Kent and Medway prison establishments wanted to consolidate the fragmented contractual infrastructure they had, with nine different healthcare providers supplying various healthcare services. Our procurement team set out to redesign and implement Integrated Healthcare Services in six Kent and Medway prisons with the ambition to improve healthcare provision to an often forgotten and challenged part of society.
We appreciated that the delivery of effective healthcare interventions in prison settings was an important component of addressing health inequalities that should not only improve the health of the prison population, but also the wider community.
Challenge
Commissioning healthcare in a prison setting can be incredibly difficult.
The difficulty was intensified with the impact of COVID-19 and the risk that timing the advertising of the opportunity at the height of the pandemic would result in low-quality bids. Potential bidders were at the time fully consumed with prioritising the delivery of existing services, and this would take precedence over developing proposals to deliver new work. To counter this risk, the strategy was adjusted to delay issuing the tender to a more appropriate time, whilst using the intervening time to continue preparation and maintain engagement with bidders.
As part of the commissioning process, lived-experience input is essential to ensure the delivery of effective services across the secure estate. NHSEI held ongoing contracts with specialist lived-experience providers which aimed to ensure that service users (i.e. prisoners) were able to effectively contribute to the continuous improvement of healthcare services and inform decision-making in relation to healthcare provision. This input helps commissioners and providers ensure that outcomes for patient/service users in the health and justice system are equivalent to those in the wider community, and that commissioners and providers are held to account for delivery against relevant statutory duties.
Ensuring the voice of the service user was heard throughout the procurement process was particularly challenging given the timing of the procurement during the pandemic. We ensured that we embedded the specialist lived-experience provider into the team. Critically we used their services throughout the planning process to ensure the service user was at the heart of the procurement.
The significant logistics of facilitating service user evaluation of bids cannot be underestimated. Achieving this in ‘normal’ times is difficult; achieving it amid a pandemic required expert navigation. Panels were convened within the prisons, by the specialist provider, to review and score the answers provided by bidders. The service user scores and comments were an important part of the wider bid evaluation and decision-making process. This would not have been possible without the drive and support of the Prison Governors as part of the wider commissioning team.
Solution
Previous similar procurement exercises in other parts of the country had failed to attract bidders. Our team recognised that to drive the desired transformational change in healthcare we would need to undertake extensive market stimulation and engagement.
This approach gave potential providers detailed insight into the commissioner’s ambitions, and the real challenges they would need to address to realistically shape the specification/approach to procurement. It created a greater understanding of the economic, environmental, and social needs of the prisons and directly resulted in quality submissions from numerous providers.
Multiple events were held to inform the market of the opportunity. Pre-market questionnaires were used to gain provider feedback on issues such as contract length, mobilisation and challenges affecting service delivery. We facilitated face-to-face 'speed-dating' events to drive collaboration between potential prime and specialist providers which was critical to forging effective partnerships and informing the specification and procurement strategy.
As part of the process, pre-procurement site visits followed by one-to-one meetings between the team and prime providers were held. This enabled further discussions on potential lotting and commercial strategies, social care provision and financial envelopes.
This engagement approach highlighted a limited interest from providers specialising in services for children and young people (CYP). Commissioners recognized that further intervention would be required to ensure a successful procurement outcome for this group.
Specific market interventions for potential providers of services for Young Offenders were designed to enable them to gain an understanding of the challenges commissioners were trying to address. This engagement highlighted escort and bed watches outside of prison were a particular issue for providers. To ensure effective and efficient service user treatment, the team incorporated a risk share agreement into the contract to address previous poor behaviour/practice.
The formal feedback received was overwhelmingly positive, informative, and increased confidence in bidding
Impact
- The person-centred service model, and success criteria, were developed based on an understanding of the population of each of the individual establishments. Health and Social Needs Assessments were commissioned for all six establishments in the pre-procurement stage, to better understand the population demography and the risk factors associated with healthcare provision to the service users.
- The service specification set out clear expectations on the new provider to play a role in ensuring a sustainable and safe health system that would keep a strong recovery focus and play its part in reducing health inequalities.
- The procurement of an Integrated Healthcare model will significantly reduce ‘silo’ working, with fewer individual assessments, and increased availability of individual and group interventions designed to improve health and wellbeing. It has improved service provision from a fragmented service across nine different providers to give greater integrated and coordinated control of service users healthcare.
- The commercial decision to award a longer-term contract will realise benefits, enabling the provider to invest in the development of services and the workforce, greater stability and continuity of service provision, engagement, and ongoing collaboration with multiple stakeholders in and outside of the health and social care community.
- The new service provider has been commissioned to mobilise the new service across the six prisons with a commitment to delivering social value throughout service delivery.
- Prisons have notoriously been difficult to attract and retain key professionals. The new provider has developed a successful targeted recruitment campaign aimed at local people.
- Wider social benefits are also being delivered based on their outline plans for supporting the health and wellbeing of their workforce, including employee assistance, flexible working, upskilling, encouragement, and financially rewarding car-sharing along with staff rewards.
An immensely positive experience and we look forward to seeing this type of practice replicated elsewhere - Care UK
We have been very encouraged by the dialogue process to date, in terms of the willingness of the commissioner to engage with potential bidders early on, bringing them on board to utilise their expertise and views - Care UK
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