http://www.kirklees.nhs.uk/fileadmin/documents/tender/HIVServiceSpec

SCHEDULE 2 - THE SERVICES SERVICE SPECIFICATION Service Commissioner Lead Provider Lead Period

Kirklees & Calderdale HIV Support and Prevention Service

01 April 2010 – 31 March 2013

1. Purpose 1.1 Aims The overall aim of this service is to deliver comprehensive, accessible and needs led support for all People Living With or affected by HIV (PLWH) and those who support and care for them. The service will help PLWH to maximise health, well-being, quality of life and social integration. The service will also provide health promotion activities aimed at preventing onward transmission and acquisition of HIV. These services do not include, but will complement: • Clinical treatment of HIV in specialist services provided within the NHS • Statutory adult social care services and children’s education and social care services provided by local authorities • Primary health care and non-HIV specific specialist health services.

1.2 Evidence Base The service will be consistent with national and local strategies and best practice as outlined in: • National Strategy for Sexual Health and HIV (DOH 2001), the associated Implementation action plan (DOH 2002) and the review Progress and Priorities (DOH 2008) • Effective Sexual Health Promotion – A toolkit for PCTs and others working in the field of promoting good Sexual Health and HIV prevention (DOH 2003) • Building on Progress – enhancing the response to HIV in England (IAG on Sexual Health & HIV 2009) • Making it Count – a collaborative planning framework to reduce incidence of HIV infection during sex between men (Sigma Research 2003) • HIV and AIDS in African Communities – A framework for better prevention and care (DOH 2005) • The Knowledge, the Will and the Power: a plan of action to meet HIV prevention needs of Africans living in England (Sigma Research 2008).

• Framework for Better Living with HIV in England (Sigma Research 2009) • Tackling HIV Stigma and Discrimination – Department of Health Implementation Plan (DOH 2007) • Standards for better health – supporting best practice (DoH, 2004)

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1.3 General Overview Kirklees has a population of 420,698 living in former mill towns, villages and rural areas spread over 40,490 hectares. 33 of the 260 Super Output Areas (SOA) in Kirklees fall in the most deprived 10% SOA in England. Approximately 30% of households do not have a car.

Calderdale has a population of 207,000 living in small towns, suburbs, villages and rural areas spread over 36,276 hectares. 13 of the 129 SOA in Calderdale fall into the most deprived 10% in England.

Over a third of households do not have a car.

Services need to be available from a number of different locations and accessible by public transport.

HIV in the UK and locally HIV remains one of the most important communicable diseases in the UK. It is associated with serious morbidity, high costs of treatment and care, significant mortality and a potentially shortened lifespan.

HIV largely affects working age adults therefore can have a significant economic impact on individuals and families.

An estimated 77,400 people are living with HIV in the UK, of whom approximately 28% are undiagnosed. A third of diagnosis are made late when individuals present unwell and with a reduced life expectancy (HPA 2007).

Men infected through sex with men (MSM) or African people account for 85% of those living with HIV in the UK. Small numbers are infected through injecting drug use, received blood products or by mother to child transmission (MTCT). HIV services must, therefore, primarily focus their activity, be accessible, acceptable and respond to the needs of MSM and African migrant groups, recognising the internal diversity of these groups.

In Kirklees and Calderdale the number of new HIV cases diagnosed each year remains low and stable.

However, modern treatments greatly improve life expectancy thus the total number of patients being treated for HIV infection continues to increase annually.

In Kirklees numbers accessing treatment doubled during 2003-07. The total number of people known to be living with HIV in Kirklees was 195 in 2007, giving a population rate of 49 per 100,000. During the same period there has been a 60% increase in numbers in Calderdale; in 2007 77 residents were accessing HIV care giving a population rate of 39 per 100,000. Local antenatal HIV testing results in positive diagnosis for 0.1% of women (Health Protection Agency 2009).

The demographic profile for people accessing HIV care differs between the two districts.

In Kirklees men outnumber women approximately 2:1, 52% of cases are from the white population and 35% are Black African (a change over recent years reflecting increasing migrant populations resident in Kirklees) and 46% are defined as being among the most deprived. Since 2003 the most common route of transmission is via heterosexual sex (51%) overtaking MSM transmission (43%). New cases

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are largely asymptomatic; however among existing cases there are a significant number of people living with advanced disease. The majority of people accessing treatment are resident in central locations; those living outside of these centres may have difficulty accessing services however 75% of residents access care within the PCT. In Calderdale men outnumber women 3:1, 74% of cases are from the white population, 21% are Black African and 35% fall into the “most deprived� category. The most common route of transmission in 2007 was MSM (54%) with 38% via heterosexual exposure; this differs from all other areas in West Yorkshire. Calderdale has a significant cohort of people living with advanced HIV infection. Many people accessing care are resident in towns within the PCT area but large numbers are resident in more rural areas and may have difficulty accessing services. Half of residents access care outside of Calderdale PCT area.

(Local SOPHID data – Health Protection Agency 2009)

1.4 Objectives The work of the HIV Support & Prevention Service will complement other (HIV specific and generic) health and social care services and enable people living with and affected by HIV in Kirklees and Calderdale to live independent lives and effectively manage their long term condition. It will also work to reduce HIV transmission and tackle HIV related stigma and prejudice.

The service will work towards high level outcomes (see 1.5) by meeting the following objectives: 1. Deliver a comprehensive, accessible and needs led support service for all people living with HIV and those that support and care for them.

2. Ensure children and young people living with and/or affected by HIV have access to child/youth appropriate support. (For the purposes of this specification young people are defined as those 1224years old who are HIV positive or affected by HIV) 3. Develop links and care pathways with other sexual health services and wider health and social care services within Kirklees and Calderdale to ensure a person centred approach to care is taken with appropriate and timely referrals.

4. Support PLWH to access mainstream health and social care services.

5. Undertake health needs assessment with PLWH to complement the work of the PCT in achieving modernised service provision 6. Deliver health promotion activities in a variety of settings and promote self management to improve the physical and emotional health and well-being of people living with HIV and reduce onward transmission.

7. Deliver targeted support and intervention work with groups identified as most at risk of acquiring HIV to reduce the number of new transmissions, i.e. men who have sex with men (MSM) and Black African migrant communities, and improve local knowledge of the availability of Post-Exposure Prophylaxis for HIV following Sexual Exposure (PEPSE) and encourage appropriate uptake.

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8. Work with statutory and voluntary sector organisations to increase access and uptake of HIV testing and develop services which reduce the prevalence of undiagnosed HIV. 9. Provide advice, support and training to service users, statutory and voluntary service providers and the public to improve knowledge around HIV infection, reduce the stigma associated with HIV and ensure services are non-discriminatory and appropriate for HIV positive people.

10. Follow legal, professional and PCT organisational guidance in respect of the Sexual Offences Act, Fraser Guidelines, Child and Vulnerable Adult protection procedures.

Services will be of a high quality, represent best value principles and will be evidence based.

1.5 High Level Outcomes • Improved health & well being for all people living with HIV • Reduced transmission of HIV • Reduced prevalence of undiagnosed HIV • Reduced stigma and prejudice associated with HIV (Specific outcomes are detailed in Part 7) 2. Scope

2.1 Service Description The service is to provide HIV Support and Prevention across Kirklees and Calderdale to meet the expected outcomes and service objectives.

2.2 Accessibility/acceptability The service will: • Offer a choice of access points such as drop-in groups, individual appointments, home and hospital visits (if appropriate), and out of hours sessions, e.g. evenings up until 9pm and Saturday mornings.

• Ensure the service is accessible to all people including people whose first language is not English, homeless and other marginalised people, people with a learning disability and people with a physical or disability or sensory impairment.

2.3 Whole System Relationships The Provider will: •

Be lead provider of HIV support and prevention services as part of an integrated network of providers offering sexual health services across Kirklees and Calderdale.

•

Develop relationships with statutory and voluntary agencies to promote and improve service uptake and to facilitate improved knowledge around HIV and issues affecting PLWH through 4

staff training and support.

•

Liaise with referring professionals and partner agencies to ensure best outcomes for service users.

•

Support the Commissioner in delivery of its duty (under The Health and Social Care Act 2001 Section 11) to make arrangements to involve and consult with clients and the public in the planning and organisation of services, by: - consulting with service users as required by the Act and assist the PCT in evidencing that all legislative responsibilities are met in this regard. This will include information and involvement with hard to engage groups, e.g. gay men, asylum seekers, sex workers, young people, etc.

- making appropriate use of User Representative panels to inform the development of the service and staff recruitment - Working with mystery shopper services and under-cover evaluation schemes as appropriate.

2.4 Interdependencies The HIV Support and Prevention Service is dependant on effective partnerships with and between commissioners and providers of other health, education and social care services.

Key partner services are: • • • • • •

Specialist HIV/GUM Services and HIV Specialist nurses Adult Social Care services including Carers Gateway Condom distribution services Children’s Services, Youth projects and young carers projects National policy, training and support for providers of HIV Support partnership organizations (e.g.

National AIDS Trust, African HIV Policy Network) Other providers offering sexual health services across Kirklees and Calderdale

•

GPs and other relevant primary care staff

•

Statutory and voluntary agencies, e.g. the police, housing, immigration services

•

Other professionals, agencies and sexual health support services.

2.5 Relevant Clinical Networks and Screening Programmes Engagement and partnership working with above partners through existing and developing local and national networks, e.g. West Yorkshire HIV clinical network, attendance at Calderdale Sexual Health Programme Board and NHS Kirklees equivalent.

2.6 Sub-contractors

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NONE

3. Service Delivery

3.1 Service Model The HIV Support & Prevention Service will be delivered in the most appropriate settings within Kirklees or Calderdale (see Appendix 1 for prevalence maps) by the most appropriate staff member to meet service user’s need. Services will be provided to compliment and enhance those provided by other local health and social care providers at a range of times from Monday to Saturday and available either by appointment or via regular “drop-in” sessions.

3.2 Service location and facilities The service premises must be compliant with access requirements of the Disability Discrimination Act 2005 and will have: • A welcoming reception area with scope to offer personal information in privacy • Clear signposting to services offering child friendly and disabled access • Security measures for staff and patient safety and protection • Private therapy and interview rooms, sound proofed to the appropriate level • Waiting areas should provide leaflets, magazines and toys, and have seating arrangements to allow service user privacy if desired.

• A secure records room compliant with data protection legislation.

• Male, female and accessible toilets.

• A staff room/seminar room for education and training • Suitable storage areas for information and resources.

• Suitable food and drink preparation areas to provide for drop-ins and meetings.

3.3 Information requirements The Service must collect service user information as follows: Postcode, age, gender, ethnicity, sexuality and presenting issue. Where possible, country of origin and length of time in the country should be collected to capture migration patterns.

The provider must also supply data on number of people unwilling to provide any of the above information. Information storage must comply with data protection and records management procedures Full quarterly reporting requirements are set out in Sections 7 and 8 of this document.

3.4 Safeguarding requirements The Service will adhere to local and national policies and procedures relating to safeguarding. Workers should know what to do if they suspect abuse and what action to take appropriate to their level. All staff within the service will undertake appropriate training and engage in child/adult protection supervision 6

in line with current policy. All staff working with children and vulnerable adults will have undertaken an enhanced Criminal Records Bureau check.

National Policy Driver; • Children Act 2004 • Working Together to Safeguard Children 2006 • NiCE GUIDANCE; When to suspect Child Maltreatment 2009 • NSF’S Local Policy Drivers; • West Yorkshire Multiagency Child Protection Procedures • Kirklees Safeguarding Adult Procedures 3.5 Service Staff Qualifications, Experience and Skills Required The Service Manager needs to be suitably qualified, have excellent leadership skills and a proven record of service delivery and development. They will need experience of managing both a diverse staff team and vulnerable service users.

The staff team need appropriate experience and understanding of the specific needs of PLWH or a similar complex client group. Staff should be able to deliver services appropriate to individual needs of service users. The service would benefit from a staff team reflecting similar backgrounds to the main service user groups.

The staff team should have a mixture of skills and experience to enhance working with PLWH and people considered at risk of acquiring HIV e.g. direct experience of supporting people living with HIV, working on health promotion initiatives with MSM and/or African communities. Staff must be prepared to work flexible hours to include some evening and weekend work. All staff should have regular supervision and an annual appraisal with the manager of the service. The service must provide staff with the training necessary to develop appropriate levels of expertise.

The Service Provider will ensure that the supervision and oversight provided to the Manager of the service is from a suitably qualified and experienced person.

Sta Staff Selection The Service Provider will: • • • •

have clear written recruitment and selection procedures which comply with equal opportunity law. prepare person specifications and job descriptions that reflect the requirements of all posts. have a thorough system of screening prospective staff and check experience and character via a written job application. undertake an enhanced criminal records bureau (CRB) check of staff it wishes to employ and 7

• • • •

other people (e.g. volunteers) that interact with young people and vulnerable adults. take up and check two references, one of which must be the current or last employer (if unemployed). verify identity of prospective staff to comply with the Asylum and Immigration Act 1996 (birth certificates or passport) prior to taking up post. ensure that the team profile includes the necessary range of competencies, gender and ethnic mix to support service users. retain full recruitment and selection records and make them available for inspection if required.

The Service Provider shall not employ staff without first obtaining the contract manager’s consent (not to be unreasonably withheld) in circumstances where they: • • •

Have a conviction for a previous offence.

Have previously resigned dismissed from employment.

Are unable to provide a satisfactory reference from their last employer.

Staff Induction Thorough induction training will be provided prior to the commencement of duties.

A record of participation and competency shall be maintained and will be available on request to the contract manager.

The Induction programme will include all of the policies and procedures of the Service Provider.

Workers competency in the areas covered by Induction Training will be assessed prior to commencing duties.

Staff Records The Service Provider shall maintain records for each employee containing application forms, interview notes, references, grievances and disciplinary records and a record of all training given. Induction record, supervision and appraisal notes shall also be contained within the file.

Staff Development and Training All staff are provided with a clear job description detailing their duties, tasks and required competencies. In addition to induction training, all staff will be given development and training opportunities to support service delivery and personal development.

Supervision and Appraisal Appropriate supervision and appraisal processes should be in place and use evidenced.

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4. Referral, Access and Acceptance Criteria 4. Referral, Access and Acceptance Criteria 4.1 Geographic coverage/boundaries - Kirklees & Calderdale Districts 4.2 Availability and Access to Services – Services must be suitable, accessible and appropriate for all potential service users, including cultural and linguistic competence. Services are to be located across the districts to ensure they can be accessed by maximum number of potential service users and be available outside of “normal working hours” to provide for service users engaged in full-time employment or education.

4.3 Referral Criteria & Sources - The support services detailed in this specification will be available to people living with and/or affected by HIV/AIDS registered with a Kirklees or Calderdale GP or resident in Kirklees or Calderdale. Referral pathways are to be agreed with partner organisations, e.g. GUM, midwifery, social services.

4.4 Exclusion Criteria – The service is available to those listed above, i.e. Kirklees and Calderdale residents. The service has the right to exclude service users who have demonstrated unacceptable behaviour which compromises the safety of staff and/or other service users.

4.5 Response time and prioritisation – there is to be recorded evidence of a minimum of 2 attempts to contact 100% of new referrals within 2 working days by an appropriate member of staff. Initial contact must be followed up within 3 working days unless contact is refused.

5. Discharge Criteria & Planning

Initial assessment of service user need will determine level of intervention and development of an individual care plan. This will be reviewed at appropriate intervals.

Drop-in services are available for all registered service users for as long as required unless exclusion criteria apply.

6. Self-Care and Patient and Carer Information

The service ensures that a suitable HIV self-care programme is available locally and contributes to the running of the programme and that the programme can be accessed by all PLWH and those newly diagnosed. Patient and carer information is to be available in a range of formats and community languages as appropriate to the client group.

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7. OBJECTIVES

OUTCOMES PLWH receive short-term, evidence based individual support at key points of their condition.

A comprehensive, accessible and needs led service is provided for all PLWH and those who support and care for them.

PLWH receive culturally appropriate, evidence based and accessible longterm group support.

PLWH know how and where to access HIV support services that are consistent with their diverse needs.

Staff are confident & competent to deliver support services to PLWA.

Children and young people (C&YP) living with or affected by HIV have access to child/youth appropriate support.

Threshold

50% of identified HIV positive people are or have been in contact with the service.

The service will develop effective outcome measures jointly with commissioners to demonstrate how individuals’ own health and well being has changed in the course of their participation in the Service within three months of service provision.

Method of Measurement

Consequence Breach

Quarterly report: Activity reporting as per Part 8 Analysis of any new or emerging trends among service users.

Detail of service user involvement in service development.

Include qualitative feedback from service users.

Contract review meeting

Record of internal & external training and development attended by staff team.

C&YP affected by HIV receive effective, youth appropriate, evidence based support services.

C&YP are supported through the transition to adult services.

60% of identified positive young people are in contact with the service and have been offered individual or group support.

Quarterly report: Activity reporting as per Part 8

C&YP living with HIV and their families/carers know how and where to access HIV support services that are consistent with their diverse needs.

All parents/carers of young people living with or affected by HIV have been offered support.

Analysis of any new or emerging trends among C&YP.

Contract review meeting

Detail of C&YPs involvement in service development, include qualitative feedback.

Specific details of partnership working with education, social care and health and other

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of

Access to education, training and employment opportunities is increased.

Links and care pathways are developed with other sexual health services and wider health and social care services to ensure a person centred approach to care is taken with appropriate and timely referrals.

services.

The service providers are networked with and informed about other relevant services operating across the districts.

Quarterly report: Details of meetings held and participation, detail of other partnership and networking approaches used.

A directory of local services is available for staff and service users.

Information disseminated.

Service users experience seamless transition between partner agencies and receive care from the most appropriate services.

Access to mainstream health and social care services for people living with HIV is increased and improved.

Service users have access to mainstream services, e.g. primary and non HIV specific health care, social care, housing, benefits, training and employment advice

Deliver a wide range of health promotion activities in a variety of settings

People diagnosed with HIV receive support to effectively self manage their health.

Contract review meeting

Up to date resource directory.

Lessons learnt that can be used for service improvement.

Details of agreed care pathways currently available

Quarterly report: Numbers requiring support to access mainstream services and any issues arising.

Contract review meeting

No. of referrals to health and social care services

Quarterly report provides: (including demographic data where appropriate) Numbers attending

Contract review meeting

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PLWH are able to negotiate safe sexual relationships, manage disclosure and know how and where to access PEPSE.

and promote selfmanagement to improve physical and emotion health and wellbeing of PLWH and reduce onward Eligible PLWH transmission report better quality of life and wellbeing through access to complementary therapies and mental health service.

HIV positive women, and couples affected by HIV, considering pregnancy can access advice and support on safe conception.

Undertake health needs assessment (HNA) with PLWH to complement the work of the PCT in achieving modernised service provision

HIV positive women are supported through pregnancy and infant feeding to reduce risk of mother to child transmission of HIV PLWH inform service providers and commissioners of their health needs and feel engaged in the service development process.

Deliver targeted support and intervention work with individuals &

Organisations and services engaged with MSM and African

self-care programme.

Number of service users attending empowerment training or workshop sessions.

Number of service users accessing complementary therapies and mental health services.

Number of women / couples supported.

Number of women/families supported during pregnancy, accessing formula milk and financial support. Number of group support sessions and attendance.

Report findings of HNA and suggest action plan from findings through providercommissioner reporting meetings.

Contract review meeting

Quarterly report: Details of agencies/venues worked with and

Contract review meeting

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groups identified as most at risk of acquiring HIV to reduce the number of new transmissions, i.e.

MSM/African communities, and improve local knowledge of the availability of PEPSE and encourage appropriate uptake.

Communities & individuals from these groups have accurate information on HIV, it’s transmission, local testing facilities and PEPSE. Free condoms and safer sex advice are available to MSM & people from African Communities & at services and venues accessed by MSM and African Communities.

MSM and African community organisations and individuals from these population groups are aware of PEPSE and it’s local availability

Work with statutory and voluntary sector organisations to increase access and uptake of HIV testing and develop services which reduce the prevalence of undiagnosed HIV.

Provide advice, support and training to service

approaches used.

Number of people accessing advice and number of condoms distributed by venue. Report feedback from service users and the public, e.g. changes in attitude towards condom use, brands of condoms supplied, public safety concerns.

Events attended and community feedback gathered.

Numbers referred for PEPSE and feedback from service users who have accessed PEPSE via local hospitals.

People from MSM and African Communities know how to access HIV testing locally.

Quarterly Report: Details of agencies/venues worked with and approaches used.

People from MSM and African Communities realise and acknowledge their risk of acquiring HIV.

Types of campaigns/awarene ss delivered, including routes of delivery, resource distributed and community feedback.

PLWH feel comfortable with their diagnosis and

Provide service user feedback on preferred/ most acceptable location for HIV testing.

Quarterly Report: Number of volunteer staff recruited and

Contract review meeting

Contract review meeting

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are supported to become advocates, peer supporters or positive speakers if they desire. users, statutory and voluntary service providers and the public to improve knowledge around HIV infection, reduce the stigma associated with HIV and ensure services are nondiscriminatory and appropriate for HIV positive people.

Providers of health and social care services can access peer support and training to ensure the services they provide are nondiscriminatory and appropriate for PLWH. Members of the public can access accurate information about HIV and issues affecting PLWH. Policy makers are challenged to address discrimination against PLWH.

Additional Measures for Block Contracts:Staff turnover Turnover rates by rates N/A in Year 1 staff group Sickness levels Contacts per FTE

trained - include demographic data.

Any issues arising or support needs within volunteer staff.

Number and content of informal peer support or training sessions provided to other services.

Number attending training, profession and organisation represented.

Report public information provided and campaigns/ awareness activities delivered - Where possible record appropriate demographics of the targeted population or setting.

Report lobbying activity and outcomes.

Quarterly report

N/A in Year 1

By staff group

N/A in Year 1

Quarterly report

N/A in Year 1

By location

N/A in Year 1

Quarterly report

N/A in Year 1

8. Activity Activity Performance Indicators The numbers and sources of referrals by service

Threshold

Method of measurement

Consequence of breach

Referral point known for all new service users.

Quarterly report

Contract review meeting

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(include self referral) Number of adults accessing service for individual support include demographic data, any specific access needs (see section 2.2) and reason for requiring support.

Number of carers and type of support provided

60% of identified HIV positive adults are or have been in contact with the service.

Quarterly Report

Contract review meeting

Quarterly Report

Contract review meeting

Carers of PLWH have been identified, given information and offered support

Number and type of group sessions and numbers participating (include demographic data).

Numbers of people supported in other ways (e.g. family work, telephone/web/electronic) Number of C&YP accessing service for individual support include demographic data, any specific access needs(see Section 2.2) and reason for requiring support.

Number of parents/carers supported and support provided.

60% of identified HIV positive young people are in contact with the service and have been offered individual or group support.

All parents/carers of young people living with or affected by HIV have been identified, given information and offered support.

Number and type of group sessions and numbers participating (include demographic data).

Numbers of C&YP supported in other ways (e.g. family work, telephone/web/electronic

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Activity Plan: Activity is based on current activity of HIV support services 2008-09. Annual staged activity levels will be agreed with the service provider.

9. Continual Service Improvement Plan To be addressed via user satisfaction surveys, access statistics and review of activity figures. A review between Commissioner and Provider to take place monthly in the first 6 months of this contract and quarterly thereafter by agreement to result in an agreed Continual Service Improvement Plan.

10. Prices & Costs

10.1 Price Basis of Contract

Unit of Measurement

Price

Thresholds

Expected Annual Contract Value

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Appendix 1 Mapping of HIV cases accessing care by postal district of residence Calderdale PCT

Kirklees PCT

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