JOINT COMMISSIONING PARTNERSHIP BOARD
6 April 2 pm
QUARTERLY JCT SUMMARY PERFORMANCE REPORT
Authors: Mark Jordan, Melanie Parker.
Tel: 01707280676
1. Purpose of report
To provide Joint Commissioning Partnership Board (JCPB) with quarterly summary information on performance; including achievements, issues and implications.
This report provides a running summary of performance throughout the year so information is repeated where it remains of significance.
The report is broken into sections according to care groups with subsections on general issues and provider specific issues.
Working Age Mental Health is covered under separate annual report (item 5)
2. Finance Summary (see also Appendix A)
a) Budget 200506
The budgets for 200506 have changed slightly from those reported in January. The most significant reason for change is that the budget for MH continuing care has been contributed to JCPB with effect from 1 July 2005 which was the date from which HPT took financial responsibility. The January report included the MH Continuing care budget from 1 April 2005. However MH continuing care remained the responsibility of the PCTs from April – July 2005, as it was in previous years, and it was therefore felt to be incorrect to include it as contributed to the JCPB for this period.
Adjustments to the budget have also been made for the transfer of medical training posts from HPT to the Eastern Deanery, capital charges, and Elizabeth and Victoria Court. None of these adjustments will affect services or service users.
b) Revenue Monitor to end January 2006: Commissioner Variances
These budgets are managed by the Joint Commissioning Team (JCT) but the variances are met by the contributing partners.
Working Age Mental Health (WAMH) services.
A decision is still awaited from the Strategic Health Authority (SHA) on the arbitration with Barnet, Enfield and Haringey MH Trust (BEH). Because the amount involved in the arbitration is in the region of £1million this means that it is impossible to estimate with any accuracy the likely outturn on this budget.
Assuming the outcome of the arbitration is in favour of the Herts JCT on all points, it is estimated that Working Age Mental Health services will underspend by £740k by the year end. However the underspend is partly offset by the expected overspend on MHSOP services (£105k). The underspend has increased by £120k compared to January because this now includes the additional savings arising from the successful outcome to the arbitration with North Essex.
If the outcome to the outstanding arbitration with BEH is not in favour of Hertfordshire PCTs it is estimated that the WAMH services will overspend by £230k.
Learning Disability (LD) services.
Based on information at the end of December, LD health services are expected to overspend by £390k by the year end. This is made up of the historic overspend of £500k on Specialist LD placements offset by an underspend of £110k on other LD services. This is a decrease of £80k from £470k reported in January, as it was found that one service user was a resettlement client and should not have been charged to this budget.
The arbitration with Ashford PCT to determine who should be the responsible commissioner for an individual service-user has not yet been resolved. If the arbitration does not find in favour of JCT there will be a further overspend of £583k.
These health overspends are held at risk by health partners
Learning Disability Continuing Care (see also below under General JCT)
Adult Care Services have agreed to manage the Learning Disability Continuing Care budget. The proposed date of transfer is 1 April 2006. However the PCTs are now re-considering the options for managing this budget and so it is now uncertain whether the transfer to ACS will take place. ACS have not undertaken any further monitoring of this budget, pending clarification of their future role, and no monitoring information has been provided by Hertsmere PCT who are currently still responsible for LD Continuing Care.
Drug and Alcohol Services,
No significant variance is expected
Child and Adolescent Mental Health Services (CAMHS)
It is expected that there will be an underspend of £380k on CAMHS services. In addition there is an underspend of £200k on the CAMHS grant.
CAMHS Specialist placements
It was agreed at Partnership Executive on 26 September that JCT would manage the financial arrangements for these placements and that PCTs would share the risk of these costs.
Two placements have been made so far, and the costs for 200506 are £280k
Mental Health Services for Older People (MHSOP)
An overspend of £105k is expected. This is mostly due to JCT being required to make notional efficiency savings from MHSOP services commissioned from BEH which were in fact made against mainstream MH services. Subsequent work by the Planning and Commissioning Mgr for MHSOP revealed far higher levels of activity in MHSOP than was captured by the activity information supplied by BEH and it was not therefore possible to reduce the MHSOP aspect of the SLA in 200506. This overspend will be addressed in 200607
Joint Commissioning Team (JCT)
It is estimated that there will be an underspend of £80k. This has arisen from delays in recruiting to new posts. As this is a pooled budget the underspend will be shared between ACS and PCTs.
The JCT has been assisting the University of Hertfordshire and others in setting up a new post-graduate training course in mental health commissioning, whose start has been delayed to September 2006. It is proposed that several of the staff in the JCT will attend this course and it is therefore requested that JCPB agree that £7k may be carried forward to 200607 to allow JCT to meet fees for staff attending this course
Grants to Voluntary Organisations
There is a projected underspend of £30k on grants to voluntary organisations which is for new schemes which did not start until part way through the year. Due to the financial pressures within ACS, JCT have been required to hold this underspend for 200506.
c) Revenue Monitor to January 2006 - Provider variances
These variances are managed within the respective provider organisations; further detail on the position in relation to any individual care groups variances within providers, is included under the specialist care group reports that follow.
Hertfordshire Partnership Trust (HPT)
In total the projected net overspend is by HPT is £1,411k by the year end across all services,
The projected overspend will be underwritten by non-recurring support from the Strategic Health Authority, which should allow HPT to reach a balanced position at the year end.
HPT have taken on the financial responsibility for the MH continuing care budget with effect from 1 July 2005, and are now projecting a total overspends of £1,415k on continuing care covering all care groups. The projected outturns below on continuing care illustrate where progress has already been made and where cost pressures still remain
Jan 2006 Oct 2005
£’000 £’000
MH 98 310
LD 111 426
CAMHS 676 455
MHSOP 530 425
Total 1,415 1,616
There are significant overspends on working age mental health (WAMH) and drug and alcohol (D and A) social care placements in the private and voluntary sector. These are now expected to overspend by £350k (October £397k) and £80k (October £137k) respectively. However these are offset by underspends on community services.
In order to contain the projected overspends a number of measures have been put in place.
i) Recruitment has been frozen except where this presents a risk to service users or staff , and would otherwise have to be covered by agency or locum staff
ii) Assistant Directors scrutinize all proposed placements to ensure that they are both appropriate and cost effective in order to minimize any further growth in numbers. However there is continued pressure on budgets in terms of high needs requiring more enhanced care during placements.
iii) For continuing care the Bed Management & Placement Team are currently reviewing and assessing placements, particularly those that are highest cost. This focuses on whether need is appropriately met in an appropriate setting. There are various pieces of work looking at whether HPT can utilise its own beds differently in order to minimise reliance on other providers. Longer term, the Strategic Outline Case (SOC) for development of additional secure services and acute inpatients for children is being worked up and this, once in place, will provide additional beds at a reduced cost
Adult Care Services (ACS)
Following the £2.2m increase in budget (virement) from Corporate services for LD services, and continuing close monitoring of placements in the private and voluntary sector, ACS are now expecting the outturn on the LD budget to be in line with budget.
S28a resettlement transfer
The S28a resettlement budget is expected to underspend by £240k by the year end (£170k overspend reported in January). The Mental Health S28a budget is expected to underspend by £520k (£290k reported in January). These changes have arisen from further detailed work to clarify funding streams and budget commitments. Following the current work LD and MH resettlement, negotiations will take place with directors of finance so as to rationalise and stabilise these budgets and ensure the future best use and management of these funds. JCPB will be again updated on this in July 06.
3. Background Information: JCT Care Groups
General JCT
a) Performance Reporting / Balanced Scorecard
With the assistance of Jamie Sutterby, a Herts County Council (HCC) Graduate trainee, JCT have been exploring the possibility of using a ‘balanced scorecard’ approach for regular high level performance monitoring and reporting. The aim of this approach is to be able to report routinely at board level on a limited selection of performance indicators which between them provide a strategic overview of performance
Appendix B1 presents initial proposals for the contents of such scorecards for Working Age Mental Health and Adult Learning Disabilities and Appendix B2 provides background commentary describing the proposed content of these trial scorecards and some of the limitations of the proposed data. These trial versions have been drawn up as viable rather than ideal models and are presented as work in progress to JCPB for their consideration.
If JCT can secure further assistance from the HCC graduate trainee scheme we would hope to continue this development and extend it to the other joint commissioned care groups. The aim would be to run the trial version on first quarter data for 0607 and then seek further advice from partners for how they would like later versions of the scorecard to be improved.
However, before proceeding with this we would like JCPB to indicate if this approach is seen to be of value. Therefore JCPB is asked to support the continued development of the proposed ‘Balanced Scorecard’ as illustrated in the attached appendices.
b) Staffing
In January, Jeanette Fulwood joined the CAMHS commissioning team on a short term secondment
At the start of February Jess Lievesley took up his appointment as lead planning and commissioning manager for Working Age Mental Health.
In March, Maureen Line joined Gerry Moir to work part time in the commissioning team for Older People’s Mental Health. Maureen was previously working at the Strategic Health Authority on ‘Improving Working Lives’.
Andy Bishop will be leaving our Drug and Alcohol commissioning team at the end of April to join Herts Partnership Trust. In recent years Andy has played a lead role in the development of Drug and Alcohol services in Hertfordshire and although he will be sorely missed in commissioning we are delighted he will be continuing to work in the field in Hertfordshire. Tom Brennan will be temporarily filling Andy’s post from the start of May while longer term plans for drug and alcohol commissioning are assessed.
c) Adult Learning Disability (LD) Continuing Care
Since November 2005 Adult Care Services have been providing interim management for Learning Disability Continuing Care. At the time of writing however, no formal agreement has yet been reached as to who will manage this service and budget from April 2006. This uncertainty around the longer term management of this service and budget has resulted in a lack of clarity about performance and budgetary information in this area. This uncertainty therefore constitutes a significant financial risk to Health partners.
JCT have suggested three possible options to Health partners:
Option 1: ACS manage LD continuing care service on behalf of the PCT's.
For this, all PCT's will need to be actively involved in the LD placement Panel and the LD strategic commissioning group so that they can ensure the service is being managed satisfactorily on their behalf. PCT's will also need to sign the draft agreement that was drawn up and agree with ACS and JCT the proposed budget and associated savings targets.
Option 2: Watford / 3 rivers PCT manage LD continuing care service on behalf of the PCT's.
For this, a nominated PCT lead will be needed to ensure a rapid and smooth transition from the current arrangements with clear accountabilities during that process.
Option 3: Joint Venture
There has been mention of a possible 'joint venture' between PCT’s and ACS. For this to be considered PCT’s would need to swiftly draw up a proposal for negotiation, along with the transition structures mentioned against 2) above.
Partnership executives have recommended that whichever option is chosen, we should still if possible seek to incorporate the LD continuing care budget in the Joint Commissioning arrangements. In this way all Adult LD services would be commissioned and performance managed through JCPB and its subgroups. However, JCPB would also have to be satisfied that a sufficient budget is assigned and that adequate risk management arrangements are in place. JCT will therefore return to JCPB in July 06 on this matter once the management intentions have been clarified.
d) Historic Joint Funding Health Monies
There are a range of historic joint funding health monies that have been managed by the Joint Commissioning Team but which have never been formally incorporated into the partnership. These monies contribute to a range of Mental Health and Drug and Alcohol services and total approx £900k. There is a need to rationalise these monies so that they can be managed effectively, supported by robust contracts, and so that PCT’s can then review their use.