PAPER B

Purpose : For Decision

Committee : EXECUTIVE

Date : 2 JULY 2002

Title : LEAD COMMISSIONING PROPOSALS

PORTFOLIO HOLDER – SOCIAL SERVICES AND HOUSING

1. SUMMARY

This report sets out proposals for merging the Lead Commissioning responsibilities for health and social care between the Primary Care Trust and the Social Services and Housing Directorate. This would lead to greater efficiency and less duplication of effort and would improve the outcomes for people who rely on the services.

2. BACKGROUND

i. The Health Act (1999) and the Social Care and Health Act (2001) have substantially increased the opportunities for closer working between Social Services and Health agencies.

ii. The Isle of Wight has a long history of successful partnership working between Health Services and Social Services. One of the first joint Registration and Inspection Units was set up between the Health Authority and Social Services. Several joint appointments have been made and most recently the lead commissioning responsibilities for all Mental Health and Learning Disabilities have been divided between the council and the Primary Care Trust.

iii. It seems natural, given this history of successful working together, to seek to build on it.

3. PROPOSALS

i. The Social Services and Housing Directorate was restructured following the retirement of one of the Heads of Operations. A new post, Head of Adult Services, was created and advertised. Unfortunately it was not possible to make an appointment. However, there have been informal discussions between the senior officers of Social Services and Housing and the PCT to explore opportunities for creating closer working relationships with respect to the commissioning of to adults services where there is identified duplication of effort.

ii. Agreement has been reached on an outline set of proposals, which the officers would like formally to consult on during July and August. Once consultation has been completed, it is intended that a report should be submitted to both the Council and the PCT Management Board in September, which seeks agreement to a detailed set of proposals.

iii. It is proposed to create 2 Heads Of Commissioning posts to cover all the Health and Social Care activities for people aged 18 and over. This would extend the agreement already in place for mental health and learning disability services to cover older people and people with physical and other disabilities. The Heads of Commissioning would report to a Management Board jointly chaired by the Strategic Director of Social Services and Housing and the Chief Executive of the PCT.

iv. The Management Board would agree a work programme for both the 2 Heads of Commissioning and for Children Services and would monitor budgets and service performance. Decision making and accountability would continue to lie within the existing delegated framework for both the PCT and the Council.

v. Budgets would continue to be agreed by the PCT Board and the Council. Accountability for the Social Services budgets will rest with the Director and for the PCT budgets with the Chief Executive. However, it is proposed that over time consideration will be given to pooled budgets for agreed areas.

vi. The Heads of Commissioning would attend meetings of the Social Services, Housing and Benefits Select Committee and the Executive as required, as well as the PCT Board.

vii. The new structure would also require the creation of a new post to support the commissioning arrangements and a new Head of Operations to manage the Social Services staff involved in assessments and direct services (see appendix 1).

viii. There are no proposals at this stage about the future commissioning of Children’s Services. Although Children’s Services will be part of the responsibility of the proposed new Joint Commissioning Board, the health and social care responsibilities of both agencies will be discharged by separate senior officers. It is recognised that the future of Children’s services could lie either in closer working relationships with Health or the Education Directorate. No change is proposed for Housing Services. Similarly the commissioning of acute hospital services will remain the responsibility of the PCT.

ix. These proposals do not commit either the PCT or the Council to any new organisational structure. They do not mean a Care Trust is inevitable.. They should however lead to less duplication of effort and better use of resources across the health and social care fields. It could remove some of the current perverse incentives, and make it easier for both organisations to set up services, which meet the needs of all adults on the Isle of Wight.

4. CONSULTATION ARRANGEMENTS

i. These are important and significant proposals. It is intended that there should be wide and careful consultation throughout July and August before coming back to the Executive and the PCT Board and for a decision.

ii. A list of agencies and organisations, which will be given the opportunity to comment, is being drawn up. Where necessary the Strategic Director and the Chief Executive will attend management meetings to explain in person the benefits of the proposals and to listen to the views of the different bodies.

iii. All the comments expressed will be recorded and taken into account when presenting the final report in September. The report will go to the 4 September 2002 Select Committee, to the Executive on the 24 September 2002 and to the PCT Board on the 25 September 2002 for final consideration.

iv. If approved, the new posts will be filled in the Autumn and the new structure implemented by January 2003.

5. FINANCIAL IMPLICATIONS

It is expected the proposed changes can be made within the existing resources of both organisations that are dedicated to this function. Any proposals for pooled budgets would need to be carefully considered to safeguard the position of both organisations.

6. PERSONNEL IMPLICATIONS

The Acting Head of Adult Services and the Direct Services Manager have agreed to extend their period of time with the Council until early Spring 2003, if it decided to adopt these proposals. The Heads of Commissioning for Older People and Learning Disabilities, who are currently employed by the PCT, would take on the full Health and Social Care Commissioning functions. Any final proposals would involve the deletion of the Head of Adult Services post and the creation of an extra Commissioning Officer to support the extra workload. It is further proposed that the assessment and care management staff and Home Care and Residential Care Services staff will remain directly accountable to Social Services managers.

7. LEGAL IMPLICATIONS

These will be carefully considered at the time when more detailed proposals are available. However, no new organisation is suggested and the accountability and responsibility for Adult Services remains as now with the Council and the PCT.

BACKGROUND PAPERS

The Health Act (1999) and the Social Care and Health Act (2001)

RECOMMENDATION

We recommend that the Executive and the PCT Board authorise the Strategic Director of Social Services and Housing and the Chief Executive of the PCT to consult on the proposals as outlined above and report back on the outcome with their recommendations in September 2002.

Contact Point : Charles Waddicor, F 520600 ext 2225

C WADDICOR Strategic Director Social Services and Housing	R MAZILLIUS Portfolio Holder for Social Services and Housing
D CRAWLEY Chief Executive of the Primary Care Trust