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ITEM EX8

EXECUTIVE – 4 MARCH 2003

JOINT HEALTH AND SOCIAL CARE COMMUNITY LEARNING DISABILITY TEAMS

Report by Director for Social & Health Care

Background

  1. In July 2002 the Executive agreed to work being undertaken to develop and consult on proposals in 3 areas of services for adults with a learning disability:

    • Joint Health and Social Care Community Teams

    • A Pooled Budget under Section 31 Health Act Flexibilities

    • A new Joint Strategy and Decision Making Structure

  1. These proposals have been developed in partnership between Oxfordshire County Council Social & Health Care Directorate, North East Oxfordshire Primary Care Trust (on behalf of all five Primary Care Trusts in Oxfordshire) and Oxfordshire Learning Disability NHS Trust.

  2. This report outlines the proposed service model for the joint teams and a summary of the work undertaken in the other two areas. It also covers the results of the consultation undertaken with staff and other stakeholders.

    3. Present Position and Reasons for Proposed Change

  3. The Best Value Review of Learning Disability Services undertaken during 2001/02 and the review of Community Learning Disability Teams undertaken during 2002 identified the following areas for improvements;

    • Restructure the services by combining the services provided by the Care Management Team and the Health Community Team to have one service providing one front door, access to information, assessment and access to services.

    • Teams managed by one line manager with one management system.

    • Joint Eligibility Criteria.

    • Strengthen shared client information and planning systems.

    • Improve the involvement of people with learning disabilities and their carers in the planning and development of services.

    • Reduce duplication of work – especially in the areas of assessment, recording and planning.

  1. The Learning Disability Valuing People Strategy identified the need for Social and Health Care teams to be integrated. Although there is no date for this to occur it is expected that this should occur by 2004.

  2. Currently there are 23.5 Social & Health Care Directorate staff working in Community Learning Disability Services across Oxfordshire. 20 staff are working in 3 Care Management Teams and 3.5 Social Work staff are based within the Learning Disability NHS Trust Community Teams for People with Learning Disabilities. The NHS Trust employs 46 staff to specifically work in the community teams plus a range of other professionals including Psychiatry, Psychology, Speech and Language Therapy, Dietetics and Physiotherapy who work as part of the teams. There is also one staff member employed by North East Oxfordshire Primary Care Trust who is seconded to work and managed within Social & Health Care Directorate. These several groups of workers have separate line management arrangements whilst working often with the same clients to achieve the same objectives.

  3. There are 2 further staff working in Community Learning Disability Services in Commissioning and Contracting who are not affected by these proposals.

  4. Work is still being undertaken in the other 2 areas for development in Learning Disability services. Proposals for a pooled budget and a new Joint Health and Social Care Learning Disability Strategy will be presented to the Executive later this year. Work is proceeding more slowly in these areas as the main focus is to bring the budget in to balance.

    5. Proposal

  5. The main elements of the proposal are as follows:

    1. 3 Joint Community Teams will be established in Oxfordshire comprising the following services (with "one front door" access):

    • Assessment, Care Planning and Reviewing

    • Occupational Therapy

    • Nursing

    • Care Management

    • Social Work

      b. The following services will be provided as part of the Joint Teams via Service Agreement with either the Oxfordshire Learning Disability NHS Trust or the Cherwell Vale PCT.

    • Physiotherapy

    • Psychiatry

    • Psychology

    • Dietetics

    • Speech and Language Therapy

      c. A single Community Team Service Manager should be established who reports jointly and equally to Oxfordshire County Council Social & Health Care Directorate and Oxfordshire Learning Disability NHS Trust.

      d. Each of these Community Teams should have a single Team Manager who reports to the single Community Team Service Manager. The Team Managers will have responsibility for the line management of the staff Joint Team on behalf of Oxfordshire County Council Social & Health Care Directorate and Oxfordshire Learning Disability NHS Trust.

      e. A new post of Senior Practitioner Care Manager should be established to manage and supervise care managers and social workers in the Joint Teams. These 3 posts will report to the relevant Single team Manager.

      f. The grades of the 3 new posts have been set and agreed with advice from Oxfordshire County Council Social & Health Care Directorate and Oxfordshire Learning Disability NHS Trust Human Resources departments.

      g. Each of the teams will work to a single joint operational protocol.

      h. The framework for this proposal will be recorded in an interagency Management Agreement similar to the mental health agreement.

  1. The existing and proposed organisational structures are explained in the diagrams attached as

    Annex 1 (download as .doc file)

    Annex 2 (download as .doc file)

    Annex 3 (download as .doc file)

    2. Consultation

  2. Consultation was undertaken on the 3 proposals during October and November 2002 with a range of stakeholders in learning disability services including staff in both organisations, people with learning disability and family carers. In principle all of those consulted have agreed with the general direction of the 3 proposals. Comments received on the time-scale of the pooled budget and the new joint strategy have led to this work not being completed at this time: it will be presented later this year.

  3. All staff in community learning disability teams have been invited to several joint and individual meetings. Monthly ‘drop-in’ sessions for staff have also been undertaken and will continue for the next 6 months as a minimum.

  4. Formal consultation has taken place with Unison for Oxfordshire County Council Social & Health Care Directorate Staff and Unison and the Royal College of Nursing for Oxfordshire Learning Disability NHS Trust. Meetings are continuing on a monthly basis.

  5. In the light of the consultation process a small number of amendments have been made to the proposal. These are:

    1. Ensuring that if professionally trained staff are not line managed or supervised by a line manager of their professional background then arrangements will be put in place to ensure that professional supervision and accountability occurs.

    2. Agreement on the appointment process and potential redeployment opportunities.

    3. Agreement on the line management and supervision arrangements for the new post of Service Manager.

    4. Agreement on the grades for the new posts.

    5. Changes to the operational protocol

    Financial Implications

  6. The proposals although identifying changes in structures and posts will be cost neutral. There will be no additional costs incurred in moving to the new structure. As part of the changes being proposed, funding will be transferred from existing posts to the new posts identified in this new structure and to strengthening the Commissioning and Contracting Team. The additional costs of the new posts are covered by the changes being proposed by the deletion of the Joint Commissioner post, the Service Manager and Team Manager posts in the Trust and the Unit Manager posts in the Social & Health Care Directorate.

    7. Current Costs for Joint Teams

    Oxfordshire Learning Disability NHS Trust

    £1,321,408

    NE Oxfordshire PCT

    £40,608

    Social & Health Care Directorate

    £736,447

    Total

    £2,098,463


    Proposed Costs for Joint Teams

    Total

    £2,069,011

    Contribution to Commissioning and Contracting Team

    £29,452

    (NB – these costs include on-costs of superannuation and NI.)

  7. There will be costs associated with accommodation in adaptation and removal costs once suitable accommodation is identified. These proposals will be identified to the Office Accommodation Working Group which will inform the County Council work in this area. In the meantime staff will continue to be based in their current locations.

    8. Staff Implications

  8. There will be no changes to the employment conditions for all staff employed by the Social & Health Care Directorate or the Trust. All staff will remain employed by their current employer irrespective of the appointment process and posts that people are selected for. There are no TUPE or staff redundancy implications in these proposals.

  9. An appointment and selection process has been agreed and shared with the Unions. All staff who are unsuccessful in the application of their choice will be offered another post within this new structure or redeployment with their current employer.

  10. The most significant change is for the posts of Joint Commissioner with the NE PCT, the Service Manager and Team Manager Posts in the OLDT and the Unit manager Posts in the Social & Health care Directorate. This has been discussed in detail with all staff concerned and personnel and staff support have been offered to all involved.

  11. The post of the 3 senior practitioners is a new one to the Learning Disability Team. This post will be responsible for managing and supervising the care mangers and social workers and undertaking complex and specialist casework. These posts will be advertised both internally and externally after April 2003.

  12. A detailed implementation process will be put in place to ensure a smooth transition to the new structure.

    13. Implications for Other Posts

  13. All other posts in the structure will not alter in terms of their roles and responsibilities. The only changes will be in the line management and supervision arrangements.

  14. Administration support is provided currently by Oxfordshire Learning Disability NHS Trust and the Social & Health Care Directorate. It is anticipated that the new joint teams will continue with their current administration support. Meetings are underway for staff to identify the new administration support requirements and procedures.

    15. Review of this Proposal

  15. There will be regular Joint Reviews of this new arrangement. The reviews will focus on service delivery and outcomes for service users and the impact on staff and will be undertaken at least annually.

    16. RECOMMENDATION

  16. The Executive is RECOMMENDED to receive the report and authorise the Director for Social & Health Care to proceed to implement the proposals.

CHARLES WADDICOR
Director for Social & Health Care

Background Papers: Nil

Contact Officers: Lorna Brown, Head of Adults and Carers, Tel: 01865 815828, Alan Sinclair, Operations Manager, Tel: 01865 854481

February 2003

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