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ITEM CA9
CABINET
- 20 SEPTEMBER 2005
INTEGRATION
OF ADULT MENTAL HEALTH SERVICES
Report by
Director for Social & Health Care
Background
- Work has been
undertaken over the last 3 years by Oxfordshire County Council, Oxfordshire
Mental Healthcare NHS Trust (OMHT) and the Oxfordshire PCTs to develop
improved joint working and to move towards a fully integrated mental
health service for adults of working age.
- Reports presented
to the Executive on 21 January 2003, 28
October 2003
and 16 March 2004 provide detailed background information.
- The Executive,
at its meeting on 16 March 2004, approved the creation of a fully integrated
Mental Health Service for adults of working age and authorised any agreements
necessary in respect of other matters arising from the creation of the
integrated mental health service subject to the terms being to the satisfaction
of the Director for Social & Health Care and the Solicitor to the
Council, following consultation with the Executive Members for Community
Care & Health and Children & Young People.
- Notwithstanding
the approval outlined above, with the passage of time, some changes
to the integration agenda and the new Administration within the County
Council, it is felt that progress on this work should be presented to
Cabinet and approval sought to take this work through to completion.
Proposals
- The proposals
for integration fall into two areas, each supported by a Partnership
Agreement under S31 of the Health Act 1999:
- Lead commissioning
arrangements supported by a pooled budget.; and
- Integrated service
provision.
Commissioning
Arrangements
- The Executive
on 16 March 2004 agreed that Lead Commissioning for Mental Health Services
should be undertaken by South West Primary Care Trust. Due to changes
within the distribution of commissioning functions between the Oxfordshire
PCTs, this subsequently changed to Cherwell Vale PCT, with whom all
subsequent negotiations have taken place.
- The initial timeframe
for completion of the commissioning agreement was April 2004, but with
changes in the PCTs and some uncertainty regarding financial balance
within the PCTs, it was decided to adopt a two phase approach. The first
phase was to bring together the commissioning team with Social &
Health Care (S&HC) staff seconded initially to South West PCT and
subsequently to Cherwell Vale PCT; to create a pooled budget to support
the team; and to unify contracts and service agreements with the voluntary
sector. The commissioning arrangements have been unified and work is
progressing on the contracting arrangements.
- The second phase
will be the completion of the overall agreement encompassing all adult
mental health services as previously described. This is now intended
to be completed by April 2006. This has been delayed in order to accommodate
two important issues:
- The merger of
the current Oxfordshire PCTs into a single PCT, with possible boundary
changes. The merger is subject to public consultation, so no final
decision has been taken.
- The continuing
financial deficit being experienced in the Oxfordshire Health system.
Integrated
Provision
- At its meeting
on 28 October 2003, the Executive approved the integration
of mental health services for adults of working age by the secondment
of staff to Oxfordshire Mental Healthcare NHS Trust (OMHT) supported
by a partnership agreement under Section 31 of The Health Act 1999.
- The initial secondment
arrangement was for a period of 2 years from 1 November 2003. Any renewal
of the arrangement was to be subject to review including a formal consultation
with seconded staff followed by a 3 month notice period of intended
future arrangements.
- The review of
arrangements was undertaken from January 2005 to May 2005 and involved
consultation with S&HC staff, OMHT staff, users and carers. UNISON
was fully involved during the review period.
- The review clearly
recommends the continuing secondment of S&HC staff to OMHT in order
to provide an integrated service. It is further recommended that this
should be for a period of at least 5 years. In order to best facilitate
this, it is recommended that the S31 Agreement and secondment arrangement
should run concurrently and should be ongoing with a clear review period
at 5 years. At this point, the agreement and secondment would automatically
continue for a further 5 years unless the review recommended termination.
- Recruitment to
staff vacancies which arise during the period of the S31 Agreement would
be undertaken directly by OMHT.
- A further change
which needs to be incorporated within a renewed agreement to run from
April 2006 is the fact that it has been agreed that Oxfordshire Mental
Healthcare NHS Trust and Buckinghamshire Mental Healthcare NHS Trust
will form into a single Mental Healthcare NHS Trust by April 2006.
- Staff have received
written confirmation that, subject to the approval of Cabinet, their
secondment to OMHT will be renewed from 1st November 2005, initially
to April 2006, and thenceforth on an ongoing basis with the successor
organisation with a clear 5 year review period.
- Similar arrangements
are recommended for commissioning staff currently seconded to Cherwell
Vale PCT, with secondment continuing with that organisation at renewal
in November 2005 and from April 2006 with the appropriate successor
organisation.
RECOMMENDATIONS
- The Cabinet
is RECOMMENDED:
- to
endorse the completion of work to create a fully integrated
Mental Health Service for adults of working age through:-
- a
Section 31 Agreement with Cherwell Vale PCT and its successor
organisation as lead commissioner of Mental Health Services,
supported by a pooled budget;
- a
Section 31 Agreement with Oxfordshire Mental Healthcare NHS
Trust and its successor organisation for integrated service
provision supported by a pooled budget;
- that
both agreements run from April 2006 on an ongoing basis, with
a 5 year review period;
- that
the secondment of staff to the respective organisations continue
from 1 November 2005 and thereafter to the successor organisations,
for the duration of these agreements;
- that
the agreements incorporate appropriate delegation of any or
all of the health-related functions of the Council as specified
in Regulation 6 of the NHS Bodies and Local Authorities Partnership
Arrangements Regulations 2000; and
- that
the terms of the agreements be to the satisfaction of the Director
for Social & Health Care and the Solicitor to the Council
following consultation with the Cabinet Member for Health &
Community Services.
CHARLES
WADDICOR
Director for
Social & Health Care
Background
papers: None
Contact
Officer: Lorna Brown, Head of Social Care for Adults Tel: 01865 815828
September
2005
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