Archived decisions

Contact: Neil Dhruev [email protected]; 02380 241326 or 07770 938109

1. Summary:

The following decisions are sought:

That the Executive Member approves the content of the S75 Agreement with the Hampshire Partnership NHS Trust for mental health service delivery.

That the Executive Member delegates authority to the Director of Adult Services to agree changes in the wording of the final agreement on the advice of Legal Services, provided that it does not change the substance of the agreement as set out.

2. Reason

2.1 Mental Health services provide essential care and support for vulnerable people who are often a risk to themselves and sometimes a risk to others. The health and social care integrated service provided by this Agreement enables a safer and more secure environment for the people of our County, many of whom will at some time in their life require mental health care and support themselves.

2.2 The integrated mental health care ensures an improved quality of service and more effective service development, thereby maximising well being.

2.3 The Agreement provides a clearer more specific agreement than the previous S31 Agreement, so that:

¬ the statutory duties of the County concerning mental health can be undertaken in a well co-ordinated manner;

¬ there can be a focussed well managed approach to the implementation of the social care agenda;

¬ there can be significantly improved support and management arrangements in place so that social care staff can feel better valued;

¬ with regard to all three of the above, County governance arrangements will be strengthened through this S75 Agreement.

3. Other Options considered and rejected:

3.1 The County is committed to the integration of mental health services as this enables improved outcomes for service users and greater efficiency in the use of resources. The partnership arrangement has been in place for 5 years and has enabled the achievement of modernising the service and the meeting of national targets.

4. Conflicts of Interest declared by the decision maker or other Executive member consulted - none.

5. Dispensation granted by the Standards Committee - none.

6. Reason(s) for the matter being dealt with if urgent - not applicable.

Approved by: ....................... Date: .......................

Councillor Felicity Hindson

Executive Member for Adult Social Care

Contact: Neil Dhruev - [email protected]; 02380 241326 or 07770 938109

1. Summary

1.1 This Agreement enables the continuation and development of mental health services provided by the Hampshire Partnership Trust on behalf of the County, as previously provided under the Section 31 Agreement which is due to come to the end of its term on 31 March 2008. The Section 31 Agreement provided a first step to working with the Hampshire Partnership NHS Trust to create an integrated health and social care mental health service for working age adults. Section 31 has now been replaced by Section 75 of the NHS Act 2006.

1.2 The Section 75 Agreement provides a clearer more specific agreement than the previous S31 Agreement, so that:

¬ the statutory duties of the County concerning mental health can be undertaken in a well co-ordinated manner;

¬ there can be a focussed well managed approach to the implementation of the social care agenda;

¬ there can be significantly improved support and management arrangements in place so that social care staff can feel better valued, ensuring a continuing development in the quality of the service;

¬ with regard to all three of the above, County governance arrangements will be strengthened through this S75 Agreement.

1.3 The Agreement is for 1 year starting 1 April 2008, after which it may be extended for up to a further 4 years, which strategically aligns the County with the PCT as joint commissioners.

1.4 The Agreement does not involve pooling budgets.

2. Recommendations

The following decisions are sought:

That the Executive Member approves the content of the S75 Agreement with the Hampshire Partnership NHS Trust for mental health service delivery.

That the Executive Member delegates authority to the Director of Adult Services to agree changes in the wording of the final agreement on the advice of Legal Services, provided that it does not change the substance of the agreement as set out.

3. Background

3.1 The County is committed to the integration of mental health services as this enables improved outcomes for service users and greater efficiency in the use of resources. The `partnership' arrangement has been in place for 5 years and has enabled the achievement of modernising the service and the meeting of national targets.

4. Governance

4.1 This Agreement ensures a clear governance structure made up of the following components:

4.1.1 The Agreement is monitored through the S75 Delivery Board which has Elected Member and Non-Executive Director (Trust Governor on the proposed formulation of the Foundation Trust) representatives, and senior management representatives from both organisations.

4.1.2 Dedicated County staff consisting of the Director of Social Work for Mental Health, the Approved Social Worker (Approved Mental Health Professional) Development Manager, the Substance Misuse Development Manager and the Training Development Manager for Mental Health, all of whom provide managerial and professional support, liaison between the two organisations, and leadership, authorisation and scrutiny on behalf of the County.

4.1.3 The above posts have direct line management through to an Assistant Director within Adult Services.

5. Schedules

5.1 The schedules that accompany this Agreement are all jointly agreed. The schedules covering the Statement of Intent, legislative functions, services that will be provided, financial commitments, premises, central services, terms of reference for the S75 Delivery Board, performance monitoring, the Terms of Secondment and the joint complaints policy, are all completed. The remaining schedules concern the breakdown of the staffing compliment, joint arrangements for managing staff, professional supervision, S117 Policy, and the IT joint working agreement are either being negotiated or reviewed and we aim for them to be agreed and in place by the end of June 2008.

6. Commissioning

6.1 This S75 Agreement enables a health and social care integrated service delivery. In addition the County will be developing a joint commissioning strategy with the PCT for mental health and for substance misuse services, with the PCT and the DAT. This will further ensure a future service that is well integrated, value for money and reflects the needs of the communities in the County.

7. Service Risk

7.1 The Hampshire Partnership NHS Trust is a well managed, sound organisation that has shown itself able to change and modernise. Continuing the Agreement maintains the good working partnership and the developmental work streams that are underway; it protects the service from disruption which would have serious service delivery and financial implications.

7.2 This is an important period in the development of mental health services. There is new mental health legislation to understand and adhere to and the Self Directed Care initiative will fundamentally improve the influence and control that service users will have when needing care and support. The partnership arrangement formed through this S75 Agreement provides a positive and realistic way for progress and development at this stage.

7.3 The consultations on this Agreement are all in favour of a continuing partnership with the Trust.

7.4 This S75 Agreement is in line with government guidance and national best practice.

8. Legal and Financial Implications

8.1 There are no foreseeable additional legal liabilities or financial pressures as a consequence of this Agreement. Indeed the Agreement provides a framework for closer cooperation helping to continually improve budget management and strategic planning.

8.2 With regard to the schedules that are a part of this Agreement, all the essential schedules notably: the Statement of Intent, Functions, Services, Finance, Accommodation/premises, S75 Delivery Board Terms of Reference and the Terms of Secondment will all be agreed and part of the Agreement by the 1 April 2008. Other schedules are being reviewed or are in draft form and being discussed by the parties. These schedules are either additional to those in the previous S31 Agreement or were previously included as draft joint policies but not ratified. Consequently the situation of having some schedules that will be ratified by the S75 Delivery Board after the Agreement is in place will not increase the risk to either party to the Agreement.

8.3 The Trust solicitors have raised a number of important points that will need addressing before the Agreement is signed. It is likely that all of these will ensure greater clarity and will not be contentious.

8.3.1 A meeting with the Hampshire Partnership NHS Trust is being arranged to reach agreement on a number of these issues including:

¬ how we further clarify the funding of the service after 2008/09;

¬ what if any are the implications for the Agreement as a consequence of the Trust's contracts with the PCT;

¬ clarification on indemnity issues;

¬ a scheme of delegation;

¬ greater clarity on delegated authority and governance in relation to the Service Delivery Board;

¬ clarification on the apportionment of funds when these are attributed to particular functions as opposed to posts.

8.3.2 These issues do not substantively affect the agreement and should all be capable of satisfactory resolution for both parties. Addressing them will ensure a more comprehensive agreement particularly with regard to the Trust becoming a Foundation Trust in the future.

8.3.3 Further necessary discussion will mean that the Agreement cannot be signed before 1 April 2008 and it will therefore be necessary to continue to work with the existing S31 Agreement in the short term. As none of these points affect the essence of the Agreement delegated authority, to the Director of Adult Services to sign off the Agreement after further detailed negotiation, is sought.

8.3.4 Elected Members will be kept informed of progress and a further report can be provided as required.

8.4 The likely change to Foundation Trust status of the Hampshire Partnership NHS Trust and our other partner Trust (the Surrey and Borders NHS Trust) will affect the commissioning environment, however the 1 year initial term for this Agreement is in keeping with the PCT timeframe and should enable us to make changes if this is necessary. Monitor, the statutory independent governing body for Foundation Trusts regard Section 75 Agreements as important as they demonstrate an alignment of commissioning bodies, a specification of the service and clear governance arrangements.

9. Conclusion

9.1 This Agreement states the binding terms for the delivery of the service. It improves the social care focus and the governance arrangements for the County, consequently it will ensure a safer, improved mental health service that is more tied into the Corporate Strategy. The Statement of Intent, which is a part of the Agreement, is attached (Appendix 1) and this summarises the raison d'etre for the Agreement.

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

Appendix 1 - Briefing Paper

Appendix 1

SECTION 75 AGREEMENT

Hampshire County Council : Hampshire Partnership NHS Trust

STATEMENT OF INTENT

This agreement is intended to ensure that particular local authority functions that are the responsibility of Hampshire County Council, with regard to the provision of mental health services including forensic and substance misuse services, are carried out by the Hampshire Partnership NHS Trust. This will be done within the integrated management arrangements, which were originally put into place under the previous S31 Agreement, 1st April 2003.

The main functions covered by this agreement are:

¬ social care support and duties as covered by the NHS and Community Care Act 1990;

¬ statutory care and protection as required by the Mental Capacity Act 2005 and the Mental Health Act 2007 including the provision of Approved Mental Health Professionals;

¬ statutory care and protection as required by The National Assistance Act 1948 and the Human Rights Act 1998 including ensuring Safeguarding Adults;

¬ assessment and support for carers as required by the Carers (Recognition and Services) Act 1995, Carers and Disabled Children Act 2000, The Community Care (Delayed Discharge) Act 2003 and the Carers (Equal Opportunities) Act 2004;

¬ support and care within the framework of social inclusion and self directed support as promoted by the white paper Our Health Our Care Our Say 2006 and the ministerial concordat Putting People First 2007;

¬ service developments and care practices to meet the requirements and express the aims of equality and diversity as required by the forthcoming Single Discrimination Act.

The planning and delivery of these functions will be through the systems and processes necessary for being a successful Foundation Trust under the Health and Social Care (Community Health and Standards) Act 2003.

Through the joint structure the partners to this agreement aim to continually develop the efficiency of the mental health service to our communities. This will mean an improved personal experience for people using the service and their family members or carers.

Modern mental health care requires an integrated approach drawing on the expertise of medical, psychological and social disciplines in the pathways of care. At all times this should be person centred and in accord with the five principles of the Mental Capacity Act 2006. These are:

1. A person must be assumed to have capacity unless it is established that he lacks capacity.

2. A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.

3. A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

4. An act done or decision made under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.

5. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.

[Mental Capacity Act 2005 - Code of Practice, TSO 2007]

In accepting the above modern mental health care requirements the partners to this agreement will further work together to ensure the following seven outcomes for people using the services:

¬ Improved health

¬ Improved quality of life

¬ Making a positive contribution to their community

¬ Exercise of choice and control

¬ Freedom from discrimination

¬ Economic well-being

¬ Personal dignity

Central vehicles to achieve these outcomes are the Recovery Approach and Self Directed Support. These are interwoven in practice and during the initial period of this agreement will be a priority in the development of the service. The approach ensures that people's human rights for self determination are fully respected. However when, and only when, someone is suffering from a mental disorder and it is necessary to safeguard them or the wider community then interventions may be made using the Mental Health Act and in these situations, care will be provided in the least restrictive ways.

The seven aims stated above have arisen from a public consultation on what outcomes people wanted from care services. They are part of the white paper Our Health Our Care Our Say and provide a strong direction for statutory care services to work together to ensure that people receiving a service are listened to and treated respectfully, that their whole situation and needs are looked at together and that they are helped to be an active part of the community.

Over the last five years, the Trust and the County have worked together successfully developing mental health services, implementing the National Service Framework for Mental Health, improving the voice and influence of service users and initiating Recovery working within the service. This agreement aims to support this collaboration and build upon it to achieve a truly person centred service.