Agenda item

Oxfordshire’s Health Overview Scrutiny Committee and Oxfordshire County Council Performance Scrutiny have asked that matters relating to the delivery of mental health support to people in Oxfordshire are brought before them for scrutiny. This item includes two reports.

S75 Adult Mental Health Social Work report

They have asked to be presented detail on the Section 75 Partnership agreement between OHFT and OCC covering the delivery of social work and the outcome of the transfer of the Older Adult Mental Health Team back into the council. It also includes team performance, the number of people supported and an overview of s. 117 funding.

The Committee is RECOMMENDED to note the report.

Mental Health Outcomes Based Contract

They have also asked to examine Mental Health Outcomes Based Contract between OHFT and OCCG (OCC contribute funding to this contract) covering the delivery of all mental health support to people with particular conditions, including inpatient care, community support, wellbeing and employment support, and housing.

This paper provides the Centre for Mental Health Review of Oxfordshire Mental Health Outcomes Based Commissioning Contract Summary Report and the next steps being taken by OCCG in relation to the contract. 

The report recognises the way Oxfordshire commissioners and providers have pioneered the model of outcomes based commissioning, and whilst the system has ongoing challenges to address, the integrated way of working across the partners is positive and beneficial for service users and carers.

The Committee is RECOMMENDED to note the report.

Stephen Chandler introduced the report on S75 Adult Mental Health Social Work.  This is a partnership agreement between Oxford Health Foundation Trust and the County Council.  The report also references the Council decision to take back mental health social work services for older adults.  He was accompanied by Karen Fuller who is on the Joint Management Group.

Officers responded to Members’ points as follows:

·         Forensic social workers work with people who have come in contact with the criminal justice system who are identified as having a mental health need.  Their needs tend to be highly complex.

·         When the older adults service was taken back the same budget came over to the Council.  There are no particular delays in relation to assessments.  There were only a few people awaiting assessment last week.

·         S117 aftercare cases are being reviewed and cross examined to see if they are still appropriate for aftercare. Continuing Health Care (CHC) is also being considered.  It’s a misconception that you can get either S117 or CHC, it’s not a question of only one or the other.

·         A doctor has to discharge individuals from a S117. 

·         Care Act assessments have to be recorded on the LAS system.  This means they must be input twice but both organisations can see each other’s system. This is double entry.

·         The only delay between an assessment and it becoming visible on the system is the time taken to enter – usually when back in the office.

·         The ‘clusters’ refer to eligibility.  OHFT deliver support for clusters 4 to 17.  Care Act eligibility is statutory for the local authority.

·         The proposed budget for next year reflects increased demand for housing support in the Outcomes Based Contract.  The Council wants to examine how it is met – if not residential care, then how to support alternative accommodation.  Some are in a grey area but may just need some signposting to services. This will be a joint piece of work

·         The reasons for eligibility or non-eligibility are not always clear in the records.  The Council is working with OHFT to ensure that recording is clear.

·         The Principal Social Worker is working closely with the Social Care lead in the Trust to share learning and development.  There will be updated guidance from NHS England soon in relation to mental health social work.

·         There are two new people in key positions with the Trust and they are clearly committed to the partnership.

·         All residents in Oxfordshire are the County Council’s responsibility even if they live in border areas and receive services from neighbouring counties.  The Trust covers Oxfordshire and Buckinghamshire.

RESOLVED: to note the report.

Stephen Chandler introduced the report on the Mental Health Outcomes Based Contract (OBC).  The Council controls the finances but is not a signatory – OBC is a contract between the CCG and OHFT.  It was innovative five years ago but parts need to be reviewed.  There are aspects that the Council would do differently, particularly where people fall between eligibilities – for example with autism.

Members raised questions on the report which the officers responded to as follows:

·         The three parties are discussing how to catch the people who fall between eligibilities.  The number of people affected is relatively small.

·         The voluntary sector is key for those who suffer from addiction-induced psychosis and those who are homeless with mental health needs.

·         CCG investment in mental health has been low.  This is a now priority in the long-term plan and for the Integrated Care System.  Both the Council and OHFT are pushing for the CCG to prioritise mental health.

·         It is a flat cash contract.  The Trust has to absorb overspend and this can have unintended consequences.

·         A review of the system highlighted the importance of the voluntary sector.

·         There is a range of support for autism.  Some have primarily learning disability and get social worker support.  Those with mental health needs still get support even if not meeting cluster eligibility.

·         The proposed budget includes investment in transformation of social care, providing accommodation-based support and reversing the reduction in S75 staffing.

·         The decision on the two year extension is for the CCG.  The report by the Centre for Mental Health recommended continuing.  We were not required to be part of the decision but were included through the Joint Management Group (JMG).  The contract has changed over the five years.  All sides want to address the problems.

·         The NHS Plan includes additional money which has to be spent on mental health.

·         The re-tender process will start in about 12 months.  In the short-term the JMG will oversee the transformation investment and see that change is delivered.

·         The Council has applied the same system that works well for older adults to this work.  The same reports can be run and audited.  The funding provided by the Council for people with higher social needs is now visible.

·         The next time this is scrutinised more detail on the budget can be provided and an update on transformation.

·         As with any re-commissioning process, the next contract might be a different provider and it might not be an OBC – that will be part of the discussion.

·         The waiting times referred to at the bottom of Agenda Page 22 were with the NHS.

The Chairman thanked the officers for the reports and their excellent work.

RESOLVED: to note the report.