MD2799 Interim Health programme funding for 2021/22

Strategic policy context for Health Team’s work programme

1.1 The GLA Health Team leads the implementation of the Mayor’s ten-year London Health Inequalities Strategy (HIS) 2018-28 (published October 2018) with relevant partners and stakeholders, and supports his leadership role as chair of the London Health Board. The vision and aims of this approach are:

• healthy children – every London child has a healthy start in life;

• healthy minds – all Londoners share in a city with the best mental health in the world;

• healthy places – all Londoners benefit from an environment and economy that promotes good mental and physical health;

• healthy communities – all of London’s diverse communities are healthy and thriving;

• healthy living – the healthy choice is the easy choice for all Londoners; and

• supporting the Mayor’s leadership role for health.



1.2 COVID-19 has had a significant impact on London’s health inequalities, and the Health Team have been reviewing work programmes throughout the last year to ensure that work is targeting on the ongoing and emerging needs of Londoners. The HIS provides an evidence-based framework for tackling health inequalities, and as a statutory strategy will be reviewed in due course, including updating the evidence base.

1.3 Health and social care services also play a key role in Londoners’ health and health inequalities. The Health Team supports the Mayor’s role to champion and challenge the health and social care system in London. One of the key ways in which the Mayor fulfils this role is through the application of his six tests – covering health inequalities, hospital beds, financial investment, social care impact, clinical support and patient and public engagement – to major health and care transformation and reconfiguration programmes in London.

1.4 In October 2019 the London health and care partnership, which includes the GLA alongside Public Health England (PHE), the NHS and London Councils, jointly published ‘Our Vision for London: The next steps on our journey to becoming the healthiest global city’ (the Vision). The Vision focuses on ten ambitions where partnership action is needed at a pan-London level to achieve change, and four ‘enablers’: workforce recruitment and retention, digital innovation, maximising the contribution of health and care estates, and health and care service integration.

1.5 The London Recovery Programme has been established in response to the impact of the COVID-19 pandemic, to address the following grand recovery challenge for London: to restore confidence in the city, minimise the impact of COVID-19 on communities and build back the city’s economy and society. The programme has established nine recovery missions, two of which focus explicitly on health:

• Mental Health & Wellbeing: by 2025 London will have a quarter of a million wellbeing ambassadors, supporting Londoners where they live, work and play; and

• Healthy Food, Healthy Weight: by 2025 every Londoner lives in a healthy food neighbourhood.

1.6 The health recovery missions are structured to amplify and expedite action on the ambitions of the Vision and Health Inequalities Strategy, particularly in prioritising improvements to Londoners’ mental health & wellbeing, and supporting Londoners to achieve a healthy weight. Additionally, the health and wellbeing cross-cutting principle aims to ensure all nine recovery missions have a positive impact on health and wellbeing, helping to tackle health inequalities and enhancing action on the Vision’s ten areas of focus.

1.7 In line with the wider GLA budget setting process, the GLA Health Team is in the process of developing its overall programme of work for 2021/22, taking into account the strategic policy context set out above. This will be the subject of a future MD.

Approvals sought within this Mayoral Decision



1.8 There are a small number of ongoing programmes of work, linked to the strategic priorities set out above, which need to continue alongside the process to develop the Health Team’s overall work programme. This MD seeks approvals to deliver these programmes of work during the early part of 2021/22, to enable flexibility after the Mayoral election. The table below gives a breakdown of these programmes, together with the rationale for expediting their approval:

1.9 Expenditure will take the form of grant awards or contracts for services which will be procured depending on the nature of the work concerned and in line with relevant GLA procedures including the GLA’s Contracts and Funding Code. These arrangements are set out within the paragraphs in section 2.

London health and care partnership

2.1 Purpose of funding: This proposal represents the GLA's contribution to London’s health and care partnership and will be made as a grant payment. The pooled partnership budget for 2021/22, of which the GLA contribution forms a part, is £650k (with other contributions from NHS London, London Councils, and the London Clinical Commissioning Groups (CCGs)). It is a key priority for all partners and planned expenditure is agreed jointly by the leaders of the partnership organisations (the Chief Officer is the GLA representative). The London Health and Care Vision was developed collaboratively over a long period with partners from the health and care system (NHS, London Councils, Public Health England) and was published in 2019. Since COVID-19 the London Health and Care Vision has been revisited and refined to reflect pandemic circumstances, and agreement has been reached that recovery work must be action-focused and reinforce existing priorities including the London Health and Care Vision and the London Health Inequalities Strategy and be ‘efficient’ (i.e., avoid reinventing the wheel, providing a ‘single narrative’ for the whole system).

2.2. Expected deliverables/outcomes: The focus of the proposal is on building capacity in neighbourhoods and communities to address London Recovery priorities, through the Vision signatory organisations – the GLA, NHS London, London Councils and Public Health England’s London Region. This is an ongoing programme of work, which uses the Vision as a framework for investment, while responding to impact of the pandemic. As a collaborative partnership process, the final design of deliverables will be a collective decision, but initial action is focusing on interventions that support the Recovery Programme’s ambitions, which also reinforce the ambitions of the Vision. This will ensure comprehensive interlinks between the work of the London Health and Care Vision and the health recovery missions.

2.3 This proposal represents the GLA's contribution to London’s health and care partnership recovery work. Planned expenditure has not yet been finalised for 2021/2 but is likely to include:

• funding for mental health initiatives (such as Thrive LDN and Good Thinking) for further specific COVID-19 response support including responding to requirements of the Strategic Coordination Group;

• support for initiatives led by the Health Equity Group, a sub-group of the London Health Board: this could include further capacity building within system partners and local government to reduce health inequalities; and working with anchor institutions – large organisations with strong roots in local places that can achieve social benefits through e.g. their procurement, workforce and buildings - to support local communities; and to become exemplars; and

• continuing to support development of the ‘Health Deal’ with partners from the health and care system to progress shared objectives to better enable greater partnership working – particularly between the NHS and local government – to underpin the delivery of the London Vision, the London Recovery Board’s missions and to support health and social care integration across the capital.

2.4 Previous approvals: MD2704 approved the same level of expenditure for the pooled partnership budget in 2020/21.

Dementia Friendly London – Alzheimer’s Society

2.5 Purpose of funding: To support delivery of the Dementia Friendly London programme. The current grant agreement with the Alzheimer’s Society will be varied to extend delivery by 12 months to end March 2022 which will enable them to provide ongoing expert advice and insight, access to research and design and deliver processes to enable people affected by dementia (people with the illness and their family and carers) and to support the GLA and partners to take action. The funding will also provide capacity to manage the governance structures and communications support to raise awareness of the issues facing people with dementia in the light of COVID-19.

2.6 Expected deliverables/outcomes:

• policy and strategy development and alignment with the London Health and Care Vision and London Recovery Board;

• coordination and support for the Dementia Friendly London ‘Executive Board’ comprised of senior leaders from key organisations across London which provides leadership and oversight;

• coordination and support of the ‘People’s Panel’, a group of people living with dementia whose role is to put people with dementia at the heart of the programme;

• communication and engagement, in particular London-action to promote Dementia Action Week (17-23 May) and World Alzheimer’s Day (21 Sept);

• support the GLA Chief Officer in her role as Mayor’s Dementia Champion for the GLA Group and support Peer Outreach Workers to roll out Dementia Friends across the GLA; and

• support and advise partners on their action plans.

2.7 Previous approvals: DD2479 approved expenditure of £70,000 in the form of grant funding to Alzheimer’s Society to enable the support and delivery of the Dementia Friendly London programme in 2020/21.

Mayor’s six tests

2.8 Purpose of funding: The Mayor has established six tests that he expects to be met before offering his support to any major health and care transformation or reconfiguration programmes in London The six tests are an important way in which the Mayor champions and challenges the NHS to consider health inequalities, bed capacity, financial sustainability, impact on adult social care, clinical support and patient and public engagement. The money is used to commission expert external organisations to complete a review of proposed reconfiguration programmes against the Mayor’s six tests to enable the Mayor to make a decision as to whether to support or challenge the proposals.

2.9 Expected deliverables/outcomes: Systematic, objective and independent assessments of up to four individual major hospital reconfigurations against the Mayor’s six tests during the course of 2021/22, subject to NHS timetables. Funding will be used to procure external analytical support, in line with relevant GLA procedures including the GLA’s Contracts and Funding Code.

2.10 Previous approvals: Previously, funding for review of major NHS reconfiguration and transformation programmes against the Mayor’s six tests was agreed in the following decision documents: DD2428, ADD2408 and MD2688. DD2428 (December 2019) gave approval for expenditure of up to £50,000 for analysis of London’s Sustainability and Transformation Partnership plan against the principles of the Mayor’s six tests. ADD2408 (December 2019) gave approval for expenditure of up to £20,000 to assess major hospital reconfiguration proposals against the six tests. MD26688 (September 2020) gave approval to spend up to £60,000 to assess major hospital reconfiguration proposals against the six tests and up to £15,000 to augment the existing approval for analysis of London’s Sustainability and Transformation Partnership plans against the principles of the Mayor’s six tests. In addition MD2704 approved £20,000 to commission an external review and refresh of the six tests in light of recent reports on the disproportionate impact of COVID-19.

Communications support for London Child Obesity Taskforce

2.11 Purpose of funding: To provide the Taskforce with ongoing external specialist communications support by requesting an exemption from the GLA Contracts & Funding Code in order to extend the contract for services with Vidal-Read Communications Ltd with the ultimate aim of championing good work relating to the 10 ambitions outlined in ‘Every Child a Healthy Weight’ (published September 2019), galvanising support across the system, inspiring action and keeping partners informed of taskforce work and priorities. The Taskforce is currently exploring a range of options for specific communications including:

• best practice case studies developed with London boroughs;

• emerging research from partners anchoring progress and challenges in the current context;

• weaving in the ‘child's voice’ and championing the child centred approach;

• utilisation taskforce assets including videos and research; and

• updates on taskforce- and partner-led projects focusing on child obesity and healthy weight.

2.12 An exemption is requested from the requirements under section 10 of the Contracts and Funding Code on the grounds that continuation of the existing work cannot be separated from the proposal outlined above. The original contract was let following a short tender process and the continued expertise, skills, knowledge of GLA systems and processes, and pre-existing, effective working relationships with the taskforce members is essential to provide consistency in this work. The costs are comparable to equivalent work commissioned by the Health Team from other suppliers in recent months and years.

2.13 Expected deliverables/outcomes: During April 2021 and May 2021 the communications lead will develop a communications and engagement strategy for the Taskforce for the remainder of its appointment, which finishes in November 2021. The lead will also prepare some communications materials drawn from the list of potential options in paragraph 2.9 in readiness for early publication early in 2021/22 (post-Mayoral election) via social media and digital platforms, utilising the Taskforce’s Medium blog site, Twitter page, Members’ LinkedIn networks, Taskforce newsletter and partner organisations’ press teams and communications colleagues.

2.14 Previous approvals: MD2222 approved expenditure of funding received from Guy’s and St Thomas’s Trust Charity and GLA funding on staffing and non-staffing costs associated with London’s Childhood Obesity Taskforce and the secretariat that supports it over 2018-2020.

London Plus – the voluntary and community sector (VCS) social prescribing network

2.15 Purpose of funding: The network was set up in 2020 and has been running for almost a year. The purpose of this funding is to enable the continuation of the network, through extending the contract for services with London Plus where the network coordinator role is located. The establishment of the network to support the social prescribing work programme was outlined in DD2419. The proposed amount for the year is £33,000, and this request is for the first instalment (covering Q1 Apr-Jun). Activity in year one of the network included: bringing in the post, promotion, arranging a series of webinars, publishing case studies and blog posts, a new web page etc. The network has increased VCSE status in social prescribing in London, with the network coordinator sitting on all major London social prescribing forums and some national forums. The membership and the influence of the network continues to increase. The network is an enabler for a number of missions, being as it brings together the voices of the VCSE sector, but is particularly relevant to the communities mission and mental health and wellbeing mission.

2.16 An exemption is requested from the requirements under section 10 of the Contracts and Funding Code on the grounds that the supplier has had previous involvement in the current project and where the work proposed cannot be separated from the new work. London Plus have already established the VCSE Social prescribing network. This proposal is a continuation of that project. If another contractor was brought in to deliver the extension to the existing network, it would most likely cause delays in delivery and implementation of the project.



2.17 London Plus is the main organisation within the capital who support Civil Society organisations to connect better, share learning and to collectively use their voices to influence and change policy. They work across Community Voluntary Service (CVS) organisations that exist within London Boroughs as well as other civil society groups. They are also playing a strategic role across London supporting VCSE and civil society in the Transition and Recovery activity.



2.18 Therefore, based on our knowledge of social prescribing mechanisms and the pan-London social prescribing support activity (networks and forums), we believe London Plus is the only organisation with the necessary reputation, specialist skills and experience needed to undertake this work. We consider it is unlikely that any other supplier would be able to submit a more economically advantageous tender than London Plus.

2.19 Expected deliverables/outcomes: A VCS social prescribing network.

2.20 Previous approvals: DD2419 approved expenditure for the establishment of the network, and MD26888 agreed a variation to that expenditure.

Sustain – Local Authority High Fat, Sugar, Salt (HFSS) advertising ban toolkit

2.21 Purpose of funding: The GLA has an existing grant agreement with Sustain to prepare a draft toolkit to support Local Authorities to implement the HFSS advertising ban. This grant agreement will be extended by three months and the GLA will provide an additional £5000 to enable Sustain to finalise the toolkit and prepare and deliver a workshop for its launch early in 2021/22 (post-Mayoral election). This timing will align with the publication of external supporting reports from the London School of Hygiene and Tropical Medicine’s external policy review.

2.22 Expected deliverables/outcomes: A finalised toolkit and a plan for its launch at a workshop for Local Authorities.

2.23 Previous approvals: Underspend from the London Health Improvement Board (LHIB) budget was used to fund Sustain to develop the HFSS advertising ban toolkit during 2020/21 at a total cost of £30,000. LHIB funding for work on child obesity was approved under MD2439 and carried forward accordingly.

3.1 Under Section 149 of the Equality Act 2010, as a public authority, the GLA is subject to the public sector equality duty and must have due regard to the need to (i) eliminate unlawful discrimination, harassment and victimisation; (ii) advance equality of opportunity between people who share a relevant protected characteristic and those who do not; and (iii) foster good relations between people who share a relevant protected characteristic and those who do not. Protected characteristics under section 4 of the Equality Act are age, disability, gender re-assignment, pregnancy and maternity, race, religion or belief, sex, sex orientation, and marriage or civil partnership status (all except the last being “relevant” protected characteristics).

Key risks and issues:

Links to Mayoral strategies and priorities:

Consultations and impact assessments:

4.1 There are no known conflicts of interest to note for any of those involved in the drafting or clearance of this decision.

5.1 Approval is sought for expenditure of up to £298,000 on an Interim Health work programme for 2021/22. The breakdown of expenditure is as follows:

5.2 The total cost of £298,000 will be funded from the 2021/22 Health Team’s programme budget.

6.1 The foregoing sections of this report indicate that the decisions requested of the Mayor concern the exercise of the GLA’s general powers, falling within the statutory powers of the GLA to do such things as may be considered to be facilitative of or conducive or incidental to the promotion of economic and social development or the promotion of the improvement of the environment in Greater London; and in formulating the proposals in respect of which a decision is sought officers have complied with the GLA’s related statutory duties to:

(a) pay due regard to the principle that there should be equality of opportunity for all people;

(b) consider how the proposals will promote the improvement of health of persons, health inequalities between persons and to contribute towards the achievement of sustainable development in the United Kingdom; and

(c) consult with appropriate bodies.

6.2 In taking the decisions requested, the Mayor must have due regard to the Public Sector Equality Duty, namely the need to eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010, and to advance equality of opportunity and foster good relations between persons who share a relevant protected characteristic (race, disability, gender, age, sexual orientation, religion or belief, pregnancy and maternity and gender reassignment) and persons who do not (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to section 3 (above) of this report.

6.3 Any services required must be procured by Transport for London Commercial who will determine the detail of the procurement strategy to be adopted in accordance with the GLA’s Contracts and Funding Code. Officers must ensure that appropriate contract documentation is put in place and executed by the successful bidder(s) and the GLA before the commencement of the services.

6.4 Officers must ensure that any grant funding is distributed fairly, transparently, in accordance with the GLA’s equalities and in manner which affords value for money in accordance with the Contracts and Funding Code. Officers must ensure that an appropriate funding agreement is put in place between and executed by the GLA and recipient before any commitment to fund is made.

6.5 Part C of the Contract and Funding Code (the ‘Code’) requires the GLA to seeks a call-off from a suitable framework, where possible, or if not, undertake a formal tender process which will be managed by Transport for London in respect of the London Childhood Obesity Taskforce and Social Prescribing Network services. However, the Mayor may approve an exemption from this requirement under paragraph 10, Part C of the Code upon certain specified grounds. One of the grounds is the previous involvement in a specific current project or continuation of existing work that cannot be separated from the new project/work. Officers have indicated at paragraphs 2.12 and 2.16 of this report that this ground applies and that the proposed contracts affords value for money. On this basis, the Mayor may approve the proposed exemption if satisfied with the content of this report.

7.1 London health and care partnership:

7.2 Dementia Friendly London:

7.3 Mayor’s six tests:

*Timelines for the remaining three assessments is dependent on the NHS timetable for public consultations which is not known in advance.

7.4 Child Obesity Taskforce communications support:

7.5 Voluntary and Community Sector social prescribing network – London Plus:

7.6 Sustain – Local Authority High Fat, Sugar, Salt (HFSS) advertising ban toolkit: