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ITEM EX16

EXECUTIVE – 16 MARCH 2004

INTEGRATION OF ADULT MENTAL HEALTH SERVICES

Report by Director for Social & Health Care

1. Work has been undertaken over the last 2 years by Oxfordshire County Council, Oxfordshire Mental Healthcare NHS Trust and South West Oxfordshire Primary Care Trust to develop improved joint working and to move towards a fully integrated mental health services for adults of working age.
2. Reports presented to the Executive on 21 January and 28 October 2003 provide detailed background information

Progress

3. Following agreement of the Executive on 28 October 2003, staff employed by Social & Health Care in adult mental health were seconded to Oxfordshire Mental Healthcare NHS Trust on 3 November 2003. Four members of staff involved in Mental Health Commissioning were also seconded to South West Oxfordshire Primary Care Trust on 3 November 2003.
4. As agreed by the Executive and on advice received from the Social & Health Care Scrutiny Committee, further work was undertaken in respect of the commissioning arrangements for adult mental health and proposals were sent to a wide range of stakeholders at the beginning of December 2003, for a 2 month consultation period ending on 28 January 2004. The consultation document is attached at Annex 1.
5. The proposals and outcome of the consultation are included in this report, which has first been presented in draft to the Social & Health Care Scrutiny Committee on 3 March for comment and advice to the Executive. The Committee’s comments will be reported at the meeting of the Executive.

Key Elements of the Integrated Commissioning Arrangement

6. The proposal states that our overarching aim ‘… is that people who experience a mental health problem, and their carers, should receive help that is:

• appropriate to their individual need;
• planned and provided with the involvement of the service users and their carers;
• available when they need it;
• of the highest possible quality; and
• Aimed at promotion and enhancing independence.

7. The lead organisation for the commissioning and pooled budget arrangements will be South West Oxfordshire Primary Care Trust, whose Board will ultimately have responsibility for ensuring the proper use of the pooled budget for adult mental health services.
8. The proposed structure for the governance, accountability and reporting of these arrangements will consist of:
   
   

1. A Joint Management Group with representation from both Oxfordshire County Council and South West Oxfordshire Primary Care Trust, which will be formally accountable for expenditure against the pooled budget to both the Council and the Trust. The Joint Management Group will also provide regular reports and update to the Mental Health Partnership Board on the delivery of the strategy and use of the pooled budget. The Joint Management Group will set the framework for performance management of both the overall pool and individual providers of services. The delegated decision making authority of the Joint Management Group will be set out in the Section 31 Partnership Agreement.
2. The Joint Commissioning Team will be managed by South West PCT and will be responsible for the day-to-day functions of the Joint Management Group. Its role will be to implement the decisions of the Joint Management Group and the Mental Health Partnership Board and support them in delivering the agreed strategy and commissioning plans. It will need to establish effective relationships with each of the five PCTs and the County Council in order to fulfil its role. The Joint Commissioning Team will also be responsible for negotiating, agreeing and monitoring the Service Level Agreements with service providers from all sectors.
3. A Mental Health Partnership Board will be established to strengthen the involvement of service users, carers, voluntary sector groups and other stakeholders in the process. The Board will play a major role in the commissioning process by being responsible for agreeing the vision, strategy and direction of adult mental health services across Oxfordshire. It will set clear recommendations for commissioning to the Joint Management Group and it is expected that through its reporting the Joint Management Group will give clear and open information about the implementation of these recommendations. This will include clear and open reasons for recommendations not being carried out. The Mental Health Partnership Board will undertake the monitoring and evaluation of progress against the delivery of the adult mental health strategy.
   
   
9. 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 for residents of Thame and Shrivenham the health elements of mental health services will continue to be commissioned by PCTs outside of Oxfordshire.
10. The total sum to be included within the pooled budget will consist of all funding for the provision of adult mental health services with the exception of funding for medium secure services, primary care based psychological therapies and counselling, budgets under the heading ‘adults at risk’ supporting people funding, the approved social work services, training budgets and any property and lease agreements between the Council and individual service providers.
11. In addition to the pooled budget the Joint Commissioning Team will have access to other Health budgets from which it will commission services on behalf of the Oxfordshire PCTs.
12. Agreements on inflationary and growth uplifts, and risk sharing will be incorporated in the Section 31 Partnership Agreement. This will also identify individual PCTs’ contributions to the pool.
13. The County Council will retain responsibility for the financial assessment of clients and for charging under Fairer Charging.

Outcome of Consultation

14. The consultation document was sent out in early December to organisations and individuals representing a wide range of stakeholders including statutory, voluntary and independent sector providers, and service user and carer groups. A covering letter offering to meet to discuss the proposals with individuals or groups was included, though this offer was not taken up.
15. A meeting was held with the Voluntary Sector forum and discussion occurred at PCT Commissioning Board and PCT led Local Implementation Teams to discuss the proposals. As well as the outcome of these discussions, five written responses were received.
16. These responses broadly welcomed the proposals and the fact that further consultation and discussion of these had been made possible. Detailed points raised are attached at Annex 2.

Conclusions

17. The proposal to put in place an integrated system for commissioning mental health services for adults of working age for the residents of Oxfordshire with a pooled budget is supported. It is proposed that the work should proceed with the agreed implementation date of 1 April 2004.
18. The Mental Health Partnership Board should have a clear remit in setting the strategy and direction for adult mental health services. It must have a role in influencing commissioning decisions and receive regular reports on the implementation of the strategy and use of the pooled budgets. The headlines from these reports should be included in a Mental Health Partnership Board briefing for wide circulation which is produced by the Joint Commissioning Team following the meetings.
19. The Joint Commissioning Team should work with colleagues to agree ways of working and respective roles of Joint Commissioning Team and PCT Mental Health Leads (this work is already under way).
20. Housing should be included on the agenda of the Mental Health Partnership Board and ways of working between the Joint Commissioning Team and Supporting People Team agreed.
21. A new form of contract which meets the requirements of the voluntary sector should be developed. This should include a commitment to three year funding for service providers at realistic levels, should address risk sharing arrangements and follow identified good practice.
22. Accountability to the wider County Council and Health systems must be clear.

RECOMMENDATIONS

23. The Executive is RECOMMENDED, in the light of the positive response to consultation but subject to consideration of the advice of the Social & Health Care Scrutiny Committee:

1. subject to (b) below, to endorse the creation of a fully integrated Mental Health Service for adults of working age by means of the formation of a Joint Management Group to discharge certain statutory functions of the County Council and other relevant NHS Trusts as described in the report;
2. to authorise completion of:

1. an agreement for the creation of a Mental Health Partnership Board and Joint Management Group and defining the functions to be discharged by them; and
2. any further agreement that may be required in respect of other matters arising from the creation of the integrated Mental Health Service;

CHARLES WADDICOR
Director for Social & Health Care

Background Papers: Nil

Contact Officers: Lorna Brown, Head of Social Care for Adults, Tel 01865 815828

February 2004

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