ADD2664 Mayor’s Six Tests Assessments 2023-24

1.1.    The Mayor has committed to championing and challenging the NHS on behalf of all Londoners, as part of his ambition for London to be the healthiest global city and to tackle health inequalities. This has been identified as a mayoral priority.
1.2.    In 2017, in response to a report commissioned by the Mayor into London’s five Sustainability and Transformation Plans (approved under ADD2067), he announced six ‘tests’ he expected to be met before he gave his support to any major health and care transformation or hospital reconfiguration proposals in London. These tests cover:
•    health and healthcare inequalities 
•    hospital-bed capacity 
•    financial investment and savings 
•    impact on social care 
•    clinical support 
•    patient and public engagement. 
1.3.    This ADD is seeking approval to procure expert external consultancy services, up to the value of £49,995, to prepare assessments of up to two upcoming NHS proposals to reconfigure healthcare services against the Mayor’s six tests. The proposals in question are yet to be confirmed by the NHS, but are expected to go to public consultation in September 2023 and October 2023 respectively.   
1.4.    The following decisions have previously been agreed for expenditure to assess major hospital reconfigurations against the Mayor’s six tests:
•    ADD2408: approval for expenditure of up to £20,000 
•    MD2799: approval for expenditure of up to £60,000
•    ADD2608: approval for expenditure of up to £15,000 
•    ADD2647: approval for expenditure of up to £25,000.
 

2.1.    The overall objective is to provide the Mayor with systematic, objective and independent assessments of up to two proposed major NHS service change proposals against his six tests. This will enable the Mayor to determine the extent to which the six tests have been met and to identify where he would like to see changes and improvements to schemes in order for them to better meet the six tests. On this basis, the Mayor will seek to influence the development of these service changes to ensure that they are in the best interests of all Londoners and help to tackle health inequalities. 
2.2.    The assessments conducted by the consultants will highlight positive evidence towards the tests being met, as well as areas where there is a lack of evidence of the tests being met. They will also critically assess key assumptions on which the proposals are based; and highlight any areas in need of further development or challenge. 
2.3.    In both cases, the assessment will form part of an overall briefing for the Mayor to inform his response to the proposed service change. In each case, the Mayor’s response, which will refer to the assessment, will be published on the GLA website. The Mayor’s response will be expected to result in positive changes being made to the proposed service changes, so that they better meet the needs of Londoners and tackle health inequalities.
 

3.1.    Reducing health inequalities underpins most of the health and wellbeing team’s work, including the Mayor’s six tests. Health inequalities are differences in health that are unnecessary, avoidable, unjust and unfair. They often disadvantage groups of people with protected characteristics; people who experience poverty; and people who experience socioeconomic deprivation.
3.2.    Assessments against the Mayor’s six tests include a specific focus on reducing health and healthcare inequalities. The first test  specifically aims to ensure that proposals make the most of every opportunity to reduce health and healthcare inequalities; and that they set out an evidenced plan for further action. The assessments will enable the Mayor to champion and challenge the NHS accordingly. 
3.3.    This work aligns with the Mayor’s Equality, Diversity and Inclusion Strategy Objectives (2022). It particularly aligns with objective 12, which commits to address the reasons for health inequalities that cause some groups to experience poorer physical and mental health outcomes.
 

4.1.    The procurement of consultants will be in accordance with the GLA’s Contracts and Funding Code. 
Risks and issues 
4.2.    The timetable for the six-tests assessments are determined by the timelines of different NHS teams and organisations. This presents the risk that, if the NHS timelines are delayed, the timelines for the assessments will also be delayed. In mitigation, officers will ensure that consultants bidding for the contracts to conduct the assessments are aware of this risk, and can build appropriate flexibility into their delivery timelines. It also presents the risk that several assessments will need to run concurrently, which will require identifying several different expert providers for delivery. In mitigation, officers will build on market cultivation undertaken in spring 2023 to ensure a sufficient level of provider market interest in bidding for the contracts.
Links to Mayoral strategies and priorities
4.3.    This work contributes to the Mayor’s Health Inequalities Strategy, which sets out plans to tackle unfair differences in health to make London a healthier, fairer city. Applying the six tests to two major health service changes will promote the implementation of the Health Inequalities Strategy by helping to address London’s health inequalities, and to reduce the number of years Londoners live in poor health. 
4.4.    There are no conflicts of interest to note for any of the officers involved in the drafting or clearance of this decision form.
 

5.1.    Approval is sought for the expenditure of up to £49,995 to procure expert consultancy services, which will provide independent assessments of up to two proposals to change healthcare services against the Mayor’s six tests.
5.2.    The expenditure of £49,995 will be funded from the following programme budgets; £30,000 from the Mayor’s six test programme budget and £19,995 from the Early Years budget. 
5.3.    This is in line with the approved budget allocations for 2023-24 financial year.

5.4.    Based on the timeline below, some of this expenditure will fall into next financial year 2024-25. The relevant amount would be accrued into the following financial year subject to budget being available.
 

6.1.    The schedule for the first six-tests assessment is as follows:

6.2.    The schedule for the second six-tests assessment is as follows: