Agenda item

13:15

To follow an item at a Performance Scrutiny meeting on the 4^th of February.

A report has been written on the council’s mental health activity and spend which covers:

a) 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.

b) The 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, housing, and Care Act assessed social care needs to include:

• How are mental contracts being fulfilled and delivered

• The outcomes being delivered for the people of Oxfordshire

Stephen Chandler, Corporate Director for Adult Services, summarised the reports.  He introduced Karen Fuller, Deputy Director for Adult Social Care, who is on the Joint Management Group that has oversight and provides assurance on the budget.

The report includes an overview of S117 funding which relates to aftercare for people who have been detained in hospital under the Mental Health Act.  Responsibility rests with the psychiatrist who consults with the Multidisciplinary Team.  Performance has been mixed with some cases not reviewed for several years.  Under a joint protocol, Oxford Health is ensuring that reviews are conducted regularly and the LAS system is up to date.

Councillor Liz Brighouse, Chair of the Performance Scrutiny Committee, gave a summary of that Committee’s discussion on the same issues.  The Committee welcomed the wider overview of mental health partnerships.  It heard about the clarity being given to individual cases that may come under S117 and/or NHS funding.  The Committee was also pleased to see that health issues are not being moved over to the Adult Social Care area.

There was discussion of Looked After Children (LACs) including concern at the numbers and that many may involve mental health issues of the parents.

On the Outcomes Based Contract (OBC) the Committee welcomed greater Council engagement, especially to ensure that young people with autism receive appropriate services.  The discussion highlighted the extent of reliance on the voluntary sector – something many Members were unaware of until last year’s budget discussion.

The Committee discussed the two-year extension of the contract and is keen that the Council plays a role in ensuring greater scrutiny and transparency.  They were pleased to hear of the improved processes being followed to ensure that the system was not so reliant on individuals.

Councillor Liz Brighouse added that investment in mental health was less than what was needed – all of the money is being used to avoid crisis point.  Any extra money needs to be matched by the NHS.  Directors and councillors need to be involved in reviewing to discuss funding issues and clarify management costs.

Stephen Chandler stated that, while the contract has been extended for two years, there will be a review which will involve both Council and CCG officers.  The budget about to be discussed by Full Council includes three items under mental health: one-off support; transformation work and the reversal of the reduction to the mental health staffing contribution.

Louise Patten stated that the review was agreed along with the two-year extension.  It is important that goodwill is not lost in advance of negotiations on the next contract.

Alan Cohen noted that the delivery of some statutory services was dependent on the voluntary sector which often struggles to raise funds.  He recalled hearing in a briefing in February 2019 that more funding was expected from the NHS.  He asked if that had happened and if it went to statutory services.

Louise Patten responded that a benchmarking exercise indicated that services were underfunded.  The CCG is in contractual discussions to decide how much more money is needed.  The voluntary sector does provide some statutory services but also wider support.  Those organisations are generally very innovative.  The CCG covers costs appropriately.  Oxford Health have agreed to work with the CCG on improving support.

Debbie Richards, Managing Director of Mental Health at Oxford Health, added that the voluntary sector is involved in different contracts – not just OBC.  All are signed up to the Centre for Mental Health’s (CMH) recommendations on transparency and sustainability.

Oxford Health’s finances are in deficit and the OBC is driving that deficit.  Such losses take away from front-line services.  There is a joint commitment to work on this and look at a strategy for the contract extension.  She is looking forward to the Long Term Plan which will bring significant money into mental health.

City Councillor Nadine Bély-Summers thanked Stephen Chandler for proposing the reversal in cuts.  There is still a shortage of funding and the City Council has written to the Secretary of State to raise this at a national level.

She expressed disappointment that users and carers were not involved in the CMH review.  Louise Patten said she was surprised by that challenge as she was satisfied that there was input from stakeholders but she AGREED to clarify that.

Councillor Laura Price asked if the reference to the improvements around the LAS system on Agenda Page 68, paragraph 16, dealt with reporting rather than delivery. She had asked at Cabinet if they could track the impact on the number of children on plans or in care but they did not have the information.

Stephen Chandler responded that it was about the system and practice.  There are two systems – LAS and the Trust has its own system.  There is now a clearer picture with records being entered as close to real time as possible.  However, LAS is now an old system.  He would welcome anyone lobbying for better technology.  LAS is the same system as used for Children’s Services so cross-referencing is possible.  Ways of tracking impact can be included in the review.

Barbara Shaw stated that she was dismayed to see that there was no increase in funding to the subcontractors in the financial review.  Costs were going up all the time.  She is aware of only one voluntary sector organisation that is running without a deficit.  She asked why there were no KPIs in the contracts.  She said that additional funding provided did not go to partners.

Debbie Richards agreed regarding the flat cash contract and said that Oxford Health will work with the partners on this.  The additional money was for core services.  The OBC is not a risk contract – there is no sharing of loses.  Louise Patten added that it was intended to be a flat cash contract but they had put additional money in and expect to put more.

Barbara Shaw noted that the KPI on four-hour assessments has not been met since November 2016.  Debbie Richards responded that there was increased demand and complexity in acute mental health services.  They are not retaining staff and therefore have a reliance on agencies.  This shows why partnerships are important.

The Chairman noted that Oxfordshire has historically spent less per head than our peers and the national average.  Louise Patten responded that funding was related to prevalence in the area.  Mental Health standards are being maintained.  The next step is to move funding around – GPs are looking after increased numbers.

The Chairman asked about the patient experience of services as outlined in the bullet points on Agenda Pages 81 and 82.  Louise Patten said that this may vary from clinician to clinician.  They are working with providers on how to support low level needs such as anxiety.

Ansaf Azhar noted that those with mental health issues have a lower life expectancy.  Many have issues with drugs, alcohol and smoking.  There is a need to work on prevention.  Smoking is highest in those with mental health issues.

Debbie Richards responded that their efforts so far to reduce smoking had not made good progress.  A refreshed approach is needed in the community.

The Chairman asked if separate reporting on OBC will take place in the contract extension.  Debbie Richards reiterated their commitment to that.

It was AGREED that the Committee should receive a report on the review of the contract.

Stephen Chandler noted that staff working in social welfare have a very positive impact that is not recognised sufficiently – including those in the voluntary sector.  He asked members of the Committee to remind people of that whenever they can.