1 Summary

The following decision is sought:

1.1 That the County Council enters into a Partnership Agreement and hosts a pooled budget, under Section 31 of Health Act 1999 with Mid Hampshire Primary Care Trust for the joint commissioning of residential care and housing services. This will be subject to the Section 31 agreement and the financial implications returning for approval to the Executive Member before Hampshire County Council enters into the agreement.

2 Reason(s)

2.1 Jointly commissioned service provision would contribute to two aims of the Corporate Strategy:

2.1.1 Aim 1, Maximising Life Opportunities and

2.1.2 Aim 5, Improving Services.

2.2 Both Aim 1, Maximising life opportunities, and Aim 5, Improving Services, will be achieved by an integrated approach to the commissioning of a range of supported housing that meets current and future local needs.

2.3 The proposed decision has been assessed for its impact under the Race Relations Amendment Act. It would enable the development of a wider range of accommodation across health and social care, offer greater choices and flexibility to meet individual need and provide fair and equal access.

2.4 The consultation plan meets the six consultation criteria set out in "The Code of Practice on Consultation" Cabinet Office, January 2004.

3 Other options considered and rejected

3.1 An agreement and transfer of funds to Hampshire Social Services under section 28A of the National Health Service Act 1977 was considered and rejected as this would only provide social care accommodation. Residential and supported housing commissioned under section 31 of the Health Act 1999 would enable the provision to be flexible enough to meet the changing health and social care needs of the residents.

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:

Councillor Felicity Hindson

1 Introduction

1.1 This report concerns residential care provision in Winchester and Eastleigh for twenty-one mental health service users. This provision was commissioned by the former North and Mid Hampshire Health Authority in 1996-8 as part of the Park Prewett Hospital closure re-provision programme and is now commissioned by Mid Hampshire Primary Care Trust.

1.2 Hampshire County Council Social Services and Mid Hampshire Primary Care Trust have been working together to evaluate these services and to determine current and future need for residential care. (Section 6.3 of Adult Mental Health Commissioning Plan 2004-2007)

1.3 This evaluation has been based on the following national guidance:

1.3.1 The National Service Framework for Mental Health, DoH, 1999 requires that a range of specialist housing and social support is available to people with severe mental health problems as close to home as possible;

1.3.2 The Mental Health and Social Exclusion Report, ODPM, 2004, highlights the need for stable and appropriate housing for people with mental health problems;

1.4 There is a greater emphasis on enabling mental health service users to live in their own home with a package of care to support their individual needs:

1.4.1 Most service users now want their own tenancy with appropriate support or Direct Payments;

1.4.2 Funding streams have changed - Supporting People now provides support to enable vulnerable people to live in their own home. Increasingly, mental health service providers are developing specialist skills to complement the Supporting People service to support, through community care funding, those people with more complex needs.

1.4.3 Local issues include:

1.4.3.1 Changing needs of people using residential accommodation;

1.4.3.2 Building and sustaining capacity in the independent sector;

1.4.3.3 Cost of care.

1.5 Hampshire County Council Social Services and Mid Hampshire Primary Care Trust have set up a multi-agency project to:

1.5.1 Assess needs and aspirations of service users currently resident in the homes;

1.5.2 Evaluate unmet provision;

1.5.3 Identify options for service improvement to maximise independence and to meet current and future needs.

1.6 One outcome of this project is that it has been agreed that a range of NHS and social care provision is best commissioned jointly through the establishment of a pooled budget.

1.6.1 Jointly commissioned service provision would contribute to two aims of the Corporate Strategy. Both Aim 1, Maximising life opportunities, and Aim 5, Improving Services, will be achieved by an integrated approach to the commissioning of a range of supported housing that meets current and future local needs.

1.6.2 The aim is to maximise opportunities for current residents to offer them more choice in their long term accommodation and more life choices. By re-commissioning accommodation services, the aim is to improve services by offering choice, flexibility and a better environment for people requiring accommodation with care and support.

1.6.3 Jointly commissioned service provision has been assessed under the Race Relations Amendment Act:

1.6.3.1 It would provide a wider range of choices to both health and social care service users and those with fluctuating needs;

1.6.3.2 It would offer a more flexible approach to meet individual need;

1.6.3.3 Services would be developed to meet local need to provide fair and equal access.

2 Progress

2.1 A Steering Group, comprising representatives of Hampshire County Council, Mid Hampshire Primary Care Trust and Hampshire Partnership NHS Trust, has been established. This is jointly chaired by senior representatives of Hampshire County Council and Mid Hampshire Primary Care Trust.

2.2 A project brief outline plan has been agreed by representatives of Hampshire County Council and Mid Hampshire Primary Care Trust. This sets out a framework and involves other stakeholders in the review of the development of future residential care and supported housing services in the locality. Key points are:

2.2.1 Project Steering Group, as above (2.1);

2.2.2 Project Development Group, chaired by a representative of Hampshire County Council;

2.2.3 Agreed levels of revenue to be included in the Partnership Agreement, as set out in 4.1;

2.2.4 Assessment of needs and aspirations of current residents;

2.2.5 Full consultation with current residents and their relatives;

2.2.6 Advocacy services made available to current residents;

2.2.7 Service providers involved in the Project Development Group;

2.2.8 Liaison with Mental Health services;

2.2.9 Unmet housing needs identified in the locality;

2.2.10 Liaison with Winchester City Council Housing Department and local housing associations to develop alternatives to residential care;

2.3 The Project Development Group is currently reviewing the needs and aspirations of the residents of two homes to see if residential care provision can be reduced and independent or supported living can be promoted. This would provide revenues to develop more independent supported housing.

2.4 Formal accountability to Hampshire County Council and Mid Hampshire Primary Care Trust for these arrangements will be via the Steering Group.

3 Section 31 Partnership Agreement

3.1 The Partnership Agreement under Section 31 of Health Act 1999 (to follow) will provide the legal framework to commission, on a joint basis, specialist mental health housing to meet the current and future needs of mental health service users in Mid Hampshire. It is proposed to have this agreement in place by April 2005.

3.2 The agreement will be for a period of at least three years, with the intention that this will continue to provide the social care and health accommodation needs of the service users throughout their lives.

4 Financial implications:

4.1 The estimated value of the Partnership Agreement under Section 31 of Health Act 1999 will be in the region of £840,000, of which Hampshire County Council's contribution is estimated at £77,000. This contribution is fundamentally based on the loss of Supporting People funding.

4.2 It is envisaged that working with Mid Hampshire Primary Care Trust will result in more efficient commissioning, which will provide service users with better care and a greater choice in accommodation for the same cost and should result in efficiency savings. It is predicted that the average social care placement for Adult Mental Health Services will cost the County Council £417 per week per person in 2004/05. The average cost of the current 21 placements covered by the proposed agreement costs £770 per person per week. This could mean significant non-recurrent savings for the partners depending on the nature and cost of the re-provision. We are not expecting to achieve this before March 2006. However, the savings will be reinvested to develop modernised services. This reinvestment will be discussed by the partnership board in accordance with the Section 31 Partnership Agreement.

4.3 It is expected that efficiencies created by the project will cover the additional costs likely to be incurred whilst voids are being created in the existing services and new placements are made. However if the new placements have to be staggered due to the availability of the new accommodation, the County Council may have to increase its expenditure on a one off basis in 2005/06.

4.4 Some of the key clauses to protect the County Council's financial position are:

4.4.1 The project expenditure will be monitored on a monthly basis to ensure that no overspend is incurred. However, should the project plan require any agreed overspend, this would have to be agreed and authorised by the partners though the Project Board.

4.4.2 Any under spends can be used in the Service as the Partnership Board agrees, or else distributed back to the partners on a proportional basis. As costs could subsequently increase as needs change, efficiency savings would have to be treated as non-recurrent to ensure the funding for this group of service users is ring-fenced for future years.

4.4.3 The Partnership Board will agree the inflationary uplift to be applied by all the partners to the pooled fund, which will equal the inflation actually incurred on the existing placements for those service users.

4.4.4 Some funding is attached to residents who are designated as `old long stay,' who had been in hospital for some years. This applies to a small number of individuals. If this money is no longer required for these individuals it returns to the Department of Health.

4.4.5 In the event that the partners withdraw from the agreement, funding for the service users covered by the agreement will have to be met in the first instance from the legacy funding arrangements.

4.5 If a partnership approach was not adopted, it is likely that the efficiencies would not transpire and could put additional pressure on the Social Services budgets. By engaging in this process, Hampshire County Council has protected the investment under Section 28A of National Heath Service Act 1977 made by Mid Hampshire Primary Care Trust.

4.6 Once the full financial implications are established for this agreement, these will be detailed fully with the Section 31 agreement for the Executive Member approval.

5 Performance Indicators:

5.1 Reduction in unit costs.

5.2 Reduction in number of people needing residential care.

5.3 Increase in number of people in supported accommodation.

5.4 Increase in range of accommodation resources.

5.5 Increased choice for service users.

5.6 Increased service user satisfaction.

6 Consultation

6.1 A wide-ranging consultation process is in place. This consultation plan meets the six consultation criteria set out in "The Code of Practice on Consultation" Cabinet Office, January 2004. This includes:

6.1.1 Three month consultation process with current residents between 19 December 2004 and 31 March 2005. This began with a written letter and meetings which set out purpose of the consultation. Advocates have been involved and made available to the residents throughout the process;

6.1.2 Consultation with relatives, including a written letter setting out the purpose of the consultation;

6.1.3 Involvement of members of the Winchester Community Mental Health Team and staff at the two residential homes through operational steering groups which meet on a regular basis;

6.1.4 Involvement of Hampshire County Council Press Officer and Social Services Communications Team to ensure effectiveness of consultation plan;

6.1.5 Regular feedback to all stakeholders.

6.2 In order to succeed, the project will require an increase in positive risk taking by mental health workers as well as individual service users.

RECOMMENDATION

6.3 That the County Council enters into a Partnership Agreement and hosts a pooled budget, under Section 31 of Health Act 1999 with Mid Hampshire Primary Care Trust for the joint commissioning of residential care and housing services. This will be subject to the Section 31 Agreement and the financial implications returning for approval to the Executive Member before Hampshire County Council enters into the agreement.

Section 100 D - Local Government Act 1972 - Background Documents

1. Project Brief Outline

2. Partnership Agreement (To follow)