Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report :

EXECUTIVE SUMMARY

1) Summary of Decision Area:

1.1. That Hampshire County Council enters into a Section 75 Partnership Agreement with Hampshire Partnership (NHS) Trust to deliver integrated community Learning Disability servicesTo seek approval from the Executive Member for Adult Social Care for the signature of the Section 75 Partnership Agreement between Hampshire County Council and Hampshire Partnership (NHS) Trust for integrated learning disability community services in Hampshire

1.2. 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

1.3. That it be a recommendation to the Executive Member (Policy and Resources) that authority be given to the Acting Director of Property, Business and Regulatory Services (Interim Head of Estates) to agree terms and conditions in respect of any leases, licences or other appropriate agreements required in respect of accommodation for the integrated learning disability teams.

2) Issues Covered in Report:

2.1. Learning Disability community teams are now managed by jointly appointed managers for health and social care. The S75 agreement will provide a legal framework to enable the partners to move integrated services forward

2.2. The S75 agreement will specifically set out the scope and nature of the partnership arrangements and the governance structure

2.3. Legal, financial , IT, performance, accommodation and personnel issues will be included in the S75, which is currently in draft form. The intention is to sign the agreement by the end of December 2008.

3) Recommendation:

It is recommended that:

MAIN REPORT

1) Purpose of the Report:

1.1. To seek approval from the Executive Member for Social Care for the signature of the Section 75 Partnership Agreement between Hampshire County Council and Hampshire Partnership (NHS) Trust for integrated learning disability community services in Hampshire

1.2 That the Executive Member agrees to delegate 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

1.3 That it be a recommendation to the Executive Member (Policy and Resources) that authority be given to the Acting Director of Property, Business and Regulatory Services (Interim Head of Estates) to agree terms and conditions in respect of any leases, licences or other appropriate agreements required in respect of accommodation for the integrated learning disability teams.

1.4 This Agreement will be monitored through an annual Section 75 Agreement report to the Executive Member for Adult Social Care and through the Learning Disability Partnership B

2) Contextual Information:

2.1. Integration of learning disability health and social care community teams is supported by a plethora of government policies. Valuing People (2001) supports an integrated model of provision as a means by which fair access to holistic services can be delivered to service users with learning disabilities and their families.

2.2. The lead authority for integrated community services for people with a learning disability is Adult Services


2.3. The integration of services for people with a learning disability in Hampshire has been driven by the need to improve outcomes for service users.  Integration is not about providing cashable savings nor will it deliver in the short-term efficiency gains to the level of decreasing headcount.  However it is a `must do' for people with learning disabilities who have found arrangements confusing and difficult to access. It will provide the structure that will support high performing services which deliver the best practice outcomes of Valuing People and Putting People First, which will support the Council's star rating.The aim is to provide a more efficient and effective service to people with a learning disability and their families through integrated working between health and social care staff.

2.4. A more efficient and effective service will be better placed to deliver the changes required for the personalisation of services to which Hampshire County Council and Hampshire PCT are committed. These changes are set out in the report of Hampshire County Council's Commission of Inquiry into Personalisation, `Getting Personal' (November 2008) The Commission of Inquiry was set up in Hampshire in response to the Government's vision for future services for adults in need of support and care set out in `Putting People First'.(December 2007)

2.5. The project to develop integrated Learning Disability services has resulted in the establishment of a joint management structure for the community teams which came into being on 1 July 2008. Locality Service Managers and Team Managers have been jointly appointed by Hampshire County Council and Hampshire Partnership (NHS) Trust.

2.6. The integrated service must be supported by a Section 75 Agreement under the National Health Service Act 2006, the terms of which will be agreed by both partners. Work is underway on the detail for the Schedules to this, coordinated by Legal Services and project officers and it is proposed that the Section 75 agreement will be signed by the end of 2008.

3) Key Issues:

3.1. The project for the integration of Learning Disability services is ongoing, notwithstanding the completion of the first phase of recruitment to integrated management posts and the creation of an integrated team structure. The project structure and workstreams will continue to support and develop the project, overseen by the Project Board and the proposed Integrated Services Partnership Board

3.2. The workstreams concentrate on HR, Learning and Development, Buildings, Systems and Information, Finance, Policy and Process, Communications, Performance Monitoring, Administration and Legal issues

4) Legal Implications:

4.1. In order to meet the statutory requirements associated with the integration of services and functions, the Council and Hampshire Partnership Trust must enter into formal partnership arrangements under Section 75 National Health Service Act 2006. Such partnership arrangements were approved by the Executive Member in the report dated [January 2008].

4.2. The Council and Hampshire Partnership Trust, with the assistance of the Legal Practice, will set out their intentions and commitment to the project and integrated service in the Section 75 Agreement This agreement will provide a framework for the partners in the implementation of their joint strategic objectives for the establishment and governance of the integrated Learning Disability service.

4.3. The S75 Agreement will:

- Set out the scope and nature of the partnership arrangements;

- Set out the governance structure;

- Record the establishment and management arrangements for an integrated management structure;

- Record the partners' financial contributions to the project for the year 2008-2009 and to provide a framework for agreeing contributions for further years

- Record the partners' mechanisms for working together for the better performance of the service and for improvement in the way the partners' functions are discharged. (see Appendix for detail of what is included in the Agreement)

4.4. The finalisation of the Section 75 Agreement has been given urgent priority to facilitate the delegation of functions, to provide clarity for the partners and to minimise liability.

4.5. Robust financial planning within the Project structure, further supported by the S75 Agreement will ensure that the department is not exposed to undue financial risk

5) Financial Implications:

5.1. The Project costs for 2008/09 (revised 3.7.08) are estimated to be £156,000 for Hampshire Adult Services to cover one off expenditure incurred around project management, training, IT requirements for integrated teams and expected co-locations in Havant Winchester and Fareham. An additional £250,000 has been provisionally earmarked as part the budget preparation process for 2009/2010.

5.2. The Section75 Agreement when signed, will describe the commitment of the partner organisations to support the project with the financial resources committed by each partner to the project for 2008-2009 and onwards which will cover capital and revenue costs for the service. This is covered in the main body of the S75 and schedules, eg relating to accommodation (see Appendix)

5.3. At the time when the Agreement is signed the vast majority of the teams will not be fully integrated. As a result, there are still a number of liabilities that are not able to be quantified at this time. The costs and other liabilities that will arise as the team bases are finalised will be reported and agreed through the Integrated Services Board.

5.4. Agreement has been reached in principle, through the Project Board that the costs associated with colocating the teams over time will be apportioned on a per capita FTEs basis as budgeted.

5.5. All costs associated with the Project Plan and the service costs will be signed off by the Project Board.


5.6. The final figures are yet to be agreed but the following table gives an indication of the dimensions of the Integrated Team, that is, the cost of the service.

	HCC	HPT	TOTAL
Number of Staff (fte)	62	104	166
Cost of Staff	£2m	£4m	£6m

5.7. The Agreement also provides a legal framework by which the health and social care funds will be managed within the integrated service, giving necessary permissions to jointly appointed managers in the service to manage those budget. The Agreement will not involve the pooling of budgets.

6) IT and Information Sharing Implications:

6.1. The S75 Agreement states the intention to adopt a strategic approach to the development and implementation of IT systems, the joint implementation of an agreed information sharing protocol which has been finalised, and the development and monitoring of joint communication strategies

6.2. Any additional costs incurred through these developments will be agreed and shared through an agreed formula by the partners.

6.3. The multi-agency information sharing protocol to cover integrated learning disability, mental health and substance misuse services has been finalised in November 2008 and dissemination to teams is imminent

7) Performance Implications:

7.1. As a consequence of the integration of learning disability community services activity and performance that previously related to Health can be included in the statutory reporting undertaken by Hampshire Adult Services to the Department of Health.

7.2. In developing the integrated teams the necessary recording and reporting mechanisms need to be in place to ensure Adult Services receive the necessary information they require for statutory reporting and performance management purposes, including:

· Learning disability activity relating to Referrals, Assessments and Packages of Care, as required for RAP

· The new National Indicator Set, in particular,

- NI145 Adults with learning disabilities living in settled accommodation,

- NI146 Adults with learning disabilities in employment,

and those NIS where LD activity feeds into

- NI132 Timeliness of social care assessments

- NI133 Timeliness of social care packages following an assessment

- NI136 People supported to live independently through social services

In order to ensure this is achieved the necessary governance arrangements will be agreed in relation to the recording and exchange of client activity. Including the reporting mechanisms and frequency of information exchanges, and the standards associated with data accuracy and the definitions for each performance measure.

7.3. The S75 Agreement will provide a legal framework to support the partners to work to achieve the above and to contribute to the delivery of relevant LAA targets for the Council

8) Personnel Implications:

8.1. There is now a jointly appointed management structure for the integrated service effective from 1 July 2008. Recruitment to the two (current at December 2008) vacant management posts is underway

8.2 The S75 Agreement and an agreed protocol for the management of staff in an integrated service will ensure that joint management of staff is effective and within the policies and procedures of both organisations

8.3 The Learning and Development workstream of the Integration Project will continue to address training issues for the integrated workforce. There is an in principle agreement that the partners will, where it is appropriate, develop joint training for staff. This will be reflected in the S75 agreement

8.4 The Section 75 Agreement supports the authority of the Head of Integrated Learning Disability Services, Derek Oliver, to lead recruitment and appointment of new managers in the integrated service. We are working towards agreed processes for the recruitment of staff in the integrated service which will be included in the S75

9) Outline of Options:

9.1. Option 1: Status Quo - No Section 75 Agreement is signed

a) The integrated learning disability service would proceed with no overarching contractual framework with which to support the processes and decisions required of the now integrated service. Operational managers will continue to experience difficulties because they do not have the necessary permissions to work effectively in an integrated service in their jointly appointed roles

b) A lack of agreed Governance arrangements exposes the integrated service to financial and operational risks, with potential challenge to the authority of managers in the service who have to carry out duties on behalf of both partners.

c) There is no contractual framework for both partners to further develop integrated services for people with learning disabilities

9.2. Option 2: Approval and Signing of the S75 Partnership Agreement to be effective from 1 January 2009

a) The integrated service and further project work required for proposed key deliverables for 2008-09 and beyond will be supported by an agreed contractual arrangement and statement of responsibilities for both partners

b) The S75 Agreement will require both partners to monitor and review the operation of the integrated service at agreed intervals through the Integrated Learning Disability Services Board

c) Managers in the service will have authority to discharge their responsibilities to work in their jointly appointed roles, working on behalf of both partners.

10) Option Analysis / Comparison:

10.1. The Integration project has now reached a critical phase. Jointly appointed managers are now managing health and social care staff, making day to day operational decisions that affect outcomes for service users.

10.2. Managers also need to work to build their new teams and develop processes that will enable integrated care pathways

10.3. There are financial, legal, HR and organisational risks to the project and the effective operation and development of the integrated service in the absence of a signed S75 Partnership Agreement

10.4. Therefore Option 2 is the preferred option. This option best meets National, Corporate and Departmental objectives, offers tangible improvements in service delivery to service users and promotes operational efficiency through joined-up working whilst allowing the Council to retain the flexibility required to respond to changing needs and priorities particularly those related to the personalisation of services

11) Conclusions:

11.1. The Council and Hampshire Partnership Trust will set out their intentions and commitment to the integration project in the S75 Agreement. This agreement will provide a legal framework to assist the partners in the implementation of their joint strategic objectives for the establishment and future development of the integrated community Learning Disability service.

12) Recommendations:

Please see Executive Summary for recommendations

CORPORATE OR LEGAL INFORMATION: