Agenda item

10:20

The paper (JHO6) sets out progress made on the implementation of the outcomes based contract (OBC) signed by the Oxfordshire Clinical Commissioning Group (OCCG) on 1 October 2015. It clarifies the scope of the contract, seeks to explain the contracting mechanism and identifies the next steps. The paper will be presented by Ian Bottomley, Head of Mental Health & Joint Commissioning, OCCG.

Ian Bottomley, Head of Mental Health Services, OCCG presented a report on progress made on implementation of the outcomes based contract (OBC) as signed by the OCCG on 1 October 2015. The report (JHO6) clarified the scope of the contract, explained the contracting mechanism and identified the next steps.

A member of the Committee asked about experience so far in relation to the new contracts. Ian Bottomley explained that OCCG had deliberately opted for a 5 + 2 year contract, as some changes would take time in order to align people to assist in helping patients into work and education. Some of the measures were new and were being developed as the contract developed. Some providers were already moving ahead, for example with the purchase of more intensive support accommodation. The full impact of year 1 would be seen at the end of year.

Mr Bottomley was asked what impact the recent County Council cuts contained in the County Council’s budget would have on the contract. He responded that there would be none, as it had been agreed prior to the recent cuts. However, there could be some implications around services for the homeless, with a significant cross over with services for people with a mental health illness. In his view there was already a reasonably good care pathway, so that help and support could be given by mental health support workers further along the line.

Mr Bottomley was asked what the impact on waiting lists for first entry into the service would be. He explained this was being monitored and the Trust had continued to meet all targets, and there was no waiting list. A national initiative requiring a two week wait for patients experiencing the first onset of psychosis had been put into place, so those patients were coming into the front door very quickly. He added that where there were instances of patients being ‘behind the front door’ these were being addressed. Mr Bottomley, explained that services provided ‘at the front door’ comprised two service contracts, ‘Assessment ‘and ‘Treatment Specification’, which provided four sessions with every patient. The provider would sit with the patient and work out what was needed. This might mean care planning and support, access to work or psychiatric care, all or part thereof. The target also ensured psychological support for the patient, if needed, as soon as possible, as well as access to housing, physical support etc.

Mr Bottomley was asked if the threshold would gradually rise over time if other organisations found it necessary to alter their thresholds due to cuts. He explained that the OCCG had built part of the contract around national measures for mental health. Over many years the ‘Care Plus’ component had stratified patients into those suffering from varying conditions categorised as mild to severe. It was not possible to move from one patient cluster to the other without being in breach of contract.

Mr Bottomley explained that accommodation provision had been organised prior to the new contract being set up. Floating Support had also been included within the new contract in the same form as before.

In response to a question about the robustness of the discharge planning process (in light of the recent fatal stabbing incident in Abingdon), Mr Bottomley stated that the aim was for people to live independently, but only with the appropriate risk planning in place. This would be flagged up with the appropriate organisations.

With regard to the monitoring of safe and effective care, a member asked how the OCCG picked up a service delivery problem within its measurement of outcomes and what would it focus on to ensure an improved service?  Mr Bottomley responded that individual incidents would continue to be investigated, and Trusts would be expected to report on how they were addressing issues arising from incidents. If necessary, associated risks would rise if the provider was not able to deliver. When measuring patients with care plans, Mr Bottomley explained that a plan was not measured per se, but certain indicators were examined to see how well patients were doing in the patients’ own experience, He pointed out, therefore, that outcome planning was measured, as well as delivery.

Ian Bottomley was asked, in light of the recent incidents in Abingdon and in Didcot, who monitored the incidents where risk assessments had gone wrong. and how was the information collected?  He explained that in cases such as these, contract monitoring took place following a review. Dr McWilliam clarified that contracts were let to credible providers who were qualified to do the job. There were internal quality controls on the provider for the daily treatment of the patient. If something was to go wrong, the provider would submit a report to the commissioner, who would do a quality check on it and draw their own conclusions. Issues would then be raised with the provider.

A member asked if there was a more robust way of ensuring that the provider reported back following an incident, and of ensuring that lessons had been learned. Mr Bottomley responded that the OCCG had never had any concerns about the reporting of incidents. An issue which the OCCG was currently addressing in relation to care providers was that the driver for outcomes was sometimes at the expense of good quality care. Dr McWilliam pointed out that generally speaking, there were many routes from which poor quality service became apparent, via inspection reports, patient groups, local members, scrutiny committees etc. Commissioners would also be talking to patient groups.

The Chairman thanked Mr Bottomley for his attendance.