JOINT COMMISSIONING PARTNERSHIP BOARD
Agenda Item No.
26 January 2006 at 2pm
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2006/7 Financial settlement and Implications
Author:
Tel:
Mark Jordan, Melanie Parker, Denise Radley
01707 280676
1.
Purpose of report
1.1
To appraise the Joint Commissioning Partnership Board (JCPB) of the prospective
2006/7 financial settlement for mental health and learning disability services.
1.2
To seek approval for the approach taken by the Joint Commissioning Team (JCT) to
negotiating 2006/7 Service Level Agreements (SLAs).
2.
Summary
2.1
Budgets for both Hertfordshire County Council (HCC) and Primary Care Trusts
(PCTs) have yet to be finalised for 2006/07. JCT work to date has been based
upon both Adult Care Services (ACS) and PCTs requiring efficiency savings from
HPT in 2006/07. Both health and social care partners are required to make year on
year efficiency savings including “Gershon” efficiencies in the case of the County
Council.
2.2
Social care savings of £300,000 are proposed for 2006/07 (subject to HCC Cabinet
approval in early February). Higher levels of savings for social care had been
considered before this level was finally put forward. ACS have asked that the JCT
consult ACS further should this level not be achievable from efficiency savings
alone.
2.3
Health savings of 5% are proposed for 2006/07 in line with across the board
savings targets as part of the overall health financial recovery plan. Planning by the
JCT had until recently been based upon 3.2% (1.5% plus a standard cash releasing
efficiency saving of 1.7%). The JCT are therefore currently working up proposals
for the higher level likely to be required. Once proposals are available, PCTs will be
able to consider and finalise the level of savings to be implemented prior to JCPB
approval of the commissioning plans.
2.4
The higher level of savings required means that further public consultation will be
necessary in relation to particular proposals put forward. Any implications for the
Investing in Your Mental Health (IIYMH) programme will need to be assessed and
made clear as part of this. It will be essential that any proposals take into account
requirements for public consultation since that might mean full year savings cannot
be assumed.
2.5
The Strategic Health Authority (SHA) has advised that whilst consultation proposals
will be generated by the Hertfordshire Partnership Trust (HPT), PCTs will need to
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act as the consultation body in these circumstances. Proposals are due to be
presented to the Health Scrutiny Committee’s Topic Group in February.
3.
Background Information
3.1
Hertfordshire Partnership Trust (HPT)
3.1.1 Proposals for achieving savings in 2006/07 were drawn up by HPT prior to revision
of the health savings targets and were provisionally confirmed by JCPB (through the
Chair and Vice Chair). These included the following savings that would not directly
impact on service delivery and JCPB is therefore asked to ratify these:




Community Mental Health Team efficiency savings – 160k (245k across health and
social care)
Review crisis/AOT/estate savings – 167k
Learning Disability rotas and medical on call – 137k
Continuing Care – 192k
3.1.2 At the original level, health savings of £2,316,000 (£1,561,000 saving for 2006/07 at
3.2% level plus £800,000 balance of 2005/06 income reductions). Proposals were
made to achieve the original level of savings (including the £656,000 referred to
above) however further savings of £1,800,000 now need to be identified. JCPB will
therefore wish to consider the whole package of proposals before proceeding.
3.1.3 Social care savings of £300,000 would be met by the following proposals from HPT
(see 2.2):


3.2
Community Mental Health Team efficiency savings – 85K (245K across health and
social care)
Reducing social care posts avoiding the need for redundancies – 215K
Adult Care Services
Savings within learning disability services are to be achieved by improved
efficiencies in service procurement practice along with cost reductions against
Community Learning Disability Teams. It is anticipated therefore that these savings
will be achieved through efficiencies and should not have a direct impact on service
delivery.
3.3
Other Trusts
Negotiations with other block providers are underway. It is unlikely we will be able to
achieve baseline efficiency savings beyond those required by their principal
commissioners so it is anticipated that the required efficiencies will be achieved
through service adjustments.
3.4
Unresolved Budgetary Areas
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3.4.1 Budget settlements that as yet remain unresolved are those areas of health
spending relating to Learning Disability continuing care (see above and also
performance report Item 4, Appendix C) and also budgets associated with specialist
and exceptional treatments. JCT will pursue these negotiations in partnership with
PCT Directors of Finance and some further information on these areas is provided
below.
3.4.2 Learning Disability (LD) Specialist Placements - the specialist placements budget
has overspent consistently since the inception of the JCPB. The original budget
passed to the JCPB in 2002/03 was sufficient to cover 31 placements. At the end of
November 2005 there were 37 service users in specialist LD placements, with one
potential service user expected to be placed in January on the direction of the court.
Since 2002/03 there have been two adjustments to the budget to reflect the
increased volume of placements, which were sufficient to cover two of the lower
cost specialist placements.
3.4.3 Taking these items into account the projected overspend based on the full year
effect of the current placements (including the expected court directed placement) is
£750,000. This does not include any allowance for any new placements. However
two service users currently in high cost specialist LD placements are due to transfer
to continuing care placements in January. Assuming these transfers take place
successfully the projected overspend will be reduced by £410,000, bringing it down
to £340,000.
3.4.4 Learning Disability Continuing Care - the estimated placements budget required for
2006/07 is £7,187,000. This is made up as follows:
Commitments 2005/06
Full year effect
Up rating (assume 2.63%)
Additional Placements
Budget required 2006/07
£ ,000
6,124
472
174
417
7,187
3.4.5 Adult Care Services have estimated that the full cost of taking on the management
of the continuing care budget will be in the region of £90,000 per year. PCTs have
offered funding of £30,000 in 2005/06 and £60,000 for a full year. The funding for
staffing and infrastructure therefore needs to be re-negotiated for 2006/07.
3.4.6 Mental Health Specialist Placements - The main source of financial pressure for
mental health services are the placements in the regional medium secure unit. At
present three service users are ready for discharge, and will be discharged once
suitable alternative placements are found. This should significantly ease the
pressure on this budget.
3.4.7 CAMHS Specialist Placements - The full year effect of two CAMHS placements is
£458,000 at 2005/06 prices. This assumes that both young people receive the
service for the full year, that the price for the second admission is the same as the
first admission and that there are no further admissions. For 2005/06 the JCT has
not received any budget for this service and the costs will be funded at risk by
PCTs.
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3.4.8 Brain Injury Rehabilitation Services (BIRU) - There is pressure on the budget for
Brain Injury Rehabilitation Services (BIRU) which is a specialist service provided by
Barnet Enfield and Haringey Mental Health Trust. For 2005/06 the value of the
SLA at outturn is expected to be £62,000 more than the available budget. The JCT
are only able to transfer the budget for this service to Welwyn Hatfield PCT and the
partners will therefore need to consider how the balance of the SLA will be funded
in 2006/07. There is a proposal documented in a separate JCPB paper that this
SLA is removed from the joint commissioning arrangements for 2006/07.
4.
Conclusion/Recommendations:
4.1
JCPB confirm approval for the proposed efficiency savings set out in this report.
4.2
That ACS and PCTs confirm with JCT the final level of savings to be implemented
in 2006/07.
4.2
Negotiation of the unresolved budget areas of Learning Disability continuing care
and specialist treatments be pursued through PCT Directors of Finance.
4.3
That JCPB receive a further report on the 2006/07 financial settlement and its
impact and the implications for any consultation required at an urgent JCPB
meeting.
4.4
That PCTs act as the consultation body for any proposals requiring further public
consultation.
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