Meeting documents

1 THE ISSUE

1.1 This report is to update Cabinet members on progress towards the integration of Children's and Adults Social Care with the Primary Care Trust (PCT). In particular it outlines the next steps to achieve joint working of health and social care at management and leadership level and supporting governance arrangements.

2 RECOMMENDATION

2.1 The Cabinet agrees that the Local Authority and PCT should build on arrangements for partnership working across health and social care with:-

(a) A joint Partnership Board to oversee the development of strategy and performance management of children's and adults' health and social care services under the LSP plans for health and wellbeing.

(b) A single leadership team for Adult Health, Social Care and Housing led by the PCT Chief Executive Officer.

(c) The transfer of the commissioning of children's health services into the work of the team led by the Director of Children's Services.

(d) The PCT CEO joins the Council's Directors' Group

2.2 The Cabinet agrees that arrangements be put in place to implement these proposals, including a public engagement process and joint senior management arrangements from 1^st April 2008 and notes that further work to develop appropriate governance mechanism to enable further integration at operational level will follow.

3 FINANCIAL IMPLICATIONS

3.1 The PCT and Council have both contributed to an integration project budget funding non-recurring costs.

3.2 The integration of services is intended to improve outcomes in the context of limited resources and as such is a key element in the council's strategy to improve value for money.

3.3 The Council's S.151 officer will need to be satisfied that the financial management arrangements which will underpin the proposed new management arrangements both support the integration objectives but also effectively control and manage resources and risks. This will need to include the source of financial advice to the Joint Board.

4 COMMUNITY STRATEGY OUTCOMES

• Promoting a 'sense of place' so people identify with and take pride in our communities
• Celebrating the contributions people from different backgrounds and with different experiences can make, and promoting equality of opportunity
• Sharing resources, working together, and finding new ways of doing things
• Building communities where people feel safe and secure
• Improving our housing situation for local people
• Improving local opportunities for learning and gaining skills
• Improving our local health and social care

5 CORPORATE IMPROVEMENT PRIORITIES

• Reducing fear of crime
• Promoting independence of older people
•  Improving life chances for disadvantaged teenagers
• Increase in Affordable Housing
• Improving customer satisfaction

6 CPA KEY LINES OF ENQUIRY

• Ambition for the community - i.e. What the council, together with its partners, is trying to achieve
  
• Prioritisation of ambitions
  
• Increasing capacity of the council to deliver ambition for the Community to ensure we achieve what we say we will
  
• Managing performance of community ambition to ensure we achieve what we say we will
  
• Creating and developing a better quality of life for the area through

• o Sustainable Communities and Transport

  o Safer and Stronger Communities

  o Healthier Communities

B7 Improving engagement with and a range of services for Older People and Children and Young People

7.1 The framework for integration has been developed in earlier reports to the Council and PCT Board. Key elements previously agreed are:

o the scope should cover adults and children

o governance would be through a Joint Board made up of representatives from the PCT and the Council

o arrangements would be enshrined in a set of Section 75 (NHS Act 2006) agreements which would enable resources to be pooled or aligned within the funding policies agreed by the Council and the PCT and allow joint management arrangements to be established.

7.2 Building on this agreed framework, proposals have been developed as follows:

o a new Partnership Board as a critical element of the Local Strategic Partnership's plans for the Health and Wellbeing Partnership arrangements

o the PCT CEO to attend Council's Strategic Directors Group

o a single team for Adults Health, Social Care and Housing under the leadership of the PCT CEO

o the incorporation of the commissioning of Children's Health Services into the work of the team led by the Director of Children's Services

o a continuing programme of work to further integrate community services, including the Joint Community Teams Project

o the appointment of a Joint Director of Commissioning responsible for adult health and social care commissioning and the appointment of an Interim Joint Director responsible for the delivery of services provided by the Council and the PCT, including those children's health services currently provided by the PCT which would be commissioned by the Director of Children's Services

7.3 The Partnership Board will oversee the development of strategy and performance management of service delivery within the parameters specified by the PCT and Council. It is anticipated the Board will form a key pillar of the Health and Wellbeing arrangements.

7.4 In line with arrangements for the current Shadow Joint Board and Joint Commissioning Board, which it will subsume, the Partnership Board will be constituted to allow contemporaneous decision making where required through single member decisions and the operation of a PCT Committee made up of PCT members.

7.5 The Statutory post of Director of Adult Social Services will remain in place and will report to the PCT Chief Executive on an operational basis but will retain statutory social care responsibilities and direct line accountability related thereto, to the LA Chief Executive.

7.6 For Children's Services, the functions and duties for commissioning children's health services will be delegated to Children's Services. The PCT will transfer the resource to support this function under arrangements to be agreed and the Director of Children's Services will be accountable to the PCT CEO for the Commissioning of Children's Health Services under a Section 75 agreement.

7.7 For Adult Social care Services a legal framework will be drawn up to cover the proposed senior management structure and accountability arrangements which are set out at Appendix 1.

7.8 The PCT and Council have been working together for several years to develop closer working relationships from the bottom up. The next step of integration raises issues around employment status which will require further work with staff, trade unions and legal advisers in order to manage the associated risks and will be the subject of a future report.

Next steps and timescales

7.9 Key next steps are:

o Cabinet approval of the senior management arrangement (March 2008).

o the establishment of the Partnership Board (May 2008)

o the development of Partnership Agreements for children's and adults services that will set out the governance and accountability arrangements

o the appointment to newly created posts of Joint Director of Commissioning (including Strategic Housing) and Joint Director of Provider, Adult Health and Social Care Services

o ongoing work to integrate community teams by October 2008.

8 RISK MANAGEMENT

8.1 The report author and Lead Cabinet member have fully reviewed the risk assessment related to the issue and recommendations, in compliance with the Council's decision making risk management guidance.

8.2 A risk assessment related to the issue and recommendations has been undertaken, in compliance with the Council and PCT's decision making risk management guidance.

8.3 A risk register has been established that will be regularly monitored by the Joint Senior Management Team.

8.4 The Strategic Director for Adult Social Services & Housing Chairs a `Due Diligence' group, where senior Council offers identify, consider and seek to mitigate any risks specific to the Council.

8.5 Further work, including the scoping of legal and financial risks, will need to be undertaken on options for the integration of staff at an operational level.

9 RATIONALE

9.1 This report proposes arrangements for taking forward the existing decision taken in principle to further integrate the work of the Council and the Primary Care Trust.

10 OTHER OPTIONS CONSIDERED

None

11 CONSULTATION

11.1 Cabinet members; Parish Council; Town Council; Trades Unions; Overview & Scrutiny Panel; Staff; Other B&NES Services; Service Users. Stakeholders/ Partners; Section 151 Finance Officer; Chief Executive; Monitoring Officer.

11.2 Proposals have been developed in consultation with staff and stakeholders across the Council and PCT, and have been recommended by the Shadow Joint Board which incorporates officers and executive members from the Council, including the Council's Monitoring Officer, and executives and non-executive members from the PCT.

11.3 Consultation meetings with staff have taken place with a series of open sessions held where staff have had the opportunity to meet with Rhona MacDonald (Chief Executive PCT) and Jane Ashman (Strategic Director Adult Social Services and Housing). Further road shows and engagement is planned.

11.4 A joint trade union forum has also been established with the PCT and Council staff side representatives. A copy of the draft of this report was sent to the Trades Union on 12^TH February 2008. No comments have been received to date.

11.5 Public and patient representatives and service users have been involved in discussions as partnership proposals have been developed, with further meetings scheduled.

11.6 The proposals presented in this report were considered by the Healthier Communities & Older People's Overview & Scrutiny Panel on 22^nd January 2008, the following comment was made that the Panel requests that Children's Health Services continue to be within the remit of this Panel following the integration of services described in the report.

11.7 There is currently a further public engagement process in line with Reg 4(2) of the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000. This public consultation process will be comprised of a press release, separate leaflets for staff, partners, users and the public and an open workshop. The consultation period will run from the end of January to the end of February, enabling the outcome of the consultation to be reported to the Partnership Board, the Council's Cabinet and the PCT Board.

12 ISSUES TO CONSIDER IN REACHING THE DECISION

12.1 Social Inclusion; Customer Focus; Sustainability; Human Resources; Property; Young People; Equality (age, race, disability, religion/belief, gender, sexual orientation); Human Rights; Corporate; Health & Safety; Impact on Staff; Other Legal Considerations

13 ADVICE SOUGHT

13.1 The Council's Monitoring Officer (Council Solicitor) and Section 151 Officer (Strategic Director - Support Services) have been involved in the "Due Diligence" group and have commented separately on this report.