ITEM EX16 - ANNEX 1EXECUTIVE – 16 MARCH 2004INTEGRATION OF ADULT MENTAL HEALTH SERVICESSouth West Oxfordshire Primary Care Trust and Oxfordshire County Council Social and Health Care Consultation on the Integration of Commissioning Arrangements for Mental Health Services for Adults of Working Age
Introduction In the summer of 2003 a public consultation took place on the principle of bringing together the commissioning and provision of mental health services for working age adults across health and social care. Responses to the consultation supported the use of the flexibilities contained in the Health Act 1999 to develop integrated mental health services for adults by:
Following the consultation it was agreed that further discussion and consultation would take place with key stakeholders, on the lead commissioning and pooled budget arrangements once proposals had been worked up in more detail. It has been agreed that the pooled budget and lead commissioning will be fully in place on 1 April 2004. This paper sets out the progress so far in developing proposals for the Pooled Budget, the working arrangements for the Joint Commissioning Team and the Governance and accountability surrounding this. The Integration Project Board, which involves statutory and voluntary sector colleagues have overseen this work – full membership is listed in Appendix 1. These proposals are for discussion and comment over the next two months, with a deadline of 28 January for comments to be submitted to: Jenny Connelly Head of Mental Health, Joint Commissioning Team, South West Oxfordshire Primary Care Trust, Abingdon community Hospital, Marcham Road, Abingdon OX14 1AG Email: jenny.Connelly@swoxon-pct.nhs.uk What are the overall aims and objectives of integrating commission? An overarching statement of aims and values has been developed for the whole integration process: ‘As many as one in four of us in Oxfordshire will experience a mental health problem at some time in our lives and this will in turn affect a wide group of family and friends. Our aim is that people who experience a mental health problem, and their carers, should receive help that is:
The provision of effective mental health services depends upon a wide range of people and agencies. This includes different NHS trusts, social services, GPs and other primary care staff, elected councillors, housing providers, employers, the police, magistrates and voluntary organisations together with service users and carers. We will involve all of these people in our efforts to turn our aims into a reality.’ Objectives of Integrated Commissioning In addition to the aims, a set of objectives to test the success of the integrated commissioning arrangements have been agreed:
A performance framework will be developed that measures both performance against these objectives and performance against national targets. This in turn will form part of the monitoring and evaluation requirements of Service Agreements with individual providers. What will the Governance, Accountability and Reporting Arrangements be? The lead organisation for the commissioning and pooled budget arrangements will be South West Oxfordshire PCT. Currently South West Oxfordshire PCT leads the commissioning of mental health services on behalf of the five Primary Care Trusts in Oxfordshire. The Joint Commissioning Team will work closely with all Primary Care Trusts and Oxfordshire County Council to ensure that the strategy and commissioning plans of the Mental Health Partnership Board and Joint Management Group are informed and influenced by local needs and issues. The framework and infrastructure for governance and accountability around the commissioning and the pooled budget is set out below.
The membership of the Mental Health Partnership Board and Joint Management Group has yet to be finalised. Full membership and terms of reference for Local Implementation Teams have been previously circulated and agreed and are included at Appendix 2 (download as .doc file). More work on these governance arrangements is being undertaken and will produce by the end of January:
What will the Pooled Budget include? The pooled budget will be used to commission mental health services for adults of working age resident in Oxfordshire from a range of providers. This means that in the first instance the pool will not include budgets for services provided for residents of South Northamptonshire, and further discussion is underway concerning services in Thame and Shrivenham. Services for adults in these areas will continue to be commissioned from outside the pool. In addition to the pooled budget the Joint Commissioning Team will have access to other budgets from which it will commission services on behalf of the Oxfordshire Primary Care Trusts. The Team will need to ensure robust links with commissioning arrangements for Child and Adolescent and Older People’s mental health services as well as the commissioning undertaken by the Drug and Alcohol Action Team. The total sum to be included in the Pooled Budget will consist of:
Clear statements around the exclusions and the need for linkages to the pooled budgets will be explicit in the Partnership Agreement. All current agreements with both statutory and voluntary sector providers will be honoured, unless an explicit end date has been agreed. Any queries on this should be addressed to Jenny Connelly. While the sum of the total pool will include the contribution made by Social and Health Care to the staffing seconded to the integrated provision within Oxfordshire Mental Healthcare Trust the funding flows will be as follows:
A similar financial flows arrangement will be in place for staff seconded to the Joint Commissioning Team within South West Oxfordshire PCT whereby contribution paid by Social and Health Care for the Joint Commissioning Team will be net of payments for seconded staff. In establishing the pooled budget for April 2004 agreements on inflationary and growth uplifts, and risk sharing arrangements will be made. This will include agreements between Primary Care Trusts – a generic risk sharing agreement has been developed which will be incorporated into the Section 31 Partnership Agreement and this will also identify individual PCT contributions to the pool. There is ongoing work to set out the key principles of these agreements, including risk-sharing agreements with the voluntary sector. Client charging, which may apply to both community and residential services, will remain the responsibility of the County Council. This is because numbers of clients charged for mental health services is small and the expertise required to undertake accurate financial assessments will not be available in the PCT. Clear information will be available to service users on the process and arrangements for this. Who is in the Joint Commissioning Team, and how will it work? A Joint Commissioning Team (JCT) is being established within South West Oxfordshire PCT to support the Mental Health Partnership Board in the strategic planning of mental health services across health and social care and to commission services to deliver the agreed strategy. The current make-up of the team is as follows:
In addition the Joint Commissioning Team will receive input and support from Public Health and Information Teams within South West Oxfordshire PCT as required. A number of key objectives for the team have been identified as follows:
Between now and April the focus of the Joint Commissioning Team will be on working with the developing Mental Health Partnership Board and Joint Management Group on the development of the Mental Health Strategy and Commissioning Plan, establishment of the pooled budget, and building links with localities. Service Development Workers will continue to work in their existing localities as above, attending Local Implementation Team meetings and developing links with Primary Care Trust Mental Health Leads. Support to individual groups and providers will continue to be a key part of their role, as will identification of needs and increasing engagement of service users and carers. What will the Service Level Agreement and Contracting Arrangements be? A new form of Service Level Agreement will be developed by the Joint Commissioning Team, which builds on good practice from both partners. This will need to meet the statutory requirements and Standing Orders of both partners. The Service Level Agreements will be proportional to the size of the funding agreement and quality issues of individual providers, in both their content and monitoring requirements. Current commitments to funding and existing SLAs will be transferred to the Commissioning Team. It is expected that as agreements are renewed with voluntary sector providers, or new agreements put in place, these will be for a period of three years. What issues are still under discussion?
What is the mechanism for commenting on these proposals? This paper has been widely circulated for discussion and comment among key stakeholders. Meetings have been arranged with the Local Implementation Teams, Voluntary and statutory sector providers to discuss the implications of what has been set out. A meeting with the voluntary sector forum has already been agreed for: Thursday 15 January at 10.30 in Oxfordshire MIND offices For details please contact Patrick Taylor at Oxfordshire MIND on 01865 310830 ext 23 If you or your organisation wishes to meet with representatives from Social and Health Care and South West Oxfordshire PCT to discuss these arrangements further please contact either of the following: Jenny
Connelly, Head of Mental Health, Joint Commissioning Team, South West
Oxfordshire PCT Lorna
Brown, Head of Social Care for Adults, Social & Health Care, Oxfordshire
County Council
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