Agenda item

(To receive a report by Carl Miller, Commercial and Procurement Manager – People Services, which invites the Committee to consider a report on the commissioning and procurement of Integrated Lifestyle Support Services (ILS), which is due to be considered by the Executive Councillor for Adult Care, Health and Children's Services between 12 and 19 October 2018)

The Committee received a report which provided members with the opportunity to consider a report on the commissioning and procurement of Integrated Lifestyle Support Services (ILS) which was due to be considered by the Executive Councillor for Adult Care, Health and Children's Services between 12 and 19 October 2018.

Members were advised that the Council currently commissioned a range of services for the prevention and management of unhealthy lifestyles.  These services were commissioned to address single lifestyle issues or with a particular intensive focus, such as smoking cessation, NHS Health Checks and alcohol treatment services.

It was noted that the existing stop smoking services delivered an evidence based intervention, but it was queried whether this provided value for money.  Members were also informed that obesity and being overweight was as much of an issue for the population in general as smoking was.  The authority was keen to review the stop smoking service as it was coming to the end of its contract with the current provider.  It was highlighted that there was a particular issue with people who had long term conditions and continued to smoke, as any surgery and anaesthesia represented a risk due to their unhealthy lifestyles.

The conclusion of the current Local Stop Smoking Service provided an opportunity to develop a more holistic approach which supported people with multiple unhealthy behaviours to improve their health and wellbeing through the commissioning of an Integrated Lifestyle Support (ILS) service.  The aim was to fundamentally change the approach.  Whilst people who wanted to quit smoking would continue to be supported the support would be broadened out to help people with diet, exercise and alcohol consumption.  It was reported that people who smoked would more often be overweight and/or would drink too much alcohol, as it had been found that people tended to have more than one unhealthy behaviour.

In relation to the contract structure, members were advised that the contract would be a 3 +1 + 1 years, as this would be a new service to Lincolnshire, and there was a need to ensure that it delivered value for money.  It was noted that the proposed maximum annual funding for the contract would be £2.75m per annum, and the contract would be made up of a block payment amount to cover core costs of delivering the service, with the addition of performance related payment linked to the delivery of contract outcomes in order to retain an incentive for the provide to drive improvements in the delivery of outcomes and performance.  In terms of next steps, the Committee was advised that an 'Invitation to Tender' would be issued in November 2018, followed by a process of evaluation.  It was expected that the contract would be a consortium model, with a lead provider working with a number of partners.  The contract would be awarded in March 2019, and the service would go live in July 2019.

Members were provided with the opportunity to ask questions to the officers present in relation to the information contained within the report, and some of the points raised during discussion included the following:

·         It was clarified that councillors were included within the offer of free flu jabs for the County Council workforce.

·         Correlations had been made between physical issues such as smoking and alcohol use and mental health.  It was queried whether there were any linkages with mental health services.  Members were advised that there would be linkages with the CCG's and there were referral pathways if it was felt that someone needed additional help.  It was reported that there would be a meeting with GP's regarding referral pathways and to highlight how people could be referred into other services.

·         Members commented that it was positive that it would be an outcome based contract. 

·         Concerns were raised regarding the possibility of someone's operation being delayed due to their weight.  However, members were advised that this would be a clinical decision made by GP's and the CCG.  What the Council would offer through this service would be the provision of support if that decision was made.  It was noted that this service would also be able to help people with mobility issues.

·         In terms of alcohol misuse, it was noted that this service would be aimed at supporting those with low level alcohol consumption.  There were other services available for those who were considered to have alcohol dependencies, as there could be a clinical risk in severe cases.

·         It was noted that in some areas of the county there were large proportions of migrants, and a large number of this group would smoke, however, they tended to be physically active and did not have weight issues.  It was queried whether this could have skewed the smoking prevalence rate for the county and also how would this part of the population be engaged with.  Members were advised that as there would be an outcome based approach to this service, it would allow for the provider to deliver different levels of service according to demand.  This should provide flexibility to deliver what is needed in each area.  It was also noted that these services would be available in appropriate languages for an area.

·         It was queried whether there was a different way to reach these population groups, such as by taking the campaign to the workplace, rather than waiting for them to go to the GP.  It was also highlighted that many migrant workers were not registered with a GP.

·         Members were pleased to see that this would be a jointly funded project.  It was recognised that this contract related to services for adults, however, it was also highlighted that there was a significant problem with children's mental health, and there was a need to look carefully at mental health issues.

·         It was commented that this was a really useful and important service, but it was thought there may be a need to increase the availability of mental health services to complement the service.

·         It was noted that this contract was focussed on preventative services and in many instances an individual's mental health could be improved by improving their lifestyle, but in other instances an individual mental wellbeing contributed to their lifestyle choices.

·         This service would mainly be about providing low level support, there was evidence that improvements to lifestyle could improve wellbeing.

·         It was noted that in terms of migrant workers, some outreach had been carried out through major employers, mainly focusing on lifestyle advice around obesity.

·         It was commented that a holistic and countywide approach was positive.

·         It was commented that some comfort could be taken from the suggestion that young people were drinking less, and that smoking rates were reducing. 

·         Members were advised that it was much more efficient and effective to help those people that were ready to change.  As the Public Health Directorate, it was necessary to look for the best outcomes for the people of Lincolnshire as a whole.

·         It was commented that although this service would be aimed at those aged 18 and over, there were now a number of primary school children who were classed as overweight or obese.  It was suggested that this was an issue of education, as if someone started over eating as a child, by 18 years of age, this would be an ingrained behaviour. 

·         The Committee agreed that it was an excellent report, and it was also commented that the four criteria outlined in the report were the key primary drivers for a healthy life.  It was considered important that GP's supported this.

·         It was suggested whether the county council should take more of a lead with this with its own staff.  Members were advised that one of the referral groups was the County Council's own staff.  There was a possibility of having this conversation with the NHS regarding the involvement of their staff.  However, the county council would not be able to fund this.

·         It was requested whether, once the procurement process was complete, the Committee could receive some feedback regarding interest and engagement, and also if it could come back to the Committee in a years' time when the service had had a chance to settle in.

RESOLVED

1.    That the Adults and Community Wellbeing Scrutiny Committee supports the recommendation to the Executive Councillor as set out in the report.

2.    That the following comments be passed onto the Executive Councillor:-

Ø  The linking of services addressing four lifestyle behaviours (smoking; physical activity; food, nutrition and weight; and alcohol consumption) is strongly supported, as a means of improving overall health and wellbeing. 

Ø  The support of Primary Care, including GPs, in guiding people to integrated lifestyle support services is stressed.    

Ø  Although not part of the proposed integrated lifestyle support services, the Committee was supportive of the relevant staff groups at the County Council promoting a healthy lifestyle; and in turn the Committee urged that these staff groups should be supported in attaining a healthy lifestyle.