Meeting documents

Cabinet
Tuesday, 20 September 2005

CA200905-09

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ITEM CA9

CABINET - 20 SEPTEMBER 2005

INTEGRATION OF ADULT MENTAL HEALTH SERVICES

Report by Director for Social & Health Care

Background

  1. 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.
  2. Reports presented to the Executive on 21 January 2003, 28 October 2003 and 16 March 2004 provide detailed background information.
  3. 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.
  4. 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.
  5. Proposals

  6. The proposals for integration fall into two areas, each supported by a Partnership Agreement under S31 of the Health Act 1999:

    1. Lead commissioning arrangements supported by a pooled budget.; and
    2. Integrated service provision.

    Commissioning Arrangements

  7. 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.
  8. 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.
  9. 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:

    1. 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.
    2. The continuing financial deficit being experienced in the Oxfordshire Health system.

    Integrated Provision

  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. Recruitment to staff vacancies which arise during the period of the S31 Agreement would be undertaken directly by OMHT.
  15. 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.
  16. 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.
  17. 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.
  18. RECOMMENDATIONS

  19. The Cabinet is RECOMMENDED:
          1. to endorse the completion of work to create a fully integrated Mental Health Service for adults of working age through:-
            1. a Section 31 Agreement with Cherwell Vale PCT and its successor organisation as lead commissioner of Mental Health Services, supported by a pooled budget;
            2. a Section 31 Agreement with Oxfordshire Mental Healthcare NHS Trust and its successor organisation for integrated service provision supported by a pooled budget;

          2. that both agreements run from April 2006 on an ongoing basis, with a 5 year review period;
          3. 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;
          4. 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
          5. 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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