HEALTH AND SOCIAL CARE PARTNERSHIP

SHADOW INTEGRATION BOARD

19TH AUGUST 2014

Shadow Integration Board – East Base Budget for 2014/15

1. Purpose

1.1 Aligned budgets will be managed by the Director of Health and Social Care and monitored during 2014-15 by the Shadow Integration Board (SIB).

2. Proposal

2.1 The health board and each council agreed to establish a SIB commencing from 1 April 2014. A joint appointment was made for the Director for Health and Social Care and with effect from 1 April 2014 these newly appointed directors will manage budgets delegated by both partners.

2.2 Each partner required to agree the scope of the budgets to be devolved and, in the case of councils, these will cover older people, physical disabilities, learning disabilities, mental health, addictions and children’s services for social work budgets. For NHS budgets, attached as Appendix is the service configuration summary approved by the NHS Board on 31 March 2013.

2.3 Certain services are best managed on a pan-Ayrshire basis and therefore a lead partnership will manage on behalf of all partners the following services:

 all mental health inpatient services (including those listed in section C and D of Appendix 1 - North Ayrshire Partnership);

 primary care management, NHS Ayrshire Doctors On Call and community dental services – East Ayrshire (Family Health Services non-cash limited also included); and,

 allied health professionals (dietetics, occupational therapy, physiotherapy, podiatry, speech and language therapy) – .

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2. Implications

3.1 Appendix 2 sets out the partnership budget in 2014-15. The NHS and council contributions to the budget are separately identified as they are aligned budgets in 2014-15 and any overspend is the responsibility of the individual partner.

3.2 Within the level one core budgets are included prescribing expenditure for prescriptions written by GPs and dispensed by community pharmacists. This will be identified as an indicative budget to individual practices. The payments made for delivery of general medical services (including the Quality and Outcomes Framework) are also shown by individual partnership. Both of the above are cash limited and at this time the non-cash limited budget for fees to pharmacists, opticians and general dental practitioners for the whole of Ayrshire are all shown under Primary Care within the East Partnership.

3.3 There will be quarterly financial reports produced to each of the SIBs to indicate spend against these budgets.

4. Consultations

4.1 Consultation on the proposed service configuration was by means of meetings held on 13 February 2014 with senior managers and a Stop Press to all staff dated the same date. Confirmation of the lead partnership agreement for primary care, community dental services and allied health professionals being within the lead partnership was agreed at the Health Integration Steering Group on 29 April 2014 and subsequently notified to all staff via a Stop Press dated 15 May 2014.

5. Recommendation

5.1 To note the 2014-15 aligned budgets managed within the East Ayrshire Health and Social Care Partnership.

Person to Contact Derek Lindsay, Director of Finance, NHS Ayrshire and Arran, Greenan House, , Dalmellington Road, AYR, KA6 6AB: Tel – 01292 – 513326: e- mail: [email protected]

Alex McPhee, Director of Finance, East Ayrshire Council

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Appendix 1 Service Configuration Summary

A NHS services which will be based and managed in individual Partnerships from 1 April 2014  Older People  Community Nursing (District Nursing)  Community Children’s (School Nursing, Health Visiting, Looked after Children’s Service) [non medical]  Community Mental Health, Addictions and Learning Disabilities (Community Mental Health Teams, Primary Care Mental Health Teams, Elderly, Community Learning Disability Teams, Addictions Community Teams)  All Community Hospitals (Arran, Lady Margaret, Biggart, Girvan, Kirklandside, East Ayrshire Community Hospital, Continuing Care wards at Ayrshire Central Hospital)

B Services which will be managed within the Partnership structure after 1 April 2014 (on an individual or Lead Partnership basis)  Primary Care (pending full analysis of Primary Care funding flows)  Community Dental Services  Community Allied Health Professionals

C Pan-Ayrshire Services which will be based and managed in a Lead Partnership from 1 April 2014  All Mental Health Inpatients Services  Psychiatric Medical Services, Eating Disorders, Forensic, Crisis Resolution and Home Treatment Team, Liaison (Adult, Elderly Learning Disabilities and Alcohol, Advanced Nurse Practitioner Services)

D Pan-Ayrshire services which will be based and managed in a Lead Partnership from 1 April 2014 subject to a review in 2014-15 to determine optimum arrangements within the partnership structure  Learning Disabilities Assessment and Treatment Services  Child and Adolescent Mental Health Services  Psychology  Prison Service

E Services which will not be in the Partnerships from 1 April 2014 which may need to be reviewed during 2014-15  NHS ADOC  Child Protection and Vulnerable Children’s Administration Team  Sexual Health  Rainbow House

F Services in the Acute Services Directorate where links to the Partnerships need to be defined and agreed during 2014-15

 Older People (acute aspects)  Neuro Rehabilitation  Stroke  Specialist Nursing

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Notes

1. For the pan-Ayrshire Mental Health Services at C above, it is proposed that North Ayrshire will be the Lead Partnership. Broad principles covering Clinical and Care and Corporate Governance arrangements have been developed for all Lead Partnership arrangements.

2. For the pan-Ayrshire Mental Health Services at D above, it is proposed that North Ayrshire will be the Lead Partnership pending review of arrangements in 2014-15.

3. At present there are a small number of services still under discussion including Family Nurse Partnership, Community Infant Feeding Service and Area Wide Evening Service which will be included in the Partnership structure from 1 April 2014 which may be suitable for a Lead Partnership approach.

4. At present there is a pan-Ayrshire Public Health and Health Improvement Workstream examining the role of the Partnerships in these areas and the way in which this can best be supported. The workstream is led by the Director of Public Health. It is anticipated that recommendations will be made by the end of March 2014. A verbal report on progress will be given at the meeting.

5. Two areas have been identified for wider review (a) Child and Adolescent Mental Health Services as to whether it is best sited in Mental Health or Children’s Services (b) Services for Older People and Elderly Mental Health Services as to whether they are best managed as part of a single service.

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Appendix 2

Health and Social Care Partnership Budgets: East

2014/15 2014/15 2014/15 Budget Budget Budget Service Division Council Health Total £m £m £m Core Services LEARNING DISABILITIES 14.694 0.477 15.171 MENTAL HEALTH 3.119 1.859 4.978 ADDICTION 0.399 1.655 2.054 ADULT SUPPORT & PROTECTION 0.453 0.000 0.453 OLDER PEOPLE 35.008 0.000 35.008 PHYSICAL DISABILITIES 0.781 0.000 0.781 SENSORY 0.230 0.000 0.230 SERVICE STRATEGY 4.327 0.000 4.327 TRANSPORT 0.431 0.000 0.431 COMMUNITY NURSING 0.000 6.037 6.037 PRESCRIBING 0.000 23.099 23.099 GENERAL MEDICAL SERVICES 0.000 14.926 14.926 RESOURCE TRANSFER / JOINT PLANNING 0.000 8.850 8.850 59.442 56.903 116.345

Non District General Hospitals EAST AYRSHIRE COMMUNITY HOSPITAL 0.000 2.775 2.775 KIRKLANDSIDE HOSPITAL 0.000 1.130 1.130 0.000 3.905 3.905

Lead Partnership Services STANDBY SERVICES 0.237 0.000 0.237 PRIMARY CARE (INCLUDING DENTAL) 0.000 60.859 60.859 0.237 60.859 61.096

Children's Services CHILDREN & FAMILIES / WOMEN'S SERVICES 17.481 0.000 17.481 JUSTICE SERVICES 1.616 0.000 1.616 HEALTH VISITING 0.000 2.144 2.144 19.097 2.144 21.241

Funded Elements RESOURCE TRANSFER / JOINT PLANNING (8.850) 0.000 (8.850) JUSTICE SERVICES GRANT (1.846) 0.000 (1.846) (10.696) 0.000 (10.696)

TOTAL 68.080 123.811 191.891

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