4.
The integration of adult social care and health services
on the island is a manifesto commitment by the current administration and
continues the direction of travel set out in previous organisational, corporate
and service plans.
5.
Integration and closer working between Health and
Social Care organisations is a national policy driver as evidenced by the
recent Green Paper, ‘Independence, Wellbeing and Choice’, National Service
Frameworks and Valuing People White Paper. It is anticipated that the
forthcoming White Paper on ‘Care Outside Hospital’, due in December 2005, will
reinforce further this direction.
6.
“Commissioning a Patient-led NHS”, an
important national document was published via a letter from Sir Nigel Crisp,
NHS Chief Executive, on 28th July 2005, and outlined a significant
reorganisation of the NHS. Much debate
has taken place during August and September between the three Island partner
organisations on the right organisational model for commissioning and provision
in light of this national guidance.
CONSULTATION
7.
Consultation was undertaken with the Island public as
part of the local healthcare strategy (the Island response to Healthfit) in
2003/04, the starting point for the current integration agenda, which
demonstrated support for an integrated health and social care organisation.
8.
A full consultation process will be part of Care Trust
application which, on current timetable, will take place in Spring 2006.
FINANCIAL/BUDGET
IMPLICATIONS
9.
It is anticipated that the Adult Services budget
applicable to Social Care provision at the time of integration will transfer to
the Care Trust with the other appropriate resources such as staff and
premises. The mechanism for the
transfer of funding will be through Health Act Flexibilities (an overarching
‘Section 31’ Agreement).
10.
Any budget transfer will be subject to approval and
based upon advice from the Chief Finance Officer. At this point we are not in a position to predict or quantify
the level of the transferable budget.
11.
There will also need to be a clear understanding between
the partners about future financial commitments, and how service levels, value
for money and affordability will be dealt with over the medium to longer
term. The Transition Project Team has a
Project Accountant who is leading on this work.
LEGAL IMPLICATIONS
12.
Health Act flexibilities will be utilised through a
Section 31 Agreement to enable pooling of health and social care budgets. Work is underway through the legal services
team and the transition team to ensure that this agreement will be robust and
fit for purpose.
13.
In effecting the integration we will ensure that we
comply with all relevant legislation including employment law, particularly
TUPE.
14.
John Lawson, Assistant Chief
Executive, is leading the legal work stream for the Transition Project.
OPTIONS
15.
A detailed Isle of Wight response to Commissioning a Patient-led NHS was
prepared by the Transition Project Team. In that paper the following options
for commissioning of health and social care services were considered:
i)
A stand alone Island Primary Care Trust (PCT) as a
commissioning only organisation, transferring its service provision to the Isle
of Wight Healthcare Trust, with adult social care remaining within Isle of
Wight Council;
ii)
An Island-based Single Care Trust hosting provision
and commissioning of health and adult social care.
iii) An
Island-based Joint Commissioning Care Trust, commissioning both health and
adult social care, and an Island-based Provider Care Trust, providing both
health and adult social care.
iv) A Mainland-based
Primary Care Trust also covering the Isle of Wight, as a commissioning-only
organisation, with an Island-based Provider Care trust, providing both health
and adult social care.
16
The preferred option is a variant of option ii). This
features the Single Care Trust which would be a provider of health and adult
social care but a commissioner for just health. Social care commissioning and
joint commissioning would remain within the Isle of Wight Council, utilising
the flexibilities available under the Local Area Agreement. This was approved at the Transitional
Steering Board, with confirmation of Council support, PCT and Healthcare NHS
Trust Board meetings in September.
17
At a Transitional Steering Board workshop last month the
partner organisations debated the key actions to strengthen integration between
now and April 2007 when the new Care Trust would be created.
18
The next steps were proposed as:
i)
Vision for the new Care Trust – How the new
organisation will improve services for the public – to be complete by February
2006;
ii)
Support work needed for the new organisation to be
created in April 2007 – this includes governance, financial arrangements, human
resources, communications, patient and user involvement, asset management and
legal services;
iii) Commissioning
– How commissioning will operate and how the new Care Trust will need to
separate commissioning and provision within the same organisation – to be
complete by March 2006; and
iv) Section
31 Agreements – It is recognised that the partners require more tangible
evidence of strong partnership working. There is much informal partnership
working but Section 31 Agreements are generally seen as evidence of formal
partnership working. Additional Section
31 Agreements are proposed to be put into place for Mental Health, Occupational
Therapy, Learning Disability, Intermediate Care, Services provided at Beaulieu
House and Emergency Planning and Business Continuity. These are proposed to be
in place by March 2006.
RISK MANAGEMENT
19
A Risk Register has been created for the Transition
Project and will be updated on a regular basis.
20
Principal risks are outlined below with actions
currently in place or proposed to be taken which will address the risk:
RISK ACTION
i) Insufficient
support from i) Manifesto commitment by new Council.
partner
organisations to
proposed
direction. ii) PCT and Healthcare Trust now have Joint
Management
Team, Joint Board meetings and
conduct much business on a joint basis.
iii) Transitional Steering Board includes
most
senior membership from each of
the
partner organisations.
ii) Insufficient public support. i) Previous
consultation in 2003/04 on the local
Healthcare
Strategy indicated support for an integrated health and social care
organisation.
ii)
Formal
public consulation will be undertaken in Spring 2006 to determine level of
support.
iii) Model for commissioning i) Strong
case supported by the Council, PCT
services
put forward is Healthcare
Trust and the local MP put to the
counter
to the national Strategic
Health Authority (SHA).
direction.
ii)
Recognition
in the SHA submission to the Department of Health that the IOW has exceptional
circumstances.
iii)
The
Isle of Wight already has a unique organisational model for healthcare as the
Healthcare Trust is the only NHS Trust that is a provider of acute, community,
ambulance and mental health services.
iv) A range of financial risks. i) It
is expected that as an integrated organisation
there
will be financial savings compared with the
current
position.
ii)
A
business case is being developed that will
require
approval from the partner organisations that will address all of the financial
risks.
iii)
Good
progress is being made on the Financial
Recovery
Plan for the PCT/Healthcare Trust.
|
RECOMMENDATIONS
21 That
the Cabinet note the current update and approve the next steps as set out in
the above update.
|
BACKGROUND
PAPERS
22
Commissioning
a Patient-led NHS – Department of Health, July 2005.
An Island Response –
Transition Project Team, September 2005.
Contact
Point: Mark Price, Transition Project Director Tel 01983 550942 email
[email protected]
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MR
MARK PRICE
Transition Project Director
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CLLR
DAWN COUSINS
Cabinet Member for Care,
Health and Housing
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