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specification - Hammersmith _ Fulham Council


									                                         Project Name:
                                        REF: PSIWS001


                                         Release: Final v14
                                    Date: 24 August 2011

                               Author: John Jeremy (RBKC)

                            Owner: Edward Barfoot (RBKC)

  .   .

                  Substance Misuse Services in HMP Wormwood Scrubs
            Service specification for the delivery of psycho-social interventions

            1.       Introduction
            1.1      In April 2011 the funding for the psycho-social interventions was transferred
                     from the National Offender Management Service (NOMS) to the Department of
                     Health. This funding came down to local partnerships through NHS Inner North
                     West London to the local Drug and Alcohol Action Team (DAAT) in
                     Hammersmith and Fulham. The DAAT and prison partners have now agreed to
                     re-commission all the psycho-social pathways for substance misusers in the
                     prison which are outlined in this specification.
            2.       Background
            2.1      Based in the north of Hammersmith and Fulham, HMP Wormwood Scrubs is a
                     category B prison – a closed prison holding local males only aged 21 or over.
                     The prison has a large diverse catchment area covering the courts of West
                     London, North West London and parts of Central London.
            2.2      The prison has an operational capacity of 1,281 male prisoners and is usually
                     considered to be at full capacity. The throughput of prisoners is very high, with
                     approximately 300 new prisoners per month.
            2.3      The prisoners broadly fall into three categories:
                     1.     Shorter sentenced prisoners and remand prisoners
                     2.     Foreign nationals
                     3.     Resettlement inmates returning to London to serve the last 6 to 9
                            months of their sentence.
            2.4      There are no large populations of ―lifers‖ or those on long sentences. The
                     average length of stay in HMP Wormwood Scrubs is 4-6 weeks.
            2.5      The prison has 5 wings A, B, C, D and E wings. There is a dedicated space for
                     substance misusers in the Conibeere Unit which is a stabilisation and
                     detoxification wing and C wing where prisoners move to from Conibeere.
            3.       Profile of prisoners
            3.1      General Profile
            3.1.1    From data based on LISAR collected in 2008/09 the largest ethnic group was
                     White Groups accounting for 49% of prisoners passing through reception. Black
                     groups accounted for 28%, Asian Groups for 17%.

3.1.2   Data from the previous IDTS Needs Assessment based on a snapshot of
        receptions in August 2007, showed that the largest ethnic group was the White
        Groups who accounted for 43% of all receptions, followed by Black groups at
3.1.3   From data for August 2007, 23% of receptions were foreign nationals, although it
        is known that the percentage of foreign nationals can often reach up to 50%.
3.1.4   37% of prisoners through reception in 2008/09 were 21-29, and 35% were
        between 30 and 39. The remainder were aged over 40. 54.7% were untried, 27%
        were sentenced, 13% were convicted but un-sentenced and 4% were recalled
        prisoners. Of those prisoners that were sentenced, 87% were sentenced for less
        than 12 months, 10% for 12 months to 4 years and 2% for 4 years to life.
3.2     Substance misusing profile from 10-11 needs assessment Drug
        use/poly drug use/alcohol use
        On average the Conibeere Unit sees approximately 117 substance misusers a
        month (average between Jan 09 to Oct 10). Approximately 56% of all clients
        coming into the Conibeere unit receive a methadone prescription.
        Between May to October 2010 Methadone was prescribed on its own in 54% of
        cases. It was prescribed with Alcohol detox drugs in 9% of cases. It was
        prescribed with symptomatic relief in 3% of cases. All three were prescribed in
        less than 1% of cases.
        In terms of numbers over the 6 month period, 695 prisoners (new arrivals and a
        minority transferred in from the wings) passed through the Conibeere Unit.
        463 were prescribed methadone; equivalent to 77 prisoners a month; that is
        approximately 19% of all new arrivals.
        Out of the 695 clients that passed through the Conibeere Unit in the 6 months
        between May—October 2010, 9 (1%) identified crack as the primary drug type,
        188 (27%) had crack as the secondary drug type and 50 (7%) had crack as a
        tertiary drug type. This is a major increase from last year when crack use was
        only noted down on 37 occasions.
        Out of the 695 clients that passed through the Conibeere Unit in the 6 months
        between May—October 2010, 364 (52%) identified heroin as the primary drug
        type, 56 (8%) had heroin as the secondary drug type and 11 (2%) had heroin as a
        tertiary drug type. These are about the same proportions as last year although
        the numbers are slightly lower.
3.3     CARATs 2009-10
        The diagram and table below show information on those prisoners that were
        referred to CARATs but did not complete a CSMA. 44% of those clients were
        referred with just alcohol only. 12% (110 individuals) were referred with heroin
        as a primary drug and crack as a secondary drug.

3.4   Prisoners that completed a CSMA in 2009/10
      The diagram and table below show information on those prisoners that were
      referred to CARATs and completed a CSMA. 29% (209 individuals) were
      referred with heroin only. 28% were referred with heroin as a primary drug of
      choice and crack as a secondary drug of choice. 6% (45 individuals) were
      referred with just crack only.

3.5   Alcohol needs
      The data above and the table below highlight the need for promotion of alcohol
      treatment in the prison as alcohol use is under-reported as currently pathways
      for assistance are not readily available for prisoners.

4       Existing group work programmes in HMP Wormwood
4.1     The psycho-social intervention service is currently split across three providers.
        The Rehabilitation of Addicted Prisoners Trust (RAPT) provides the counselling,
        assessment, referral, advice and through-care (CARAT) service, CRi deliver the
        alcohol programme and the Building Skills for Recovery programme is delivered
        by prison staff.
        These three services are now going to be brought under one contract, with one
        provider. The outline of the new services sought is detailed in section 5 below.
        Currently the staffing structure has:
        CARAT (joint stabilisation programme):
              One manager; two senior practitioners and seven service staff.
        CRi (Alcohol group):
              One manager and four programme staff
        Prison (BSR):
              One manager and seven prison officers
4.2     The intention is to award the contract to a single provider, subletting elements
        of the service to other providers will be permitted, subject to approval. In such
        cases the appointed lead provider will hold the contract and will be responsible
        for the overall delivery of the service.
4.3     Bringing the three contracts into one will offer opportunities for efficiencies in
        staffing as well as performance management and this is welcomed.
4.4     It is anticipated that the employment of the staff assigned to the three services
        will transfer to the successful Provider under the Transfer of Undertakings
        (Protection of Employment) Regulations 2006 (―TUPE‖). Therefore, the Provider
        shall assume all rights, powers, duties and liabilities under the contracts of
        employment of all the staff who will transfer save for any terms relating to
        benefits for old age, invalidity or survivors contained in an occupational pension
        scheme. However, certain of the staff are either former public sector staff, or
        will be transferring from the public sector, so the Cabinet Office Statement on
        Staff Transfers in the Public Sector 2007 (as amended), the annex to
        this Statement entitled ―A Fair Deal for Staff Pensions‖ and all related guidance
        will operate to protect the pension entitlements of these staff.
4.5     Integrated substance misuse group programme
4.5.1   This programme improves integration between clinical and psychosocial services
        and reinforces the continuity of care between prisons and for those released
        into the community. This consists of two components; enhanced clinical
        management of drug dependence, and enhanced psychosocial support. The
        service model integrates clinical and psycho-social interventions into one system

        that works to the principles of Building Recovery in Communities (BriC) and
        promotes the use of node link mapping to increase engagement of substance
        misusing prisoners. The service provider is expected to comply with this
        integrated model of service delivery.
4.5.2   The group work currently provided in HMP Wormwood Scrubs is a rolling
        programme of psycho-social intervention modules delivered by both the CARAT
        service and Healthcare teams. This is available to those leaving the Conibeere
        Stabilisation Unit.
4.5.3   This group is run on a 4-5 week basis with one-to-one key work sessions
        available for all group work participants as part of their recovery care plans. 12
        participants per group and their module selections are agreed with the CARAT
        worker at the initial care planning stage.
4.6     Building Skills in Recovery (BSR) programme
4.6.1   Building Skills for Recovery (BSR) is a new programme which has been
        developed around the same ideas as the Short Duration Programme (SDP) and
        P-ASRO. The programme is based on cognitive behavioural theory model and
        explores substance use. BSR is designed to help group members develop skills
        to prevent future relapses. Some of the topics covered in BSR are:
              Substance awareness,
              Relapse prevention,
              Harm minimisation, and
              Goals for recovery.
4.6.2   What is BSR?
        The group is a closed group. The course is 15 sessions long over a 4 week
        period, as well as a minimum of 2 one to one sessions with an assigned key
        worker. The programme is available for both remand and convicted
        prisoners. Group members can be on methadone but cannot be on detox, and
        they must have clearance to participate in group work and to travel on free flow
        if necessary.
        i.     Create an intervention that offers a route out of dependency and has a
               focus on recovery.
        ii.    It is person-centred and offers a holistic approach to recovery.
        iii.   It is outcome focused and the outcomes reflect those outlined in the
               2010 Drug strategy.
        iv.    Offers the opportunity to identify recovery champions
        v.     Is considered an ―end to end‖ treatment intervention with post-
               completion support.

        vi.     Offers continuity with community offender managers and aims to
                ―encourage social skills, improve self esteem and challenges substance
                misusing offenders to improve social networks in an attempt to reduce
4.7     Alcohol Intervention Programme (AIP)
4.7.1   AIP is a new alcohol misuse programme introduced in 2011-12. The aims of the
        programme are to:
        i.      Address problematic alcohol use or avoid any use becoming dependant
        ii.     To explore attitudes and thoughts around alcohol use
        iii.    To lessen the impact problematic alcohol use has on yourself, others
                around you and society as a whole.
        iv.     To apply skills to personal life experience
        v.      Offer additional support once the programme has been completed
4.7.2   Eligibility Criteria
               Those with current primary alcohol use (does not need to be alcohol
               Sentenced prisoners with a minimum of 6 weeks left to serve
               Those where alcohol is related to the offence
               Must have basic literacy skills
               Those motivated to address alcohol problems
               Those willing to undertake group work
4.7.3   What does AIP involve?
               14 sessions which are 2.5 hours long
               The programme runs every day for 3 weeks and key-work sessions with
                a facilitator are available on completion of the course.
               Minimum of 4 group members and a maximum of 12 per group
               Examine thinking, behaviour and actions
               Assignments are set to be completed in prisoners’ own time
               Group discussions
               Attendees are paid approximately £9 a week for engagement on the
               Prisoners will be placed on hold whilst on the programme

5.      What we want from the new service
5.1     The new structure for the delivery of psycho-social interventions will meet the
        needs of primary drug and alcohol users as well as addressing secondary drug
        and alcohol use and will offer a comprehensive, recovery centred, outcome
        focused approach to treatment.
        a.     Primary drug use including all drugs.
        b.     Primary alcohol use, this will include work to build capacity across the
               prison estate on the use of the Audit screening tool and the delivery of
               identification and brief advice.
        c.     Group work and one to one sessions to be delivered built on node link
               mapping to help assist prisoner engagement and participation. The
               programmes and key-working will enhance the culture of recovery with
               substance misusing prisoners within the short period of time they are in
               HMP Wormwood Scrubs.
        d.     Provision of a continuity of care service that promotes continued
               engagement and support for released prisoners.
        e.     Provision of an outreach service across the prison estate to increase
               referrals into specialist treatment where appropriate. The provider will
               work in conjunction with existing peer mentors and drug strategy staff to
               promote this pathway.
5.2     Drug Treatment Pathway
        As stated above, the Building Skills for Recovery is an existing accredited
        programme. The provider is expected to devise appropriate interventions based
        on the principles laid out in the BSR and to the outcomes outlined in point 2
5.3     Drugs Group-work
        The interventions will include the delivery of 2 group programmes.
5.3.1   Group 1- joint delivery between the successful provider and the healthcare
        staff. This programme will be run on C wing and support the stabilisation work
        from the Conibeere Unit. This will be a rolling programme, 4 weeks in length,
        offering creative, therapeutic modules to promote understanding, offer support
        on dependency issues and relapse management.
        Due to the service users in Conibeere, this group will primarily be made up of
        heroin users on maintenance or reduction substitute medication or have
        completed detoxification from opiates.
5.3.2   Group 2- this will be a closed 4-5 week programme offering innovative,
        therapeutic interventions for drug users. This group work intervention model
        will address the needs related to all drug use including heroin/crack
        cocaine/cocaine and cannabis use.

        The programmes will deliver the agreed aims and objectives set out in section
5.4     Alcohol Teatment Pathway
5.4.1   The Provider is expected to deliver a set of programmes/interventions to
        address the key cohorts within the prison where drinking was a significant factor
        in their offending and where there is identified dependency.
        These are:
              Alcohol users (those from the general population and those leaving
               Conibeere Unit having completed detoxification)
              Domestic abuse perpetrators
              Violent offenders
5.5     Alcohol Screening and brief advice
        The Provider will work across all of the prison establishment from reception,
        wing-based healthcare services and independent units to build capacity within the
        nursing staff group to be able to identify and offer brief advice to prisoners who
        have a score of 5 or above from the Audit C (Alcohol Use Disorders
        Identification Test) screening tool.
5.6     Alcohol Group
        The group work will be for primary alcohol users as stated above. This will be a
        rolling programme of appropriate, therapeutic interventions. The group will be
        run on 3- week cycles.
5.7     Continuity of care service
5.7.1   The contract will include a practical support service through escorting the
        released prisoner to the appropriate community service in order to assist in the
        delivery of the principles of integrated offender management. Integrated
        Offender Management (IOM) is an approach to working with offenders that
        brings all local agencies working with the offender and prioritises interventions
        tailored to offender need. IOM arrangements provide local areas the opportunity
        to target offenders of most concern in a structured and co-ordinated way with
        the objective of reducing re-offending, integrating offenders into the community
        in a positive way and challenging criminal attitudes. The provider will ensure that
        they have links with local IOM schemes in each borough to ensure that there is
        continuity of care for offenders, that they reach appointments on release and
        comply with joint release/treatment plans in the community. On the day of
        release, the provider will escort the prisoner to the arranged health and/or
        social care appointment. This includes appointments for welfare benefit

5.7.2   The provider will work with existing community prison link services within the
        drug interventions teams and use community services to support the health and
        social care needs of the offender.
5.7.3   The provider will introduce/comply with continuity of care/information sharing
        protocols with the appropriate borough of residence.

6.      Outcomes
The key outcomes sought are to:
               Improve substance misuse pathways from stabilisation/detoxification to
               Reduce substance misuse related re-offending
               Increase engagement in psycho-social interventions
               Increase the demand for reduction prescribing
               Increase the demand for the abstinent pathway
               Increase referrals from the general population to treatment
               Improve health amongst substance misusing prisoners
               Promote the culture of recovery
               Improve continuity of care from prison to community and community to
                prison in order to stop the revolving door of offending linked to
                substance misuse.
7.      Treatment and Recovery approach
7.1     Drugs
7.1.1 Access
        HMP Wormwood Scrubs offers a challenge to providers to be able to affect
        behaviour change within a short period of time. The needs assessment clearly
        states that the dependent cohort, primarily heroin users or those on substitute
        medication in the community, will come through as a referral from the
        Conibeere Unit. The greater challenge is to improve the pathway and increase
        engagement in treatment from crack users, cannabis users and other drug users
        where structured support would greatly impact on their offending behaviour and
        increase their health outcomes.
        Therefore building a robust pathway with general healthcare and prison
        establishment officers is vital to improving access to treatment.
7.1.2   Assessment

        The provider will have an assessment that is fit for purpose to identify health
        harms/needs, risk and social care needs. This assessment should be built on
        node link mapping principles to promote prisoner/service user treatment
        engagement. This assessment will include the information on the Minimum Data
        Set (MDS).

7.1.3   Engagement and treatment approach
        As noted above, the assessment will adopt the approach of a mix of questions
        and maps to identify needs. The consequent care planning will determine the
        level of work to be achieved within the time-frame in the prison.
        The provider will offer key-working and run day programmes that are evidenced
        based and offer the elements needed to address substance misuse and offending.
        The programmes will need to be short duration in order to meet the prisoner
        length of stay.
        Elements for delivery are:
              Harm reduction and risk management
              Access to blood borne virus treatment
              Key-working and referral to group work programmes
              Therapeutic approaches to address the links between substance misuse
               and offending, triggers for behaviour, building skills to work towards a
               cessation of using and offending.
              Linking with mutual aid networks, complementary therapies and
               programmes to promote skills to assist in community re-integration to
               help sustain behaviour change.
              Links to education, employment and training advice.
              Promotion of recovery champions and service user involvement
              Links to community services to ensure continuity of treatment and
               reduce the opportunity for re-offending
7.2     Alcohol
7.2.1   Access
        The provider will ensure that there is a clear pathway to psycho-social
        interventions for increasing risk, high risk and dependent drinkers. This means
        delivering a stepped care approach to impact on differing categories of drinkers.
        These interventions include:

              Building capacity among all nursing staff to deliver identification and Brief
               Advice (IBAs) to prisoners. IBAs are a simple effective public health
               intervention that identifies the degree of drinking with the use of the
               AUDIT C screening tool with a brief discussion on addressing the
               drinking using a motivational interviewing approach.
              Receiving referrals from healthcare and prison staff for extended brief
               interventions (EBIs)
              Group-work and one-to-one interventions offered post detoxification
               and pre-release.
7.2.2   Assessment
        Same tool used as in point 7.1.2 above with the added information gathered
        from the IBA where completed.
7.2.3   Engagement and treatment approaches
        As noted above, the screening tool will determine the need for further
        interventions. Individual service user care plans will outline the treatment
        agreed to be delivered within the prisoner’s time at HMP Wormwood Scrubs.
        Interventions to be delivered are:
              Identification and brief advice (IBAs) (harm reduction).
              Extended brief interventions (EBIs) (harm reduction).
              Access to blood borne virus treatment.
              Access to complementary therapies.
              Key-working and access to group-work programmes for the target
              Key-working for post detox and pre-release with the dependent drinker
               cohort from Conibeere.
              Links to mutual aid networks and assist in building skills to assist in
               community re-integration and to sustain behaviour change post release.
              Links to education, employment and training advice.
              Promotion of recovery champions and service user involvement.
7.3     Expected outputs
        Numbers in (referrals from CI/general population/attrition rate)
        Numbers by drug type
        Number of escorts

7.4   Expected outcomes
      Numbers completing treatment interventions
      Referrals to ETE
      Referrals for housing
      Number completing and number completing drug/alcohol free
      Successful transfers, including those escorted
      Successful discharges (continuity of care/actual pick ups)
8.    Service user involvement/peer mentoring
8.1   The provider will ensure that service users and carers have the opportunity to
      become involved in the development of the service and feedback on its impact.
      This involvement will support the continued work on the progression of service
      user involvement and promote good practice changes. The provider will identify
      a service user champion from their staff group to lead on the involvement
      agenda within the service.
      The Provider will record and report to the prison’s drug strategy manager and
      the substance misuse service project management group, any changes made to
      service delivery or policies as a result of service user involvement. These will be
      reported in the quarterly monitoring meetings.
8.2   Family link work - The prison has an existing contract to deliver family support
      work for parents/carers/significant partners of prisoners with drug users or
      where drug use is an issue within the family. The new service is expected to
      work closely with this service where the prisoner has indicated and given
      consent for family contact.
9.    Performance management/monitoring
9.1   Hours of operation
      Service delivery hours will fit with the prison regime, demands of substance
      misuse clinical treatment, the mutual aid/recovery based services currently
      operating in the prison and with prisoner needs. In general the programmes will
      run from Monday-Friday in office hours between 9am and 6pm.
9.2   Performance management
      The Drug Strategy Unit within the prison currently operates payment to
      providers based on an income calculator tool. This tool monitors staffing,
      activity and outcome levels and determines the cost of the service on a monthly
      basis. The Drug Strategy Manager works with providers to ensure staffing
      capacity and performance remains high. The manager will continue to have this
      role and report to the substance misuse strategic commissioning group on
      performance and financial management.
9.3   National/local requirements

        The provider will have the capacity and ability to meet all national and local
        reporting requirements. Data is currently held locally with System One for
        healthcare and local spreadsheets for data entry for psycho-social interventions.
        The prison partnership would need to see that the provider has considered
        some of the challenges of operating ICT systems in the prison and is fully
        equipped to manage necessary reporting requirements with ICT support and
        training for all their staff.
9.4     Audit
        The successful provider will become a part of the existing prison governance
        structure and will comply with best practice guidelines for auditing to benchmark
        quality service delivery. The prison partnership will have the right to
        independently audit service provision giving 48 hours notice prior to doing so.
9.5     Partnership work (internal/external)
        The successful provider will commit to pro-active engagement in the prison and
        in the community. The provider will employ innovative practice to ensure that
        recovery is embedded in their everyday work in order to have the greatest
        impact and ambition for prisoners. The Provider will achieve sustained recovery
        and stabilisation for users of the service. The provider will challenge pro-criminal
        attitudes and work with internal and external partners to offer options for
        individual development to reduce reoffending.
9.6     Confidentiality and risk
9.6.1   The provider will manage all information on individual cases within their
        information governance arrangements. The provider should be aware of all legal
        requirements relating to information governance including those within the
        Crime and Disorder Act 1998, section 115 which relates to information sharing
        to prevent crime.
9.6.2   The Provider will respect information given by service users or their
        representatives in confidence and handle information about service users in
        accordance with the Data Protection Act 1998, the Human Rights Act 1998,
        Caldicott principles and the agency’s written policies and procedures and in the
        best interests of the service user. Personal or other information about service
        users will not be shared with any parties other than those who need to know in
        order to provide the service effectively. Personal information will be handled
        discreetly so it is not seen or overheard by other parties.
9.6.3   In circumstances a risk assessment will be completed and where there is
        potential or actual risk of harm to the service user or others (the above
        paragraph does not apply in these circumstances), relevant information should be
        passed by the Provider to the appropriate agency.
9.6.4   Wherever possible the service user’s consent will be sought before information
        is passed to any other party as part of the consent form within the assessment
        process. However, this consideration will be overridden where there is a

        potential or actual risk of harm to the service user or others or in the
        prevention of a crime.
9.6.5   There is still a particular stigma associated with HIV infection leading to
        discrimination of those affected and their families. Breach of confidentiality can
        be exceptionally distressing for those concerned, and may lead to social isolation
        or even harassment. Any breach of confidentiality will be treated very seriously
        and will be investigated.
9.7     Safeguarding
        See Module D schedule 10 of the contract for the NHS Safeguarding Policy.
9.8     Serious and untoward incidents
        See Module D schedule 11 of the contract for the NHS Serious and Untoward
        Incident Policy.
9.9     Health and Safety
        It is the responsibility of the service Provider to familiarise themselves with the
        health and safety regulations within HMP Wormwood Scrubs and NHS H&F
        Health and Safety policies and procedures and to ensure their safe
        implementation at all times.
        The Provider is expected to demonstrate in everyday practice that regard for
        service users’ health and safety is understood and implemented.
10.     Terms and conditions
10.1    Licence requirements
        In addition to the Contract to be entered into with NHS Hammersmith &
        Fulham, the Provider will be required to enter into a licence agreement with
        HMP Wormwood Scrubs. The licence will confirm the Provider's rights of access
        to HMP Wormwood Scrubs, and will govern the terms on which that access is
        permitted (for example, the licence will contain HMP Wormwood Scrubs'
        requirements in relation to security, data protection and confidentiality, and (if
        relevant) use of HMP Wormwood Scrubs equipment). A copy of the licence
        terms will be provided to potential Providers with the Invitation to Tender
10.2    Governance
        HMP Wormwood Scrubs has an existing governance structure to drive forward
        the improvements in the delivery of treatment interventions. The substance
        misuse pathway also has its own governance structure to promote joint working
        and ensure clinical and psycho-social interventions are provided based on good
        practice evidence and are robust in meeting the needs of the substance misusing
10.3    Financial management

       The prison partnership will report to the borough’s Substance Misuse Strategic
       Commissioning Group on performance in relation to activity, outcomes and
       results as well as budget monitoring. The provider is expected to report on
       current levels of productivity and staffing capacity and will be paid via an income
       calculator tool against their outputs/outcomes.
10.4   NHS Hammersmith & Fulham propose to contract with the successful Provider
       on the NHS Standard Community Services Contract (Bilateral) 2011/12 (or such
       later version as may be released by Department of Health prior to
       commencement of the Contract). This form of contract is a standard (and not
       model) form of contract and, accordingly, it is therefore not open to NHS
       Hammersmith & Fulham to negotiate on the contract terms and conditions
       under the standard contract". The PCT is also advised to confirm that "NHS
       Hammersmith & Fulham reserves the right to determine to use an alternate
       form of contract to the NHS Standard Community Services Contract prior to
       the submission of tenders. The form of contract to be awarded will be
       confirmed by NHS Hammersmith & Fulham under the Invitation to Tender
10.5   The NHS Standard Community Services Contract (Bilateral) 2011/12 provides
       for a one-year contract term. NHS Hammersmith & Fulham are seeking approval
       from NHS London (the relevant Strategic Health Authority) to amend the NHS
       Standard Community Services Contract to provide for a three-year term, with
       the option for NHS Hammersmith & Fulham to extend the contract term by a
       further two-year term. NHS Hammersmith & Fulham are also seeking NHS
       London's approval to the inclusion of a twelve month probationary period. The
       contract term will be confirmed at the Invitation to Tender stage..
10.6   Contract variation
       The Contract may be varied in accordance with the terms of the NHS Standard
       Community Services Contract.
10.7   Contract termination
       The Contract (or any part of the services provided thereunder) may be
       terminated by NHS Hammersmith & Fulham in accordance with the terms
       provided by the NHS Standard Community Services Contract (Bilateral) 2011/12
       (which provides the commissioning body with, amongst other rights of
       termination, the right to terminate on 12 months' written notice, or with
       immediate effect where the Provider is in persistent or repetitive breach or
       other material breach of quality or certain performance requirements).
10.8   Budgetary fluctuations
       The significant reduction to public sector grants in 2011-2012 will continue for
       the foreseeable future, therefore the provider needs to be able to offer a degree
       of flexibility within the contractual arrangements with the understanding that the
       commissioning body will always be transparent and direct in their financial

10.9   Working in the secure environment
       The provider needs to be aware that the delivery of clinical and psycho-social
       interventions is dictated by the prison Governor. All staff must at all times be
       compliant with the security regime. All staff are subject to a rigorous
       background check before starting work in the prison.
10.10 PSOs/PSIs/Governors orders
       The prison has a set of prison service orders, instructions and governor’s orders
       with which the incoming provider must be compliant. It is expected that the
       provider and their staff are aware of these and deliver their services within the

APPENDIX A – Prisoner Journey Flowchart (next page)

Appendix A - Prisoner Journey Flowchart


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