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Supporting People Mental Health Strategic Review

This paper is for decision.

Financial Options to achieve savings

Background

The proposed reconfiguration of services and financial commitments needed to achieve a balanced budget for Mental Health, have been calculated on a revised basis from the previous papers in this area and have been agreed at the December Core Strategy Group.

The savings figure has been based on 2005/06 figures for actual spend and takes account of budgetary shortfalls at the time of the Platinum Cut (total savings figure is £559k).

It is recommended that the total savings target should be sought by a mixture of decommissioning and remodelling where this is considered to be appropriate in order to ensure sufficient geographical spread of services and to ensure that the continuing needs of existing service users are met.

Recommendations

The Commissioning Body is asked to:

1. Approve the strategic decisions relating to service reconfigurations and outline financial plan. These are summarised below:

2. Instructs the Administering Authority to implement service reviews and reach agreement with providers to reduce costs and reconfigure services in line with the strategic review.
   
   
3. Notes the comments and contributions received from service users and instructs the Supporting People team to take these into account in reviewing the Five-Year Strategy, drawing up the Annual Plan for 2006/07and considering the relative allocation of Supporting People Grant for each client-group.

SUMMARY AND PURPOSE OF THE PAPER

• This paper aims to map out key proposals for a strategic approach with key decisions relating to mental health to develop services and manage budgetary pressures.
• It is written with the aim of reaching agreement after inconclusive discussions at the previous Core Strategy Group. It has been amended in light of these discussions and contact with key partners.
• The mental health priorities have not changed since the final report of the Strategic Review of Mental Health Services was submitted to the Core Strategy Group (detailed in the main paper attached).
• The overall savings figure is made up of:
  
  
• 15% of the predicted 05/06 contract values as indicated in November Core Strategy Group paper that looked at savings in Mental Health
  (£2, 532, 000 is 05/06 contract value = £380k)
  

• The £180k shortfall incurred at the time of the Platinum cut in 2003, of £180k

• The key areas and services that regrettably will need to be cut, reconfigured and/ or asked to make efficiency savings are listed in the recommendations above and in the paper attached.

Introduction and key themes and priorities in Mental Health

This paper builds on the papers and discussions of the Strategic Review Group for Mental Health and the Core Strategy Group.

The key service priorities and themes from the review group can be summarised as:

• Users want:
• Flexible services and choice, including having control of when a service stops.
• Secure accommodation is vital to have alongside support (accommodation generally felt to be good).
• Services that are not providing support that is too high/ intense
• Support should be ‘float off’ when support not needed or people should be moved on from high support housing schemes.
• Lowest possible support when they leave hospital, to prevent institutionalisation.
• More intensive floating support is needed, for fluctuating mental health and/ or rehabilitation from hospital.
• Staff not to be ‘tied’ to offices in low support accommodation.
• Statutory services should fund a greater proportion of high support accommodation based services.
• Alarms could be as effective as visiting staff for low needs.
• Developing a better geographical split of services throughout the County, to facilitate equitable access to services e.g. 1 medium support service in each District. The concentration of high support services in the City is accepted.
• There is a need for rehabilitative services, but not high cost ‘home for life’ models.
• There is a need for long term low support services.
• Both high and low support, permanent and temporary services (e.g. rehabilitative) reduce hospital admissions.
• High support accommodation staffed 24 hours a day is a key resource, but needs to show that it is efficient.
• Replacement funding should be sought where Supporting People funding is reduced or withdrawn completely.
• Funding should be higher for more intensive short term services that move people onto independent accommodation, as opposed to permanent intensive services.
• Housing-related support should continue to be provided to users who need it when any reconfiguration of Supporting People services takes place. This may have to reduce in some cases.
• There are related critical issues in developing or reconfiguring Supporting People services that have a major impact on pace of change and final outcome e.g. leases, landlord preferences, condition of properties etc.

The above themes and priorities have been incorporated in the service review recommendations and will also need to be followed up where possible as part of the ongoing development of services together with service providers.

Savings figures

The discussion and analysis in the following sections, recommends how to achieve savings to mental health services of £559k. The plans are based on discussions of members of the Mental Health Review group and include elements from the previous paper submitted to the Core Strategy Group in November.

The savings figure is calculated based on the figure in the November Core Strategy Group paper for 05/06 anticipated expenditure for all Supporting People mental health services:

• 15% of the predicted 05/06 Supporting People contract values (£2, 532, 000), minus 15% (£380k) = £2,152,000

• The £180k shortfall incurred at the time of the Platinum cut in 2003, of £180k (gives £1,972,000)

This leads to:

• A total savings figure of £560k and
• Predicted total spend for 06/07 of £1,972,000

All figures are ‘best estimates’; fluctuations are due to the different amounts that are actually paid to Supporting People providers as this varies according to occupancy levels within some long term contracts (block subsidy).

The Mental Health Strategic Review Group recommended making savings from each type of service except floating support (unless floating support service not strategically relevant, i.e. cleaning; or not for people with mental health problems) and to preserve geographical spread of services.

1.i Current expenditure by type of service

Ensuring Value for Money from all mental health providers

It is recommended that the providers of all types support services are asked to provide similar levels of service across the services they provide (i.e. across high/medium/low support services) for a minimum of 10% less than their existing contract value. This will be achieved by:

a) The Supporting People team working with providers to negotiate better value for money, ensuring that overhead costs are reduced if they are too high.

b) The Supporting People team and relevant stakeholders working with providers to consider remodelling options that will achieve cost savings.

In order for providers to reduce costs by at least 10% it is felt important to recognise that in some cases this will not be able to be achieved whilst maintaining the same level of service and/ or capacity. The Supporting People team, together with colleagues in the procurement team will work through the implications of these negotiations with individual providers on a case by case basis. The overarching policy commitment in Oxfordshire in this areas stands; service users who have a support need, will not be without housing related support in any changes to services linked to the management of Supporting People grant, but this support may be provided in a different way to how it is at the moment.

Risk will be effectively managed to ensure that changes do not increase risk to service-users or staff. (E.g. if staffing levels are significantly reduced, the level of support need of new service-users may have to be reduced).

1. High Support Accommodation-based Services

1.1. Table of high support services showing 2005/06 predicted expenditure before any efficiency / remodelling savings will be achieved.

Total target savings figure is £164k to be achieved across all services linked to VFM negotiations and procurement of services from April 2006. Alongside these negotiations, an application will be made by OGHO for extra funds from S&HC for replacement funding. This application is against a background of major budgetary pressures in S&HC.

• As can be seen from the above table, there is considerable variation with regard to unit costs of support. These will be investigated further as part of the discussions and negotiations with providers linked to realising the sector wide 10% savings figure. Cost comparisons will be made with other similar services and proposals and justifications for higher costs will be requested from providers.
• OGHO is the main provider of high support services with four services in the city including Morrell Crescent. In addition OGHO has two other Supporting People funded services, one providing medium/low support in Oxford, and a visiting floating support service in Cherwell. OGHO has indicated that it could achieve savings in the region of 10% of the total contract value by remodelling existing services and through efficiency savings and has begun work on detailed proposals that have been sent to the Supporting People team to start off the process of discussion and negotiation.

• Close cooperation between the Supporting People team and other sections of S&HC will be needed to:
• Possibly reallocate part of the current expenditure, once the service review has been carried out, to fund the care tasks that are not eligible for Supporting People funding.
• Reassessment of the needs of service-users to establish their ongoing support needs and whether these can and should be met in the same way as before. There may be some potential for other existing services to complement any reconfigured Supporting People service at minimal additional cost.
• The Strategic Review Group anticipated that remodelling the high support accommodation-based services to achieve savings will be difficult and will not achieve a significant saving. They anticipated this may result in having to decommissioned up to 10 units of high support.

2. Medium Support Accommodation-based Services

2.1. Table of medium support services showing 2005/06 predicted expenditure before any efficiency / remodelling savings that will be achieved.

• The annual contract values for the same number of units (provided by different providers) vary from £7,572 to £13,278 (annual unit cost). It is recommended that action stated at point one above is used to achieve best value for money, i.e. a similar unit cost.
• There is not funding to achieve a medium support accommodation-based service in the Vale or in Banbury (Cherwell). This would be a priority should funding become available, but is unlikely in the current financial climate.

3. Medium/low (in one service) and low support accommodation based services
   
   3.1. Table of services with medium and low support units in one service, based on 2005/06 predicted expenditure before any efficiency / remodelling savings that will be achieved (see Section 1)

The strategic review group does not recommend further changes to this group of services apart from 10% efficiency / remodelling savings.

1. Low Support accommodation-based services

5.1 Table of services with low support units, based on 2005/06 predicted expenditure before any efficiency / remodelling savings that will be achieved (see Section 1)

Provider	Service	District & Capacity	05/06 predicted expenditure
Bromford	Bure Park	Cherwell, 8 units	£35,955
Bromford	Merton Street	Cherwell, 4 units	£18,943
Stonham	The Bramblings	West, 6 units	£55,574
Advance	Co wide MH Scheme	Cherwell & West, 9 units	£74,288
OGHO	Banbury Floating Support	Cherwell, 13 units	£40,203
MIND	New Internationalist Flat	Oxford, 1 unit	£3,511
Stonham	Cowley Road	Oxford, 6 units	£43,456
Stonham	Chipping Norton move-on	West, 3 units	£20,054
Oxford City Council	Riverside Court	Oxford, 80 units	£18,530
	TOTALS	130 units	£310,514

The strategic review group has identified that some of the low support services are either partially or not strategically relevant. Some of these services could therefore be remodelled to achieve significant savings, or decommissioned if this cannot be achieved.

5.ii Table of low support services to be remodelled or decommissioned:

As highlighted in the recommendations above, District Core Strategy Group members will need to formally approve any final decommissioning and / reconfiguration proposals. The table below is presented in this context.

Provider	Service	District & Capacity	Anticipated maximum saving in 2006/07
OGHO	Banbury Floating Support	Cherwell, 13 units	£14,000
Stonham	Chipping Norton Move On	West, 3 units	£2,000
MIND	New Internationalist Flat	Oxford, 1 unit	£3,511
		Total maximum anticipated saving	£19,511

It is recommended that through negotiation with providers some of these units should be preserved through remodelling although this of course has an impact on the total savings to be obtained from other services (see timescales and budgetary management section below).

At the time of writing detailed proposals from a number of providers have been received by the Supporting People team (e.g. OGHO have submitted a proposal that leads to approximately £15,000 saving which is included in the service review report elsewhere on the Core Strategy Group agenda).

Because of the complexity of the proposals from other providers (which cover several services, often across a number of Districts), further discussions are necessary after the formal Core Strategy Group service review decisions and linked to the procurement and negotiation process that will take place early in the new year. The result of these discussions will be reported to future meetings of the Core Strategy Group.

Low support services that are to be decommissioned

The table below shows 2 services that the Core Strategy Group has agreed to decommission.

Cowley Road is an accommodation-based service. The current property is unsuitable.

Riverside Court does not require service-users to have a mental health problem in order to access the accommodation and the level of support is very low.

Provider	Service	District & Capacity	Annual contract value forecast 2005/06
Stonham	Cowley Road	Oxford, 6 units	£43,456
Oxford City Council	Riverside Court	Oxford, 80 units	£18,530
		Total potential saving:	£61,986



5. Floating Support

5.1 Table of service with low support units, based on 2005/06 predicted expenditure before any efficiency / remodelling savings that will be achieved.

Floating support services that are not strategically relevant

The Strategic Review Group recommend that floating support services should be maintained except where they are inappropriately classified or do not provide eligible housing related support. Two services fall within the latter category, one service provides cleaning, and one is a misclassified service, which is not a mental health service.

Continuing support to existing service users

It is anticipated that some of the service users in low support services that will be decommissioned will be supported by existing floating support services, or by other agencies. There is likely to be a small number of service users who no longer require support, so in these cases support will be stopped in a planned way.

As part of either decommissioning and/ or remodelling, the Supporting People team will work with mental health professionals in statutory organisations and providers when assessing the ongoing needs of service users.

Timescales (pace of change) and budgetary management

The savings target must be achieved during 2006/07.

The Supporting People Team will monitor how quickly savings are achieved and work together with providers on the pace of change issues (which they highlighted in the Mental Health Strategic Review). For example, if 10 units of high support have to be decommissioned, this will involve a process to ensure that the service-users affected continue to receive support, which could involve them moving to hospital, residential care, or lower support accommodation.

It is not possible to predict exact figures and timescales at this point, but these will be closely monitored by the Supporting People Team.

In essence, the key point is that the total savings targets must be managed and reached in year and compensated for if there are delays in realising monies from the outline list of services identified above. Reports on progress will be made to the Core Strategy Group.

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