Report Author: Nick Blake AB Tel: 01733 452486

COMMISSIONING A LOCAL HEALTHWATCH

Councillor Wayne Fitzgerald, Cabinet Member for Adult Social Care

FEBRUARY 2013

Deadline date: N/A .

Cabinet portfolio holder: Cllr Wayne Fitzgerald, Cabinet Member for Adult Social Care Responsible Director: Terry Rich, Interim Executive Director for Adult Social Care

Is this a Key Decision? YES If yes has it been included on the Forward Plan : Yes Unique Key decision Reference from Forward Plan : KEY/30NOV12/02

Is this decision eligible for call-in? YES Does this Public report have any NO annex that contains exempt information?

R E C O M M E N D A T I O N S The Cabinet Member for Adult Social Care is recommended to:

1. Approve the proposed approach to commissioning a local Healthwatch service 2. Approve the proposed local Healthwatch budget of £198,000 per annum, subject to final funding confirmation. The excludes £12,000 per annum retained by the Council to support contract management costs 3. Approve the proposed sub-regional joint commissioning arrangements for Healthwatch Independent Complaints Advocacy 4. Approve the procurement process to purchase a local Healthwatch service 5. Authorise the Executive Director of Adult Social Care to award the contracts for the local Healthwatch service in consultation with the Cabinet Member for Adult Social Care, Cabinet Member for Children’s Services and the Cabinet Member for Resources

1. SUMMARY OF MAIN ISSUES

1.1 This report seeks approval for a proposed approach to commissioning a local Healthwatch service.

1.2 There are three main elements to the Healthwatch service: local engagement and representation of people using health and social care services; providing information and signposting to health and social care services; and independent complaints advocacy.

2. PURPOSE OF THIS REPORT

2.1 This report is for Cllr Fitzgerald to consider exercising delegated authority under paragraph 3.3.3 of Part 3 of the constitution in accordance with the terms of their portfolio at paragraph 3.10 (d).

3. TIMESCALE

Is this a Major Policy NO Item/Statutory Plan?

4. Health and Social Care Act 2012

4.1 The Health and Social Care Act 2012 sets out the requirement for first tier local authorities to have in place a local Healthwatch organisation by 1 April 2013. The local Healthwatch will be the new local Health and Social Care consumer champion and watchdog representing the views of local residents of all ages, advocating and influencing the delivery and commissioning of Health and Social Care services. Local Healthwatch will replace the current Local Involvement Network (LINk) and will include additional functions.

4.2 A representative of local Healthwatch will have a statutory place on the Health and Wellbeing board, ensuring that the views and priorities of local people are represented in strategic commissioning, the Health and Wellbeing strategy and in the development of local Joint Strategic Needs Assessments.

4.3 Local Healthwatch will have a range of responsibilities to various groups and organisations: representing the views of the local population in relation to health and social care services, delivering the local Healthwatch service as commissioned by the Council, reporting local issues and concerns to Healthwatch England.

4.4 Healthwatch England will act as the health and social care consumer champion at a national level and sits within the Care Quality Commission. Healthwatch England will advise the NHS Commissioning Board, English local authorities, Monitor (health sector regulator) and the Secretary of State. It will also have the power to recommend that action is taken by the Care Quality Commission (CQC) when there are concerns about health and social care services.

Local Healthwatch functions

4.5 As set out in section 1.3 above, there are three main elements to local Healthwatch: engaging with and representing the view of local people in relation to health and social care, providing signposting to health and social care services, providing independent complaints advocacy.

4.6 Engaging with and representing the views of local people will involve:

• Gathering views and understanding the experiences of people who use services, carers and the wider community • Making people’s views known • Promoting and supporting the involvement of people in the commissioning and provision of local services and how they are scrutinised • Recommending the investigation or special review of services to Healthwatch England or directly to the Care Quality Commission (CQC)

4.7 Signposting to health and social care services will involve:

• providing information and advice about local health and social care services • supporting people to make informed choices about which services they access

4.8 Independent complaints advocacy will involve:

• Supporting people who wish to make a complaint about NHS services

4.9 Independent complaints advocacy may be commissioned from the local Healthwatch directly or through a third party organisation.

Guidance on commissioning local Healthwatch

4.10 The Department of Health (DH) and the Local Government Association (LGA) have provided a range of information and guidance on commissioning local Healthwatch organisations. Additionally there had been some consultation on secondary legislation following on from the Health and Social Care Act 2012. Key points from this guidance are summarised within this section of the report (sections 4.10 to 4.14 inclusive).

4.11 Local Healthwatch is required to be a body corporate, an organisation that has a legal identity and that can enter into contracts and employ people directly. The decision on what form the organisation should take has been left to Local Authorities to decide and could include a registered charity, a public company or some other form of legally constituted organisation.

4.12 DH guidance has stated that Local Authorities should identify the most appropriate procurement route and that this could include grant aid, single tender or formal tendering.

4.13 Funding for Healthwatch will be made up of three parts: the current LINk funding allocation in the local formula grant, a specific DH grant for additional Healthwatch functions and DH independent complaints advocacy funding. DH has provided indicative funding allocations for 2013/2014. The proposed annual budget for Healthwatch Peterborough would be £198K, made up of:

• Current LINk funding £110K • Additional DH Funding for 2013/2014 £88K

4.14 No Healthwatch funding streams will be ring fenced and will be subject to local decision on final allocation. The Council retains around 10% of the current LINk funding to support associated contract management costs, which equates to £12k and is excluded from the figures in section 4.13.

The proposed approach to commissioning Healthwatch Peterborough: Engagement and Signposting

4.15 Given Peterborough LINk’s track record of delivering effective engagement with local people, representing their views to commissioners, an approach to commissioning Healthwatch Peterborough that retains the strengths and experience of Peterborough LINk whilst complying with statutory requirements is proposed.

4.16 Preparatory work has been undertaken with Peterborough LINk to set up a Community Interest Company (CIC) with the principal purpose of providing local Healthwatch functions. The Council has supported development of organisational structures and the recruitment of directors to the CIC board to ensure that the organisation has robust governance in place to support it in discharging its responsibilities should the proposed commissioning approach be approved. It is proposed that both the community engagement and representation functions and the signposting functions are commissioned from the Healthwatch CIC.

4.17 Healthwatch CIC will be responsible for providing the signposting function currently provided by NHS PALS (Patient Advice and Liaison Service). This will require a dedicated staff resource to be available to field enquiries from the public and availability will be key to the service successfully meeting the required outcomes. The two main options considered so far are for the Healthwatch CIC to purchase this service from: • a local voluntary sector organisation or group of organisations: this would involve a local provision of sign posting support and would enable a local face-to-face service based within Peterborough. • the NHS Peterborough / Clinical Commissioning Group PALS service: this would involve a telephone based service and would mean that the PALS service would also have close links with health patient engagement.

4.18 Initial discussion with NHS Peterborough and PCC Human Resources has identified that TUPE will apply to one current NHS PALS post employed by NHS Peterborough. This will mean that, should there be a change of organisation delivering these services, the post will transfer to the new organisation retaining its current contractual terms and conditions. As part of agreeing funding with the Healthwatch CIC the Council will ensure that whichever option is agreed can deliver the required outcomes and offers best value.

The proposed approach to commissioning Healthwatch Peterborough: independent complaints advocacy

4.19 Currently Independent Complaints Advocacy services are commissioned by the Department of Health; the contract covering the Eastern Region was awarded to PoHWER which will continue to deliver this service up until 31 March 2013.

4.20 The regional DH and Local Government Association programme to support local authorities to commission local Healthwatch has supported a group of nine councils from the Eastern Region to explore the option of jointly commissioning Independent Complaints Advocacy Services (ICAS) and it is proposed that ICAS be commissioned from the current provider, PoHWER. The nine local authorities involved in this are:

• Bedford Borough Council • Central Bedfordshire Council • Cambridgeshire County Council • Essex County Council • Hertfordshire County Council • Luton Borough Council • Norfolk County Council • Peterborough City Council • Thurrock Council

4.21 The expected benefits of taking this joint approach with other local authorities are:

• Economies of scale: commissioning a larger service as part of a group is expected to offer lower unit costs than individually commissioning these services separately. • Stability of service: given the changes within the health system and the relatively new Healthwatch arrangements using the current provider will ensure stability of supply during this period of transition • Improved information to support future procurement: local authorities have no experience of commissioning ICAS; a one year contract will provide access to detailed service data and a better understanding of the service so enabling an effective procurement exercise to identify a supplier for 2013/14 onwards.

4.22 The proposed regional ICAS commissioning approach would involve negotiating a one year contract with the current ICAS provider to cover the period 1 April 2013 to 31 March 2014. Bedford Borough Council has agreed to act as lead commissioner on behalf of the other councils; this proposed arrangement would be formalised through a Memorandum of Understanding between the councils involved in the joint commissioning project.

4.23 Should this regional approach be approved and following contract formalities with the current provider, local authorities will review activity data to better understand the service and to inform future commissioning. Individual local authorities will review whether continuing the joint arrangements continues to offer the most effective solution to commissioning Healthwatch ICAS services for 2013/2014 and beyond. Any future joint commissioning arrangements between local authorities will be agreed over the first six months of 2013/2014.

5. CONSULTATION

5.1 Consultation has been undertaken with a range of organisations and groups over the previous 12 months, specifically:

• Peterborough LINk members and management committee • Voluntary sector organisations • Peterborough Health and Well Being Board • NHS Peterborough and Cambridgeshire • Peterborough City Council Adult Social Care Departmental Management Team • Peterborough City Council Children’s Services • The Scrutiny Commission for Health Issues • Local residents through public consultation events

5.2 Groups consulted have supported the broad proposal to transition the current LINk into the new Healthwatch arrangements.

6. ANTICIPATED OUTCOMES

6.1 The anticipated outcome is for an effective local Healthwatch organisation to be commissioned and in place by 1 April 2013 and for ICAS arrangements to be in place over 2013/2014 whilst a formal procurement exercise is undertaken.

7. REASONS FOR RECOMMENDATIONS & ANY RELEVANT BACKGROUND INFORMATION

7.1 The proposed approach will mean that the Council complies with its statutory duty to commission a local Healthwatch organisation whilst also following DH and Local Government Association guidance and complying with relevant public sector purchasing and contract legislation.

7.2 It is anticipated that the proposed approach retains the effectiveness of current LINk arrangements and builds on its legacy by transitioning from Peterborough LINk into Healthwatch Peterborough.

8. ALTERNATIVE OPTIONS CONSIDERED

8.1 Formal procurement of a local Healthwatch service was considered. This approach would mean that the Council would enter into a contract with one or more independent organisations to deliver some or all aspects of the local Healthwatch. The principle reasons for rejecting this option were:

• Maintaining a service user/patient led structure, governance arrangements and control over the local Healthwatch is viewed as desirable as it supports active public engagement in delivering services and strategic commissioning • There would be significant loss of LINk membership and expertise during transition which would affect the future effectiveness of the local Healthwatch • Initial market analysis identified limited local capacity to deliver the required service

8.2 Formal procurement of a host organisation to support the local Healthwatch organisation was considered. This proposal as rejected on the following grounds:

• This would lead to complex governance arrangements and would complicate accountability for delivering Healthwatch outcomes • Delegating purchasing of any required support arrangements to local Healthwatch would offer an effective way of Healthwatch controlling and managing this resource, the Council could provide initial support

8.3 Commissioning ICAS independently or including it as part of the proposed funding of the Healthwatch CIC was considered. This proposal was rejected on the following grounds:

• The amount of funding available would not be sufficient to purchase a sustainable service available between 9am and 5pm over Monday to Friday. • The Council has no experience of commissioning this type of service and very limited information to inform development of a specification or evaluation of competing bids at this stage. • Healthwatch Peterborough will be a relatively new organisation and is unlikely to have the capacity or expertise to negotiate and agree delivery of this element of the overall service with potential suppliers.

9. IMPLICATIONS

9.1 Financial The proposed approach will lead to the Council taking on an annual financial commitment to support Healthwatch Peterborough and to discharge it’s duties over 2013/2014 under the joint commissioning arrangements for the ICAS service. Given the restricted budget available to the Council it is proposed that the amount taken to support contract management costs is maintained at the current level of £12K per annum and is not increased to cover the additional funding available for the new signposting and ICAS service elements.

Final funding amounts will be confirmed before April 2013 through the Council’s budget setting process and the Healthwatch budget will be managed within the available funding.

9.2 Legal The Health and Social Care Act 2012 sets out the Council’s statutory duty to commission a local Healthwatch organisation, secondary legislation relating to Healthwatch and its functions is being introduced incrementally. The proposed approach set out in this document complies with current guidance and legislation and will mean the Council is meeting its statutory duties in relation to Healthwatch.

9.3 Human resources The Healthwatch signposting function is currently carried out by NHS Peterborough through their Patient Advice and Liaison Service. Initial discussion with NHS Peterborough and Peterborough City Council Human Resources has identified that TUPE legislation could apply to NHS Peterborough PALS posts. The Council will be supporting the Healthwatch organisation to comply with any TUPE requirements that arise through developing the signposting function. Final responsibility for complying with legislation will fall to Healthwatch.

9.4 Procurement The proposed approach to commission through a single tender action complies with Department of Health guidance on commissioning local Healthwatch in terms of commissioning engagement and signposting functions and in contracting with a third party for ICAS functions. The procurement approach proposed has been consulted on with a range of stakeholders including the Council’s Legal Services and Adult Social Care procurement team. In relation to ICAS commissioning local stakeholders as well as regional procurement leads working with the Association of Directors of Adult Social Services and the Department of Health have been consulted.

9.5 Risk assessment and management Please see the attached risk log attached as Appendix 1 to this document.

10. DECLARATIONS / CONFLICTS OF INTEREST & DISPENSATIONS GRANTED Declarations by any cabinet member consulted by the decision maker and any dispensation granted by the Audit Committee or Head of Paid Service (Chief Executive). Note, the Audit Committee grants dispensations where the member concerned has a pecuniary interest, whereas the Chief executive may grant a dispensation for these purposes to any cabinet member consulted on these proposals whether by an officer or another individual cabinet member where there is a common law conflict of interest that may not amount to a pecuniary interest under the Regulations.

None.

11. BACKGROUND DOCUMENTS

None.