PAPER B
Purpose : For Decision
Committee : EXECUTIVE
Date : 24
SEPTEMBER 2002
Title : LEAD COMMISSIONING PROPOSALS
FOR HEALTH AND SOCIAL CARE SERVICES FOR ADULTS
REPORT OF THE PORTFOLIO HOLDER FOR SOCIAL SERVICES
AND HOUSING
SUMMARY
This report sets out the proposals
for the Lead Commissioning arrangements for Health and Social Care for adults.
The results of the consultation are included which gives the scheme a strong
endorsement. The new structure is set out in Appendix 1.
The paper includes a timetable,
which would mean the new structure would be in place by January 2003 (see
appendix 2).
BACKGROUND
The long history of partnership
between Social Services and Health has lead to closer working relationships
between both parties. The joint Registration and Inspection Unit and the joint
Occupational Therapy Team were 2 early examples. In April 2001, the Primary
Care Trust (PCT) became lead commissioner for Health and Social Care mental
health services and Social Services became the lead commissioner for Learning
Disability.
In the Health Act (1999) and the
Social Care and Health Act (2001), the Government envisages closer working
still, up to full organisational integration .
PROPOSAL
The senior managers in the
Directorate have worked with their counterparts in the PCT to produce a set of
proposals, which will lead to joint commissioning for all adult services. Under
these arrangements, there will be two Heads of Health and Social Care
Commissioning Posts (one for services for adults under 65 and one for adults
over 65). They will be supported in their work by a new post of Senior
Commissioning Manager. They will report to and be held accountable for their
performance by an Officer Management Board jointly chaired by the Strategic
Director of Social Services and Housing and the PCT Chief Executive. The
Management Board will agree their work programme and will meet every 2 months
to review progress.
All the care management and
assessment staff, together with those in Direct Services staff, will remain
under the operational control of Social Services. It is proposed to create a
new post Head of Operations to manage these staff groups. This post will report
to the Strategic Director.
There are no current proposals to
merge further, the commissioning budgets. However, an officer group is studying
the implications of such a proposal, which is generally regarded as a sensible
development. This may form the basis of a future report. There would have to be
adequate safeguards to protect the interests of the Council and the PCT.
The Council and the PCT would
retain ultimate responsibility for the standard of Social Care and Health Care
respectively for the Isle of Wight. The Heads of Commissioning would attend
council committee meetings and PCT Board meetings as required.
There are no proposals to merge
the commissioning arrangements for Children’s Services. Although it will be
part of the remit of the Management Board, the Health and Social Care functions
regarding Children’s Services will continue to be discharged by 2 separate
senior officers. However, good practice would be to include a representative
from Education Services on the Management Board. This would ensure the 3 main
agencies involved in carrying for children in need are involved in commissioning
future services.
The long-term future of Children’s
Services is unclear at present. The Government’s response to the Laming enquiry
into Victoria Climbie’s death is expected in the late autumn. This could have
profound implications for the future shape of these services. These proposals
do not commit either the PCT or the Council to a new legal body. A Care Trust
is not an inevitable consequence of these proposals. However, if adopted these
proposals should lead to less duplication of effort and better use of
resources. It could remove the perverse incentives, which currently exist and
will make it easier to plan and deliver services which meet the needs of people
on the Isle of Wight.
CONSULTATION ARRANGEMENTS
A copy of the report, which went
to Executive Committee and the PCT Board in July, was sent to key stakeholders.
The Chief Executive of the PCT and the Strategic Director were also present at
a public meeting at the Riverside in Newport in August. There is a broad
consensus in favour of the proposals. They are seen as positive and helpful;
offering the chance to reduce duplication. As one group said: “This is a chance
not to be missed”. However, both agencies were asked to make sure they learnt
the lessons from merging mental health services. We were also asked to see if
we could merge the complaints processes at some stage in the future. We were
also asked to ensure the proposal didn’t lead to a loss of funds to the
voluntary sector. There was support for joint budgets, but we were asked to be
clear about how overspends are dealt with. Letters of support were also
received from the Chair of the Nursing Home Owners Association, the Chair of
the Learning Disabilities Parent/Carer Forum and from the Chief Executive of
the NHS Trust.
The Social Services, Housing and
Benefits Select Committee have considered these proposals and recommends the
approval of these proposals.
FINANCIAL IMPLICATIONS
This proposal will mean
commissioning up to £18m. worth of services for adults in collaboration with
the PCT each year. The ultimate responsibility for ensuring the funds are spent
wisely, prudently and in accordance with the assessed needs of residents rests
with the Strategic Director. However, by agreeing to spend this money in
conjunction with the PCT we are ensuring better value for money in the work we
do.
The cost of the restructuring is
being contained within existing budgets. £179,000 worth of senior posts,
including the salaries of 2 personal assistants are being cut. This has enabled
the Directorate to make a contribution to the savings target of £50,000 in
2002/03 and to fund 3 new posts and salary enhancement in the new structure.
PERSONNEL IMPLICATIONS
This proposal will mean the
deletion of the posts of Head of Direct Services and Head of Adult Services.
Both post holders have agreed to redundancy and will leave on 31st
March 2003. This will mean there will be time for the new structure to be put
in place. This follows the previous redundancy of the Head of Operations in May
2002.
PCT employed posts:
There are two existing posts,
which on personnel advice are eligible for slotting into the Heads of Health
and Social Care Commissioning Posts. The new Senior Commissioning manager post
will be advertised by the PCT in the normal way.
Council employed posts:
The Head of Operations Post will
also need to be filled. This will be done in the normal way. The two new
Service Manager posts, which will be needed to support the Head of Operations,
will also need to be filled. One post will be
filled by the current
Service Manager in the Adults Division. The remaining post will be filled in
the normal way.
LEGAL IMPLICATIONS
There are no legal implications
arising from this paper. The duty to provide services remains with the Council.
RECOMMENDATIONS
The Executive Committee is asked
to agree the proposed structure for adult services as set out in Appendix 1.
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BACKGROUND PAPERS
Paper to Executive Committee July 2002
Various working papers for
internal meetings May-July 2002
Paper to Select Committee
September 2002
Contact Point : Charles Waddicor
520600 ext 2225
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C
WADDICOR
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R
MAZILLIUS
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Strategic
Director
Social
Services and Housing
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Portfolio
Holder
Social
Services and Housing
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Appendix 2
Timetable
for implementation of Commissioning Structure for Adults
Select Committee 4th September 2002
Executive Committee
24th September
2002
PCT Board 25th
September 2002
Recruitment to key posts
October-January 2003
Retirement of Acting Head of Adult Services and Head of
Direct Services March 2003