PAPER
C
Purpose : for Decision
Committee : CABINET
Date :
Title : MEMORANDUM
OF UNDERSTANDING BETWEEN THE ISLE OF WIGHT COUNCIL AND THE ISLE
OF WIGHT
NATIONAL HEALTH
SERVICE PRIMARY CARE TRUST
Report of : THE CABINET MEMBER FOR
IMPLEMENTATION
DATE :
1.
To progress the Memorandum of
Understanding (MoU) between the Isle of Wight Council (IOW Council)
and the Isle of Wight National Health Service Primary Care Trust (IOW
NHS PCT) which will enable us to work together to deliver person centred Local
Authority (LA) and Health Care services.
OUTCOMES
2.
There are five outcomes which will
be delivered through this Memorandum of Understanding:
a. To work together to improve the health of the
3.
The Director of Public Health post
will be a joint appointment and will advise both organisations together. The
Director will have direct access to the Chief Executives and the Annual Report
will be addressed by both the PCT Board and by the Council.
b. To agree a disposal programme for a joint property portfolio
4.
Specialist property services will be
jointly commissioned. They will prepare the property portfolio for the market
and manage the disposal process. Capital receipts will be drawn
back into the Council and the PCT to clear historic debt and to invest in new
build community health and social care services.
c. To agree a move towards shared
support functions where that will produce efficiencies
for both organisations
5.
Examples of functions where there may
be scope for joint work include some parts of each of HR, Communications,
Informatics Support, Information Management and Analysis, Finance, Procurement
and Performance Management. We will test moves to shared headquarters and
increasingly integrate our management and governance arrangements.
d.
To develop joint commissioning arrangements which make best use of
our available resources to meet the needs of local
people
6. We
will assess need, prioritise those most vulnerable and work in partnership with
the third sector, private sector and local businesses to ensure people are able
to live in their own homes with appropriate care and support.
e. To develop local models of joint health and social care delivery
7.
This will be work to deliver a model
of care of integrated working which can be rolled out across the
BACKGROUND
8.
IOW Council and PCT have been
discussing how they work together better for some time. A Care Trust had been
planned and a Transition Team put in place to deliver that model underpinned by
Joint Commissioning. This approach was disrupted by the national reorganisation
of the NHS and provided any opportunity for both agencies to review the way
forward. In particular the combination of the NHS Acute Trust and the PCT made
the proposed Care Trust model inadvisable. This reflected a national trend away
from the Care Trust model.
9.
On October 25th 2006, the Leader of
the IOW Council, the Chair of the PCT, the Lead Cabinet Member , the two Chief
Executives and the lead care group Directors met to agree a way forward.
10. There is a strong momentum for change, commitment to a new way of
working and a determination to deliver on key areas of joint working. These are
set out in the overarching Memorandum of Understanding which will be
underpinned itself by Memorandums of Agreement for each of the five development
areas identified in the outcomes above.
11. This
approach is currently being upheld up as a good national example of joint working
by both the LGA and the NHS Confederation, both of whom are keen to see us
succeed and tackle some of the challenges which thwart others. They are
particularly interested in our joint approach to property and shared
accommodation and the collaboration on commissioning and joint working. We have
been described as unique in putting delivery before structure in our new joint
arrangements.
STRATEGIC CONTEXT
12. The
White Paper "Our Health, Our Care, Our Say" sets out a framework for joint working for the
Local Authority and NHS .The approach to joint commissioning and the local
joint working will deliver on the expectations in the White Paper, which
seek a shift in care pathways from acute
to community based care.
13. The
White Paper "Stronger Prosperous Communities" requires local
authorities and all the other local agencies to work together and empower local
communities to deliver services in partnership with the LA and the PCT.
14. The
PCT and the LA have identified the future cost of care for older people as
a key strategic risk. Delivering on this Memorandum of Understanding will
enable both organisations to manage their respective budgets in the most cost
effective way through a collaborative approach. Through joint commissioning and
the care pathway work they will ensure that health and social care is being
delivered in the most efficient and person centered way which will reduce the
burden of expensive acute and institutional care.
CONSULTATION
15. There
has been initial consultation with key people within the LA and the PCT. This
report begins the process of consulting with the public, staff and partners on
the general direction of travel for the joint approach of the PCT and IOW
Council. Staff briefings and public briefings are planned with the PCT and this
paper will go to the next Trust Board meeting in February for ratification.
16. We
will be officially launching the MoU at a White Paper conference on
FINANCIAL/BUDGET IMPLICATIONS
17. The
MoU in itself brings not budget implications other than a commitment of member
and officer time to work on the proposals set out in the five outcomes. There
will be a detailed financial and budget analysis done for each of the outcomes
when that work is further progressed and these will be brought before the
cabinet at that stage.
18. The
driving force behind the MoU is to achieve better service for local people.
Inherent within the proposal however is the desire within both organisations to
achieve efficiencies and changes in the delivery of services and model of care
which will enable us to afford the financial pressure of the unique demographic
picture on of the
LEGAL IMPLICATIONS
19. Initial
soundings on this approach have been sought by the LA and the PCT and there is
nothing to prevent us from moving forward on this. For each of the five
outcomes there will be a proposal which will require separate legal
consultation and advice and these will be taken as and when required.
OPTIONS
Option
One - To agree to proceed with the Memorandum of Understanding.
20. There
is a clear strategic need for the IOW Council and the IOW NHS PCT to
collaborate. Without some form of agreement there will not be clarity about the
aims and objectives of that collaboration and the key priority areas.
21. Partnerships
between the LA and the NHS have faltered in the past where there has not been
this clarity of purpose or where the agreement has been so cumbersome and
legalistic (e.g. Section 31 agreements) that it has got in the way of
delivering the service improvement and has taken an unprecedented amount of
time. We are determined this will not happen.
Option Two - To reject the
Memorandum of Understanding.
22. This
option will leave us in a vacuum for proceeding with achieving the outcomes we
have identified in the MoU. Neither party wants to enter into a more
bureaucratic arrangement (S.31) because of the time involved but both parties
are keen to have some demonstration of their commitment to work together.
23. The
agreement does not tie the LA into anything legally binding at this stage and
Cabinet will be able to review its success as the proposal for each of the
outcomes is brought forward.
EVALUATION
24. The
decision to proceed with the MoU has been drawn up on behalf of the Leader and
Lead Cabinet member of the Council and the Chair of the PCT by Chief Executives
and Chief Officers who have worked successfully with such arrangements in other
LA and NHS systems. What is unique about this approach on the Island is that it
is tackling the very real tangible challenges for the organisations - the need
for the PCT to break even, the need for the LA to make best use of its property
portfolio and the need to reduce the burden of the cost of resident and patient
care for the future.
25. The
launch of the MoU in April will begin a process of external evaluation as the
programme of work to support the delivery of the outcomes will have a validated
process wrapped around it.
RISK MANAGEMENT
26. This
report has set out the opportunities in pursuing this approach. A detailed risk
analysis for the delivery of each of the five outcomes will be carried out at
the appropriate time.
27. However
the missed opportunity if we do not take this approach at this unique time of a
new Directors teams, new leadership at the PCT and a determined approach to
jointly managing our financial risk will far out way any risks in
collaboration.
RECOMMENDATIONS
28. To agree to proceed with the Memorandum of
Understanding between the IOW Council and
the IOW NHS PCT which will enable us to work together to deliver person centred
Local Authority and Health Care services.
BACKGROUND PAPERS
1.
" Our Health, Our Care, Our
Say" - www.dh.gov.uk
2.
"Strong and Prosperous Communities" - www.communities.gov.uk
APPENDICES
1. Memorandum of
Understanding
Contact
Point : Sarah Mitchell, Director of Adult and Community Services, tel: 01983 821000
ext. 5667, email: [email protected]
|
SARAH MITCHELL |
COUNCILLOR DAWN COUSINS |
|
Director of Adult and Community
Services |
Cabinet Member for |