1 Summary

The following decisions are sought.

1.1 That a community equipment service is established with effect from 1 April 2005 within existing levels of investment to the following: Hampshire County Council; Portsmouth City Council; Portsmouth City PCT; East Hampshire PCT; Fareham and Gosport PCT; Blackwater Valley and Hart PCT; North Hampshire PCT; Mid Hampshire PCT; Eastleigh and Test Valley South PCT; New Forest PCT.

1.2. That pooled budget arrangements under Section 31 of the Health Act 1999 are developed by July 2005, with Hampshire Social Services being the host partner.

1.3. That a service manager be appointed to manage the integration and performance of the community equipment and technician services.

1.4 That the success of the partnership is reviewed after six months, with a report to the Integrated Community Equipment Partnership Board.

1.5 That an action plan be developed both to address differential investment between PCTs and to make recommendations on areas identified for further development.

2 Reason(s)

2.1 Social Services plays a key role in the community equipment service across Hampshire, both as a direct provider and as a commissioner from other agencies.

2.2 The provision of equipment to enable vulnerable and older people to live independently in their own home supports the Corporate Aims 1 and 4 Maximising Life Opportunities and Building safer communities. In implementing service developments required by the Integrated Community Equipment Services Initiative it supports Corporate Aims 2 Stewardship of the Environment, through recycling. The workforce developments outlined support Corporate Aims 3 and 6 Achieving Economic Prosperity and Developing Staff.

2.3 As 80% of Community Equipment is provided to older people, this supports the County Council priority for Older People.

2.4 These decisions support the conclusions of the Occupational Therapy, Equipment Services and Technician Best Value Review 2000.

3 Other options considered and rejected

3.1 None as this report actions the medium term plan identified in the report of 23 January 2004

4 Conflicts of Interest declared by the decision-maker or other Executive Member consulted

4.1 None

5 Dispensation granted by the Standards Committee

5.1 None

6 Reason(s) for the matter being dealt with if urgent

Not applicable

Approved by: Date of decision:

Councillor Felicity Hindson

1 Summary

1.1 The development of Integrated Community Equipment Service (ICES) outlines how Social Services in partnership with health colleagues intend to meet both national and local requirements in response to the Integrated Community Equipment Services initiative.

1.2 This initiative is featured in the National Service Framework for Older People, Supporting People, Fair Access to Care Services and other Government guidance. Challenging targets for increased equipment provision have been set by the Government as part of the Priorities and Planning Framework 2003/2006.

1.3 Impact Assessment

1.3.1 There is a need to undertake further work in understanding how black and minority ethnic groups access equipment services across health and social care. In Social Services historical systems did not record this information for Occupational Therapy users. This will be rectified with the implementation of SWIFT this month.

1.3.2 It will be important that all staff within the equipment services promote race equality in the way they work.

2 Background

2.1 The purpose of this report is to seek Executive Member approval for a Hampshire and Portsmouth wide Integrated Community Equipment Service. The report will also provide an update on the developments and progress to achieve this. This initiative is featured in the National Service Framework for Older People and other key government guidance.

2.2 Following a previous report to the Executive Member on 23 January 2004, Hampshire became the service provider for ICES for five of the PCT's on 1 April 2004. As identified in that report Hampshire's preference was for a single service to cover the whole of Hampshire. Consequently a subgroup of key stakeholders for South East Hants met to look at the viability of a Hampshire / Portsmouth store. The conclusion supported by all five stakeholders (Hampshire County Council, Portsmouth City Council, Portsmouth City PCT, East Hants PCT, Fareham & Gosport PCT) was for the development of a Hampshire / Portsmouth service.

2.3 This was ratified by the ICES Partnership Board (the board) on 23 August 2004. As a consequence of this and subject to Executive Member approval, it was agreed that Hampshire Social Services will be the provider of Community Equipment Services. A number of working groups were established in order to ensure that the service is operational from 1 April 2005.

2.4 This report sets out progress to date with key milestones for achievement, and includes human resource issues, pooled budget, equipment to be supplied, IT and future service improvements.

3 Human Resources Group

3.1 A working group has been tasked with ensuring the smooth transfer into the new service. As a consequence of the timescale and to avoid disadvantaging any staff member, it has been proposed that all staff members employed by Portsmouth City PCT will be seconded to the new service. This currently involves 12 posts at a cost of £241,000 per annum, which will be transferred into the pooled fund by Portsmouth City PCT and paid from it. This decision will be revisited as part of the overall review

3.2 At this stage the process has only incorporated staff at the two equipment stores. It is the intention to integrate the technician service during the course of 2005 / 2006 to provide a truly integrated service.

3.3 A draft structure has been developed and is being consulted upon currently. All of the relevant job descriptions are being prepared and will be evaluated against HCC criteria within the Pay and Benefits reviews. The draft structure chart is attached as Appendix 1

3.4 Essential to the successful implementation and performance of the integrated services is the appointment of a head of service at service at service manager grade (Hay management grade F) The post will be funded, for the most part by deletion of the current project manager post (Hay management grade G). The shortfall will be met from existing capacity within the Physical Disability budget. A detailed costing schedule is attached at Appendix 2

3.5 In addition to managing the integration of the community equipment services, the service manager will review the management and staffing structure of the technician services and plan and implement their integration within the integrated community equipment service.

3.6 Although authorisation for the majority of staff changes will be sought through the workforce plan, authority to introduce the service manager role with effect from the 1^st April 2005 is sought through this report so that implementation of the integrated community service is not unduly delayed.

3.7 Any proposed workforce changes within the equipment and technician services will be cost neutral and managed through existing County Council procedures. It is envisaged that most staff will slot into similar posts, and that there will be no redundancies. Proposals will be presented in the workforce plan for approval and through subsequent reports to executive member as necessary.

3.8 A communication and change management strategy is being developed by the two relevant HR departments.

3.9 Key Milestones achieved

January 05

- HR group established

- Management structure agreed

- Job Descriptions Completed

3.10 To be achieved

February 05

Communications strategy confirmed for staff and trade unions

Role profiles evaluated

March 05 - Secondment details for Portsmouth PCT drivers to be finalised for implementation on 01 April 2005.

4 Pooled Budget

4.1 The current budgets of the Joint Equipment Store is £814,000 net of current health funding of £616,000 (from the north and south west Primary Care Trusts) which will be part of the pooled fund. The net budget for the Technicians Service is £611,000. Both budgets are predicted to balance at the end of this financial year.

4.2 The full details of the partners contributions will be reported to the Executive Member and included in the s31 agreement once they have been finalised.

4.3 The key financial clauses in the s31 agreement are:

4.3.1 There is no delegated authority to overspend without Board approval.

4.3.2 If an agreed overspend occurs, the partners share this in proportion to their financial contributions to the pooled budget.

4.3.3 Any under spends can be used in the Service as the Board agrees, or else distributed back to the partners.

4.3 The Board will agree the inflationary uplift to be applied by all the partners to the pooled fund.

4.4 It is unlikely that the legal documentation relating for the pooled funding will be agreed by all partners by 1 April 2005, consequently a letter of agreement for funding will be agreed for the first quarter of 2005/06.

4.5 This is one of the more complicated arrangements as the South East Health economy operates a risk sharing arrangement which requires resolution. In addition to this there are three policy initiatives identified, which have led to significant health investments over recent years, when compared to PCT investment in other parts of Hampshire.

4.6 Work is ongoing to separate out and identify financial implications. It is likely that "core" activity will be identified with separate funding being provided for the policy differences. There is a further complication regarding the current "saving target" for the current South East store, the impact of which will need to be factored in.

4.7 It has been agreed that the level of investment for the South East will be no less for the core aspects of the service in order to enable effective planning to take place.

4.8 There will be an action plan to look at longer term funding issues to ensure equity of funding commitments amongst the partners. It is anticipated that this will be presented to the Partnership Board during 2005/06.

4.9 Key Milestones

Jan 05 - Initial funding issues identified

March 05 - Final version of Section 31 prepared

May / June - Section 31 signed by partners

5 Equipment Supplied

5.1 One of the key tasks in terms of equipment supplied has been to harmonise the two catalogues that exist. A separate group of professionals has met to identify differences and agree the way forward. This element of the task is almost complete.

5.2 In addition to this a communication plan is being prepared to inform all prescribers of equipment of the changes and the new catalogue. Whilst there might be changes in equipment supplied, this will not mean that current equipment will be recalled. It will continue to be reissued as long as it meets needs of users / patients. Over time, progress to a common stock will be achieved.

6 IT Developments

6.1 Current services are experiencing problems with the supplier of the software and the capability of the system. It is clear that the new integrated service will require a more robust system. This system will need to be capable of producing all of the necessary performance data required by the stakeholders.

6.2 A group has been working on this and a plan is to be presented to the next board meeting, as there will need to be additional investment.

6.3 IT2000 will be supplied to the South East store. This will enable the recently developed electronic referral form to be utilised initially within all Social Services teams and it is anticipated that it will be capable of being used across health and social care in the near future.

7 Future Service Improvements

7.1 There are a number of items which require development and whilst the current focus has been on establishing a Hampshire and Portsmouth solution, these items will form part of the first years action plan for the service.

7.2 At present, following an assessment visit by an Occupational Therapist or Nurse, the appropriate equipment is requested from and delivered by the Joint Equipment Service. Following delivery, the OT or Nurse will visit again to fit and demonstrate the item and ensure that it meets the service users needs. If a minor adaptation is also required, then the Technician Service will visit as well. On occasions a check visit will be made by the OT or Nurse after the Technician has completed their work.

7.3 There is therefore considerable overlap and duplication in a number of areas within this process and Occupational Therapists or other professionals are required to make several visits. The following proposals are currently being developed to streamline this process.

7.3.1 Driver/fitters

7.3.1.1 The introduction of drivers who are able to fit and give instruction on the use of some items of equipment would reduce the need for Occupational Therapists and other professionals to make additional visits, thereby enabling them to focus on other aspects of their work.

7.3.1.2 Additional posts would be required, as the number of deliveries/collections made each day decrease due to the extra time taken to fit the equipment.

7.3.2 Technician Service

7.3.2.2 Hampshire County Council Technician Service is based at Segensworth, near Fareham, where there are workshop and storage facilities. Three Technicians are based at the JES in Basingstoke, but managed by the Technician Service. The Technician Service is responsible for carrying out minor adaptations in privately owned property, repairing special equipment, constructing bespoke items (particularly for children) and installing equipment for Deaf and Hard of Hearing Service Users.

7.3.2.3 It is anticipated that the Technician Service and the Joint Equipment Service will merge into a single Integrated Community Equipment Service during 2005 / 06. The advantage of this would be to further enhance the skill mix of the staff within this service and reduce the overlap and numbers of visits to service users.

7.3.2.4 These will be identified in the 2005/06 Workforce plan.

7.4 Decontamination and recycling

7.4.1 Due to other developments at the Robinson Way site in the South East, there may be opportunities to develop a more strategic approach to the decontamination and recycling of equipment which will be explored during the forthcoming year.

8. Conclusion

8.1 The past months have seen a considerable amount of activity by a whole range of staff within the department and with colleagues from Health and Voluntary sectors.

8.2 There is still work to be done, but given the nature of the partnership that now exists and a shared commitment across all ten health and social care agencies to achieving the outcomes identified, it will be a promising but challenging time as the new Integrated Community Equipment Service copes with the changes in expectations and demands of demographic change.

8.3 Once the South East services are integrated, Hampshire will have achieved its medium term goal in establishing a single service for all of the residents of the County.

9. Recommendations

9.1 That a community equipment service is established with effect from 1 April 2005 within existing levels of investment to the following: Hampshire County Council; Portsmouth City Council; Portsmouth City PCT; East Hampshire PCT; Fareham and Gosport PCT; Blackwater Valley and Hart PCT; North Hampshire PCT; Mid Hampshire PCT; Eastleigh and Test Valley South PCT; New Forest PCT.

9.2 That pooled budget arrangements under Section 31 of the Health Act 1999 are developed by July 2005, with Hampshire Social Services being the host partner

9.3 That a service manager is appointed to manage the integration and performance of the community equipment and technician services.

9.4 That the success of the partnership is reviewed after six months, with a report to the Partnership Board.

9.5 That an action plan be developed both to address differential investment between PCTs and to make recommendations on areas identified for further development.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents discuss facts or matters on which this report, or an important part of it, is based and have been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act

NONE

Proposed ICES Structure Appendix 1

Integrated Community Equipment Service Appendix 2

Proposed New Post - Service Manager

Funding Summary

The post will be paid for by deleting the existing project officer post and from existing monies received during 2004/05 for Community Equipment. The current associated costs will all be transferred into the Service Manager role, the additional cost is the salary difference identified below

Recurring Costs:

Total full year recurring costs :	£48,659
Total costs This year:	£ n/a