Archived decisions

HAMPSHIRE COUNTY COUNCIL

Decision Report

1. Executive Summary

1.1. The purpose of this paper is to seek approval from the Executive Member for Adult Social Care for the proposed transfer of commissioning costs and responsibility for social care for adults with a learning disability in Hampshire and the proposed legal bases for both the transfer of funding and the contractual payments to existing organisations providing services.

1.2. This paper seeks to provide background information regarding the requirement to negotiate a transfer. It also provides a proposal for a transfer amount and seeks permissions to establish the necessary legal and contractual arrangements.

2. Contextual information

2.1. The Department of Health has issued guidance stating that responsibility for commissioning social care for adults with a learning disability should transfer from the NHS to Local Authorities from April 2009. This transfer should be in the form of a local agreement for two years, 2009/10 and 2010/11. After this time, funding will be allocated to Local Authorities directly from the Department of Health according to a national funding formula. This formula has not yet been announced. This report is addressing the issue of the local transfer.

2.2. Letter from the Department of Health (DH) to Local Authorities and Primary Care Trusts August 2008

2.2.1 This letter stated that the responsibility for commissioning social care for adults with a learning disability should transfer from NHS Primary Care Trusts (PCT's) to the Local Authority. The policy rationale for this transfer was based in:
_ Our Health, Our Care, Our Say
_ Valuing People Now; From Progress to Transformation
The guidance stated that the revenue sum to transfer would include all social care funding but would not include funding for mainstream/general healthcare or offender/forensic services. Responsibility to fund Continuing Healthcare would also remain with the PCT.

2.2.2 The transfer is a positive move for people with a learning disability and clearly underlines the commitment to move away from a medical model of provision to socially integrated services. The Department of Health clearly re-enforces the key role of the Local Authority, stating that the transfer will benefit in the following ways:

· Improved quality of Life, economic well-being and enabling people with a learning disability to make a positive contribution, by the Local Authority, as lead agency for these issues, having direct access to and control over all social care funding to support this.

· Choice, control and Independent living - by local authorities commissioning all social care services. Local authorities have the legal and policy framework to maximise choice and control for people with a learning disability.

· Improved health and emotional well-being - by, for example, enabling PCT's to focus more clearly on commissioning high quality inclusive mainstream and specialist health services for people with a learning disability.

· Efficiency and value for money - by removing duplication of effort.

2.2.3 The guidance states that the transfer should be done within the principles of fairness, partnership and local solutions. In Hampshire, these principles formed the basis of our final negotiations.

2.2 Financial basis for the transfer
The Department of Health proposed that discussions should be based on PCT expenditure in 2007/8. For many PCT's (including Hampshire) it was more practical to use 2008/9 figures, due to restructuring within the NHS.

2.3 Letter from the DH to Local authorities and PCT's November 2008

2.3.1 After pressure from ADASS (Association of Directors of Adult Social Services), pro-actively co-ordinated by Hampshire, this letter changed the submission date for information to March 2009.

2.4 Letter from the DH to Local Authorities and PCT's March 2008

2.4.1 Acknowledged difficulties faced by many PCT's and local authorities. It also re-affirmed the deadline and gave assurance that further guidance would be produced on transfer of capital interest.

2.5 Letter from ADASS to Local authorities March 2008

2.5.1 Following concerns from a number of local authorities, ADASS commissioned a survey of local interpretation of the guidance. The resulting letter advised local authorities to be satisfied that the quantum for the Local Authority in 2009/10 was a reasonable proportion of what the PCT(s) recorded as their spend on learning disabilities in their accounts for 2007/08, and they should be satisfied that the difference was being spent appropriately by the PCT(s) on NHS commissioned services to people with learning disabilities in 2009/10.
Two of the three issues which had come up most frequently in discussion had been resolved: the treatment of inflation uplift for 2009/10 and anticipation of 2010/11 and issues about people with complex care needs, `joint packages', assessments/re-assessments and continuing health care.
On the third issue, the need for further guidance about capital expenditure, ADASS have stressed the urgency of this to Department of Health.

2.6 Hampshire's response

2.6.1 Process
Hampshire took a systematic approach to reaching a realistic figure for transfer. It was not possible to follow DH guidance that the starting point for discussion should be total expenditure on Learning Disability by the PCT, with reductions for known amounts spent on healthcare, as these figures were not presented by the PCT. We therefore took a three stage approach:

· Received a submission from the PCT on known expenditure on social care

· Commissioned Treasurers Consultancy to verify the figures with Adult Services commissioning and operational staff and with service providers, principally Hampshire Partnership NHS Trust (HPT), but also others receiving spot-purchases.

· Re-aligned the figures with Hampshire PCT.

Alongside consultation with commissioners and service providers, the Hampshire Learning Disability Partnership Board was kept informed throughout the process.

3. Finance

3.1. Schedule for Transfer
The schedule for transfer is attached as an appendix and includes the following amounts:

3.1.1 Known existing s256 funding
The Adult Services department already receive £19 million s256 funding per year from the PCT to pay for previous campus reprovision projects. This funding has been subject to a s256 Memorandum of Understanding (MOU) that enabled the PCT to "claw-back" funding for continuing healthcare. The MOU is being re-written to reflect the recent guidance that proposes that the transfer is absolute.

3.1.2 South West Locally Based Hospital Units (LBHU's)
The recent Campus reprovision project in the South West of the county is an example of national good practice. £6.5 million will transfer to fund high quality personalised services for 47 people in their own homes. 22 homes are run by HPT and five people are with independent sector providers.

3.1.3 East Southampton Day Services
Eight Hampshire people attend an NHS Day Service in Southampton. Funding of £189,000 will transfer to cover the cost of their day care.

3.1.4 Tamerine Respite
HPT run a small respite unit which is used by both Hampshire and Portsmouth residents. Funding for the unit will transfer but no permanent commitment will be made to funding the unit. Service users will be offered choice.

3.1.5 Joint funding
Approximately £1 million of joint funding will be transferred which has historically funded in-house schemes, care management and advocacy.

3.1.6 Agenda for Change
Approximately £1 million will transfer to "top-up" existing payments to HPT. This additional funding covers the cost of new terms and conditions for NHS staff agreed through "Agenda for Change".

3.1.7 PCT Infrastructure costs
The PCT will transfer £40,000 to the local authority to cover the additional costs associated with commissioning all social care.

3.1.8 Other Infrastructure costs associated with campus reprovision
Parts I, J, K, L, M in Confidential Appendix D refer to costs presently funded through the Campus Closure Programme Revenue Grant 2008-11. As the grant ends, so does the local transfer from the PCT and we will move to the national allocation formula. We need to indicate to the DH the total cost of local provision so that this is reflected in the allocation formula.

3.1.9 Inflation
Inflation rates of 2.5% for each year have been agreed with the PCT.

3.1.10 Total amounts
We are proposing that total transfer amounts of £29.503,437 for 2009/10 and £30,241,023 are agreed, with a part-year effect to be implemented for 2009/10 aligned to the award of the new contracts. This figure has been used as a benchmark to compare with other local authorities and this is presenting indication that this amount is fair and sustainable. It will therefore be used to set a baseline for negotiations with the Department of Health with regard to the national allocation system to be in place for 2011/12.

4. Performance

4.1. The transfer will increase the numbers of adults with a learning disability with complex needs in supported living (settled accommodation) who are funded by Adult Services. (PSA16).



5. Other Key Issues

5.1. Children's services
For young people moving into the service the existing arrangements for Continuing Healthcare will apply. The risk of demographic pressures will therefore be evenly split for young people.

5.2. Commissioning and Infrastructure Costs
The PCT invests a low level of resources specifically attached to commissioning social care for adults with a learning disability. Other costs are integral to the organisation, such as finance and HR support. A sum of £40,000 is proposed as an estimate of the infrastructure cost.

5.3. Workforce
No posts are transferring, and after consultation with the PCT we can confirm that no posts are subject to TUPE. There are no explicit workforce implications.

5.4. Capital Asset Values
The Department of Health has promised further guidance on this very complex issue but this has not as yet been published. It is proposed that an amendment to the schedule is made in April 2010 to reflect any agreement made.

5.5. NHS Campuses
The schedule includes the transfer for the reprovision of the Locally Based Hospital Units. This is slightly ahead of schedule. We had originally agreed that levels of need would be re-assessed six months from the date of the last placement, which occurred November 2008. This timescale has been fast-tracked by one month. The remaining NHS campuses will be closed by December 2010. It is proposed that agreement for a sum to be transferred is made in April 2010 and that the schedule is amended accordingly.

6. Project Alignment

6.1. Contracts and Justification for Single Tender
In order to pay the providers concerned, contracts need to be established. The PCT do not have transferrable contracts. We are therefore seeking permission for single tenders.

6.1.1 This report is seeking approval for a single tender. We do not currently want to move service users who are settled with their existing provision. It is for this reason that we seek single tender approval to maintain continuity of service with a specialist provider.

6.1.2 The policy decision to transfer learning disability commissioning responsibility from Primary Care Trusts (PCT) to Local Authorities was set out in both Valuing People Now and in the 2008/09 NHS Operating Framework This supports the role of the Local Authority as the lead commissioner for social care for people with a learning disability. This guidance identified the scope of the transfer, its timescales and included the process for agreeing resources to be transferred, which have been outlined earlier in the report.

6.1.3 The resources associated with the transfer will include both the services commissioned by the PCT and the dedicated commissioning resources associated with these services. Within the services commissioned by the PCT there are a total of 23 contracted services with Hampshire Partnership Trust (HPT) with an overall contract value of £6,228,230 per annum. There are also a further 5 contracts with other providers with an overall contract value of £481,735 per annum.

6.1.4 With effect from 1 July 2009 these contracts will transfer to the County Council subject to authority being given to the Director of Adult Services to negotiate a single tender for the services detailed in the recommendations of this report.

6.1.5 The proposal does meet the single tender criteria, as this is an interim arrangement. The services are being reviewed to ensure that they are shaped to meet the personalisation agenda.

6.1.6 The single tenders to be negotiated would be for two years with effect form 1 July 2009, with an option to extend for a further year until 30 June 2012.

6.1.7 Competitive tendering, is not appropriate in these circumstances at this stage due to the timescales imposed by the Department of Health.

6.1 s256 Memorandum of Understanding

6.1.1 Legal Services are finalising the wording of the s256 Memorandum of Understanding to reflect recent guidance. We are requesting that the Executive member agrees for the legal agreement to be signed by the Director of Adult Services, providing that the finalised wording of the agreement does not change the substance of the agreement as set out.

6.1.2 The Executive Member for Adult Social Care is therefore requested to delegate authority to Director of Adult Services to finalise wording of the agreement on the advice of Legal Services

7. Future direction

7.1. There are two key areas of work that are still underway. These are mentioned elsewhere in the report:

· Transfer of capital interest in properties and associated revenue (see para 4.4)

· Remaining NHS campus project (see para 4.5)

7.2 As agreement cannot yet be reached on these issues for the reasons stated, they do present an ongoing risk to the local authority.

8. Conclusions

8.1. The Department of Health has requested that the responsibility for commissioning social care for adults with a learning disability should transfer from the PCT to Local authorities. This will take the form of a local transfer for the two financial years 2009/10 and 2010/11. After this time, funding will be allocated directly to local government by the Department of Health. The national funding formula has not yet been announced.

8.2. A comprehensive process has been undertaken in Hampshire to identify and verify all relevant funding for transfer. Extensive negotiations have taken place both with NHS Hampshire and the relevant provider organisations.

8.3. The schedule attached represent a transfer amount that is fair to both NHS Hampshire and the local authority and is sustainable for the two years of its existence.

8.4. The transfer will be supported by new contractual arrangements through the single tender process and a revised legal agreement in the form of the s256 Memorandum of Understanding

9. Recommendations

9.1. That agreement is given to a transfer of £29,503,437 for 2009/10 and £30,241,023 for 2010/11 from Hampshire NHS to Hampshire County Council to support the transfer in responsibility for commissioning social care for adults with a learning disability. A part-year effect will be implemented for 2009/10 aligned to the award of the new contracts.

9.2. That approval is given for single tender with organisations that are presently funded for these purposes. This will ensure continuity of service delivery for the service users involved.

9.3. That the Executive Member for Social Care delegates authority to the Director of Adult Social Care to finalise wording of the s256 Memorandum of Agreement on the advice of Legal Services, provided it does not change the substance of the Agreement as set out.

CORPORATE OR LEGAL INFORMATION:

Links to the Corporate Strategy

Other Significant Links

IMPACT ASSESSMENTS:

1. Equalities Impact Assessment:

1.1. A summary of the Equalities Impact assessment is as follows:

The transfer of commissioning from the Primary Care Trusts to the Local Authority for Social Care for Adults with a Learning Disability is likely to have a positive impact on all groups as the system will be easier to understand and access. There will be an end to split commissioning which many service users and carers found difficult to understand and access.

For young people, this should result in a smoother transition from children to adult services as the arrangements for continuation of existing healthcare will apply.

For people from BME groups in particular, with little or no English language skills and little or no understanding of the social care system in England, it will be easier to understand and should lead to more personalised choice.

As a result of this transfer, all clients will now benefit from the work of a specialist equalities team within the HCC Learning Disability Commissioning team.

The single tender will ensure there is no change in providers; there should therefore be no immediate adverse effect for staff.

Finally, existing data relating to equality strands will be transferred and in future collected in a consistent way, leading to better understanding of stakeholders needs and planning. An annual review of the Equality Impact Assessment should insure this contributes to improving the knowledge base needed for effective commissioning.

1.2. The Full Equalities Impact Assessment is attached as Appendix C.

2. Impact on Crime and Disorder:

2.1. No impact on Crime and disorder has been identified.

3. Climate Change:

a) How does what is being proposed impact on our carbon footprint / energy consumption?
The proposals to move people into ordinary housing should have a positive impact on the carbon footprint.

b) How does what is being proposed consider the need to adapt to climate change, and be resilient to its longer term impacts?
Accommodation provided by Housing associations is subject to monitoring with regard to energy efficiency. The same regulation is not applied to NHS Campuses.