Bidder Information Event: Non-Opiates Service and Opiates Service

1. Bidder Information Event: Non-Opiates ServiceandOpiates Service 30th January 2014 www.sheffielddact.org.uk

2. Welcome Jo Daykin-Goodall Director of Substance Misuse Strategy

3. Changing trends: Non-Opiates • Drug trends nationally and locally are changing toward more non opiate use amongst the under 40s. • Cannabis remains the main non-opiate drug used. • Sheffield has developed a New Psychoactive Substances Strategy and Action Plan in response to the new challenges of NPS. • Sheffield is an area with c.1,000 khat users who will be affected by classification of khat as a Class C substance this year. A multi-agency steering group is progressing actions to promote community preparedness and resilience and this includes treatment providers • There is an active steroid using population in Sheffield accessing harm reduction services www.sheffielddact.org.uk

4. Culture Change • Drug treatment is now commissioned from within Local Authorities. • Local Authorities (elected members) want to see the social return on investment in the communities they serve e.g. less anti social behaviour due to cannabis. • Local Authorities are financially squeezed and need to achieve “more for less” – budgets diminish over time. • This requires a culture change from providers to be more responsive, more intelligence led from communities and more agile. • This is the big “ask” from the non-opiates service. www.sheffielddact.org.uk

5. Commercial ServicesJill SmithCategory Support Officer An overview of the procurement process and timetable for Community Drug Treatment - Non Opiates

6. Non-Opiates • 2 stage, restricted process • Opportunity will be published week commencing 3 February 2014 • Full timetable will be available within the documents • Anticipated Contract Start Date – October 2014 • Submissions will be evaluated against criteria and shortlisted providers will be invited to submit a tender • Advertised via www.yortender.co.uk

7. Procurement Process – 2 Stage (Restricted) • Restricted, 2 stage procedure, bidders complete the Pre Qualification Questionnaire, (PQQ) • Submissions are evaluated against criteria set out in the documentation the PQQ • A set number of bidders are shortlisted and invited to submit a tender against a method statement • All opportunities are advertised via www.yortender.co.uk

8. Completion of Documents • Bidders must answer all questions • If a question is not clear then clarification may be sought via yortender • PQQ is a backward look at your organisation- Are you suitable? • ITT is a forward look – How your organisation plans to deliver the service requirement • Question and answers will be published and available to bidders (anonymised) • Please ensure all documents are submitted on time as late submissions cannot be accepted

9. Content of PQQ and Tender Documents PQQ Document • Instructions and guidance notes • Procurement timetable • Specification or Market brief • Evaluation criteria • Organisational Questions • Terms and conditions • Request for additional documents e.g. Accounts may be requested to support response Tender Document • Instructions and guidance notes • Procurement timetable • Specification or Market Brief • Evaluation Criteria • Method Statement Questions • Form of tender • Pricing schedule • Request for additional documents to support response

10. Tender evaluation • Read the specification and questions carefully. This is your opportunity to tell us how you will provide the service. If you require clarification please ask! • Pre-determined tender evaluation criteria is detailed within the tender documentation and is weighted according to importance. • Ensure all documents requested are submitted back prior to the closing date and time. Late submissions cannot be accepted • Organisations with the highest tender evaluation scoring would be recommended for award • Subject to council decision making process

11. Next Steps • All tenders are advertised on www.yortender.co.uk – please make sure you are registered on the site in order to receive opportunities • Commercial Services hold monthly workshops via Buy4Sheffield which cover the following topic Writing a Better Pre-Qualification Questionnaire, (PQQ) and Tender Response. For further information please contact www.buy4sheffield.co.uk

12. Non- Opiates Specification Magdalena Boo Joint Commissioning Manager

13. Non Opiate Contract • Non-Opiates • Part A: Specialist Needle Exchange • Part B: Open Access • Part C: Targeted/Assertive Outreach • Part D: Formal Psychosocial Interventions (non opiates) • Part E: Post treatment recovery support • Part F: Universal prevention/education • Part G: Learning Schemes Contract 1 – Non-Opiates Expected Volumes • 400 registered needle exchange* • 400 Open Access/ Assertive outreach* • 400 PSI * No double-counting and not on DIP caseload • The capacity is capped based on unit price. www.sheffielddact.org.uk

14. Non-Opiates Service - Finance • Contract envelope of £613, 481 (to be confirmed) • Per capita payments are paid within the contract. Capped costs are given based on DACT calculations. However, it is expected that bidders will develop their own ‘cost per activity’ and indicate this within the financial model template. • Recovering any under-used capacity or increasing capacity in line with need will be discussed at the Q3 performance review annually. • No dual funding within the contract and no dual funding of those on DIP caseload • Capped cost per registered needle exchange user: £250 per unique individual meeting criteria within the specification • £1.60 per transaction for those registered within other services (emergency transactions or DIP clients) • Capped cost per open access/outreach: £250 per unique individual meeting the criteria within the specification • PSI: £350 per unique individual (based on 12 week package) • The volumes are capped based on these as maximum unit prices. It is acceptable for bidders to bring their bids in at lower than this unit price.

15. Non-Opiates Service Part A: Static, mobile and embedded specialist needle exchange (NEX) • Specialist NEX to non-opiate users and (mobile only) opiate users • Overdose prevention and safer injecting advice • Visible mobile needle exchange (van and bicycles) • Embedded drug workers in busy pharmacy exchange • Discreet onsite specialist needle exchange e.g. within steroids clinic appointments • Professional advice and training to pharmacy needle and syringe programmes (NSP) • Managing a capped budget for paraphernalia for all exchanges • Brief motivational interventions to engage with formal structured treatment with target of 30% modality start from NEX • Allow in-reach from harm reduction nursese.g. hepatitis and wound-care • Per capita payments per registered user (initial assessment, initial care plan, personal identifiable data to identify unique individuals) www.sheffielddact.org.uk

16. Non Opiates Service Part B: Open Access – Single Point of Contact Access without appointment to non-opiate users for: • Marketing the single point of contact/open access for non-opiates • Screening assessment of drug use, including alcohol as part of poly drug use using AUDIT • Harm reduction • Brief advice • Motivational interviewing to engage in treatment • Escorted formal handover to treatment services • Recovery focussed service – not a “crisis” service • Per capita payments for unique individuals with an initial assessment and care plan, registered on the NDTMS dataset (completing all criteria as described in the specification) • Managing treatment appointments for Non-Opiates Psychosocial Interventions e.g. booking, cancelling, re-booking and following up DNAs • Managing presentations from Opiate users and re-directing them to relevant services for Opiates www.sheffielddact.org.uk

17. Non-Opiates Service Part C – Targeted/Assertive Outreach • Aimed at treatment naïve / resistant non-opiate users. • Targeted work based on substance (cannabis, steroids, NPS, khat etc.), on distinct communities (BME, LGBT, etc.) and geographic Sheffield areas. • Focus on ‘vulnerable communities’ including homeless and vulnerably accommodated, street drinkers, street sex workers, individuals with dual diagnosis and younger adults (18-25) with intergenerational substance misuse. • These interventions will be paid per capita for individuals who successfully engage with the service (including being NDTMS registered). • Those not engaging at this level will be recorded as unique individual ‘contacts’ of the service but will not attract payment. • The Provider will be paid once per annum for unique individuals accessing the service. Individuals in receipt of support from DIP will not be eligible for payment under this service and there will be no dual funding. www.sheffielddact.org.uk

18. Non-Opiates Service • Part D – Formal Structured Psychosocial Interventions • 12 week packages of formal PSI in line with national clinical guidelines. • Range of interventions at varied levels of intensity through 1:1 and groups. • Recovery Sub-Interventions must be delivered alongside informal PSI (key working). • Must be delivered in line with NICE Clinical Guideline 51. • Must only deliver interventions that PHE accept as being recorded to NDTMS under core data set L (data set will change annually). • As brief interventions will be offered in other parts of the Non Opiate contract, the provider must have a clear patient placement criteria for suitability for BI rather than formal PSI. • The use of telephone, e mail and new technologies for the delivery of PSI is encouraged, but the primary form of delivery must be face to face. • Staff delivering formal PSI must be appropriately qualified – Diploma in Counselling from a recognised higher education awarding body with a minimum of 100 hours supervised practice with substance misusing clients in a substance misuse setting.

19. Non-Opiates Service • Part E – Post Treatment Recovery Support • Consolidating gains of treatment and preventing re-presentation within 6 months (PHOF indicator). • Complementary to a detailed preparation for discharge and recovery planning. • ‘Recovery check ups’ must be offered to ALL service users leaving the service with a drug free discharge (drug free or occasional user). • Frequency to be tailored to individuals however, within the Non-Opiates Service a minimum of weekly checks for 6 weeks post treatment, and monthly thereafter until a mutually agreed end date. • Check ups can be face to face, by telephone or text, through social media (privately) or e mail dependent on the need, preference and consent of exiting individual. • Provider must facilitate participation with mutual aid, peer support and recovery opportunities in the city. • Encourage ‘contagious recovery’ within service by use of volunteers and peer support.

20. Non-Opiates Service • Part F – Universal Prevention /Education • Enabling staff in generic settings to identify drug use needing intervention. • Provider must develop a simple electronic and paper screening tool for illicit drug use for use by staff in non-specialist settings (i.e. housing, job centre). • Will provide assessment, referral and written harm reduction information. • Must be useable in electronic and paper formats and be able to be embedded in a number of case management systems. • Roll out must include; • 1. Induction via formal briefing, demonstration etc. • 2. Supported implementation including embedding into software, case management systems and mobile devices. • 3. Supported case finding using profiling to identify likely candidates for screening. • 4. Monitoring of screening and referral levels within each setting and formal feedback on activity. • 5. Troubleshooting and additional support for a further period. • Expected roll out of tool should take 6-12 weeks for each setting.

21. Non-Opiates Service • Part G – Learning Schemes • 1. Peer Mentor Schemes Structured learning programmes which individuals must complete to become peer mentors within the service. • 2. Service User Recovery Ambassador Scheme For those having successfully exited treatment and in recovery, formal programme of learning and brokering of voluntary placements within Sheffield treatment system. • 3. Family Ambassador Scheme Aim to increase social capital of families in contact with drug treatment services. Structured learning programme to be delivered and brokering of voluntary placements within Sheffield treatment system. • 4. Expert Patient Programme or equivalent EPP or bespoke local self-management programme. May provide benefit to individuals who have long addiction histories or long treatment journeys. • 5. Expert Families Programme Providing families of individuals with substance misuse issues with information and resources to build recovery capital. • 6. Preparation for Employment Formal structured supported setting to develop employment skills. The provider must issue a schedule of proposed schemes at beginning of contract.

22. Questions?

23. Welcome Jo Daykin-Goodall Director of Substance Misuse Strategy

24. Changing trends: Opiates • Opiate use is declining locally and nationally: most opiate users coming to treatment are 40+. • Most heroin users in Sheffield inject heroin/crack together. • Sheffield has a small but significant population of Iranian/Iraqi opium smokers in treatment who require a culturally appropriate offer. • Over-the-Counter: Sheffield has sought to increase the profile of treatment services to those using codeine based drugs running pharmacy based campaigns in March and November 2013. • Prescription drug misuse, particularly pregabalin and gabapentin is an issue in Sheffield. www.sheffielddact.org.uk

25. Culture Change • The Opiates Service is a large clinical service commissioned by the Local Authority. • The Clinical Commissioning Group (CCG) are not “co-commissioners”, but they do have an interest in terms of impact on community and hospital services they commission. • Sheffield is including “GP led” recovery support within the Opiates Service for 1,500 patients but there is freedom for bidders to design their model. • The “big ask” for the Opiates Service is to address long term users in treatment (6 years+), increase their recovery capitaland progress their treatment journeys AND ensure those recent or new to treatment experience the full range of Recovery Orientated Drug Treatment and have the expectation of leaving treatment drug free, sustaining their recovery and becoming productive members of society and their communities www.sheffielddact.org.uk

26. Commercial ServicesJill SmithCategory Support Officer An overview to the procurement process and timetable for Community Drug Treatment - Opiates

27. Opiates • Single stage, open process • Opportunity will be published week commencing 3 March 2014 • Full timetable will be available within the documents • Anticipated Contract Start Date – October 2014 • Submissions will be evaluated against criteria • Advertised via www.yortender.co.uk

28. Procurement Process – Single Stage (Open) • Single stage or open procedure combines the Pre-qualification Questionnaire, (PQQ), and tender, (ITT). Both must be completed and submitted at the same time • Bidders are evaluated against the PQQ first and then against the ITT • All opportunities are advertised via www.yortender.co.uk

29. Completion of Documents • Bidders must answer all questions • If a question is not clear then clarification may be sought via yortender • PQQ is a backward look at your organisation- Are you suitable? • ITT is a forward look – How your organisation plans to deliver the service requirement • Question and answers will be published and available to bidders (anonymised) • Please ensure all documents are submitted on time as late submissions cannot be accepted

30. Content of PQQ and Tender Documents PQQ Document • Instructions and guidance notes • Procurement timetable • Specification or Market brief • Evaluation criteria • Organisational Questions • Terms and conditions • Request for additional documents e.g. Accounts may be requested to support response Tender Document • Instructions and guidance notes • Procurement timetable • Specification or Market Brief • Evaluation Criteria • Method Statement Questions • Form of tender • Pricing schedule • Request for additional documents to support response

31. Tender evaluation • Read the specification and questions carefully. This is your opportunity to tell us how you will provide the service. If you require clarification please ask! • Pre-determined tender evaluation criteria is detailed within the tender documentation and is weighted according to importance. • Ensure all documents requested are submitted back prior to the closing date and time. Late submissions cannot be accepted • Organisations with the highest tender evaluation scoring would be recommended for award • Subject to council decision making process

32. Next Steps • All tenders are advertised on www.yortender.co.uk – please make sure you are registered on the site in order to receive opportunities • Commercial Services hold monthly workshops via Buy4Sheffield which cover the following topic Writing a Better Pre-Qualification Questionnaire, (PQQ) and Tender Response. For further information please contact www.buy4sheffield.co.uk

33. Opiates Contract Helen Phillips-Jackson Commissioning Officer

34. Opiate Contract • Opiates contract • Part A: SPAR – Single Point of assessment and referral to drug treatment (opiates) • Part B: Pharmacological Interventions • Part C: Formal Psychosocial Interventions • Part D: Post treatment recovery support • Part E: Specialist Harm Reduction Interventions including static needle exchange provision and vulnerable adults/dual diagnosis. Contract 2 – Opiates Expected Volumes • 800 SPAR assessments • 2,450 prescribing places including: • 950 Secondary Care • 1500 Primary Care • 900 PSI of which: • 600 standard • 300 high intensity • These volumes are capped based on unit price. www.sheffielddact.org.uk

35. Opiates Service - Finance • Contract envelope - £2,859, 907 – to be confirmed • Per capita payments are paid within the contract. Capped costs are given based on DACT calculations. However, it is expected that bidders will develop their own ‘cost per activity’ and indicate this within the financial model template. • Recovering any under-used capacity or increasing capacity in line with need will be discussed at the Q3 performance review annually. • Estimated cost of £90 per SPAR assessment • Specialist prescribing places (secondary care) at a capped cost of the National Unit cost of £1,338.23 per prescribing place per annum • GP prescribing places at a capped cost of £500 per place per annum • 600 ‘standard’ PSI treatment places at a capped cost of £350 based on a12 week package • 300 high intensity places for PSI/CBT drugs at a capped cost of £450 based on a 12 week package

36. Opiates Service • Part A – (SPAR) – Single Point of assessment and referral (opiates) • Clinical nurse specialist led assessment service providing a point of assessment and referral for opiate users (including over the counter). • To be provided on an appointment based and ‘walk in’ basis. • Assessment will include – full clinical assessment, health care assessment, summary of personalised care, urine testing to ascertain drug/s of misuse, venous blood testing, AUDIT C screening, Needle and syringe exchange offer and referral onwards as follows; • 1. Internally provided consultant led secondary care pharmacological intervention. • 2. Internally provided GP led primary care pharmacological intervention. • 3. Internally provided pregnancy clinic for opiate using pregnant women. • 4. Internally provided PSI for SU not requiring pharmacology but who would benefit from PSI for opiate related drug misuse. • 5. Inpatient detoxification and residential rehabilitation. • 6. Externally provided Non-Opiate services for non-opiate users with liaison with GP if symptomatic prescribing is deemed appropriate. • 7. Externally provided Alcohol services.

37. Opiates Service • Part B – Pharmacological Interventions (Drugs) • Range of recovery focussed prescribing interventions – through both secondary and primary care treatment interventions (including stabilisation, relapse prevention, non-medical prescribing etc.) • Provider must implement guidelines within service on frequency of drug testing. • Specialist clinics to include pregnancy clinic for opiate misusing pregnant women and over the counter/prescribed opiate misuse clinics. • All pharmacological interventions must be delivered in line with Strang’s ‘Medications in Recovery’ which states the following about prescribing treatment; • 1. Exiting prescribing prematurely can be harmful. • 2. Ambition for recovery is legitimate and deliverable. • 3. There is an aging cohort of drug dependent and ex-dependent individuals who will experience an increase in morbidity and mortality as they develop multi-system diseases that need complex treatment, and they will need primary and secondary care services –this indicates the co-location of primary and secondary treatment places as well as harm reduction interventions within the Opiates Service will support successful treatment of complex service users.

38. Opiates Service • Part C – Formal Psychosocial Interventions • 100% of caseload MUST receive a form of psychosocial intervention. • Informal – through monthly key work. • Formal – through 12 week evidence based PSI interventions (expected 30% of overall caseload, for both primary and secondary places). • Workforce delivering formal PSI within this contract must have the minimum qualification of a Diploma in Counselling from a recognised awarding education body and a minimum of 100 hours supervised practice with substance misusing individuals. • Formal PSI must be delivered in line with NICE Clinical Guideline 51. • Must only deliver interventions that PHE accept as being recorded to NDTMS under core data set L (data set will change annually). • For individuals whose use is protracted, very entrenched or complicated by mental health difficulties, interventions at a level of clinical psychology must be offered.

39. Opiates Service • Part D – Post Treatment Recovery Support • Consolidating gains of treatment and preventing re-presentation within 6 months (PHOF indicator). • Complementary to a detailed preparation for discharge and recovery planning. • ‘Recovery check ups’ must be offered to ALL service users leaving the service with a drug free discharge (drug free or occasional user). • Frequency to be tailored to individuals however, within the Non-Opiates Service a minimum of monthly checks for 12 weeks post treatment, and monthly thereafter until a mutually agreed end. • Check ups can be face to face, by telephone or text, through social media (privately) or e mail dependent on the need, preference and consent of exiting individual. • Provider must facilitate participation with mutual aid, peer support and recovery opportunities in the city. • Encourage ‘contagious recovery’ within service by use of volunteers and peer support.

40. Opiates Service • Part E – Specialist Harm Reduction Interventions / Vulnerable Adults/Dual Diagnosis • A) Needle Exchange Delivery of needle, syringe and paraphernalia within clinical appointments. SUs to be asked in their monthly clinical appointments about requirements for equipment. SUs will also be offered the chance to return equipment in these appointments. The provision must be discreet and needs based. • B) BBV and venous blood testing Provision of nurse led harm reduction interventions including BBV screening and immunisation, wound-care and venous care services. • C) General Healthcare assessment and provision Having received a healthcare assessment at SPAR, and internally referred to HR services for interventions or liaison with other relevant healthcare services e.g. dental health, sexual and reproductive health services. • D) Overdose Prevention Provision of OD prevention training to vulnerable service users (those with opiate use as primary and/or secondary drug of misuse). • E) Naloxone Provision of Clinical Guidelines and process to administer ‘take home’ Naloxone to appropriate Service Users.

41. Opiates Service • F) Vulnerable / non-engaging adults • Addressing problematic non-engagement and support management of vulnerable adults with substance misuse problems. For SUs not responsive to adult safeguarding – team will oversee with key worker. SUs likely to need support with help seeking behaviour. • Role in planning and convening case conferences to discuss and safety plan for these individuals. To include comprehensive assessment of risk and safeguarding, and initial care plan, general healthcare assessment, a social work assessment where indicated, a mental capacity assessment where indicated, harm reduction interventions, motivational interventions, an agreed care plan / case manager, contact at an agreed frequency determined by need and risk, weekly face to face welfare checks as a minimum, and discharge including aftercare planning and rapid access back. G) Dual Diagnosis • Allocation of RMHN time to address dual diagnosis needs of Opiate SUs. • Small number of individuals with severe and enduring MH issues alongside opiate use. • Delivered in line with local dual diagnosis protocols. • Facilitation and development of referral route from substance misuse to MH services, lead in multi-agency working.

42. Questions?