Contact: Philippa Smart e mail:[email protected], ext 7336

1. Summary and Purpose

1.1 At the Safe and Healthy People Policy Review Committee meeting held on 19 January 2007 two topics were selected for further research, with a view to these being included in the PRC scrutiny work programme for 2007. These topics were:

- Making Best Use of the Third Sector

- Access to Mental Health services for people with Alcohol Problems

1.2 Briefing workshops were held for each of the above topics on the 5 and 12 March respectively. Information was provided at the events by a variety of presenters. Write ups of the discussion areas at the workshops are attached as Appendices to this report.

1.3 In the light of the presentations and discussions that took place at the workshops, members of the Safe and Healthy Policy Review Committee are now in a position to decide whether to incorporate the topics into the committee's scrutiny work programme, and, if this is agreed, to consider the depth of scrutiny each merits.

2. Financial implications

2.1 None as a result of this report

3. Impact assessment

3.1 None as a result of this report

4. Crime Prevention

4.1 None as a result of this report

5. Section 100 - 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 on to a material extent in the preparation of this report.

NB: this includes-

1. Published works

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

None.

Appendix One

1. Best use of the Third Sector - Hampshire County Council strategic view

Discussion points

1.1 What value is the One Compact for Hampshire ?

- ensures that there is an organisation-wide approach to the relationship with the voluntary and community sectors

- helps to avoid Departmental variations

- promotes good working practice, behaviour and culture change

- can act as a basis for challenge, if need be

- some doubt as to whether sufficient people know about it, particularly at senior officer level

1.2 What support are smaller voluntary and community groups getting ?

- routes to support seem to be better known about at district and parish council level

- the county wide grants database is providing better intelligence about grant allocation and use

- reality of grant cuts creates uncertainty in the sector, as does short term (one year) funding

- grants/seed corn funding is available to smaller community organisations now outside a contract relationship eg. wellbeing agenda; is availability assured in the future ?

- will pooling of funding streams into a LAA pot make it more difficult for groups to access funding?

1.3 Will voluntary sector organisations want to play a greater role in service

delivery, as proposed by government policy ?

- volunteers in those organisations may be deterred by such a role

- need for increased infrastructure support

- issue of funding for organisations' infrastructure/overhead costs; project funding needs to include this

2. Best use of the Third Sector - the sector's view

Discussion points

2.1 How can Hampshire County Council respond to the sector's need to have

better knowledge about opportunities for tendering ?

- joint work has begun under the LAA about improving current approaches to Third Sector involvement in

commissioning. The working group has representation from both the public and voluntary sectors including

HCC, Community Action Hampshire and Hampshire PCT

2.2 Does an improved role for Third Sector involvement in the commissioning

cycle lead to better quality services ?

- not necessarily. Larger organisations that can compete for contracts may not be able to provide the personalised service that smaller organisations can

- some organisations will not want to get involved in service delivery, and for others the role is not necessarily appropriate eg. advocacy groups. However, they should be involved in helping to develop commissioning strategies and the discussions about what services should be like: many VCOs say they are not consulted early enough in the process, only once the commissioning strategy has been drafted, contrary to government guidance.

3. Best use of the Third Sector - Hampshire County Council Departments'

Views

3.1 What are the Departments' views about funding issues affecting the Third

Sector at present eg. annual grants, cuts etc ?

- recognition that Departments need to be smarter in the way they work eg. greater efficiency coming from closer working at an earlier stage in the commissioning cycle. This will need a change in culture in Departments

- Departments need to be less short term and more strategy led, leading to more frequent use of three year funding

- closer working relationships between Departments and Third Sector organisations over and above grant renewal processes may help

3.2 How confident are Departments with regard to quality and capacity of

voluntary and community sector organisations ?

- it varies, because of the variety of organisations comprising the Third Sector eg. non service delivery groups, small and large providers of services, not for profit businesses, Social Enterprises

- while there are difficulties managing quality when a Department is contracting with a number of different organisations, this is something Departments need to learn to do better.

- confidence might be increased where Third Sector organisations collaborate to maximise opportunities for engagement

3.3 Are there ways that Hampshire can be flexible about `topping up' a voluntary

sector provided service if it is unable to provide a full service that is needed eg. community transport ?

- yes, through partnership working, but unlikely through extra funding due to financial pressures eg Passenger Transport, although cuts in Passenger Transport are in local bus services not in community transport.

- another way is for the county to be an agent for assisting voluntary groups to access funding to strengthen what they do eg. BASICS (British Association for Immediate Care)

3.4 How does the One Compact for Hampshire affect what officers do ?

- Officer comment is that the things that the Compact stands for are happening anyway. Community Action Hampshire comment expressed concern about its implementation: while there is good practice this appears to depend on individuals rather than being part of corporate culture.

4. Current issues

Issues arising from the briefing that could form the focus of a scrutiny review

a) Delivery of public services:

- in the light of national policy drivers, how far do Hampshire County

Council and Hampshire's Third Sector want to take Third Sector service

delivery ?

- what would the consequences be for smaller groups and organisations if the service provision role increases, particularly for those who do not want to become service providers ?

- what are the likely consequences for volunteering in the Third Sector if

it increases its provider role ? Will volunteers become more disengaged ?

- what would increasing `professionalisation' of the Third Sector mean in the long run ?

- what progress are Hampshire County Council and the Third Sector making at arriving at mutual expectations and practice regarding consistent roles and relationships in relation to tendering, contract monitoring and review ?

b) Accountability and role of the sector:

- how can Hampshire County Council and the Third Sector continue to value the latter's role in accountability (helping people to hold public services to account for the approach they take to delivery) at the same time as that of service provision, particularly if the amount of involvement in provision increases ?

c) Capacity building:

- what areas would Third Sector capacity building need to move into if their

role in provision increases ? eg. Social Enterprise development

- might this be commissioned differently ? eg. jointly with other agencies

d) The One Compact for Hampshire

- if the Compact and accompanying Codes of Good Practice are not common currency across all staff, both strategic and front line, in Hampshire County Council and partnerships, what can be done to improve this ? eg. a Third Sector Champion

- is the Compact achieving what it set out to achieve in terms of a relationship of trust between the county and Third Sector organisations, and if not, why not ?

e) The Commissioning cycle

- What progress are Hampshire County Council and the Third Sector making to arrive at mutual expectations and practice regarding consistent roles and working relationships within Departments and partnerships in the commissioning cycle - planning, procurement, contracting - as well as in relation to funding programmes?

Appendix Two

1. What is dual diagnosis ? Policy context, national and Hampshire wide.

Discussion points

1.1 How does Hampshire compare with other authorities regarding dual

diagnosis ?

- national prevalence is largely consistent across the country, but there will be `hot spots' eg. urban areas, areas of deprivation

1.2 Are we more effective at treating people in the hot spots or in the other

areas ?

- effectiveness can depend on the amount of resources in the widest sense eg. housing, employment etc available in an area. Outcomes to measure effectiveness can include reducing hospital admission rates, increasing numbers in employment, use of the Mental Health Act.

1.3 What difference does partnership working across agencies actually make ?

- improves the commissioning process, especially with Health now that there are fewer PCTs and boundaries are coterminous, thus reducing the likelihood of parochial attitudes

1.4 Is there joint funding to support mental health and alcohol services ?

- all new mental health funding comes through PCTs, and is then the joint responsibility of health and adult services to allocate to service improvement and development within integrated mental health services

- the DAAT pooled treatment budget is for drug treatment services only. There is no dedicated funding stream for services for people who misuse alcohol; PCT funding is used to commission alcohol treatment services

1.5 How will the remodelling of Community Mental Health Teams (CMHTs) help to tackle the problem of `revolving door' patients ?

- the changes are aimed at improving the situation of people who are not eligible for support from CMHTs but for whom interventions from primary care need to be over and above routine care. If CMHTs can work more closely with primary care, this should benefit this group by helping them access care and support in a timely way and make cross referrals easier.

Information requested:

- budgets Action: to be provided by officers

- presenter views about areas that scrutiny could

add value to Action: to be provided

- Mental Health Assertive Outreach Teams

style of working Provided at the meeting:

proactive outreach engagement, using a team approach, with people with severe and enduring mental illness, who are difficult to engage, histories of non compliance, multiple hospital admissions. Broad assessment of needs.

- service effectiveness outcomes in `hotspots'

vis a vis outcomes in areas with lower prevalence Action: to be provided by officers

- use of Third Sector organisations Provided at the meeting:

Adult Services contracts with 53 organisations, to provide a range of service

eg. day services, advocacy, supported housing etc. DAAT contracts with

a number of voluntary sector and service user led organisations.

2. The public experience of accessing mental health services

Discussion points

2.1 Would Spotlight want to be able to make direct referrals into mental health

services ?

- Yes. Discussions are ongoing about this in Havant

2.2 If Spotlight is appearing to treat people with personality disorder, who are least likely to respond compared to others, where would they draw the line in terms of stopping contact ?

- Provided the person was cooperating and seeking assistance, that help would continue to be

offered, as an erratic pattern of response is to be expected from this client group. Both

mental health and DAAT commissioned services could be organised more efficiently and

work more cooperatively to support individuals with complex problems

2.3 Are the numbers of difficult cases the services are dealing with the tip of the iceberg ?

- while figures are not immediately available, the complex cases need to be balanced against

the successes ie .those for whom service contact works

2.4 Recognising the limited extent of alcohol service provision in Hampshire

compared to that for drug users, what balance is there in a service such as Spotlight that delivers both ?

- while Spotlight is commissioned to deliver a 80% - 20% split between drug and alcohol

services, in reality the demand is such that the delivery is more in terms of 40% - 60%

Information requested:

- numbers of people accessing services Action: to be provided by officers

3. Outline of mental health services available for Hampshire residents with

Alcohol problems

Discussion points

3.1 Why aren't services spread evenly where need is, and what happens when

need changes?

- Tier 3 Alcohol services are evenly spread, and commissioning is undertaken on a geographical basis to ensure everywhere gets something. The main difficulty is in the under funding. Resources are being sought for a new worker to be based at the prison based on prison population needs assessment.

- Spotlight seeks to make its services available in response to demand, largely self referrals

- Mental health is embarking on a county wide commissioning strategy, involving the creation of a jointly appointed mental health commissioner post

3.2 How can binge drinking be overcome?

- where outreach extends into deprived areas there is good evidence for small diversion

programmes eg. football, to have good effect. Again, limited funding means insufficient programmes. Commissioners' dilemma is between core business and health promotion

3.3 Is the issue of dual diagnosis increasing or stable ?

- drug treatment target monitoring shows year on year increase of people in treatment. No

national indicators for alcohol treatment service monitoring. Proxy indicators include increasing deaths from liver disease, increasing use of alcohol by young people

3.4 What value will scrutiny add ?

- by throwing a spotlight on the balance between commissioning and provision, by looking at the gap between an ideal range of alcohol services and those available, by looking at best practice elsewhere, by reviewing the capacity of the Third Sector to respond to need, by considering the particular needs of transient populations

Information requested:

- added value of outreach work Provided at the meeting

- strength of close working with police, probation & CDRPs "

- numbers of staff employed Action: to be provided by

Officers

- whether the licensing laws have made a difference Provided at the meeting