Part one Open to the Public
ITEM NO.A5
___________________________________________________________________
REPORT OF
LEAD MEMBER FPR COMMUNITY HEALTH AND SOCAIL CARE
___________________________________________________________________
TO
CABINET
ON
28TH July, 2009
TITLE: Section 75 Agreement Intermediate Care Services
___________________________________________________________________
RECOMMENDATION: That Cabinet approve the Council entering in to the
Agreement
___________________________________________________________________
EXECUTIVE SUMMARY: This agreement builds on the excellent working relationships
between major health and social care partners in the City of Salford. It is a significant step
towards us using financial and staffing resources across the health and social care system,
as effectively as possible, to meet the needs of older people.
___________________________________________________________________
BACKGROUND DOCUMENTS:
(Available for public inspection)
___________________________________________________________________
KEY DECISION:
YES
___________________________________________________________________
DETAILS:
2
Introduction and Background
2.1
Salford Older People’s Partnership Board, Salford City Council and other health
partners are committed to working together to improve the health and well being of the
population of Salford.
There are numerous examples of partnership arrangements under
Section 75 agreements which allows pooling of resources between the
Health Service and Local Authorities in order to achieve more integrated and efficient
services.
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2.2
The previous section 31 of the Health Act 1999 has now been replaced, for England,
by the section 75 of the National Health Service Act 2006 that has consolidated
NHS legislation. The new Section 75 has the same terms and conditions of Section
31 arrangements.
2.3
Intermediate Care is a key service area for some older people who need intensive
support in order to maintain their independence, either as an alternative to a hospital
admission or from prematurely entering long-term care, or to assist recovery after a
period of significant illness.
2.4
During the previous 18 months all key partners in both the commissioning and
provision of intermediate care services have worked to develop a proposed
agreement to achieve the above objective
3
Partnership Vision, Aims and Objectives
3.1
The agreement represents an important development for health and social care
partners in Salford:
 It builds on the strong partnerships between health and social care partners and
pools significant resources that are currently spent on intermediate care services,
into a single budget.
 It recognises the segregation between the commissioning and provision
of services and, therefore, the agreement proposes that the Local
Authority is the Lead Commissioner and that Salford Community Health is the lead
deliverer of the service.
 The agreement is a significant development towards the objectives of the White
Paper, Our Health, Our Care, Our Say, which promotes greater integration of
services. The agreement recognises that the integration of intermediate care is
one aspect of an ongoing development of health and social care services joining up.
3.2 The overall objectives of the partnership as agreed at a joint workshop between Salford
Community Health and the City Council sets the direction of the partnership. These are
to:
 Be a first class provider of intermediate tier services
 Provide value for money services
 Meet the needs of commissioners and services of intermediate care; and
 Work in partnership with stakeholders
3.3 The specific aims of the partnership agreement are to:
 Have strong reported patient outcomes
 Provide excellent clinical and social care
 Develop as learning organizations
 Meet required quality standards
 Use joint resources flexibly
 Identify service gaps and make changes to provide seamless services to patients
 Have strong governance arrangements: and
 Work in partnership with the third sector providers, acute trust, mental health trust
and other providers
4
Process undertaken for completion of Section 75 agreement
4.1
The process undertaken for the completion and agreement of this partnership
arrangement is set out in Appendix 1.
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4.2
4.3
The process has been completed in a bilateral way following the implementation of
the PCT’s new governance framework in October 2008.
A decision was made by the Executive teams of both the City Council and PCT to
split the previous section 31 agreement into separate commissioning and provider
documents to clearly identify the required governance and contractual arrangements.
5
Outcomes
5.1
The section 75 has added benefits and also identified risks for both commissioners
and the principal provider, these are outlined in the table below:
Potential Benefits









Services are available when
patients need them
Patients
understand
what
services are available and how
to access them
Appropriate staff are available to
patients when they need them
Patients receive a range of
services of a high quality that
meets patient needs
Services delivered in a safe and
effective way
Staff
have
the
required
experience and qualifications to
deliver services to the highest
standards
Reduced levels of complaints
and incidents
Accessible
good
quality
information for staff and service
users
Integrated information system
for monitoring and reporting
purposes
Operational and Strategic Risks








Technical and Operational Risks
Political
Stakeholder Interest
Financial
Organisational
Management/Resources
Procurement
Legal
Strategic and Performance
5.2
The table above details the outcomes that the partnership agreement is expected to
deliver. The governance arrangements should ensure that assurances can be
provided to Salford Community Health Board, PCT Trust Board and the City Council
that sufficient controls are in place to manage the identified risks
6
Section 75 Agreement
6.1
Attached at Appendix 2 are both the Provision and Commissioning agreements that
detail the following:
Partnership vision, objectives and outcomes
Services provided under the agreement


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









Joint structures and responsibilities
Governance arrangements and dispute resolution
Financial arrangements
Liabilities and indemnity
Sub-contracting
Complaints
Review process
Sharing and handling of information
Variation and Waivers
Notice
7
Implementation
7.1
The Section 75 agreement will be implemented on the 1st April 2009 and will be
subject to annual review
7.2
Intermediate care will be an integrated service, with a single line management, led by
the Associate Director of Intermediate Care
7.3
The agreement recognises the importance of operating within a robust
performance management framework. There has been significant progress in
developing measures to ensure that all partners can be confident that the needs
of service users are being met, and that the service, and the whole system is
functioning effectively.
7.4
The monitoring of the agreement will be at the Intermediate Care Divisional Board
that will report to the Salford Community Health Board, the Integrated Section 75
Monitoring Board and the Older Peoples Partnership Board.
7.5
The Intermediate Care Divisional Board will review and agree the range, quantity and
nature of the services provided under the agreement each year. This will be in line
with requirements defined by Commissioners and their commissioning specifications
4 Recommendations
8
Summary
8.1
This paper summarises the changes to the section 75 agreement. This has been
achieved through partnership working and has used the new governance
arrangements within the PCT.
However, as the City Council is the Lead
Commissioner, approval is sought from Cabinet.
___________________________________________________________________
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Salford Community Health - Intermediate Care Budget Summary
2009/10
PCT Services included within Section 75 agreement:
Social work input
Heartley Green (29 nursing beds)
Rapid Response & CAST Team
Intermediate Care Rehabilitation
District Nurse Liaison (Discharge Assessment
Team)
GP SLA's
Additional Investment
Swinton Hall (18 nursing beds)
The Limes (11 residential/rehabilitation beds)
Intensive home support service
Furnished tenancies
subtotal SCH budgets
Gross Costs
Income
Net Costs
£
£
£
1,031,569
924,890
1,179,311
208,939
-41,350
134,127
1,937,000
636,119
192,785
-41,350
6,203,390
Services excluded from Section 75 agreement (Community Contract):
Gross Costs
COPD (additional monies expected from
Pulmonary Rehab BC)
Oxygen Service
Int Care Management
Total SCH budgets excluded
Total IC budgets 2009/10
£
34,500
Income
£
34,500
96,619
140,548
271,667
0
96,619
140,548
271,667
6,516,407
-41,350
6,475,057
Salford Community Health - Intermediate Care Budget Summary
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Net Costs
£
£
350,270
1,031,569
924,890
1,179,311
167,589
134,127
1,937,000
636,119
192,785
6,244,740
CHSC
294,040
2,290,280
18,000
2,952,590
2009/10
PCT Services included within Section 75 agreement:
Social work input
Heartley Green (29 nursing beds)
Rapid Response & CAST Team
Intermediate Care Rehabilitation
District Nurse Liaison (Discharge Assessment
Team)
GP SLA's
Additional Investment
Swinton Hall (18 nursing beds)
The Limes (11 residential/rehabilitation beds)
Intensive home support service
Furnished tenancies
subtotal SCH budgets
Gross Costs
Income
Net Costs
£
£
£
1,031,569
924,890
1,179,311
208,939
-41,350
134,127
1,937,000
636,119
192,785
6,244,740
6,203,390
Services excluded from Section 75 agreement (Community Contract):
Gross Costs
COPD (additional monies expected from
Pulmonary Rehab BC)
Oxygen Service
Int Care Management
Total SCH budgets excluded
Total IC budgets 2009/10
D:\98945838.doc
£
34,500
Income
Net Costs
£
£
350,270
1,031,569
924,890
1,179,311
167,589
134,127
1,937,000
636,119
192,785
-41,350
CHSC
£
34,500
96,619
140,548
271,667
0
96,619
140,548
271,667
6,516,407
-41,350
6,475,057
294,040
2,290,280
18,000
2,952,590