Invitation to Tender (ITT) Evaluation of a pilot of the

Maternity Vulnerability Assessment Tool (MatVAT)

Lambeth Early Action Partnership (LEAP) is seeking an evaluation partner to design and deliver an evaluation of a pilot of the Maternity Vulnerability Assessment Tool (MatVAT) - a holistic tool to measure social vulnerability in pregnant women. MatVAT was developed by the award-winning, multi-disciplinary LEAP Health Team.

We will accept bids up to a maximum of £10,000 (inclusive of VAT and expenses).

Deadline for receipt of bids is: Friday 14th August 2020, 14:00.

We anticipate the pilot will run for 6 months, starting October 2020, with the pilot evaluation lasting up to 9 months, to include design, data collection, analysis and write-up.

Date: 21.07.2020Named procurement officer Carla StankeEmail address cstanke@ncb.org.ukName of contracting organisation

National Children’s Bureau

Postal address National Children’s Bureau, 23 Mentmore Terrace, London, E8 3PN

Deadline for receipt of bids 14th August 2020, 14:00

1. Overview of Lambeth Early Action Partnership (LEAP)

1.1 LEAP aims to transform the lives of babies and toddlers (aged 0-3) and their families in four Lambeth wards: Stockwell, Vassal, Coldharbour and Tulse Hill.

1.2 We are a 10-year initiative – currently in year 5 - set up with funding from The National Lottery Community Fund, as part of the Better Start initiative, and hosted by the National Children’s Bureau (NCB).

1.3 LEAP is an innovative partnership programme committed to transforming early years services in Lambeth. The partnership incorporates Lambeth Council, Lambeth Clinical Commissioning Group (CCG), Lambeth Public Health, King’s Health Partnership (KHP), King’s College Hospital Trust, Guys and St Thomas’ Hospital Trust, as well as local voluntary organisations, community groups, local parents and carers, babies and children, schools, nurseries, and statutory bodies.

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LEAP offers over 25 services and training for parents, their young children, and early years professionals and practitioners

1.4 LEAP uses a place-based, collective impact framework and approach to help us achieve our ultimate goals.

1.5 This means we bring together people and organisations to share information and work in mutually reinforcing ways to:

meet the unique needs of local children and families; and achieve our common goals of improving ECD and reducing inequalities within

and across our four wards.

1.6 The LEAP strategy can be found here.

1.7 Whilst the LEAP Partnership operates with a high level of autonomy, it is still accountable to the National Children’s Bureau as this is the National Lottery Community Fund’s nominated lead, falling under a single charity number (National Children’s Bureau 258825), a single registered company limited by guarantee (National Children’s Bureau 952717), and a single Board of Directors/Trustees.

2. Overview of LEAP’s approach to evaluation

LEAP has two main ambitions for our local evaluation. We want to track progress and demonstrate the impact of LEAP as a place-based, collective impact initiative and some of our individual services and initiatives.

2.1 This ITT covers an ad hoc evaluation of one of LEAP’s initiatives – the Maternity Vulnerability Assessment Tool (MatVAT).

3. Background to the maternity vulnerability assessment tool (MatVAT)

3.1 In 2017, LEAP created a multi-professional Health Team to directly contribute to the following LEAP shared outcomes:

More integrated early years provision for women and babies; and A shift in approach to early identification and intervention models (systems

change).

3.2 The LEAP Health Team is comprised of two midwives from local hospitals, a Lambeth Health Visitor, and a Lambeth GP (representatives of the primary care

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team who look after all pregnant women and their families), overseen by LEAP’s Public Health Specialist.

3.3 The LEAP Health Team won the 2018 RSM/CAIPE Prize for Interdisciplinary Team Working in primary Care, and the 2019 London Maternity & Midwifery Forum: Team Award, and was shortlisted for the 2019 Royal College of Midwives Award for Partnership Working, and the 2019 Institute of Health Visiting: Creating Integration in the Early Years Workforce e-poster.

3.4 The Health Team undertook a mapping and scoping exercise in 2017 – 18. One of the key findings was that different healthcare professions are using no or different tools to assess and measure social vulnerability across maternity and early years.

Profession Formal assessment tools/modelsGPs

Lambeth and Southwark safeguarding tier 1-4 threshold assessment tool (designed for children aged 0-18 years).

Social ServicesChildren's Centres

Health VisitorsHealthy Child Programme levels - Universal, Universal Partnership, Universal Partnership Plus (U, UP, UPP) (designed for children aged 0-5 years) – mapped against the 4-Tier thresholds.

Midwives

The Health Team found that although midwives are good at identifying safeguarding cases (Tier-4), very few midwives were aware of or using an existing vulnerability assessment tools (based on a poll of 12 NHS Trusts, 2 universities and 100 local midwives).

3.5 Identifying and assessing maternal vulnerability is important because it enables managers and practitioners to make timely and appropriate referrals, which benefits women and their families. It also allows them to quantify the complexity and needs of the populations they serve, which has resource implications.

3.6 For midwives, having no formal framework to assess maternal vulnerability means:

they can’t consistently identify lower levels of vulnerability (Tier 2-3); there are no clear referral pathways for care planning for mild-moderate

vulnerability; they have to rely on tacit knowledge which we describe as ‘gut instincts’ or

proxy measures (e.g., Index of Multiple Deprivation (IMD), ethnicity, age), to measure the vulnerability of their population

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they don’t have a shared language to discuss vulnerable women with other disciplines, leading to poor inter-professional communication around assessment and referral

managers cannot quantify the vulnerability (and hence the needs) of the population they care for.

3.7 For women, children and their families, having no formal framework to assess maternal vulnerability means they’re less likely to receive timely and appropriate preventative support.

3.8 To address this gap, the Health Team, in partnership with King’s College and Guy’s and St Thomas’ Hospital Trusts, designed and produced the Maternity Vulnerability Assessment Tool (MatVAT) in 2018/19 – a holistic tool to measure vulnerability in pregnant women and during the early postnatal period (see Appendix 2). A literature review to support this development can be found in Appendix 7.

3.9 MatVAT is a bespoke tool that complements and integrates other assessment tools (i.e. Lambeth and Southwark 4-Tier Safeguarding thresholds), and uses a structure familiar to other professionals to ease inter-professional communication and referral.

3.10 One of the main purposes of MatVAT is to support the care of women with ‘low-grade’ vulnerability who would benefit from preventative care and support. The onset of the Covid-19 pandemic, which has resulted in changed and in some cases reduced services for pregnant women, has made identifying those with complex social needs even more important in order to ensure that those most in need are offered support at a vital time of change. The MatVAT is currently being reviewed to ensure that it takes into account the needs of Black, Asian and ethnic minority (BAME) groups.

3.11 The MatVAT will support a holistic evaluation of pregnant women by midwives and other maternity professionals who will draw on a range of information sources, including GP- or self-referral form information, booking information, antenatal and postnatal assessments, and women or family disclosures.

3.12 The MatVAT is not intended to replace any standards or pathways for safeguarding, nor is it intended to replace clinical guidelines or clinical judgement. Rather, it is intended to enhance overall support and guide care provision.

3.13 MatVAT is expected to have benefits for a range of beneficiaries:

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Beneficiaries Desired outcomes

Women, children and their families

More consistent and accurate assessments of vulnerability.More timely and appropriate referrals to support services.More women feel that they are at the centre of care.

Maternity services

Improved quality of care (i.e. higher levels of support to vulnerable women who do not meet the threshold for safeguarding or perinatal services).Improved inter-professional communication.More managers effectively assessing and measuring the vulnerability of their population, and allocating appropriate resources.More midwives feel supported to effectively care-plan for women assessed as having mild-moderate levels of vulnerability.

Early years servicesImproved inter-professional communication.More timely and appropriate referrals received.Reduced long-term demand for acute services.

3.14 A working visual and narrative theory of change is included in Appendix 3 and Appendix 4, respectively.

3.15 As part of the consultation and approval process, the LEAP Health Team mapped the 4-levels included in the MatVAT to local services, to guide referrals. Part of this work included developing an easy-reference list of primary care practitioners to facilitate inter-professional communication.

3.16 See Appendix 6 for a diagram of the current systems for assessing vulnerability in primary care and maternity services and how the MatVAT would fit into this.

4. Scope of the evaluation

4.1 LEAP is seeking researchers or a research organisation to design, manage and conduct an evaluation of a multi-centre pilot of the MatVAT.

4.2 We are commissioning this evaluation to provide an understanding of the extent to which MatVAT is achieving its early desired outcomes, and to inform the ongoing design, implementation and potential roll-out of the MatVAT in participating and other NHS trusts, if appropriate.

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4.3 The MatVAT tool will be piloted in one or two teams in up to three NHS Foundation Trusts (King’s College, Guy’s and St Thomas’, and Chelsea and Westminster Hospital Trusts).

4.4 The successful bidder will be responsible for designing, managing and conducting the evaluation; analysing the findings; and producing clear and concise summary and full evaluation reports that synthesise the key findings.

4.5 We envisage the pilot of MatVAT will last approximately 6 months, with the pilot evaluation lasting 6 – 9 months. The two LEAP Health Team midwives will act as liaison between the research team and the Trusts, will provide training to the teams implementing the MatVAT and can support data collection where appropriate.

4.6 The LEAP Health Team have developed a draft design for the evaluation, but we want to work with the successful bidder to develop and agree specific key evaluation questions, based on the working MatVAT theory of change (see Appendix 3 and 4), and an evaluation framework. However, we are particularly interested in understanding the following:

Acceptability: To what extent do managers, midwives and other maternity professionals perceive the MatVAT as acceptable, and why?

Adoption: What uptake of MatVAT is achieved? What proportion of midwives and other maternity professionals routinely use MatVAT during the booking appointment? What influenced uptake?

Appropriateness: What is the perceived fit of MatVAT to address the identified problem, compared with current practice (i.e. no assessment tool), or other existing vulnerability assessment tools?

Cost: What is the financial and resource implications of implementing and using MatVAT?

Feasibility: To what extent is MatVAT successfully used in the participating trusts?

Fidelity: To what extent is MatVAT used as intended? How accurate are midwives’ evaluations of women’s vulnerability?

Sustainability: To what extent is use of MatVAT likely to be maintained across participating trusts?

What is the influence of different models of maternity care (i.e., traditional vs. case loading), on MatVAT’s implementation and impact?

How is the MatVAT tool communicated to midwives and other health professionals? And to what extent does this influence implementation outcomes and effectiveness?

In what way does the MatVAT fit in with service priorities in the context of the Covid-19 pandemic at a time of changes to maternity and support services?

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In what way does the MatVAT support providing enhanced care for BAME and other groups who have worse maternal and neonatal outcomes?

To what extent, if at all, are early outcomes achieved or not achieved, and what influenced this? For example:

o How, if at all, does the MatVAT affect inter-professional discussion and referral?

o To what extent do women move up and down the MatVAT levels (1-4) between their booking appointment and on discharge from maternity care?

Are there any negative outcomes or unexpected/unintended consequences associated with the implementation and use of MatVAT?

4.7 Although we will be guided by the successful bidder, we would like the successful bidder to use a range of quantitative and qualitative research methods – balancing rigour, validity and creativity - to answer the key evaluation questions, which might include: surveys; interviews with staff and managers; audits of referral practice; and review of the completeness and accuracy of maternity systems (i.e. Badgernet and other IT systems).

4.8 The successful bidder will need to work collaboratively with the LEAP Health Team and participating NHS Trusts on the final evaluation design, and to assess which data and information is necessary to be collected and analysed for the pilot evaluation. They will need to understand and utilise existing data that is being collected by midwives and other health professionals, as well as collect additional data to support the evaluation framework.

5. Expectations and deliverables

5.1 We require a research partner with experience of designing and conducting evaluations of innovative health or social care programmes, services or initiatives for children, parents and families, as well as the ability to write in a clear and concise way.

5.2 The successful bidder will have strong research expertise, and strong project management skills.

5.3 We are especially interested in suppliers with expertise and experience in the field of maternal and child health, and of designing and conducting evaluations of vulnerability/risk assessment or screening tools in a health or social care context, including applying for relevant ethical approval.

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5.4 Experience of designing and conducting developmental evaluations is desirable.

5.5 The successful bidder will be expected to meet with the LEAP Health Team at the outset to develop a deep understanding of MatVAT and its development (this can be a virtual meeting).

5.6 We want the successful bidder to write a clear and accessible summary and full evaluation report to be published on the LEAP website.

5.7 The evaluation will be thorough and high-quality, representing good value for money for LEAP. It will include:

- Executive summary- Introduction- Methodology- Findings by key evaluation questions- Conclusion and recommendations- Bibliography.

5.8 The successful bidder will be expected to attend relevant meetings with key stakeholders (which can be on an online platform) as necessary to provide updates on the evaluation, and to share findings and recommendations.

5.9 The successful bidder will also be required to work with the LEAP Health Team to write and submit an article for publication in an academic or trade journal. We will therefore be looking for bidders with experience of writing for peer-reviewed journals.

6. Budget

6.1 We will accept bids up to a maximum of £10,000 (inclusive of VAT and expenses).

7. Indicative timescale

7.1 Subject to any changes notified to potential suppliers by NCB in accordance with the Tender Conditions, the following timescales shall apply to this Procurement Process:

Activity Date

Invitation to Tender opens 21st July2020

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Last date for questions about the process 7th August 2020

Deadline for receipt of bids 14th August 2020 14:00

Internal panel meeting w/c 17th August 2020

Telephone interviews w/c 3rd September 2020

Notification of outcome 7th September 2020

Introductory session to commence work w/c 10th September 2020

Evaluation design and plan complete 28th September 2020

Ethics submission and training of midwifery teams

Early October 2020

Pilot launch Mid-end October 2020

8. How to apply

8.1 Suppliers should submit all documents required for this ITT to cstanke@ncb.org.ukby 14th August 2020, 14:00. Please indicate ‘Evaluation of the MatVAT pilot’ followed by your organisation name in the subject line.

8.2 In their tender applications, suppliers will be required to complete the application template providing answers to each of the questions. The weighting for each question is provided on the template. There is also a references template that must be completed and submitted with the application template.

8.3 The following requirements should be complied with when submitting your response to this ITT:

Please ensure that you send your submission in good time to prevent issues with technology – late tender responses may be rejected by NCB.

Please ensure that information provided as part of your response is of sufficient quality and detail that an informed assessment of it can be made by NCB.

Do not submit any additional supporting documentation with your ITT response except where specifically requested to do so as part of this ITT. PDF, JPG, PPT, Word and Excel formats can be used for any additional supporting documentation (other formats should not be used without the prior written approval of NCB).

All attachments/supporting documentation should be provided separately to your main tender response and clearly labelled to make it clear as to which part of your tender response it relates.

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If you submit a generic policy/document you must indicate the page and paragraph reference that is relevant to a particular part of your tender response.

Unless otherwise stated as part of this ITT, all tender responses should be in the format of the relevant NCB requirement with your response to that requirement inserted underneath.

Where supporting evidence is requested as ‘or equivalent’ – you must demonstrate such equivalence as part of your tender response.

Any deliberate alteration of NCB requirements as part of your tender response will invalidate your tender response to that requirement and for evaluation purposes you shall be deemed not to have responded to that particular requirement.

Responses should be concise, unambiguous, and should directly address the requirement stated.

Your tender responses to the tender requirements and pricing will be incorporated into the Contract, as appropriate.

9. Clarification questions

9.1 All clarification questions should be submitted no later than 7th August 2020 to cstanke@ncb.org.uk cc’d to octavia.wiseman@nhs.net and Claire.Spencer@gstt.nhs.uk as set out in the Timescales section of this ITT. NCB is under no obligation to respond to clarification requests received after the clarification deadline.

9.2 Any clarification requests should clearly reference the appropriate paragraph in the ITT documentation and, to the extent possible, should be aggregated rather than sent individually.

9.3 NCB reserves the right to issue any clarification request made by you, and the response, to all potential suppliers unless you expressly require it to be kept confidential at the time the request is made. If NCB considers the contents of the request not to be confidential, it will inform you and you will have the opportunity to withdraw the clarification query prior to NCB responding to all potential suppliers.

9.4 NCB may at any time request further information from potential suppliers to verify or clarify any aspects of their tender response or other information they may have provided. Should you not provide supplementary information or clarifications to NCB by any deadline notified to you, your tender response may be rejected in full and you may be disqualified from this Procurement Process.

10. Evaluation criteria

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10.1 You will have your tender response evaluated as set out below:

Stage 1: Tender responses will be checked to ensure that they have been completed correctly and all necessary information has been provided. Tender responses correctly completed with all relevant information will proceed to Stage 2 of this ITT procedure. Any tender responses not correctly completed in accordance with the requirements of this ITT and/or containing omissions may be rejected at this point. Where a tender response is rejected at this point it will automatically be disqualified and will not be further evaluated.

Stage 2: If a bidder succeeds in passing Stage 1 of the evaluation, then it will have its detailed tender response to the NCB requirements evaluated in accordance with the evaluation methodology set out below.

10.2 Moderation and application of weightings – The evaluation panel appointed for this procurement will meet to agree and moderate scores for each award criteria. Final scores in terms of a percentage of the overall tender score will be obtained by applying the relevant weighting factors set out as part of the award criteria table below. The percentage scores for each award criteria will be amalgamated to give a percentage score out of 100.

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Requirement Weighting Requirement

Requirement 1

10% Delivery of project in line with allocated budget (up to £10,000), representing good value for money.

Requirement 2

25% High-level draft/preliminary evaluation design (including framework and questions)

Requirement 3

25% Experience of designing and conducting evaluations of innovative health or social care programmes, services or initiatives for children, parents and families.

Expertise and experience in the field of maternal and child health; designing and conducting evaluations of vulnerability/risk assessment or screening tools in a health or social care context; and experience of developmental evaluation, is desirable.

Requirement 4

20% Experience of writing for publication and peer-reviewed academic / trade journals, as well as the ability to write in a clear and concise way.

Requirement 5

20% Strong research expertise, and strong project management skills.

Requirement 6

No score but compulsory

Provide a cost breakdown of your proposed approach.

10.3 Scoring Model – Tender responses will be subject to an initial review at the start of Stage 2 of the evaluation process. Any tender responses not meeting mandatory requirements or constraints (if any) will be rejected in full at this point and will not be assessed or scored further. Tender responses not so rejected will be scored by an evaluation panel appointed by NCB for all criteria other than commercial using the following scoring model:

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Score of 5: A score here, as well as addressing all, or the vast majority of, bullet points under each criteria heading, will demonstrate a deep understanding of the specification. All solutions offered are linked directly to project requirements and show how they will be delivered and the impact that they will have on other areas/stakeholders. Proposals will contain ideas related to the specification that are realistic and would enhance the service provision.Score of 4: A score of 4 will reflect that the organisation will have addressed, in some detail, all or the majority of the bullet points listed under each criteria heading. Evidence will have been provided to show not only what will be provided but will give some detail on how this will be achieved. Organisations should make clear how their proposals relate directly to the aims of the project and be specific, rather than general, in the way proposed solutions will deliver the desired outcomes.Score of 3: A score of 3 will again address the majority of the bullet points under each criteria heading but will lack some clarity or detail in how the proposed solutions will be achieved. Evidence provided while giving generic or general statements is not specifically directed toward the aims/objectives of this specification. Any significant omission of key information as identified under each criteria heading will point towards a score of 3.Score of 2: A score of 2 will reflect that the organisation has not provided evidence to suggest how they will address a number of bullet points under the evaluation criteria heading. Tenders will in parts be sketchy with little or no detail given on how they will meet specific requirements. Evidence provided is considered weak or inappropriate and it is unclear how this relates to desired outcomes.Score of 1: A score of 1 will reflect that there are major weaknesses or gaps in the information provided. The organisation displays poor understanding and there are major doubts about fitness for purpose.Score of 0: A score of 0 will result if no response is given and/or if the response is not acceptable and/or does not cover the required criteria.

10.4 Effectiveness, Efficiency and Economy - all Organisations applying for funding need to demonstrate value for money in their application, which should consider:

a) Inputs: the resources that are put into a service that would make it work, for example, number (people and days) and skills of the staff who would be delivering the required service.

b) Outputs: scale of the work delivered for the funding being requestedc) Outcomes: the benefits of the service.

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11. General tender conditions (“Tender Conditions”)

11.1 Application of these Tender Conditions - In participating in this Procurement Process and/or by submitting a tender response it will be implied that you accept and will be bound by all the provisions of this ITT. Accordingly, tender responses should be on the basis of and strictly in accordance with the requirements of this ITT.

11.2 Third party verifications - Your tender response is submitted on the basis that you consent to NCB carrying out all necessary actions to verify the information that you have provided, and the analysis of your tender response being undertaken by one or more third parties commissioned by NCB for such purposes.

11.3 Information provided to potential suppliers - Information that is supplied to potential suppliers as part of this Procurement Process is supplied in good faith. The information contained in the ITT and the supporting documents and in any related written or oral communication is believed to be correct at the time of issue, but NCB will not accept any liability for its accuracy, adequacy or completeness and no warranty is given as such. This exclusion does not extend to any fraudulent misrepresentation made by or on behalf of the NCB.

11.4 Potential suppliers to make their own enquiries - You are responsible for analysing and reviewing all information provided to you as part of this Procurement Process and for forming your own opinions and seeking advice as you consider appropriate. You should notify NCB promptly of any perceived ambiguity, inconsistency or omission in this ITT and/or any in of its associated documents and/or in any information provided to you as part of this Procurement Process.

11.5 Amendments to the ITT - At any time prior to the Tender Response Deadline, NCB may amend the ITT. Any such amendment shall be issued to all potential suppliers, and if appropriate to ensure potential suppliers have reasonable time in which to take such amendment into account, the Tender Response Deadline shall, at the discretion of NCB, be extended.

11.6 Compliance of tender response submission - Any goods and/or services offered should be on the basis of and strictly in accordance with the ITT (including, without limitation, any specification of NCB requirements, these Tender Conditions and the Contract) and all other documents and any clarifications or updates issued by NCB as part of this Procurement Process.

11.7 Format of tender response submission – Tender responses must comprise the relevant documents specified by NCB completed in all areas and in the format as

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detailed by NCB. Any documents requested by NCB must be completed in full. It is, therefore, important that you read the ITT carefully before completing and submitting your tender response.

11.8 Modifications to tender response documents once submitted – You may modify your tender response prior to the Tender Response Deadline by giving written notice to NCB. Any modification should be clear and submitted as a complete new tender response in accordance with Template 1 and these Tender Conditions.

11.9 Rejection of tender responses or other documents - A tender response or any other document requested by NCB may be rejected which:

contains gaps, omissions, misrepresentations, errors, uncompleted sections, or changes to the format of the tender documentation provided;

contains hand written amendments which have not been initialled by the authorised signatory;

does not reflect and confirm full and unconditional compliance with all of the documents issued by the NCB forming part of the ITT;

contains any caveats or any other statements or assumptions qualifying the tender response that are not capable of evaluation in accordance with the evaluation model or requiring changes to any documents issued by NCB in any way;

is not submitted in a manner consistent with the provisions set out in this ITT;

contains information which is inconsistent with answers already given in the pre-qualification questionnaire completed as part of this Procurement Process or;

is received after the Tender Response Deadline.

11.10 Disqualification - If you breach these Tender Conditions, if there are any errors, omissions or material adverse changes relating to any information supplied by you at any stage in this Procurement Process, if any other circumstances set out in this ITT, and/or in any supporting documents, entitling NCB to reject a tender response apply and/or if you or your appointed advisers attempt:

a) to inappropriately influence this Procurement Process; b) to fix or set the price for goods or services; c) to enter into an arrangement with any other party that such party shall

refrain from submitting a tender response; d) to enter into any arrangement with any other party (other than another

party that forms part of your consortium bid or is your proposed sub-contractor) as to the prices submitted;

e) to collude in any other way;

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f) to engage in direct or indirect bribery or canvassing by you or your appointed advisers in relation to this Procurement Process; or

g) to obtain information from any of the employees, agents or advisors of NCB concerning this Procurement Process (other than as set out in these Tender Conditions) or from another potential supplier or another tender response.

11.11 NCB shall be entitled to reject your tender response in full and to disqualify you from this Procurement Process. Subject to the “Liability” Tender Condition below, by participating in this Procurement Process you accept that NCB shall have no liability to a disqualified potential supplier in these circumstances.

11.12 Tender costs – You are responsible for obtaining all information necessary for preparation of your tender response and for all costs and expenses incurred in preparation of the tender response. Subject to the “Liability” Tender Condition below, you accept by your participation in this procurement, including without limitation the submission of a tender response, that you will not be entitled to claim from NCB any costs, expenses or liabilities that you may incur in tendering for this procurement irrespective of whether or not your tender response is successful.

11.13 Rights to cancel or vary this Procurement Process - By issuing this ITT, entering into clarification communications with potential suppliers or by having any other form of communication with potential suppliers, NCB is not bound in any way to enter into any contractual or other arrangement with you or any other potential supplier. It is intended that the remainder of this Procurement Process will take place in accordance with the provisions of this ITT, but NCB reserves the right to terminate, suspend, amend or vary (to include, without limitation, in relation to any timescales or deadlines) this Procurement Process by notice to all potential supplier in writing. Subject to the “Liability” Tender Condition below, NCB will have no liability for any losses, costs or expenses caused to you as a result of such termination, suspension, amendment or variation.

11.14 Consortium Members and sub-contractors – Bids from consortia organisations will be considered as well as independent suppliers. If a consortia bid is being put forward the role and share of the business that each member will have should be explained. The lead bidder should put forward its own details in relation to contact information, address and only its own financial documents will be required. It is the supplier’s responsibility to ensure that any staff, consortium members, sub-contractors and advisers abide by these Tender Conditions and the requirements of this ITT. 11.15 Liability – Nothing in these Tender Conditions is intended to exclude or limit

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the liability of NCB in relation to fraud or in other circumstances where NCB liability may not be limited under any applicable law.

12. Confidentiality and Information Governance

12.1 All information supplied to you by NCB, including this ITT and all other documents relating to this Procurement Process, either in writing or orally, must be treated in confidence and not disclosed to any third party (save to your professional advisers, consortium members and/or sub-contractors strictly for the purposes only of helping you to participate in this Procurement Process and/or prepare your tender response) unless the information is already in the public domain or is required to be disclosed under any applicable laws.

12.2 You shall not disclose, copy or reproduce any of the information supplied to you as part of this Procurement Process other than for the purposes of preparing and submitting a tender response. There must be no publicity by you regarding the Procurement Process or the future award of any contract unless NCB has given express written consent to the relevant communication.

12.3 This ITT and its accompanying documents shall remain the property of NCB and must be returned on demand.

12.4 NCB reserves the right to disclose all documents relating to this Procurement Process, including without limitation your tender response, to any employee, third party agent, adviser or other third party involved in the procurement in support of, and/or in collaboration with NCB. NCB further reserves the right to publish the Contract once awarded and/or disclose information in connection with supplier performance under the Contract in accordance with any public sector transparency policies (as referred to below). By participating in this Procurement Process, you agree to such disclosure and/or publication by NCB in accordance with such rights reserved by it under this paragraph.

12.5 The Freedom of Information Act 2000 (“FOIA”), the Environmental Information Regulations 2004 (“EIR”), and public sector transparency policies, including the placing of contract award notices on the Contracts Finder database, apply to NCB (together the “Disclosure Obligations”).

12.6 You should be aware of NCB obligations and responsibilities under the Disclosure Obligations to disclose information held by NCB. Information provided by you in connection with this Procurement Process, or with any contract that may be awarded as a result of this exercise, may therefore have to be disclosed by NCB

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under the Disclosure Obligations, unless NCB decides that one of the statutory exemptions under the FOIA or the EIR applies.

12.7 If you wish to designate information supplied as part of your tender response or otherwise in connection with this tender exercise as confidential, using any template and/or further guidance provided in Template 1, you must provide clear and specific detail as to:

the precise elements which are considered confidential and/or commercially sensitive;

why you consider an exemption under the FOIA or EIR would apply; and the estimated length of time during which the exemption will apply.

12.8 The use of blanket protective markings of whole documents such as “commercial in confidence” will not be sufficient. By participating in this Procurement Process you agree that NCB should not and will not be bound by any such markings.

12.9 In addition, marking any material as “confidential” or “commercially sensitive” or equivalent should not be taken to mean that NCB accepts any duty of confidentiality by virtue of such marking. You accept that the decision as to which information will be disclosed is reserved to NCB, notwithstanding any consultation with you or any designation of information as confidential or commercially sensitive or equivalent you may have made. You agree, by participating further in this Procurement Process and/or submitting your tender response, which all information is provided to NCB on the basis that it may be disclosed under the Disclosure Obligations if NCB considers that it is required to do so and/or may be used by NCB in accordance with the provisions provision of this ITT.

12.10 Tender responses are also submitted on the condition that the appointed supplier will only process personal data (as may be defined under any relevant data protection laws) that it gains access to in performance of this Contract in accordance with the NCBs instructions and will not use such personal data for any other purpose. The contracted supplier will undertake to process any personal data on NCB behalf in accordance with the relevant provisions of any relevant data protection laws and to ensure all consents required under such laws are obtained.

13. Tender Validity

13.1 Your tender response must remain open for acceptance by NCB for a period up to 2 months from the Tender Response Deadline. A tender response not valid for this period may be rejected by NCB.

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14. Payment and Invoicing

14.1 Payment arrangements with suppliers - Value for money and cost benefits will be taken into consideration by the selection panel. [DO WE WANT TO PUT SOMETHING IN ABOUT SOCIAL VALUE?]

14.2 All costs should be submitted as NET. Any essential management/overheads fees should be no more than 10% of the value of the bid submitted and should be itemised to show what they cover against the areas listed under ‘What we will fund’ detailed at 5.4. A template to complete can be found Annex 1.

14.3 NCB will pay correctly addressed and undisputed invoices within 30 days in accordance with the requirements of the Contract. Suppliers to NCB must ensure comparable payment provisions apply to the payment of their sub-contractors and the sub-contractors of their sub-contractors. General requirements for an invoice for payment by NCB will follow the payment plan set out in the task order which is the commissioning agreement for the work to be completed with agreed deliverables. NCB must fully understand that progress is being made and outcomes are being achieved.

14.4 Suppliers should feel free to add any specific KPIs that they propose. However, the supplier should explain how KPIs will relate to the planned trajectory of the staff training and the build-up of caseload over the contract period to show how planned performance relates to actual performance. Note that NCB can only commit to funding support cases that will be completed within the contract period unless otherwise agreed.

14.5 What we will fund

The service will use contract funding to contribute to the following costs:

Time for expert staff in an organisation to manage the services required, related to this work

Cost of participating in training provided by LEAP or NCB Administration co-ordination and data collection for management reporting and the

preparation of such reports Incentives for stakeholders to participate in any evaluation tasks Travel integral to carrying out this work Utilities – e.g. electricity, gas, telephone that relate to the project Volunteer expenses of persons who participate in the evaluation

14.5 What we will not fund

b) The service will not use contract funding to contribute to the following costs:

The cost of buying food and refreshments Capital costs Campaigning and lobbying activities Rent and/or business rates Insurance Disclosure & Barring Service checks Organisation infrastructure costs not directly related to Independent Support

14.6 Effectiveness, Efficiency and Economy - all Organisations applying for funding need to demonstrate value for money in their application, which should consider:

Inputs: the resources that are put into a service that would make it work, for example, number and skills of the staff who would be delivering the required service.

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Outputs: scale of the work delivered for the funding being requested.

15. Key background and further information

15.1 Further relevant background information is provided to potential suppliers through hyperlinks as set out below. Where no such information / documents are provided, this Section of the ITT will not apply.

a) Click here for information on the National Lottery Community Fund’s A Better Start Programme.

b) Click here for information on the LEAP programme.

ANNEX 1: TEMPLATESPlease complete all of these templates as part of your application.

Template 1: Application (attached as part of ITT pack)Template 2: References (attached as part of ITT pack)

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APPENDIX 1 – ILLUSTRATIVE PROGRAMME-LEVEL THEORY OF CHANGE (HIGH-LEVEL)

APPENDIX 2 – DRAFT - The Maternity Vulnerability Assessment Tool (MatVAT)

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APPENDIX 3 – MatVAT (visual) working Theory of Change

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APPENDIX 4 – MatVAT (narrative) working Theory of Change

Context Different healthcare professions are using no or different tools to assess and measure social vulnerability

across maternity and early years. The Health Team found that although midwives are good at identifying safeguarding cases (Tier-4), very

few midwives were aware of existing vulnerability assessment tools. For women, children and their families, having no formal framework to assess maternal vulnerability

means they’re less likely to receive timely and appropriate preventative support. To address this gap, the Health Team, in partnership with King’s College and Guy’s and St Thomas’

Hospital Trusts, designed and produced the Maternity Vulnerability Assessment Tool (MatVAT) in 2018/19 – a holistic tool to measure vulnerability in maternity.

Assumptions MatVAT will be acceptable to midwives. MatVAT will trigger more, and more appropriate referrals at Level 2 & 3. The existing system can manage additional referrals. Pregnant women will welcome referrals and that these will lead to an improvement in outcomes for

women and their families. Changes to services due to the Covid-19 pandemic and evidence poorer outcomes for women from BAME

groups increases the relevance of the MatVAT which will support the identification of vulnerability and the development individualised pans.

Evidence No formal evaluation of existing tools (4-Tier, U, UP, UPP), was identified. Government-based policies identify the need for disciplines to undertake an assessment of vulnerability

as evidence of the long-term impact of early trauma and complexity grows.1

A growing body of evidence suggests that early intervention reduces the need for downstream acute services, with associated cost savings.2

Supported by national and local maternity guidelines – NICE, NMC, RCM, KCH and GSTT Better Births – Using common thresholds for assessment of vulnerability across different services and

Trusts fit in with the priorities for maternity care outlined in Better Births.3

1 Shribman & Billingham (2009) Healthy Child Programme: Pregnancy and the first five years of life. Department of Health, London. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf (accessed 14.5.19); Every Child Matters (2010) CAMHS: Four-tier strategic framework. Available: https://webarchive.nationalarchives.gov.uk/20100202120904/http://www.dcsf.gov.uk/everychildmatters/healthandwellbeing/mentalhealthissues/camhs/fourtierstrategicframework/fourtierstrategicframework/2 Cattan S, Conti G, Farquharson C & Ginja R (2019). The health effects of Sure Start. London, Institute of Fiscal Studies. Available: https://www.ifs.org.uk/publications/14139 (accessed 5/7/19)3 NHS England (2016) Better Births: Improving outcomes of maternity services in England: A Five-Year Forward View for Maternity Care.

Desired outcomes

Beneficiaries Desired outcomes

Women, children and their familiesMore consistent and accurate assessments of social vulnerability

More timely and appropriate referrals to support services

More women feel that they are at the centre of care

Maternity services

Improved quality of care (i.e. higher levels of support to vulnerable women who do not meet the threshold for safeguarding or perinatal services)

Improved inter-professional communicationMore managers effectively assessing and measuring the vulnerability of their population, and allocating appropriate resourceMore midwives feel supported to effectively care-plan for women assessed as having mild-moderate levels of vulnerability.

Early years servicesImproved inter-professional communication

More timely and appropriate referrals received

Reduced long-term demand for acute services

Enablers The MatVAT has been designed to make it easier for midwives to fulfil their responsibility and desire to

support vulnerable women. The Health Team can support training and implementation of the MatVAT in local trusts, including ‘train

the trainer’ approaches, and can support the printing of materials, etc. The MatVAT has been approved by the Lambeth Safeguarding Children Board and Lambeth

Commissioners. The local maternity trusts involved have approved the next stage of the MatVAT development.

Barriers / risks Maternity services face financial pressures, which may limit the support that can be given to service

improvement projects, particularly in the context of a possible second surge of Covid-19 cases. Support services might receive more referrals than they have capacity for.

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APPENDIX 5 – DRAFT Flow-chart mapping service provision to MatVAT Levels 1-4

APPENDIX 6 – Flow-diagram to show current system of assessment for vulnerability by primary care health workers, and possible new system with MatVAT

APPENDIX 7 – Literature Review

Assessing vulnerability in health and early years

When developing the maternity vulnerability assessment (MatVAT) tool, the Health Team undertook a scoping literature review to explore the development and impact of other tools used in health care to assess vulnerability within health and social careWe had three main questions when evaluating the literature. These were: i. How is vulnerability defined within healthcare?ii. What tools are there within healthcare/early years to assess social vulnerability and

how were they developed?iii. How have any tools for assessing vulnerability been evaluated?

A search for academic articles on the development or evaluation of vulnerability assessment tools was undertaken using health, social care and maternity databases (Figure 1) using MESH subject headings and free text. Discrete concepts were combined with the Boolean operator ‘OR’ then combined with other concepts using ‘AND’.

Figure 1. Databases searched on 14.5.19

In addition, an informal search was undertaken via an internet search engine to capture policy documents, reports and grey literature on the subject, including some snowball reference-searching. Search terms included ‘4-tier model’ ‘4-tier thresholds’, ‘safeguarding tiers’, ‘Healthy Child Programme’, ‘Universal, Universal Partnership, Universal Partnership Plus’, ‘assessing vulnerability’, ‘vulnerability AND health’ etc.

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Findings4-Tier Thresholds ModelNo academic papers were found about the development of the 4-Tier thresholds model, which appear to have been brought into regular use from the time of the introduction of Child and Adolescent Mental Health Services (CAMHS) in 1995. This multi-agency approach to identifying vulnerability to support safeguarding was integrated into Every Child Matters in 2003 and the 2004 Children Act following the Victoria Climbie murder, alongside the extension of health and other professionals’ responsibilities to include safeguarding. Every Child Matters (2010) set the scene as to how the 4-tier model has been widely adopted for practitioners.

Child and adolescent mental health services (CAMHS) deliver services in line with a four-tier strategic framework which is now widely accepted as the basis for planning, commissioning and delivering services. Although there is some variation in the way the framework has been developed and applied across the country, it has created a common language for describing and commissioning services… However, it is important to bear in mind that neither services nor people fall neatly into tiers. For example, many practitioners work in both Tier 2 and Tier 3 services. The model is not intended as a template that must be applied rigidly, but rather as a conceptual framework for ensuring that a comprehensive range of services is commissioned and available to meet all the mental health needs of children and young people in an area, with clear referral routes between tiers.’

No formal evaluation of the acceptability, impact or evaluation of the 4-Tier model was identified. A recent briefing paper looking at mental health services suggests that the 4-Tier model has not worked to integrate services:

Some have argued that the 4-tier model is unhelpful and reinforces distinctions between different of types services when an integrated service structured around the needs of children and young people would be more effective. (Parking et al 2019)

The Children’s Commissioner (2017) concluded that the strength of this approach was to ‘provide a very rich and nuanced understanding of the challenges and strengths’ for the family but acknowledge a downside that it may lead to over complication on description rather than analysis of the multitude of factors considered.

Healthy Child ProgrammeIn 2006 The Healthy Child Programme was launched - the first national programme set out in Government legislation, integrating early years services with Health Visitors as the lead clinician and one third of programme influencing maternity services. It introduced the ‘Universal, Universal Partnership and Universal Partnership Plus’ vulnerability assessment tool (U, UP, UPP) and outlines the importance of early identification and assessment of risk (Shribman & Billingham 2009) :

Early identification of need and risk: At population level, commissioners need a systematic, reliable and consistent process for assessing needs. At an individual level, families need a skilled assessment so that the programme is personalised to their needs and choices. The HCP health reviews provide the basis for agreeing with each family how they will access the HCP over the next stage of their child’s life. Any system of early identification has to be able to:

identify the risk factors that make some children more likely to experience poorer outcomes in later childhood, including family and environmental factors;

include protective factors as well as risks; be acceptable to both parents; promote engagement in services and be non-stigmatising;

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be linked to effective interventions; capture the changes that take place in the lives of children and families; include parental and child risks and protective factors; and identify safeguarding risks for the child.

They also recognise that validated tools are very much needed in on order to support clinicians in assessment for risk and early identification:

A variety of different processes have evolved locally, and more needs to be done to provide the service with validated tools. We will be producing further guidance, in particular to support the PSA maternity indicator. The aim will be to enable and encourage earlier access to maternity care, with women having the opportunity by the 12th week of pregnancy to see a midwife or maternity healthcare professional for a health and social care assessment of their needs, risks and choices. This assessment will form the starting point for the HCP.’ (Department of Health 2009)

No academic papers were found about the development, implementation or evaluation of the U, UP, UPP tool. The latest update of the Healthy Child Programme by Blair and Macauley (2014) summarises how the model reflects changes of priorities:

Over the last 40 years the content of [the Child Health Programme] programme has changed, to reflect a changing focus from an active “seek and treat” paradigm to one of “protect and promote” explore risk factors and health education and support.

When looking through this lens of protect and promote it can be seen that safeguarding is an essential element of any framework i.e. 4-tier model and the progressive universalism of health promotion and psychoeducation elements of the Healthy Child programme.

Defining vulnerability

It was noticeable through evaluating the literature that there did not appear to be a clear definition of vulnerability used within different disciplines and their policies or research. The original work of the health team used the definition developed by the local maternity system (LMS, 2018 unpublished) for South East London:

In defining who our vulnerable women are, the table below shows examples of complex social factors associated with poor maternal and neonatal outcomes. They have been divided into two groups depending on need, although these will likely overlap for a vast majority of women

Women who find services hard to access

Women needing multi-agency services

Socially isolated women Those living in poverty / deprivation / who are homelessRefugees / asylum seekers Non-native language speakers Victims of abuse Sex workers Young mothers Unsupported mothers Women within travelling communities

Women who are subject of safeguarding concerns Women with substance and/or alcohol abuse Women with physical / emotional and/or learning disabilities Women who have been victims of female genital mutilationWomen who are HIV positive

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This definition is based on the criteria for defining the vulnerability of pregnant women used in the National Institute of Health and Care Excellence (NICE)’s guideline on pregnancy and complex social factors (2010) which highlights four social complexities as exemplars, namely:

women who misuse substances (alcohol and/or drugs) women who are recent migrants, asylum seekers or refugees, or who have difficulty

reading or speaking English young women aged under 20 women who experience domestic abuse

The LMS definition above incorporates more social complexities relevant to the local population of the area.

The lack of a clear definition of vulnerability has also been identified within maternity services. Briscoe et al (2016) undertook a concept analysis and found that it ‘should be viewed as a complex phenomenon rather than a singular concept’. This lack of clarity has the potential to lead practitioners to have varying understanding and interpretation of the impact of vulnerability on family life. Briscoe et al conclude that greater clarity is needed in assessing women’s vulnerability in the maternity pathway as this will inform practice, policy and further research and ultimately improve outcomes for women.

When integrating the work for children and vulnerability we can see that there is a wide spectrum of vulnerability, some of which is not relevant to maternity care. The Children’s Commissioner (2017, 2018) concludes that there is little consistency or guarantee about how vulnerable child is defined. For this reason, the commissioner uses a wider range of sources in order to estimate numbers of children living with vulnerability in England and the reports identify a very large number of children in England who fall into the vulnerable categories. For 2019 it is standing at 2.3 million. When we translate this knowledge in terms of pregnancies, we can see that there is a need to identify women and their families early in order to gain the benefits of early intervention. The Social Exclusion Task Force (2007) concludes from their analysis of the literature that there is evidence of ‘a clear relationship between the number of parent-based disadvantages and a range of adverse outcomes for children’. Adverse Childhood Experiences (ACEs) have been shown to increase the risk of adverse long-term health and social outcomes, including the parenting abilities of those affected (Hughes et al 2017). There are currently local and national initiatives looking at developing trauma-informed care, including Lambeth Made (Children’s and Young People’s Plan).

It is worth noting that within some frameworks and tools families can become invisible to services (Children’s Commissioner 2019). There is a growing body of work looking at the limitations of risk/deficit-based models, and the need for holistic, asset-based approaches which include assessment of families’ strengths (Morgan & Ziglio 2007).

Early Years interventions

Two evidence-based early years intervention programmes implemented in the UK have been evaluated - the Family Nurse Partnership programme and the Sure Start programme. The Family Nurse Partnership used high quality real-time data collection but initial evaluation of the UK programme showed little evidence of cost-effectiveness when compared with US outcomes, however a longer term approach is needed (Bate, 2017). A recent UK evaluation of the health effects of the Sure Start programme, which was developed in 1999 to give children a better start from pregnancy and into childhood, found that:

Our research suggests that the Sure Start programme has had significant benefits for children’s health, preventing hospitalisations throughout primary school. But these benefits are only felt in the most disadvantaged areas… Measured on a purely financial

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basis, the reduction in hospitalisations at ages 5–11 saves the NHS approximately £5 million, about 0.4% of average annual spending on Sure Start. But the types of hospitalisations avoided – especially those for injuries – also have big lifetime costs both for the individual and the public purse (e.g. through healthcare costs and the tax and benefit system). (Cattan et al 2019)

Conclusion

No formal evaluation of existing tools (4-Tier, U,UP,UPP) were identified. There is variation in how vulnerability is defined across health and social care and within maternity. Despite the lack of validated tools for clinicians to assess vulnerability, government-based policies clearly identify the need for disciplines to undertake an assessment of vulnerability as evidence of the impact of early trauma and complexity on later life grows. Early identification and interventions can and do impact the lives of women and children, as has been shown by the recent evaluation of Sure Start. More work is needed to develop tools which:

Support a holistic assessments of families’ needs and strengths Are relevant and acceptable to individual services Provide a shared language and understanding between early years services and

beyond Are formally evaluated to produce much-needed evidence on the acceptability and

impact of such tools on services and service-users

References

Bate A (2017) Briefing Paper #07647 Early Intervention. House of Commons Library Available: https://www.evidence.nhs.uk/search?q=Evaluating+the+Family+Nurse+Partnership+Programme+in+England (accessed 11.7.2019)

Blair M & Macaulay C (2014) The Healthy Child Programme: how did we get here and where should we go? Paediatrics and Child Health 24(3): 118-123

Briscoe L, Lavender T and McGowan L (2016) A concept analysis of women’s vulnerability during pregnancy, birth and the postnatal period, Journal of Advanced Nursing, 72(10) pp. 2330-2345

Cattan S, Conti G, Farquharson C & Ginja R (2019). The health effects of Sure Start. London, Institute of Fiscal Studies. Available: https://www.ifs.org.uk/publications/14139 (accessed 5/7/19)Children’s Commissioner (2017) Constructing a Definition of Vulnerability; online 4 th June 2019: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2017/07/CCO-TP1-Constructing-a-Definition-of-Vulnerability-Coram-1.pdfChildren’s Commissioner (2018) Vulnerability Report 2018 online 4 th June 2019: https://www.childrenscommissioner.gov.uk/wp-content/uploads/2018/07/Childrens-Commissioner-Vulnerability-Report-2018-Overview-Document-1.pdfEvery Child Matters (2010) CAMHS: Four-tier strategic framework. Available: https://webarchive.nationalarchives.gov.uk/20100202120904/http://www.dcsf.gov.uk/everychildmatters/healthandwellbeing/mentalhealthissues/camhs/fourtierstrategicframework/fourtierstrategicframework/

Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C et al. (2017) The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis . The Lancet Public Health, Volume 2, Issue 8, e356 - e366. Available: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(17)30118-4/abstract?code=lancet-site (accessed 14/7/19)

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Morgan A & Ziglio E (2007) Revitalisign the evidence base for public health: An assets model. Promotion and Education 14(17) DOI: 10.1177/10253823070140020701xAvailable: http://ped.sagepub.com/content/14/2_suppl/17 (accessed 14/7/19)

National Institute of Health and Care Excellence (NICE) (2010, updated 2018). Pregnancy and complex social factors: a model for service provision for pregnant women with complex social factors. Available: https://www.nice.org.uk/guidance/cg110 (accessed 14/7/19)

NHS England (2016). Better Births: Improving outcomes of maternity services in England. A Five Year Forward View for Maternity Care Available: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdfParking E, Long R, Gheera M & Bate A (2019) Briefing paper #07196. Children and young people’s mental health: policy, services, funding and education. House of Commons Library. Available: https://researchbriefings.files.parliament.uk/documents/CBP-7196/CBP-7196.pdf (accessed 5.6.2019) Shribman & Billingham (2009) Healthy Child Programme: Pregnancy and the first five years of life. Department of Health, London. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/167998/Health_Child_Programme.pdf (accessed 14.5.19).Social Exclusion Task Force (2007) Families At Risk Background on families with multiple disadvantages. Cabinet Office. Available: https://webarchive.nationalarchives.gov.uk/20100407191619/http://www.cabinetoffice.gov.uk/media/cabinetoffice/social_exclusion_task_force/assets/families_at%20_risk/risk_data.pdf (accessed 14.5.19)

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