the likelihood of serious illness and death. Weight loss of 5kg has been shown to reduce blood pressure, cholesterol and the risk of developing 2 diabetes as well as other health conditions (reference: modest weight loss benefits). For that reason, offering our city’s residents access to a free and evidenced based weight management service will support more people to make these important health improvement changes.
3.2 The Service
3.2.1 The purpose of the Service is to:
· Assist children and young people aged between 2 and 18 years who are on or above the 91st percentile to reach and maintain a healthier BMI,
· Support overweight and obese adults aged 16 years and over to lose weight and learn how to maintain healthier weight (The age overlap between children and adults provided the flexibility to decide which services to refer children to. Providers will wish to consider a range of issues, including the views of the family), and
·
Support the referral of families, children, and adults to
services through the Healthy Lifestyle Referral Service.
3.3 Strategies and Priorities
3.3.1 The Health and Wellbeing Board (HWB) Strategy states that “information, advice and support will be provided to help people to eat well and move more (drink less and stop smoking) to reduce their risk of developing long-term health conditions”. The (HWB) Strategy also states, “that local people and communities will be encouraged to make the most of these opportunities to improve their health and wellbeing”.
3.3.2 Council priorities, as detailed in the corporate plan, advocate for a healthy and caring city, which is to be achieved by:
· increasing healthy life expectancy and reduce health inequalities,
· supporting people to live independently,
· supporting people in ageing well,
· supporting carers, and
· ensuring that health and care services meet the needs of all.
3.4 The Current Contract
3.4.1 The Services are currently provided via a Contract with a private third-party provider, BeeZee Bodies Ltd. The current contract will expire on the 30th of September 2023.
3.5 Budget
3.5.1 The budget for the Services is agreed annually and is estimated as £0.4m for the first year of the Contract or £2m for the lifetime of the Contract including the optional extension period.
3.6 Procurement Considerations
3.6.1 The Services fall within the ambit of the ‘Light Touch Regime’ of the Public Contracts Regulations 2015. The total contract value exceeds the relevant threshold of £663,540. Given this, the Services must be advertised to the market.
4. Analysis and consideration of alternative options
4.1 In-Sourcing
4.1.1 The Commissioner explored the option of the Council in-sourcing the Service using a SWOT (strengths, weaknesses, opportunities, and threats) model and following challenges were identified; -
· The success of an in-house Service would be heavily dependent on the success of a recruitment of in-house weight management expertise which would pose challenges given the current recruitment climate,
· Moving from Commissioner to the Provider would increase the risk of requiring a lengthy mobilisation phase given that the service would need to be organized and developed from the beginning. This would involve significant internal infrastructure (such as technical systems, reporting structures and service operations) along with interdependencies with other council departments and local partners.
· Moving from Commissioner to the Provider would mean the establishment of a brand-new service, one that takes time to gather experience of best practice delivery, ultimately impacting on its ability to deliver a high-quality service.
· Market warming/engagement carried out in summer 2022 indicated that there is sufficient interest from suitable providers (with best practice experience) to meet the needs of the population.
4.1.2 In consideration of the above reasons, it was agreed that the service which would deliver the best value for money for the Council would be that provided by an external provider.
4.2 Procurement
4.2.1 Several providers have expressed an interest in tendering for the Services. It is therefore recommended that the Services are advertised via an Open Tender Process.
5. Community engagement and consultation
The Community Engagement Framework was used to inform and guide the rationale and processes of how to best inform, consult and collaborate with each of the groups below.
5.1 Procurement Advisory Board
The Procurement Advisory Board was attended on November 21st 2022 by the public consultant and lead for the health weight management service. The Procurement Advisory Board was asked to support the re-tender, led by BHCC, for the procuring and award of a tier 2 weight management service for adults and families. The contract will be for an initial 3-year term with the optional extension of a further 2-year term. The recommendation of the above to the Adult Social Care & Public Health Sub-Committee was supported.
5.2 Market Engagement & Consultation
5.2.1 Commissioning and Procurement undertook a market engagement in Summer 2022 which indicated interest in the contract from both the incumbent and other market participants.
5.2.2 An engagement exercise is currently running with the City’s healthcare professionals to invite their feedback on experiences with interacting with the service. The findings of this feedback will inform the development of the new Service Specification.
5.2.3 Feedback from Service Users has been gathered by the current provider via the post programme evaluation and will be used to inform the development of the new Service Specification.
5.3 Interested Parties
5.3.1 Market Engagement
With the support of the procurement team, public health ran a soft market engagement exercise from mid-August to mid-September 2022. There were 13 responses (comprising local, regional and national organisations) which indicates that there is sufficient interest to run a tender.
5.3.2 Stakeholder Engagement
Stakeholder engagement is ongoing, and collection is via an online survey shared with local health care professions that are likely to have engaged with the service in the last 4 years. The survey has been circulated twice and yielded no results.
5.3.3 Partner organisations have been invited to give feedback on the draft service specification once underway.
5.3.4 Partner Engagement
Informal conversations with partners have allow for feedback to be shared on the operations of the current service. Partner organisations will also be invited to give feedback on the draft service specification once underway.
5.3.5 Local Resident Engagement
Service user satisfaction forms have been gathered from 98 adults and 22 families. As per the Community Engagement Framework, this maximises opportunities for individuals and communities to take control over the issues that affect their lives.
5.3.6 In January of 2022, Brighton and Hove residents were invited to participate in a survey regarding their experience of weight management services, the findings of which will be used to inform the service specification amendments.
6. Conclusion
6.1 It is recommended that the Adult Social Care and Public Health Sub-Committee delegates authority to the Executive Director, Health and Adult Social Care to advertise and award the Weight Management Service for a period of three (3) years with one optional extension period of a further two (2) years.
7. Financial implications
7.2 The planned budget for financial year 2023/24 is in line with the proposed waiver and overall contract sum of £0.400m per annum. However, the Public Health grant allocation has not been confirmed for financial year 2023/24 which may impact on the availability of funding, though it is anticipated that financial resources will be available to enable the commissioning of the services detailed above up to financial year 2026/27.
Name of finance officer consulted: Sophie Warburton Date consulted: 14/12/2022
8. Legal implications
8.1 The procurement recommended in this report must be conducted in accordance with the Public Contracts Regulations 2015 and the Council’s Contract Standing Orders.
Name of lawyer consulted: Alice Rowland Date consulted: 14/12/22
9. Equalities implications
An Equalities Impact Assessment (EIA) is currently in draft but the key findings to date are described below:
9.1 Relationship with deprivation
Obesity levels are increased for adults living in the most deprived areas of the city (71.9 %) versus the least deprived (58.2%)
Nationally, year 6 children living in the most deprived areas in England are more than twice as likely to be living with obesity compared to those living in the least deprived areas.
9.2 People with disabilities
People with learning disabilities are underserved by the current provision. Learning from a pilot project have illustrated the changes that need to be made to the service specification to provide a more inclusive service.
9.3 Obesity prevalence by ethnic group
Adults from Black backgrounds were the most likely out of all ethnic groups to be overweight or obese at 72%.
9.4 Obesity in children
Nationally, obesity prevalence in Reception aged children is highest among children from black African and black other ethnic groups. Children in Year 6 from most minority ethnic groups (with the exception of white Irish, mixed white and Asian, and Chinese) are more likely to be obese than white British children. See appendix 2 for detail.
10. Sustainability implications
10.1 To ensure that the provider shares our commitment to reducing the impact of the products and services, the service specification will include BHCC’s Sustainable Procurement Policy highlighting key sustainability requirements.
10.2 Key considerations for this contract are sustainable travel and transport (the accessibility of programme venues and encouragement of participants to engage in active travel) and circular waste (provider to consider sourcing ethical materials, support local economy and consider leasing equipment).
10.3 The provider will be asked to consider sustainable water (hydration has a strong focus in the programme) and biodiversity and nature conservation (provider to consider when planning physical activity components).
10.4 Sustainability and The Reduction of Carbon Footprint
The service specification will be amended to include a Key Performance Indicator (KPI) pertaining to sustainability and the reduction of carbon footprint.
10.5 Sustainable considerations such as:
Online focus over paper
Paper only as necessary – recycled paper/ethical supplier
Office – full recycling and green shredding scheme
Refillable ink
All computers are wiped end of life and repurposed for community volunteers
Cycle purchase scheme and provide safe cycle parking
Delivery within communities close to target communities (rather than city centre focus) reduces need for travel.
10.6 To reduce carbon footprint:
Support parks groups and deliver youthwork, learning events, community festivals from community green spaces.
Parks used as outreach to engage local people including Brighton Streets.
Delivery will be where people live - reducing travel to access support. Particularly important for fringe estate communities targeted in this work
In addition, we will ensure the use of a sustainability question as part of the Quality Questions which will carry a weighting of 10% of the quality based total percentage.
11. Social Value and procurement implications
11.1 Social Value
The service specification will be amended to include a Key Performance Indicator (KPI) pertaining to how the provider will work in collaboration with and complement partners/other services to ensure that the programme is consistent and integrated with the local system.
Considerations to include:
· Partnering with local organisations and statutory services across the city and the provider will build on existing partnerships
· Working closely with PCNs, prioritising those operating in areas of highest deprivation and lowest support services uptake.
· Co-production at neighbourhood level provides the framework for creating integrated systems between partners and services – coordinating with established community networks and with libraries, community centres, forums etc, and with neighbourhood newsletters, social media, electronic information screens etc.
In addition, we will ensure the use of a social value question as part of the Quality Questions which will carry a weighting of 10% of the quality based total percentage.
We will consult the social value framework when creating our question and if required liaise with the sustainability and social value procurement manager.
Public health implications:
11.2 As this is a public health service, all public health implications are detailed in the sections above.
Supporting Documentation
1. Appendix 1: Certain adult groups with higher risk of unhealthy weight
Brighton and Hove residents living with a disability
Brighton and Hove residents living by area of deprivation
Brighton and Hove residents by ethnicity
2. Appendix 2: Healthy Weight in children by deprivation and ethnicity
The graph above shows a higher risk of obesity amongst children living in more deprived areas.
