ITEM 9 appendix
Project Steering Group for MH/LD/CAMHS Health Placements.
1Terms of Reference and Project Initiation Document
1.1Introduction
Purpose and Scope of the Project
The project will identify what is required for those Mental Health and Learning Disability budgets and functions currently managed by the Hertfordshire Continuing Care Team to come within the partnership arrangements in Hertfordshire.
It will review arrangements for the budgets and functions currently held by JCT, ACS and HPT associated with Mental Health and Learning Disability placements.
It will encompass all placements with a health component that have to be made outside of HPT.
It will produce arrangements that will incentivise and enable all staff to maximise the use of available resources.
Decision Making Structure
How each organisation runs its internal processes will be up to that organisation but the project and partners will want to ensure that planned processes and structures are robust and manage risks effectively.
Proposals and options around budgets will need to be negotiated between PCT’s, JCT, HPT and ACS.
If budgets are to come within the partnership arrangements then budgets and arrangements wiil needto be agreed by the Joint Commissioning Partnership Board.
The steering group will report to and be accountable to the Partnership Executive with individuals reporting to their respective partner’s boards.
The Joint Commissioning Team will be responsible for coordinating the project.
1.2Steering Group Meetings and Membership.
The steering group will meet as follows:
- 3rd May to agree terms of reference and initial project plan.
- 10th June to consider draft proposals and review progress (0900 at Mt Pleasant)
- 4th July to review progress and finalise proposals for agreement at July JCPB (1400 at Mt Pleasant)
-Early September to review implementation and close the project.
The above timescales can be modified and further meetings arranged as needed.
The steering group will have the following core membership:
Mark Jordan (JCT) : Chair and Project Coordinator.
Helen Buckingham (CC / PCT)
Anne Markwick (HPT)
Roisin Fallon Williams (HPT)
Sue Darker (ACS)
Linda McQuaid (HPT)
Keith Loveman (HPT)Gill Humby (HPT)
Andrew Theidemann (HPT)
Mike Curtis (ACS)
with the following additional members who are also invited to attend if available and who will be circulated all documentation:
Ann Roberts (HPT)
Jeya Balakrishna (HPT)
John Jones (HPT)
Sally Hulin (HPT)
Steve Knighton (SHA)
Theresa Reid (SHA)
Denise Radley (ACS)
Cathy Kerr (ACS)
Debbie Pyne (CC)
Moira Swan (CSF)
Mark Janes (ACS)
1.3Steering Group Terms of Reference
The steering group will be responsible for agreeing and delivering a project plan (see 3 below) whereby arrangements are proposed, negotiated, agreed and implemented for incorporating within the partnership arrangements, the MH / LD / CAMHS budgets and functions of the continuing care team. This plan will also review arrangements for those budgets and functions currently held by JCT, ACS and HPT associated with Mental Health and Learning Disability placements.
It will ensure that options are drawn up and negotiated within identified timescales and then implemented.
It will not be responsible for deciding between options: such decisions will take place through the structures identified above (see 1.1).
It will agree a hypothetical model from which proposals will be developed (see 2 below)
It will pursue approaches that will produce best value for for people registered with Hertfordshire PCTs and which will satisfactorily manage financial and clinical risks for the partners.
It will produce proposals that will form part of an effective integrated overall placements system for Mental Health and Learning Disabilities and CAMHS. In so doing, it will design the best arrangements for the management of all current and future joint commissioning monies associated with such placements.
Although the project will not directly review arrangements for social care placements it will ensure that the appropriate links are drawn together between all care groups and their placement arrangements .
It will take a system-wide approach which will question all current arrangements and where appropriate, propose radical alternatives that may require significant changes in culture and practice . It will therefore exercise caution over using old terminology such as “continuing care” or “panel” to describe the new arrangements that are developed.
It will ensure that arrangements provide sufficient flexibility for those patients who do not always fit into standard arrangements
It will not renegotiate local continuing care criteria but will plan in the context of forthcoming national criteria.
It will evaluate the potential disruption of any proposed changes to ensure that they are worth it!
2Potential Model From Which Proposals Will Be Developed.
The model and potential assumptions outlined below are a starting point for the project. The project will test and develop these ideas and modify them as needed.
The model needs to be designed to support the following principles:
-To have as few separate budgets and systems as possible and utilise the flexibilities of pooled budgets.
-To only apply current ‘continuing care’ procedures where absolutely necessary
-To minimise the numbers of people required in decision making and incentivise operational staff and teams to make best value use of resources.
2.1Who would do What
JCT
-Oversees and performance manages HPT and ACS delivery against overall SLA
-Monitors and plans for future demand
-Assists in the commissioning and contracting of block contracts
Working Age Mental Health
-HPT manages the health and social care placement system within a set budget and contract manages providers where appropriate
Learning Disabilities
-HPT manages the placement system within a set budget for any wholly health funded short and medium term placements . Consideration should be given to this being a joint budget with Mental Health.
-ACS manages the placement system within a set budget for any long term health placements and any health placements that also have a social care component.
CAMHS
-HPT manages the placement system for short and medium term placements IPA’s within a set budget. (This will be a different system from that of Adult Mental Health since these are emergency placements that at present will generally last at least 4-6 weeks. It is recommended that a structure is developed based around a county-wide outreach / assessment team, a placements officer and active care coordination and care planning.)
-CSF continues to manage the ‘Out of County’ panel that oversees CAMHS longer term placements . It is recommended that a pooled budget is established in anticipation of a future children’s trust. If this does not happen then PCT’s would need to hold the appropriate continuing care psychiatric budget alongside the continuing care paediatric budget.
Older People’s Mental Health
It is recommended that proposals for OPMH continuing care are developed in conjunction with the consultancy (SCCD) that is developing proposals for other older people’s services
Options: :
-1) HPT manage a placement system for any pure mental health placements within a set budget with PCT’s managing the system for joint placements
-2) HPT manage a jointly funded system for all MHSOP placements within a set budget
2.2What is needed to make this work
There will be placements procedures and structures in HPT and ACS
That gatekeep and manage the portfolio of placements and that provide clear budgetary and clinical authority and responsibility
There will be clear accountability throughout the process.
Budgets will be overseen by a named senior manager and byfinance staff.
There will also be team level clinical and financial accountability for ensuring effectiveness and economy
The systems will be based on planned decision making.
With additional emergency processes established for interim decisions while the case is picked up by the mainstream process. (For CAMHS IPA’s the emergency process will be the mainstream process).
Interim ‘waiting’ processes may also be required for occasions where placements cannot be made immediately.
A funding panel and / or manager will oversee the whole portfolio of current and planned placements for each budget.
-They will agree to the funding of the placement for a set period of time which can only be extended by rereferral to them.
-They will make decisions about the notional portions of health and social care funding for each case.
-They will ensure that a named care coordinator and care plan are in place throughout each placement and that there are regular reviews of each placement.
-They may be supported by a placement officer and some independent internal audit that double checks team casework decisions and ensures that the most cost effective options are in place.
-They will maintain a database of all the placements in the portfolio, including costs / responsibilities / planned discharge timescales / actual length of stay etc.
-They will ensure there is effective communication and documentation between all parties including those situations where there are potential transition issues.
There will be systems that collect and provide the required information
That support the management of the placement process (including waiting lists) and provides the necessary detail to all partners for budgetary management and future planning (including the apportionment of health and social care costs.
And a contracts database to manage supplier relationships and to support block and spot contract management.
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ITEM 9 appendix
Project Steering Group for MH/LD/CAMHS Health Placements.
3Initial Project Plan
The plan below takes us to the point of proposals and agreement during which time potential implementation plans will be drawn up.
People are identified below as acting for their respective organisations HPT (H), ACS (A) , PCTs (P), JCT (J), Social Care Can Do (SCCD)
Task / By When / Notes / WAMH / LD / CAMHS / MHSOPDevelop and Document Placement Procedures and Structures. / 1st Drafts available prior to June Steering Group. Final Drafts by July . This should include arrangements for emergency placements. / Gill H (H), / Anne W (H) , Sue D (A), / Amanda F (H), / Keith M (H),
Define budget required to fund placements in 2005-6 and likely future growth rates. / Initial estimates by 14th June for discussion at Partnership Execs 21st June. Full estimates by 24th June for negotiation prior to July JCPB. Estimates will be prepared by both the potential receiving organisation (HPT / ACS) and the funding organisations (PCTs) / John J (H),
Helen B (P), / John J (H),
Mike C? (A),
Helen B (P), / John J (H),
Helen B (P), / John J (H),
Helen B (P),
Identify Staff Resources needed. / To be based on the proposed procedures and structures developed in May and to be incorporated in the budget proposals above (14th June). Line up with phys dis, / Gill H (H), / Anne W (H) , Sue D (A), / Amanda F (H), / Keith M (H)
Develop system for ascribing health and social care funding proportions. / Proposal by 14th June for agreement at partnership execs and JCPB.
To be based on existing models / Graham M (J),
Gill H (H), / Judith J (J),
Sue D (A) / Miriam M (J) / Gerry M (J).
Develop or Adopt placements information system. / Initial requirements and proposal by 14th June
Consideration to include current CC access database and the ACS IRIS systems / Gill H (H),
Patricia B (H), / Sheila D (A)
Gary N (A)
Patricia B (H) / Patricia B (H), / Patricia B (H)
Develop schemes of delegated authority. / These will be designed around the procedures and structures above and be drawn up mid July. / Gill H (H), / Anne W (H) , Sue D (A), / Amanda F (H), / Keith M
Conduct risk & benefit analyses / Based on proposals this should be drawn up in second half of June so as to inform implementation planning. / Gill H (H), / Anne W (H) , Sue D (A), / Amanda F (H), / Keith M
Draw up implementation plans / Initial plans for discussion at July steering group / Gill H (H), / Anne W (H) , Sue D (A), / Amanda F (H), / Keith M
Draw proposals re OATS and JCT cost per case placements. / Clarity is needed re future management of NHS non SLA and JCT cost per case placements. / Graham M (J) / Judith J (J) / Miriam M (J) / Gerry M (J)
Clarify / pursue arrangements for CAMHS continuing care / Helen B (P),
Miriam M (J)
Clarify and pursue arrangements for MHSOP / Debbie P (P),
Gerry M (J),
Brief CC team staff members on likely plans . / Ongoing. / Debbie P (P)
Helen B (P)
Draw up potential ‘fall back’ risk / benefit sharing structure. / By 14th June ideas are required for any risk / benefit sharing models that might be applied as fall back alternatives should a set budget not be immediately negotiable. / Helen B (P)
John J (H)
Melanie P (J)
Mike curtis / Helen B (P)
John J (H)
Melanie P (J) / Helen B (P)
John J (H)
Melanie P (J)
Check legal validity of proposals. / In particular any implications re existing Beds and Herts continuing care policy and criteria and consequent impact on social care charging. / Mark J (J) / Mark J (J) / Mark J (J) / Mark J (J)
Report to Partnership Chief Execs and JCPB / Partnership Execs 21st June
JCPB 14th July / Mark J (J) / Mark J (J) / Mark J (J) / Mark J (J)
Redraft Partnership Agreement / For July JCPB / Mike Curtis (J) / Mike Curtis (J) / Mike Curtis (J) / Mike Curtis (J)
Maitaining links and communications / Escalations and coordination point and collation of pre- steering group progress updates / Mark J (J) / Mark J (J) / Mark J (J) / Mark J (J)
3.1Notes
-The CAMHS tasks above relate to the IPA work. A further task is noted to define the approach that will be taken for CAMHS continuing care work and budgets
-It is proposed above that the consultancy working on older people’s continuing care (SCCD) lead on developing proposals for MHSOP.
-People working on the same task for different care groups will need to link with each other.
-Respective jct officers will be available to assist with and help join up tasks as required
3.2Potential Risks to Project Timescales
-Data: Until data analysis is commenced it cannot be confirmed that it can be completed sufficiently within the proposed timescales since if crucial data is not immediately available, associated estimates may not be confirmed until the data is obtained.
-Information system: If an adequate information system requires further development then this may impact on implementation timescales.
-Negotiation on budget levels: if there is a significant divergence between provider and funder budget estimates delay may occurr. In anticipation of this a task is proposed above that would draw up a potential risk / benefit sharing structure as a fall-back position
-Staffing and deployment of existing staff: Obligations to existing staff and matching these with the staffing needs within organisations will require sensitive management.
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