Cabinet
Subject: Mental Health Support Services for Adults
Date of meeting: 26 September 2024
Report of: Cabinet Member for Adult Social Care, Public Health and Service Transformation
Contact Officer: Name: Steve Hook, Interim Corporate Director (Health & Adult Social Care)
Bernadette Alves, Consultant in Public Health
Tel: 01273 29
Email: Bernadette.Alves@brighton-hove.gov.uk
Ward(s) affected: (All Wards);
Key Decision: Yes
Reason(s) Key: Expenditure which is, or the making of savings which are, significant having regard to the expenditure of the City Council’s budget, namely above £1,000,000.
1.1 This report asks for agreement to jointly commission community mental health support (MHS) services for adults with NHS Sussex Integrated Care Board (ICB). The procurement is to be led by the ICB, and the proposed contract is to be for seven years (five years plus optional two-year extension) from October 2025. The current MHS service is called UOK (previously known as Community Roots) and is provided by a network of local voluntary and community sector organisations.
1.2 Mental Health has been identified through the city’s Health & Care Partnership and the Health & Wellbeing Board as one of our five population health priorities for the city.Mental health need within the city is high and growing.
1.3 MHS services can improve mental health outcomes for residents, reduce inequalities. MHS services support the Council’s public health duty to improve the health and wellbeing of residents and deliver against city priorities including outcomes in the Council plan as outlined below[1]:
1. A city to be proud of. Good mental health and wellbeing for those living and working in the city will increase productivity, reduce sickness absence and create an environment where everyone can flourish.
2. A fair and inclusive city. The service will aim to ensure equitable access to support and information, particularly for local communities at increased risk of mental ill health.
3. A city where people can thrive. MHS Service will enable people to live healthy, happy and fulfilling lives through offering advice, targeted support and working in collaboration with local communities, to promote good mental wellbeing and reduce the risk of suicide
4. A city of responsive and well-run Council services. The MHS Service will listen to communities through engagement and collaboration to shape service delivery and to build on their assets.
2.1 Cabinet delegates authority to the Corporate Director of Housing, Care and Wellbeing to participate in a procurement process, conducted by the NHS Sussex ICB for community mental health support services for adults.
2.2 Cabinet agrees to the award of a contract via the procurement process set out in 2.1 and delegates authority to the Corporate Director of Housing, Care and Wellbeing to enter into the contract with the successful bidder for the provision of community mental health support services for adults. The length of the contract to be five years from 1 October 2025 with the option to extend by a further two years on the basis of satisfactory performance by the service provider.
3.1 Strategic context
3.1.1. The MHS service is universal and preventative and can reduce costs in the future. Prevention is cost-effective and intervention can both prevent mental health problems from arising in the first place, and through early identification and intervention, prevent them from becoming more severe[2]. Taking a preventative approach can reduce the need for more specialist services and support from adult social care. Continued joint investment in community MHS services for adults strengthens the local preventative approach to improving population wellbeing and reducing health inequalities.
3.1.2. Mental Health is one of five population health priorities in the Brighton and Hove Shared Delivery Plan[3] and underpins and contributes to several of the other priorities. The city’s Shared Delivery Plan is aligned with the five-year Sussex Integrated Care System Strategy Improving Lives Together.[4]
3.1.3. MHS services contribute towards delivery of key city strategies including
The Brighton & Hove Joint Health and Wellbeing Strategy 2019 – 2030
The Brighton & Hove suicide prevention action plan 2024 – 2027
3.2. Local Need
3.2.1. The city has high and growing levels of mental health need and high rates of death by suicide. A recent joint assessment of population need within the city[5] found that:
· A higher proportion of adults in the city experience common mental health conditions such as depression or anxiety (Brighton & Hove 1 in 5, England 1 in 6).
· A higher proportion of adults are on GP registers for severe mental illness such as schizophrenia or bipolar disorder (Brighton and Hove 1.3% of adult patients, England 0.95%).
· A statistically significantly higher suicide rate in the city (Brighton & Hove rate is 1.5 times higher than England).
· Statistically significantly higher rates of hospital admissions for self-harm for 10-24 year olds (Brighton and Hove rate is 1.3 times higher than England).
3.2.2. The needs assessment identified communities at increased risk of experiencing poor mental health including those living in more deprived areas, people who engage in harmful drug or alcohol use and people with multiple compound needs (meaning they have experienced at least two of the following: homelessness, mental ill health, domestic abuse, harmful drug or alcohol use or offending behaviour).
3.2.3. Local insight highlights that wellbeing and mental health is a community priority. Threeout of four recent city-wide health forums identified mental health as one of the community’s key priorities with a particular focus on children and young people. The fourth forum highlighted social isolation and the impact that has on people’s physical and mental health.
3.3. Current community mental health support service for adults
3.3.1. The current MHS service for adults began in October 2019 and was jointly commissioned by Brighton and Hove City Council and Brighton and Hove CCG (Clinical Commissioning Group). In July 2022, the CCG was abolished and its functions assumed by the NHS Sussex ICB (Integrated Care Board). The contract for the current service called UOK ends on 30th September 2025.
3.3.2. The UOK service is delivered by a network of local voluntary and community sector organisations, led by a single provider, Southdown (providers are listed in Appendix 1). It provides support for people experiencing mental ill health and their friends, family and carers. The service promotes wellbeing and prevents mental ill health through offering advice, information, education, system coordination, wellbeing hubs and a range of psychosocial services including 1 to 1 and group work.
3.3.3. Elements include:
· A central access point for information, advice and referrals
· Individual and group psychosocial support tailored to communities at increased risk of mental ill health
· Three Wellbeing Hubs providing psychoeducation, a drop in wellbeing centre, support for people with complex emotional needs
· Specialist support for people with severe mental illness including employment support and physical health checks
· An out of hours mental health crisis support service
· Training for professionals that support adults experiencing mental ill health on topics such as mental health awareness, self-harm awareness and suicide prevention
3.3.4. Overall, performance has been good since the contract began in 2019. The service has delivered well on its objectives, received positive feedback from service users, and has been responsive to service user experience feedback. There has been a year on year increase in the number of people accessing the services. Key activity in 2023/24 included:
· Over 20,000 people visited UOK website to access information and advice on local mental health support
· Over 6,000 adults accessed and received psychosocial support
· Over 1,600 hours of 1:1 support sessions provided
· Almost 1000 group sessions provided with over 10,000 attendances
· Over 3,000 adults received peer support
· Over 600 adults supported by out-of-hours mental health crisis support service
· Where patient reported outcomes were collected, 85% of service users reported an improvement in their wellbeing
3.3.5. The original contract value in 2019 was £2.108m per annum, of which the ICB contributed approximately 80% (£1.699m) and Brighton & Hove City Council approximately 20% (£0.409m). The ICB investment has varied over the lifetime of the contract whereas the BHCC contribution has not changed. In 2024/25, the contract value was £2.398m, made of up £0.409m from BHCC, and £1.989m from the ICB.
3.4. Reprocurement
3.4.1. The intention is to run a competitive tender for the new MHS service with a contract length of five years plus a two-year optional extension. The ICB is conducting the procurement and will manage the procurement and legal process. The new service will start on 1st October 2025.
3.4.2. The procurement covers services across both Brighton and Hove and West Sussex. West Sussex have a MHS service, known as Pathfinder, whose contract expires at the same time. The procurement will use a single core service specification however there will be two separate place-based lots which will result in two separate contracts.
3.4.3. Leadership for the procurement is provided by a steering group jointly chaired by the NHS Sussex ICB Heads of Mental Health Commissioning in Brighton & Hove and West Sussex, with representation from agencies including NHS Sussex ICB, Brighton & Hove City Council, West Sussex County Council, and Possability People, a voluntary sector organisation who run a mental health Lived Experience Advisory Group in Brighton & Hove and West Sussex and bring a lived experience perspective to the steering group.
3.4.4. The annual budget for the new Brighton and Hove MHS service will be £1.837m which represents a reduction in funding of approximately 15%. Both the ICB and the council are reducing their contribution. The annual BHCC contribution will be £0.27m per annum funded from the Public Health ring fenced grant (see Table 1 below). This equates to a BHCC expenditure of £1.89m over the lifetime of the seven-year contract.
3.4.5. The budget for this service is reducing against a backdrop of increasing need. Through working in a more integrated way with primary care and secondary mental health services, the service can provide a more targeted and joined up offer with reduced potential duplication. The community engagement and development element will strengthen support to people at lower intensity of need with the intention of reducing need for specialist services, and targeting support more effectively.
|
Proposed budget |
Per year |
Over seven years |
|
NHS Sussex ICB |
£1,567,316 |
£10,971,212 |
|
BHCC |
£270,000 |
£1,890,000 |
|
TOTAL expenditure |
£1,837,316 |
£12,861,212 |
Table 1: Proposed annual budget for MHS Service
3.4.5 BHCC and NHS Sussex ICB will both be joint parties to the contract and each will hold contract management responsibilities.
3.5. New community mental health support services for adults
3.5.1 The new MHS service has a single aim: to improve the mental health and wellbeing of the adult population. It has a range of principles (Appendix 2) that include a commitment to:
· Address health inequalities through increasing access and improving outcomes for those with protected characteristics and for populations at higher risk of developing mental ill health.
· Embed co-production into the service model by collaborating with people and communities who use services.
· Deliver an accessible and person-centred service
· Ensure the service offer is evidence based, trauma informed, innovative and flexible.
· Focus on promotion & prevention to promote wellbeing, prevent escalation of distress and intervene early.
3.5.2 The new service will have the following characteristics:
· Flexible and dynamic to ensure it responds to the changing environment and changing needs within the communities.
· Outcomes led and with a strong focus on communities of interest including but not limited to: black and racial minority communities, people aged 18 to 25, adults with experience of the care system, neuro-divergent people, LGBTQ+ communities, refugees, asylum seekers and vulnerable migrants, Gypsy, Roma and Traveler communities, carers, people who misuse drugs and alcohol and people who are homeless.
· Voice of the local community and those who use services will be integral to service development and delivery
· More systematic and meaningful collection of data and intelligence including mental health outcomes and service user experience
3.5.3 The MHS service will be delivered through Neighbourhood Mental Health Teams (NMHTs). This model of delivery integrates working between the MHS service, Sussex Partnership NHS Foundation Trust, primary care, social care, and the local community. It also aims to ensure people are linked in with wider community support services where needed for example drug and alcohol treatment services and housing services.
3.5.4 The NMHTs model is a component of the Sussex Integrated Care System’s long-term improvement aim to develop Integrated Community Teams across the city.
3.5.5 Key elements of the new MHS service are outlined below. The BHCC funding will be primarily focused on the third strand:
· Advice Information and Guidance: This will act as the central point of information and access to the MHS Service, the NMHTs and wider community support services. It will include opportunities for drop-in and outreach access.
· Getting Support: Will deliver a range of interventions that relieve stress, promote resilience, sustain wellbeing and prevent deterioration in mental health. This will include a wide range of group and 1 to 1 psychosocial support, specialist support for people with severe mental illness including employment support and physical health checks
· Community Development and Engagement, Promotion and Prevention: It will deliver several elements including an asset-based approach to strengthening community voice; increasing influence; and identifying and addressing challenges related to improving mental health and wellbeing and preventing suicide.
4.1 Option 1 – invest jointly into MHS Service with NHS Sussex ICB (preferred)
4.1.1 The joint approach supports the Sussex Integrated Care System strategy and the commitment the Local Authority has made as one of the lead partners to the strategy. The strategy has a strong focus on joined up working across partners to improve services for the local population, maximise benefits that joint commissioning can bring to improve health & care outcomes, reduce inequalities and improve value for money.
4.1.2 The service will help address the high and growing levels of mental health need in the city and supports the delivery of priorities identified by communities through the BHCC led community insight programme.
4.1.3 A joint contract with ICB and BHCC as parties with the service provider builds on existing positive partnership working and creates opportunity to maximize outcomes through an integrated approach. This can deliver value for money by avoiding duplication. In addition, the ICB will be taking over the legal and financial responsibility of the new contract, freeing up capacity of BHCC staff. This is the preferred option.
4.2 Option 2 – MHS services are commissioned separately by NHS Sussex ICB and BHCC
4.2.1 This will help address the high and growing levels of mental health need in the city and reduce inequalities but won’t have the same reach as a jointly commissioned integrated service.
4.2.2 If separate contracts are put in place, there will be duplication of administrative costs and potential duplication of service provision and reporting, increased demand on BHCC staffing capacity and the need for additional liaison between council and NHS Sussex ICB. This may also impact on the funding available for delivery of the service compared to administration of the service.
4.2.3 This option entails the same contract expenditure as option 1 but requires additional officer time to administer and brings no additional benefits. It is not recommended.
4.3 Option 3 – do not invest in the service
4.3.1 Not investing in the MHS Service would risk the Council failing its public health duty to improve the health of its local population, as well as Council commitments to improve mental health and wellbeing for residents in Brighton & Hove, as identified through previous community insight work and engagement with local health forums.
4.3.2 It would reduce council capacity to meet priorities, recommendations and actions identified in key city and council plans and strategies.
4.3.3 Overall, this option would weaken the local preventative approach to improving population wellbeing and reducing health inequalities in the city and would lead to greater demand and greater cost pressure across the system. It is not recommended.
5.1 The following engagement and consultation activities have shaped the MHS service proposal:
5.2 A thematic review was conducted of over 50 engagement and consultation activities both nationally and locally. This approach was taken based on feedback from the city’s mental health Lived Experience Advisory Group, that findings from recent engagements and consultations be used rather than approaching communities with similar consultation questions again.
5.3 A pre-market engagement event took place on 6 March 2024 with over 100 attendees from over 50 local organisations across Brighton & Hove and West Sussex.
5.4 A Request for Information (RFI) went to the market in July 2024 to gather views about the proposed model. Over 40 responses were received.
5.5 BHCC community engagement and insight programme recently ran health forums with communities in the city, with three out of four forums raising mental health as a key issue.
5.6 The lead Cabinet Member for Adult Social Care, Public Health and Service Transformation Councillor Burden, the chair of the Health & Wellbeing board Councillor De Oliveira and the mental health policy lead Councillor Czolack were consulted on 23rd August 2024.
6.1 This report indicates that the financial commitment from BHCC for the Community Mental Health Support Services for Adult programme is currently £409k per year. The new proposed budget for the whole programme is reduced, and the amount that BHCC will contribute annually from October 2025 will reduce to £270k for the next 5 years with optional 2 years. The £270k is earmarked to come from the ring-fenced Public Health budget which will not have an impact on the BHCC general fund at this time. However, if public health funding were to cease or reduce in the future within the duration of the contract, then the outstanding contractual obligations link to the programme could then fall on the BHCC general fund. This would result in an unplanned expenditure, which could affect the overall expenditure of BHCC
Name of finance officer consulted: Jamiu Ibraheem Date consulted (23/08/24):
7.1 The MHS services outlined in this report include health care services which fall under the scope of The Health Care Services (Provider Selection Regime) Regulations 2023. The services must therefore be procured in accordance with these regulations. The Council’s Contract Standing Orders will also apply. As indicated in the report, as the procurement is being led by NHS Sussex ICB, the procurement documentation will be monitored by Orbis Procurement to ensure compliance with the Contract Standing Orders.
Name of lawyer consulted: Sian Stevens Date consulted (28/08/24):
8.1 The new MHS service aims to improve the mental wellbeing of the adult population and includes engaging with and supporting adults in the city at higher risk of mental ill health and suicide. The specification is underpinned by the national evidence base, and an analysis of data including protected characteristics data. The national and local intelligence identified that many of those who experience higher risk of mental ill health and suicide have protected characteristics and many of the risk factors that are associated with mental ill health and suicidal ideation are more common in those with protected characteristics. The new service commits to providing tailored, targeted support to these groups and will therefore have a positive impact on equalities.
8.2 For joint commissioning contracts with NHS Sussex ICB, the NHS Equality and Health Inequalities Impact Assessments online form is completed which assesses impact on protected characteristic groups, social inclusion groups (e.g., carers, homeless people) as well as those living in areas of deprivation or rurality.[6] NHS Sussex ICB incorporated the data and evidence used for the service specification into this assessment, which was reviewed by their Equalities Team and approved by ICB Commissioning Group in November 2023
8.3 The findings of the Equality and Health Inequalities Impact Assessment were that the new service would have a positive impact on local communities by enabling more equitable and fair access to MHS services, particularly for adults that belong to one or more protected characteristic groups
8.4 The Equalities Impact Assessment will be included within the tender documents, and the provider of the new service will be required to collate Equalities Monitoring for all service provision which will be regularly reviewed at contract review meetings.
9.1 The Brighton & Hove Sustainability Implications checklist identified 3 areas as potential positive impacts of this procurement.
9.2 Sustainable transport: MHS Service will be delivered flexibly with both online and in-person services. The provider will be expected to ensure local activities will be accessible by sustainable travel options such as walking, cycling and public transport.
9.3 Sustainable procurement: The provider will be expected to put in place environmental sustainability policies and can raise any environmental concerns, feedback or improvement opportunities during performance review meetings.
9.4 Health, safety, wellbeing and local communities: The new service will work towards reducing the impact of mental ill health in communities, and therefore promoting a healthy environment to live and work in.
9.5 In addition, the provider of the new service will be required to demonstrate how they will reduce emissions and air pollution, commit to circular economy principles and reduce consumption and waste.
10. Health and Wellbeing Implications:
10.1 The new service aims to improve the mental health and wellbeing of adults and includes a focus on increasing access for those who are at greater risk of mental ill health and suicide and includes a focus on more disadvantaged communities.
10.2 People with mental health problems are often more disadvantaged and have poorer health outcomes. The service, by improving mental health and wellbeing can reduce unfair differences in health. One of the key principles proposed in the new services is addressing inequalities.
10.3 No negative health and wellbeing impacts were identified.
11. Procurement implications
11.1 NHS Sussex ICB are leading on the procurement. Due to the nature of the services required, the proposed approach is a competitive process under Health Care Services (Provider Selection Regime) Regulations 2023. NHS Sussex ICB completed a Procurement Strategy Document which details the process and was reviewed by the steering group.
11.2 Bids will be evaluated against the required Key Criteria of: Quality & Innovation; Value; Integration, collaboration and service sustainability; Improving access, reducing health inequalities, and facilitating choice; Social Value.
11.3 When bids are evaluated, Social Value will make up 15% of the evaluation scoring - 10% to be applied to social value and 5% to sustainability. Potential providers will be required to show how they will support social value by supporting staff and volunteers, smaller local voluntary sector providers, and their plans for community organization and engagement.
11.4 Since NHS Sussex ICB are leading on the procurement, this matter has not been presented to the Council’s Procurement Leads meeting. The procurement documentation will have oversight from Orbis Procurement (acting on behalf of BHCC) to ensure compliant with Contract Standing Orders.
12. Crime & disorder implications:
12.1 There are no crime and disorder implications
13.1 Preventative MHS services for adults are currently delivered by a network of local voluntary and community sector organisations. They offer a wide range of support options for those with mental health problems and their families and carers.
13.2 The city has high and growing mental health need and re-procurement of these preventative services can improve mental health and wellbeing outcomes, reduce demand for more specialist services and reduce inequalities.
13.3 The proposed service will support the city’s five population health priorities, delivery of outcomes in the Council Plan, and delivery of key strategic documents including the Brighton and Hove Joint Health & Wellbeing Strategy.
13.4 A jointly commissioned service builds on existing positive partnership working and creates opportunity to maximize outcomes through an integrated approach.
13.5 We are seeking Cabinet delegation to enter into a procurement process, led by the NHS Sussex ICB, to procure MHS services and to enter into the awarded contract for seven years.
Supporting Documentation
1. Appendix 1 – List of providers in the current service
2. Appendix 2 - Mental health Support Service aims and principles
1. Sussex Integrated Care System strategy Improving Lives Together Our strategy - Sussex Health & Care (ics.nhs.uk).