Report by Director of Health and Social Care Commissioning and Interim Director of Joint Commissioning

Transcription

1 Agenda Item No. 5 Policy and Resources Select Committee 21 February 2013 Progress Report on the Joint Commissioning Unit Report by Director of Health and Social Care Commissioning and Interim Director of Joint Commissioning Executive Summary This report sets out the progress made by the Joint Commissioning function of the new Health and Social Care Directorate in the six months since a report was presented to the Business Planning Group (BPG) of the Policy and Resources Select Committee (PRSC). It reviews performance in adapting to meet Future Council and NHS changes; identifies how current objectives have been achieved; and outlines future ambitions. Recommendations The Committee is asked to support how the JCU over the past six months has: 1) reviewed the current performance to make sure any changes to structure, function and strategy meet the changing demands of the Future Council and NHS 2) planned to deliver those changes 3) achieved current targets 4) identified future ambitions 1. Introduction 1.1 The Policy and Resources Select Committee BPG met on 16 July 2012, and considered a report of the functioning of the Joint Commissioning Unit (JCU). The BPG requested that a report be presented to full committee in February This report outlines current performance, and sets out assurance that structure, function and strategy meet the demands of Future Council, and NHS changes. It states how current ambitions have been achieved by outlining examples of key achievements specified within the County Council s Directorate Business Plan ( ) and demonstrates forward plans and ambitions for 2014 and beyond. 2. Background 2.1 West Sussex has a strong tradition of working in partnership with health to jointly commission health and social care services for its customers. Joint commissioning arrangements and pooled budgets for learning disability, mental health, substance misuse and community equipment services have been in place for a number of years. 2.2 In April 2011, the County Council committed to develop and extend these long standing arrangements by setting up the Joint Commissioning Unit

2 (JCU). A single and new Section 75 (a legal agreement between West Sussex Primary Care Trust (PCT) and the County Council outlining the scope of commissioning responsibilities and budgets to be delegated to the County Council) was agreed. This included pre-existing arrangements outlined above but also widened the agreement to include new arrangements for adults and older people, housing, carers and children and families. With the abolition of the PCT, and the creation of Clinical Commissioning Groups (CCGs), of which there are 3 in West Sussex, the Section 75 is currently being reviewed. In addition, the role of the Council in commissioning is changing as part of the Future Council, requiring further review of the JCU structure. 3. Budget in 2012/ Table one below shows the make-up of the 2012/13 Joint Commissioning Unit budget, including the contributions from both West Sussex County Council and the NHS. NHS WSCC Other Total ( m) ( m) ( m) ( m) Total budget ** Efficiency target * * the efficiency target of 2.995m has been deducted from the base budget at the start of the year and results in a total budget of m. ** sources of funding includes Home Office funding for substance mis-use and Dedicated Schools Grant for speech and language therapy. 3.2 In 2012/13, to date, the JCU has remained within budget and is on target to achieve WSCC efficiency targets of 2.995m for the year, and should also be able to deliver the 2.55m Quality, Innovation, Productivity and Prevention (QIPP) target, set by NHS colleagues, in full by year end. It has also, in the Learning Disabilities pooled budget, exceeded savings targets for , and has thus been able to deliver some elements of savings targets early. 3.3 Through the Department of Health, 14.1m of NHS Support for Social Care Funding has been allocated to the JCU this year with a further 11.8m planned for Working with NHS colleagues through the Joint Commissioning Management Group, commissioners have sought to invest these funds in transformational programmes, such as Proactive Care and Community Neurological Rehabilitation. A key element of such programmes is to ensure benefits realisation through appropriate modelling and tracking. 4. Performance in 2012/ There are 30 high level transformational measures within the JCU which are monitored on either a monthly or quarterly basis. Reports which include risk mitigation plans are presented monthly through a dashboard to the Director of Health and Social Care and Joint Commissioning Management Group and quarterly to the Joint Commissioning Board. For example, the performance

3 report in December 2012 outlined that 3 out of 13 quarterly risks were reported red and three of the monthly measures were reported red (although two of these are predicted as being categorised as green within the January 2013 dashboard). 4.2 All the JCU TPM priorities are recorded as being green or completed, as of 31 December An improved integrated performance management system is being currently being developed for Review of Joint Commissioning Unit fitness for purpose for Future Council and reformed NHS 5.1 Since the agreement of the Future Council, and the move towards being a Strategic Commissioner, the JCU has been reviewing its structure and working arrangements to ensure that it is fit for purpose in this light, and the new NHS organisational changes. 5.2 JCU Partnership Agreements and Section 75 The Section 75, the legal agreement between the NHS and WSCC, is currently being reviewed, in consultation with the shadow CCGs. It will be completed by 1 April 2013, at which point 3 new documents, supported by separate partnership agreements, which will set out governance structures, core targets and priorities for each commissioning area, will be signed by the Council and the new CCGs. 5.3 The supporting governance structures set out in the original Section 75, including the Joint Commissioning Board, and Joint Commissioning Management Group, will also need to change, and a paper outlining proposals in this area will be taken to Cabinet on 12 February. 6. Restructure 6.1 The JCU structure, and that of the new Directorate of Health and Social Care Commissioning, are also being reviewed in the light of the above changes. At the most senior level, there will be 7 direct reports to the Director of Health and Social Care Commissioning, including a Head of Integrated Adult Care, due to start 1 March Alongside the structural changes is a programme of improvements in communication, focus groups responding to the staff survey, and the implementation of a training programme, to provide all staff within the JCU with a consistent knowledge and understanding of the commissioning cycle, and improve specific skillsets. 7. How progress has been achieved since July A series of ambitions were identified within the report taken to the PRSC Business Planning Group in July The following provides a brief update on these: Relationship of the JCU with the rest of the council as the Future Council organisational design is implemented. The redesign of the JCU has fully incorporated the Future Council model to support the County Council emphasis on being an effective commissioner as outlined above.

4 Partnership and integration with the work of the CCGs as they move to authorisation and take over the responsibilities of the PCT. The JCU has worked proactively with Crawley and Horsham and Mid Sussex CCGs and Coastal CCG to ensure a more integrated approach to business planning for The CCGs have also been engaged in the review of the Section 75 and development of the Partnership agreements including the review of governance arrangements and current restructure of the JCU. Health and Wellbeing Board going live and how JCU and HWB work together. The JCU commissioning intentions have been developed in light of the priorities outlined through the Health and Wellbeing Board to ensure that shared objectives and priorities are identified. Keeping customers at the heart of JCU business and a local emphasis on commissioning and performance management Within the commissioning of services, customers are actively involved in business planning, developing specifications and service models and consultation. The Learning Disability Partnership Board and Mental Health Implementation Board have continued to have strong customer input and leadership. New fora have been established to ensure customer engagement and to monitor the customer experience. Examples of these include the NHS Customer Reference Group, Carers Reference Group and Adult Services Customer and Carers Group and Autism Planning Group. Performance management developing an outcome focused approach The JCU is currently developing an integrated and shared system for performance management in partnership with CCG colleagues to reflect service and developmental measures to deliver an outcome focussed approach. Supporting the rapid development and implementation of proactive care, early intervention and prevention The JCU is supporting and leading on proactive care programmes funded through the NHS Support for Social Care Fund to develop a sustainable multi-disciplinary approach, aligned with changes in working practice within adult social care. Five Multi-disciplinary teams are now operating across West Sussex to deliver early intervention and prevention services, with the remainder of the county to be covered before the end of Developing the strategic element of commissioning, in line with Future Council The JCU will be developing an overarching three year Commissioning Strategy in partnership with key stakeholders with underpinning delivery plans, an evidenced needs assessment, gap analysis and whole market development. This will be supported by the development of supporting strategies including the Sub Acute/Re-ablement Strategy, Mental Health Strategy and review of the carers and learning disability strategies.

5 Focussing on health and social care integration working with adults and children s services The JCU is fully committed to commissioning quality services and efficiencies through integrated working with health and social care. Examples include the integration of learning disability community teams, development of integrated dementia crisis teams, improving quality in nursing and care homes; implementing a recovery plan to bring the community equipment spend in line with projected budgets; and developing a warfarin pathway in partnership with acute trusts, voluntary sector and CCGs. Integrating contracting between health and social care more effectively There is increased appetite to make efficiencies through joint commissioning between health and social care. For example, there are more opportunities for integrated contracting when Continuing Health Care (CHC) transfers from the NHS to the JCU in April There is a stronger emphasis on contracting through the restructure of the JCU, through the appointment of a Head of Contracts and Performance and more dedicated resources for contracting as part of the JCU restructure. 8. Future ambitions 8.1 Future ambitions for and beyond include:- Closer working between the existing joint commissioning function and other areas of the new Health and Social Care Directorate including safeguarding. Continuing to deliver increasingly challenging savings set by the County Council and NHS. Reviewing the impact of the NHS Social Care Fund to maximise investment in transformational changes Completing the redesign and restructure of the JCU in line with Future Council, and as part of the new Health and Social Care Directorate Ensuring a robust strategic approach to future commissioning through the development of West Sussex Commissioning Strategies for all adult and children client groups, including a Sub Acute Care Strategy, and a Mental Health Strategy Ensure a clear understanding of the health and social care market in West Sussex and how best to stimulate the market to deliver JCU commissioning Commissioning quality services fairly and ensuring that a sustainable market is developed e.g. build on the review of the residential fees assessment methods to consider how best to ensure quality is built into payment mechanisms Agree joint policy and processes to deliver an integrated CHC service to the customer and ensure seamless transition into joint commissioning. 9. Implications 9.1 Resource, risk, Equality Act 2010, Human Rights Act and Crime and Disorder Act implications are not relevant to this report as it is for information. When developing specific service plans and policies the council will consider in greater detail the impact of proposals that might be implemented.

6 Dr Mike Sadler Director of Health and Social Care Commissioning Sally Burton Interim Director of Joint Commissioning Contact: Sally Burton, Appendices Appendix A Impact of the JCU on the commissioning of services in 2012/13. Background Papers None