Return to Agenda

ITEM EX12

EXECUTIVE – 28 OCTOBER 2003

INTEGRATION OF MENTAL HEALTH SERVICES: OUTCOME OF CONSULTATIONS

Report by Director for Social & Health Care

 

1. This report describes the consultations that have been carried out over the proposed integration of mental health services, and sets out the conclusions that can be drawn. The Executive agreed in principle to the integration of mental health services at its meeting on 21 January 2003 and requested that consultation should begin, with a report back to the Executive. The report proposed that the integration would best be achieved through the secondment of Community Mental Health Staff (CMHT) staff from the County Council to the Oxfordshire Mental Healthcare Trust (OMHT), and that pooled budget and lead commissioning arrangements be developed.
   
   
2. The Executive also authorised establishing a Project Board to oversee the integration of services. It was decided at the Project Board that the work of establishing a Pooled Budget and Lead Commissioning arrangements should be run in parallel with the work on the integration of services. This meant that the Service Development Workers, 4 staff in total, were included in the staff consultation process. The consultations carried out therefore covered all aspects of the integration project. All the consultations necessary for the Executive to decide on the secondment of staff have been completed, but it is likely that further consultation on pooled budget and lead commissioning arrangements will be necessary.
   
   
3. Within the NHS in Oxfordshire the lead commissioning responsibility for mental health services rests with the South West Oxfordshire PCT (SWPCT), acting on behalf of the 5 PCTs across the County. Establishing pooled budget and lead commissioning arrangements requires a partnership agreement covering these arrangements to be agreed with SWPCT, which will also cover the secondment of the development workers. The secondment of CMHT staff will be covered by a partnership agreement with OMHT.

Consultation Processes

4. The details of the consultation processes are given at Annex 1 and Annex 2. Annex 1 covers the consultations that were carried out with the Council’s staff and Annex 2 the public consultations. The Consultation Document setting out the proposals is at Annex 3 (download as .doc file).

Staff Consultation

5. Consultations with staff in CMHTs were carried out through meetings arranged in the North and South of the County, and in Oxford City. The Service Development Officers discussed the proposals in a team meeting with a senior manager. UNISON were involved in the meetings with CMHT staff, but not with the development workers, who did not feel the need for the union to be present. The formal consultations were on the proposal that CMHT staff and their managers would be seconded to the OMHT, and the development workers to the South West Oxfordshire PCT (SWPCT). The outcomes of staff consultation are summarised below.

• All Social & Health Care staff have been consulted on the principle and the details of the proposed secondment to the OMHT or the SWPCT.
• Questions and issues arising from the consultation have been answered, and minor amendments made to the proposals.
• Both staff and Unison are willing to proceed with the proposal put forward. Work has started to integrate human resources (HR) policies wherever this is possible without altering employees’ terms and conditions of service.
• Staff have been consulted on the content of the Secondment Agreement; no one has raised any objection to the document in its present form.
• Throughout the consultation process it has been clear that staff are in favour of the proposed changes because of the potential for the development of services that integration can lead to.

 

6. As part of the development of mental health services a new structure for middle management within OMHT has been consulted on and is in the process of being implemented. This will directly affect two Social & Health Care managers. This should not prevent the secondment process from going ahead, and the staff concerned are fully involved with the process.
   
   
7. The secondment arrangements and all related HR issues are considered and overseen by an HR group that reports to the Project Board. This group will continue to deal with any HR issues that may arise for County Council Staff following the proposed secondment.

Public Consultation

8. Public consultation included consultations with the voluntary sector. Public meetings were held in the north and south of the county and in Oxford City. There were also separate meetings with voluntary sector representatives.

• There was overall support for the secondment of staff and the integration into a single management structure.
• There was broad support for the establishment of a pooled budget but more detail on how this would work and what funding would be in the pool, together with the accountability processes for both health and social and health care, was requested.
• The development of mechanisms to ensure full engagement and involvement of the voluntary sector in both service provision and commissioning was felt to be vital.
• Robust communication processes, which include service users, carers, staff and the general public is necessary if integration is to be truly effective.
• The boundary issues covering neighbouring counties for both the commissioning and provision of services needs to be clarified and communicated, especially to GPs and other primary care staff.
• Clarification of the services currently provided and their future development as a result of integration work were raised. Services about which more information was requested included the impact on hospital services, housing, respite care, transport, training and the transitional issues of moving between services for service users in Children’s, Older People, Learning Difficulties and Dual Diagnosis services.

 

9. This arrangement is being supported by a Partnership Agreement between the County Council, which contains a secondment agreement for the staff concerned. The Council’s Legal Services are reviewing this and their conclusions will be reported to the Executive.

Conclusions

10. The consultation process has shown that there is support for the integration of mental health services, and it is recommended that the Executive agrees to the secondment of staff to OMHT and SWPCT.
    
    
11. However, while the objectives that underpin the proposal to pool budgets and establish lead commissioning arrangements are appreciated and agreed with, there were a number of concerns that were expressed. These include the level of investment by the County Council in the pooled budget and the arrangements for monitoring and review. The voluntary sector has particular concerns about the contracting arrangements, and any loss of expertise that there may be as responsibility for contracting with voluntary organisations moves away from Social & Health Care.
    
    
12. It is proposed that further public consultation is carried out when proposals for pooled budgets and lead commissioning arrangements are finalised. It is anticipated that this will be in January and February 2004 for implementation in April 2004. This will be on how these arrangements will be put in place.

Scrutiny Committee Views

13. A draft of this report was considered by the Social & Health Care Scrutiny Committee on 24 September. The Committee agreed to:

(a) urge the Executive to ensure that the Social Care element is a recognised responsibility it its own right and does not become subsumed into the more acute service responsibilities; and

(b) endorse the intention to carry out further consultation on pooled budget and lead commissioning arrangements.

RECOMMENDATIONS

14. The Executive is RECOMMENDED to:

 

CHARLES WADDICOR
Director for Social & Health Care

Background Papers: Nil

Contact Officers:
Lorna Brown Head of Social Care for Adults (Project Sponsor) Tel ((01865) 815828
Nicholas Welch, Head of Service Planning and Partnership (Project Director) Tel (01865) 815714

October 2003