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Cabinet
Tuesday, 17 March 2009

 

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ITEM CA12

 

CABINET - 17 MARCH 2009

 

THE EXPANSION OF THE COMMISSIONING POOLED BUDGET FOR MENTAL HEALTH SERVICES FOR ADULTS OF WORKING AGE

IN OXFORDSHIRE

 

Report by Director for Social & Community Services

 

EXECUTIVE SUMMARY:

 

This paper is being presented to Oxfordshire County Council Cabinet and to Oxfordshire Primary Care Trust Board

 

1.                  To inform Oxfordshire County Council (OCC) Cabinet/Oxfordshire Primary Care Trust (OPCT) Board of the plans for expansion of the Mental Health Commissioning Pooled Budget between OCC and OPCT and the necessary arrangements to put this in place.

 

ACTIONS REQUESTED:

 

1.1.           To obtain Cabinet/OPCT Board approval for the expansion of the Commissioning Pooled Budget from April 2009 to include all Budgets from both organizations for adults of working age with mental health problems

1.2.           To obtain Cabinet/OPCT Board agreement to the governance  arrangements to oversee the expanded Commissioning Pooled Budget

1.3.           To request that Chief Officers are given delegated authority to agree the budgets that will contribute to the Mental Health Commissioning pool.

 

Introduction and Context

 

2.                  Cabinet members and OPCT Board members are advised that the Commissioning Pooled Budget arrangements described in this paper refer to the commissioning of mental health services for adults of working age. Cabinet members and OPCT Board members will also be aware that there is a Commissioning Pooled Budget for Older People between OCC and OPCT and a Provider Pooled Budget between OCC and Oxfordshire and Buckinghamshire Mental Health NHS Foundation Trust (OBMH).

 

3.                  This report is further to Paper 08/79 Mental Health and Mental Well-being in Oxfordshire presented to the OPCT Board in July 2008. This is the first paper on this matter to be presented to the OCC Cabinet.

 


Legal Context

 

4.                  Section 75 National Health Service Act 2006 makes provision for partnership arrangements between NHS bodies and local authorities. In this instance this would be by pooling commissioning budgets that currently fund services for people with mental health problems who are adults of working age.

 

5.                  As Cabinet members/Board members are aware, a Mental Health Commissioning Pooled Budget has existed for three years and has been used to commission services from voluntary and community sector organizations. These arrangements have been of considerable benefit to users of voluntary and community sector services and their carers. In addition, these arrangements have allowed OCC and OPCT to streamline processes and plan strategically to target services across the spectrum of health, social care and well being for adults of working age affected by mental illness in the County.

 

Strategic Context

 

6.                  All partners involved in both the commissioning and provision of mental health services have agreed The Oxfordshire Mental Health Strategy 2007-12. This recommended the completion of a commissioning strategy to underpin the plan. In line with this a Mental Health Needs Assessment and an engagement exercise were carried out in the second quarter of 2008.

 

7.                  Additionally, these 2 exercises have informed OPCT’s refreshed Strategy in line with World Class Commissioning.

 

Reasons for expanding the Commissioning Pooled Budget

 

8.                  The Oxfordshire Mental Health Strategy 2007-12 aims to improve the experience of adults with mental health problems by completing a commissioning strategy for health and social care. This will ensure that the appropriate vehicle for delivery of joint commissioning is in place.

 

9.                  It is intended that this Commissioning Pooled Budget be expanded from April 2009 to include all non-forensic services addressing the health, social care and well being needs of working age adults living with mental health problems.

 

10.             An expanded Commissioning Pooled Budget will better meet the needs of people living with mental health problems in Oxfordshire through giving greater scope for improving care pathways and alignment of resources to meet service users’ and carers’ needs.

 

Financial Contributions to the Commissioning Pooled Budget

 

11.             The contributions to the current and incoming Mental Health Commissioning Pooled Budget are as follows (2008-09 figures):


 

Resources:

£000s

Current mental health pool

 

OPCT recurrent funding

1,419

OPCT non recurrent funding

83

OCC funding

2,018

Total current resources

3,520

 

 

Incoming mental health pool

 

OPCT recurrent funding

36,058

OCC funding

5,317

Total incoming resources

41,375

 

 

Total Mental Health Pool

 

OPCT recurrent funding

37,477

OPCT non recurrent funding

83

OCC funding

7,335

Total resources

44,895

 

12.             The detail of the budget is included within Schedule 4 to the s75 Partnership Agreement. The final agreement on the contributions will be made in March 2009.

 

Benefits of an enlarged Commissioning Pooled Budget

 

13.             An enlarged Commissioning Pooled Budget will bring significantly increased resources to bear on the revised strategic priorities. It will:

 

(a)               Enable OPCT as lead commissioner to commission services that will be delivered through more responsive services with improved integrated care pathways. These will focus on enhancing recovery for service users, ensuring support for them and their carers and emphasise the need for care being provided closer to home.

 

(b)               Give much greater flexibility in the redesign and commissioning of services.

 

(c)               Revise governance arrangements so as to deliver the same level of accountability but in a way that will better support joint working.

 

Pooled Budget Arrangements

 

14.             With the support of a consultant (Robin Lorimar) who is a specialist in section 75 Pooled Arrangements a Shadow Enlarged Pool has been in operation since October 2008. The Cabinet Member for Social and Community Care, a Non-Executive Director of the OPCT Board and Chief Officers in both organizations have been fully involved in the planning process.

 


The Mental Health Strategy Implementation Group [MHSIG]

 

15.             As part of the process of expanding the s75 Commissioning Pooled Budget MHSIG was reviewed with new terms of reference agreed. The role of MHSIG is to ensure that the strategic direction of mental health is in line with The Oxfordshire Mental Health Strategy Oxfordshire 2007-12. MHSIG agrees the action plan to deliver this strategy and monitors progress.

 

16.             A Non Executive member of the OPCT Board Chairs MHSIG and provides a direct reporting link to the PCT Board. MHSIG comprises the Head of Adult Services (OCC), Director of Commissioning (OPCT), the Pooled Budget Manager (OPCT) and senior officers from Public Health and Supporting People, the Chief Operating Officer (OBMH) and nominated representatives from voluntary and community sector providers and service users and carers.

 

17.             Whilst MHSIG acts as the local implementation team [LIT] for the Mental Health National Service Framework for Oxfordshire, it is not the accountable body for the mental health Commissioning Pooled Budget. Accountability for this rests with the mental health Joint Management Group [JMG]. MHSIG does not have a formal relationship with JMG, but can make recommendations to it.

 

Mental Health Joint Management Group

 

18.             A partnership agreement under Section 75 National Health Services Act 2006 has been drawn up to underpin the work of the JMG. This was passed for legal review on 12th January 2009. The schedules to the Agreement include the Aims and Objectives, OPCT and OCC Health Care and Health Care related functions, Scope of the Pooled Fund and eligibility for services, Pooled resources, Governance and the Joint Management Group. This will act as the framework for the pooled budget arrangement.

 

19.             Key Performance Indicators are currently in preparation and will be used to monitor performance of the Pool.

 

20.             The Cabinet/OPCT Board are asked to grant delegated authority to the Head of Adult Services OCC and the Director of Commissioning OPCT to sign off the final contributions to the Commissioning Pooled Budget.

 

Governance and Pool Responsibilities

 

21.             The diagram in Annex 1 (download as .doc file) illustrates the governance arrangements for the JMG. The OPCT is the host partner for the purposes of the Regulations. As Lead Commissioner, OPCT will be responsible for commissioning health and social care for mental health services for adults of working age across Oxfordshire. OPCT shall enter into care contracts as and when agreed by both OCC and OPCT through the JMG.

 

22.             The Pool Manager is the Head of Joint Commissioning at OPCT and is responsible for authorising payments from the Pool and for managing the Pool Budget. The Pool Manager is accountable to the Director of Commissioning at OPCT.

23.             The Pool Manager will report to JMG which will meet 10 times a year. Voting members of the JMG will be Head of Adult Services (OCC), Strategic Finance Manager (OCC), Director of Commissioning (OPCT) and Deputy Director of Finance (OPCT).

 

24.             The JMG has executive function and is responsible for budgets and contracts and is accountable to the OCC Cabinet and OPCT Board.

 

Management of Risk

 

25.             Throughout the shadow phase of the pooled budget a risk register has been in place. This will continue once the full pool is in place.

 

26.             An area of risk that has required considerable thought between OCC and OPCT has been the expenditure on social care accommodation and support for people with mental health problems. These budgets are currently held by OCC. The current budget shows a recurring year end cost pressure of £364k. The following measures have been agreed to address this pressure:

 

·        The Commissioning Pooled Budget will not inherit a deficit. OCC will make good any overspend in 2008-09.

·        The Commissioning Pooled Budget will start in April 2009 with a pressure. OCC and OPCT will work together to address this pressure, but should it recur at year end OCC will meet the overspend in line with paragraph 6.14.1 of the Partnership Agreement.

·        OCC will fund 2 posts (a Contracts Officer and an Accommodation Project Manager) to work on a commissioning plan to reduce this deficit

·        All contracts within the Pooled Budget will be reviewed and efficiencies made that will contribute to the variance in future years

 

27.             In addition, in order to have greater control over future social care accommodation and support costs OCC, OPCT and OBMH are in discussion about the responsibility for the assessment and placement function being discharged by OBMH and monitored through the Provider Pool. It is proposed that OBMH would then hold the financial risk.

 

28.             The other key risks and the mitigation plans are as follows:

Risk

Mitigation

The expanded Pooled Budget does not meet the expenditure of the Pool.

The Partnership Agreement has measures for monitoring and taking action in respect of over and under spends.

OCC and OPCT are unable to agree to measures to deal with an overspend

The Partnership Agreement has provision for how to settle disputes in relation to overspends, and how to allocate liability where agreement cannot be reached.

Impact of personalised budgets on pooled budget arrangements

A pilot involving MH service users will commence at the earliest possible opportunity and be used to assess risks to inform commissioning from April 2010

 

Arbitration

 

29.             The Partnership Agreement makes provision for disputes. Where officers cannot resolve disputes within 4 weeks these shall be escalated to the respective Chief Executives. If within a further 4 weeks the dispute remains unresolved either party may refer the matter to an arbitrator appointed by agreement or by the President of the Royal Institute of Arbitrators. Any such reference will be subject to the Arbitration Act 1996 and OCC and OPCT agree that the outcome of the arbitration process will be binding and that they will act on any recommendations. 

 

Conclusion

 

30.             The expansion of the Pooled Budget for Commissioning Mental Health services in Oxfordshire will improve services for adults living with mental health problems by bringing increased and better aligned resources to the commissioning of Mental Health services. This will be in line with The Oxfordshire Mental Health Strategy 2007-12.

 

31.             Cabinet Members/OPCT Board members are asked to approve the S75 Partnership Agreement and the expansion of the Commissioning Pooled Budget from April 2009 which will enable the continual improvement of the commissioning of mental health services for adults of working age.

 

RECOMMENDATIONS:

 

32.       The Cabinet is RECOMMENDED to:

 

32.1    give approval for the expansion of the Commissioning Pooled Budget from April 2009 to include all Budgets from both organizations for adults of working age with mental health problems

32.2         agree to the governance  arrangements to oversee the expanded Commissioning Pooled Budget

32.3    agree that Chief Officers are given delegated authority to agree the budgets that will contribute to the Mental Health Commissioning pool.

 

 

 

JOHN JACKSON

Director for Social & Community Services

 

Background papers              Section 75 Agreement and Schedules

 

Contact Officer                      Paul Purnell Tel: (01865) 323576

 

March 2009

 

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