Agenda item

10.45 am

 

Fenella Trevillion, Head of Joint Commissioning for Mental Health, Oxfordshire Primary Care Trust, Ian Bottomley, Service Development Manager – Mental Health and Dennis Preece, Chairman – Mental Health Commissioning Programme Board will attend for this item. They will present plans to re-commission day services provided by voluntary and community services for adults over the age of 18 who have mental health problems. A paper which has been prepared by Ian Bottomley is attached at JHO8.

Prior to consideration of this item, the Committee were addressed by Councillor Jane Hanna and by Dr Agulnic. They each made the following points:

 

Councillor Hanna

 

• She spent four years as mental health lead during the course of her duty as non-executive director of one of the Oxfordshire PCT’s. During this time she endeavoured to accrue as  much information as possible on this highly vulnerable group of society;
• This Committee had a reputation for very careful scrutiny and she therefore hoped that its members would ensure that they were fully informed about the outcomes of service change for future and existing service users, when financial details were known;
• It was difficult to take a view at this time because there was an absence of key information in the form of the value of contracts going forward. It was understood that the specification for service suppliers was to be approved on 13 May;
• She hoped that an evaluation of the existing services would take place and that this would be an independent evaluation.;
• Much of the voluntary sector requires statutory funding;  and
• A timeline with regard to the management of this process would be useful.

 

(Councillor Hanna left the room at this point for the duration of the consideration of this item)

 

Dr Agulnic (accompanied by Patrick Taylor, Chief Executive, MIND and Benedict Leigh, Director of Oxfordshire RESTORE)

 

• Was a retired psychiatrist who had worked for the Trust for 32 years, based at Littlemore Hospital;
• He had had a keen interest and involvement within the voluntary sector and  had worked to represent some of the organisations listed on page 13 of the report;
• The county’s voluntary services were lead agencies of a very high quality comprising models of good practice and innovation;
• Particular applications, such as day services which promote recovery and rehabilitation should be regarded as front line services as they have to meet some exacting standards of governance;
• A critical mass of core activity was maintained to meet objectives. Thus, small cuts in funding would threaten the survival of the organisation as a whole or, at best, would take years to repair;
• The above would put increased breakdown pressure on an already stressed service. It would serve to prolong illness, which would result in increased costs to the NHS service;
• A feature of Oxfordshire was close, collaborative working of which there was a strong voluntary contribution;
• He urged the Committee to support at least the maintenance of the current level of voluntary service.

 

Patrick Taylor and Benedict Leigh were invited to comment. Patrick Taylor commented that he had found the tendering process talks encouraging and that the current services were valued. Benedict Leigh added that one of the aims of his organisation was to help people back into employment, which ultimately saved the Government money. Any cuts would result in a small saving, but the long term implications would be dire.

 

In response to a question asking what the £2m funding was spent on, Mr Taylor referred to the services listed in the report, together with information services and Mr Leigh commented that the vast majority of the spend was on staff (80%).

 

Alan Webb, Director of Service Redesign, Fenella Trevillion, Head of Joint Commissioning for Mental Health and Ian Bottomley, Service Development Manager, Oxford PCT were invited up to the table. Alan Webb, introducing the report commented as follows:

 

• The PCT were committed to working with the voluntary sector who worked both in a complementary capacity and in the delivery of other services;
• The Health & Well-Being Partnership had  produced a paper 18 months ago which described the current provider services and, whilst recognising that they were good, also recognised that they were not necessarily as integrated as they might have been. The PCT were therefore looking at a wide range of services, whilst keeping the wider Mental Health Strategy in mind.

 

Fenella Trevillion presented the main points of the report for the Committee. Members of the Committee asked a number of questions, some of which are included below:

 

Comments made by members of the Committee during the course of the discussion included the following:

 

• There is insufficient information. It would be useful to know the value of the contracts which are going forward;
•  It may be a retrograde step that the new service will see the demise of some very good local services, particularly in the smaller towns and villages;
• Concentration on the geographical profile may be a red herring. The reason why they are concentrated on the Cowley Road is because that is where the users are situated;
• Mental Health sufferers can often feel quite isolated and the day centres help them with their communication skills and cooking skills etc;
• The Chinese Advice Service has a large membership;
• Most of the current funding focuses on the severe end of the illness. These proposals appear to be a change in focus to help those with milder illnesses – but would funding be redirected from the former to the latter. If this should happen the outcomes would be disastrous ;
• Poor service links to BME people and to the primary care sector do not appear to have been picked up in the proposals as they stand at the moment;
• If one FTE post is lost, then many more volunteers would be lost to the service.

 

The Director of Public Health commented that anything which improved services with regard to well-being and education would be a positive move. He added that one could not argue with commissioning on outcomes as long as one is commissioning for the right results. Although he gave the proposals, as far as they were known, a cautious welcome, he wondered where the ‘human factor’  would be in the light of the new ‘business like’ stance of the NHS and their partners.  He praised Fenella Trevillian for her close work with the voluntary sector.

 

Alan Webb reported that the contract value had been reduced from £2m to £1.7m, adding that the PCT needed to work with the voluntary sector on what that would mean to the services and to give additional support if required. The intention was to increase throughput and people accessing voluntary services for a reduced amount of money. The focus of the services would be on local delivery, building on the Needs Assessment already carried out and also based on the Community Strategy. He added that there were significant numbers of volunteers in Oxfordshire, particularly in the Mental Health sector. With regard to the Committee’s anxiety around the possible loss of smaller providers , sub-contracting would be actively encouraged and also joint bidding would be encouraged. It was hoped also that grant money would be accessed.

 

In response to concerns that money might be taken away from those with severe mental health difficulties in order to establish public health/community services, Mr Webb assured the Committee that funding for the acute mental health care services would not be affected.

 

Fenella Trevillion commented as follows:

 

·        Very key service users were involved. Ian Bottomley had visited all current users who had expressed a wish to be involved. Moreover, carers and users sat on the Programme Board in order to feed in their views;

·        People were aware of the changes and had been sympathetic to the adverse financial environment;

·        The proposals encompassed a recognition that the geographical spread of services needed to be improved. Work was being done to assist people to retain their links with their community. There were a significant amount of services being delivered on the Cowley Road in Oxford which were very similar and therefore not a good use of resources;

·        There would be a continuation of linkage to other services , however, there some dovetailing of services and linkage to key mainstream services would occur;

·        Services for older people were being looked at within the aegis of ‘Ageing Successfully’ ie prevention.

 

Ian Bottomley responded to issues raised by the Committee concerning:

 

• Gaps in service for the Bangladeshi community and people of black minorities and ethnic background have been identified. There will be service specifications to state how that process will be managed. It was expected, however, that not all the services will be going to a community service provider;
• With regard to day service provision, there was no intention to abolish the peer support function. New buildings will not be commissioned, but creative thought will be given into different ways in which this could be given.

 

Whilst welcoming the very detailed discussions which had taken place with service users, members of the Committee continued to express their concern about the 20% reduction in funding for these services and the lack of information about where the cuts, reductions or reconfigurations would fall. It was this is mind that the Committee AGREED to

 

(a)                 thank Councillor Jane Hanna and Dr Agulnic for their addresses;

(b)                 thank Patrick Taylor and Benedict Leigh for attending the meeting;

(c)                 thank Alan Webb, Fenella Trevillion and Ian Bottomley,  Oxfordshire PCT for their presentations and for making themselves available to respond to questions; and

(d)                 form a working group, comprising Dr Dickinson and Councillors Rose Stratford and Jenny Hannaby to work with the PCT commissioners to ensure that:

 

(1)   the Keeping People Well service level outcomes were equitable, there was equity of access and that the current level of service was maintained and/or improved;

(2)   that the process had been transparent throughout; and

(3)   whether a full public consultation was required.