Stakeholder Engagement Report - London Councils

Key Issues
Commissioning Experience
The commissioning of HIV prevention was perceived by some stakeholders to be
contentious, and concerns were raised as to the variance in commissioning expertise,
and how individual Local Authorities see the priority. There was an overall sense that
commissioning responsibilities had yet to “bed down and really take hold in their new
home of local authorities”.
The shift to ever-smaller areas had not been seen to support London wide initiatives
and the necessary innovation and creativeness required to deliver HIV prevention models
appropriate to Londoners’ needs.
There was some concern expressed that there was little incentive for Local Authorities
to prioritise HIV prevention as they will not be responsible for the lifetime drug costs for
those living with HIV, as HIV treatment and care costs lie with NHS England.
There was also a sense that present commissioners were “too reliant on the perceived
wisdom of current providers”, and that this needs to be addressed to reassure providers
that there will be strong accountability for decision making and governance arrangements.
Stakeholders agreed that commissioners should be clearly defining their expectations,
defining excellence and settling the parameters for the providers. This will rely on
excellent communication channels.
Stakeholders called for an iterative commissioning process to be introduced for London
with major opportunities to commission appropriately across the broad range of public
health interventions, tailored to support individuals with their lifestyle challenges and
choices - including and not exclusively for HIV.
Service Level Agreements (SLAs),Contracts
and Tendering
“Can we stop the tail wagging the dog please?”
Comments on the present situation regarding SLAs raised a number of issues for
stakeholders. These concerns included the following:
• Present SLAs are not deemed to be flexible enough.
• Some provider stakeholders are concerned that forced levels of delivery
promises set within SLAs often persuade commissioners to fund the
‘bigger players’, and invite bids on discrete areas with no capacity to
develop joint work or to encourage partnership approaches.
• Competitive funding/bidding arrangements are viewed as problematic as
partnerships with and between providers are ‘set up to fail’ as a result of the
bidding/tendering process. It is widely acknowledged that there has been more
success recently with HPE, but the DH and not Local Authorities fund this.
• There was a plea from stakeholders that all Local Authorities examine carefully
the local contracts they have with smaller organisations and ensure that any
specifically targeted work is well co-ordinated with that of the bigger players.
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