Memorandum of Understanding Between Devon County Council and Northern Devon Healthcare Trust for the Provision of Integrated Adult Health and Social Care Services 2011 ~ 2014
Version Control
Draft 2 28th March 2011 Damian Furniss
Draft 2.1 11th April 2011 Phil Heywood
Draft 3 15th April 2011 Damian Furniss Phil Heywood (on feedback Draft 3.1 26th April 2011 from Jan Ingram) Draft 3.2 13th May Phil Heywood
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Table of Contents
1 Memorandum Partners 4 2 Memorandum Purpose 4 3 Memorandum Principles 4 4 Duration 5 5 Obligations of the Partnership 6 6 Services 6 7 Policies & Procedures 8 8 Managerial and Governance arrangements 9 9 Finance 11 10 Quality & Performance 13 11 Confidentiality 14 12 Freedom of Information 15 13 Human Resources 15 14 Dispute Resolution 16 15 Signatures 16
Annexes Organisation Structure 17 Locality Structures 18 Service Descriptions 20 Specification for Complex Care Teams 22 Specifications for Care Direct Plus, Community Equipment Store 23 Annual Strategic Agreement 24 Interface Services 25 County Council Support Services 26 Budget 2011/12 28 Budget by Locality 30 CCT Budget Summaries 31 Strategic Meeting Terms of Reference 33
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1. Memorandum Partners 1.1 The partners to this memorandum are:
• Devon County Council of County Hall, Topsham Road, Exeter, Devon, EX2 4QD
• Northern Devon Healthcare Trust of Northern Devon District Hospital, Raleigh Park, Barnstaple, Devon, EX31 4JB
2. Memorandum Purpose
2.1 The purpose of this Memorandum is to promote the delivery of integrated health and social care services in Northern and Eastern Devon by assigning the accountability for the local management of a set of social care resources to Northern Devon Healthcare Trust.
2.2 The objective of this assignment is to enable Northern Devon Healthcare Trust. to align and integrate the arrangements for the management and provision of community based health and social care services, in Northern and Eastern Devon, by deploying and managing these resources alongside the NHS services which the Care Trust is contracted to provide in Northern and Eastern Devon.
2.3 The resources assigned to Northern Devon Healthcare Trust under this Memorandum are staff employed by Devon County Council and specified non‐staff resources.
3. Memorandum Principles
3.1 The following general principles will apply to this memorandum: Devon County Council and Northern Devon Healthcare Trust wish to work in partnership to improve the health and well being of adults and their carers/families in Northern and Eastern Devon. This memorandum does not change the statutory responsibilities of either organisation regarding service provision. The resources assigned to Northern Devon Healthcare Trust will be “ring fenced” and deployed solely to meet the needs of people in Northern and Eastern Devon. Devon County Council will retain responsibility for the delivery of the services defined within this agreement; the management of Northern Devon Healthcare Trust will take on accountability
3.2 To achieve this the partners will establish arrangements to ensure: Effective operational management and day to day communications to ensure the delivery and development of services in line with the aspirations of the partners. This will be managed in accordance with the organisational and locality structures set out sin Annexe 1 and 2. The development of a strategic relationship between the partner organisations at the most senior level to provide a mechanism through which: i. This agreement will be governed. ii. The partners will agree the performance and activity requirements of the
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services assigned to the accountability of Northern Devon Healthcare Trust under this Memorandum. iii. The partners will work to align their aspirations for the future development and integration of health and social care services in Northern and Eastern Devon.
3.3 No financial transfer between partners is necessitated by this agreement except that required by the joint funding of posts in the integrated management structure.
3.4 Each partner gives the assurance that the services provided under this agreement are within the powers of the partners to arrange or provide and that all statutory and internal decision making processes have been followed, thus giving the partners the necessary authorisation to enter into this memorandum.
3.4 This memorandum follows consultation jointly by the partners with such persons or organisations as appear to the partners to be affected by the arrangements and these arrangements shall contribute to the fulfilment of the objectives set out in The Way Ahead: A Strategic Framework for Health and Social Care in Devon originally published in March 2008 following the first iteration of the Joint Strategic Needs Assessment for Devon.
3.5 This Memorandum is a development of the previous arrangements in which Devon County Council partnered with NHS Devon through Devon Provider Services.
3.6 Below the level of Cluster Manager, the responsibilities and terms and conditions of employment of staff will remain substantively unchanged with Devon County Council remaining the employer of those staff it employs but assigns to the current partnership.
4. Duration
4.1 The duration is this memorandum is 1st April 2011 to 31st March 2014.
4.2 The memorandum, and schedules set out in the annexes to the memorandum, shall be reviewed and renewed annually or by mutual agreement by the signatories or their delegates.
4.3 The memorandum may be extended on eth basis of such a review unless formally terminated by the partners, with one year notice given in writing.
4.4 The partners agree to waive the requirement to give notice of termination if a new agreement or contractual arrangement that concerns the substance of this memorandum is reached between the partners.
4.5 Any variations to this agreement must be agreed in writing by the partners.
4.6 Each partner shall notify the other of any organisational change that has a substantive impact on the partnership and this agreement with a review to it being reflected in the next review and update.
4.7 This agreement replaces those between Devon County Council and NHS Devon which applied between 1st July 2008 and 31st March 2011.
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5. Obligations of the Partnership
5.1 The partners are committed to improving outcomes for individuals, their families and carers by: Developing a more integrated approach to the management and delivery of services. Collaborating by sharing expertise across the organisations Avoiding duplication of effort and functions by increasingly sharing service capacity and capability, Pooling scarce resources to achieve economies of scale Exploring the potential of developing integrated support service functions to support the delivery of integrated front line services.
5.2 The partners will work together to: Share organisational and service information openly in accordance with the terms of this partnership agreement e Shar service user information lawfully in accordance with the Information Sharing Protocol for Devon Health and Social Care Provide services in an integrated manner in accordance with commissioning specifications Solve problems jointly through the agreed joint management arrangements applying to business‐as‐usual activity Innovate and implement change effectively through the agreed joint governance arrangements for programmes and projects Record significant actions through the agreed joint arrangements for strategic governance and leadership Acknowledge the diversity of contributions to a successful partnership and maintain effective joint working by ensuring positive relations are maintained between the parties.
6. Services
6.1 The nature and scope of the services and functions covered by this memorandum are described in Annex 3 and summarised below:
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Service Area Service Outline Delivery Area Complex Care The social care practitioners employed and Northern and Teams contracted by Devon County Council to work both Eastern Devon reactively and proactively with people with long‐ term conditions and complex needs. Intermediate Range of largely historically‐determined services, Northern and Care Services including: Eastern Devon (i) Rapid response (ii) Community rehabilitation teams (iii) Recuperative care Devolved The arrangement and commissioning, on an Northern and Commissioning individual basis, of a range of social care services to Eastern Devon meet peoples’ assessed needs e.g. day services, domiciliary services and residential/nursing care Sensory Team A specialist countywide team providing services to Southern those who have impaired vision and/or hearing Eastern and Northern Devon
6.2 The Objectives and Delivery Plans for the services covered by this memorandum are set out in the following documents: Specification for Complex Care Teams ‐ annex 4 Specification for Sensory ‐ annex 5 Annual Strategic Agreement – annex 6
6.3 Where these specifications and agreements are in draft, this agreement commits the relevant commissioners (Devon County Council, NHS Devon) and providers (Torbay Care Trust, Northern Devon Healthcare Trust, Devon County Council) to finalise and sign‐off specifications by August 1st 2011 and incorporate them into this agreement from that date. In the interim the services will continue to be delivered as currently constituted.
6.4 The services and functions covered by this memorandum will be provided by interfacing with a range of other providers which are described and agreed in Annex 7.
6.5 The services and functions covered by this memorandum are currently provided by interfacing with a range of integral support services which are currently provided by Devon County Council. These support services have described and agreed as set out in Annex 8.
6.7 The objectives and delivery plans of support services set out in Annex 8 will remain the responsibility of Devon County Council. However to ensure the best fit with operational requirements these objectives and delivery plans will be shared and subject to discussion as part of negotiating the Annual Strategic Agreement and performance objectives for the services assigned to Northern Devon Healthcare Trust.
7. Policies and Procedures
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7.1 All elements of service delivery will be compliant the code of practice established by the Devon Multi‐Agency Safeguarding Adults framework for the development of policies and procedures and the underlying policies and guidance which apply in the localities of Devon County Council, Torbay Council and Plymouth City Council and cover:
The safeguarding of adults vulnerable to abuse The investigation of alleged incidents of abuse Responsibilities under the Mental Capacity Act 2005 Responsibilities under the Deprivation of Liberties Safeguards 2008
7.2 The current arrangements for receiving and coordinating the response to Safeguarding alerts will be maintained i.e.
CareDirect as a central point to receive alerts The Safeguarding Adults Team as a central point to coordinate the response The Safeguarding Adults Team to coordinate any Serious Case Reviews
7.3 Both partners will be represented on the Devon Safeguarding Adults Board which meets quarterly and reports to the Safeguarding Improvement and Development Board; these governance arrangements are summarised on p.26 of the Devon Safeguarding Adults Annual Report.
7.4 The current arrangements for the development of the workforce with regard to safeguarding will be maintained, with courses available at three levels.
7.5 These form an integral part of Devon County Council’s strategy towards adult social care workforce development with additional supporting strategies covering Personalisation, Dementia and Carers. These will form the framework for workforce development of the Devon County Council employees within the integrated service.
7.6 Managers at all levels, whoever their employer, shall be responsible for ensuring GSCC registration, CRB checking, annual appraisal/review and regular supervision of Devon County Council employees supported by a range of toolkits.
7.7 Managers at all levels, whoever their employer, shall be responsible for ensuring the continuing professional development of staff employed by Devon County Council, supported by the relevant job competency framework. Access to CareKnowledge will be available for all staff employed by Devon County Council as a resource to support them in their continuing professional development.
7.8 Devon County Council will provide funding and access to training and development opportunities for all staff employed by DCC but working under the integrated management arrangements set out in this memorandum.
7.9 Devon County Council employees shall be subject to the policy, procedures and guidance of the organisation including those pertaining to:
Social care law
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Assessment, eligibility, case recording and care planning Financial assessment and charging Equalities, inclusion and partnership Health and safety
7.9 In particular, all elements of service delivery should promote equality of opportunity and ensure the diverse needs of service users, carers and staff are met regardless of gender, race, disability, age, sexual orientation, religion, belief or any other factor in compliance with the Joint Declaration for Equality of the Devon Strategic Partnership.
7.10 Devon County Council shall use the tools and processes specified by the Way We Work group in their social care practice.
7.11 Devon County Council qualified social workers and occupational therapists shall benefit from the professional leadership of the lead practitioner for their profession.
8. Management and Governance Arrangements
8.1 The joint management structure for the partnership provision of health and social care to adults with physical and sensory disabilities and older people in Northern and Eastern Devon is shown in Annex 1.
8.2 Overall accountability for day to day service delivery rests with the Assistant Director, Health and Social. Care They will report operationally to the Director of Operations and the Strategic Director for People Services of Devon County Council (in their role as Director of Adult Social Services) or their delegated representative.
8.3 A tripartite meeting will take place annually between the Assistant Director Health and Social Care, Director of Operations and the Strategic Director for People Services (Devon County Council) (or their nominated deputy) to appraise performance and set objectives for the Assistant Director, Health and Social Care.
8.4 Regular Strategic Partnership Meetings (to be held at least quarterly) will be established between senior officers of the County Council and Northern Devon Healthcare Trust to oversee the operation of this agreement and provide a mechanism through which: i. This agreement will be governed. ii. The partners will agree and monitor the performance, finance and activity requirements of the services assigned to the accountability of Northern Devon Healthcare Trust under this memorandum. iii. The partners will work to align their aspirations for the future development and integration of health and social care services in and Northern and Eastern Devon. iv. The partners will agree and monitor any tests of change necessary to assess the impact and viability of different delivery models.
8.5 As a minimum these Strategic Partnership Meetings will involve the Strategic Director for People Services (Devon County Council) and the Chief Executive (Northern Devon Healthcare
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Trust), terms of reference for these meetings (including clarification of the full membership) will be agreed by the 31st May 2011 and appended to this Memorandum as Annex 12.
8.6 Additionally meetings will be held annually to negotiate and agree the detailed improvement, activity, financial and delivery plans for each of the service areas assigned under this memorandum. Agreement on these issues will be set out in the Annual Strategic Agreement which will clarify and the aspirations and accountabilities of the partners.
8.7 It is recognised that other stakeholder may need to be involved in this process and agreed that in negotiating the Annual Strategic Agreement:
i. The Devon County Council Portfolio Holder and Northern Devon Healthcare Trust Board Chair may be invited to appropriate meetings. ii. It may be necessary to convene meetings which include Devon County Council and NHS Devon (as joint service commissioners) and Northern Devon Healthcare Trust and Devon Partnership Trust (as beneficiaries of these services).
8.8 Additionally, senior officers of the County Council and Northern Devon Healthcare Trust will be required to report individually or collectively to the Cabinet Member for Social Care and the committee structures of the County Council by request and as required.
8.9 Where jointly appointed managers are employed by Northern Devon Healthcare Trust they will be required to sign a document accepting Devon County Council’s financial regulations in the discharge of such duties, this will include:
The constitution of Devon County Council The financial regulations of Devon County Council The accountability framework for adult social care budgets
8.10 Risk management shall be undertaken according to approach of the organisation responsible for that element of the service. For adult social care functions, the Assistant Director Health and Social Care shall be responsible for appropriately registering risks and issues on Devon County Council risk registers and ensuring their appropriate management.
8.11 To ensure that the risks associated with running integrated services in Northern and Eastern Devon can be seen in one place, and understood in relation to each other, these risks will also be logged on the risk registers held locally and centrally by Northern Devon Healthcare Trust.
8.12 Change management shall be agreed through the senior / strategic meetings described in 8.3 above and undertaken according to the approach of the organisation responsible for that element of the service. For adult social care functions, the Assistant Director Health and Social Care shall be responsible for participating in the governance of change within the appropriate programme and/or project boards of Devon County Council and ensuring the implementation and benefit realisation of any such changes within partnership structures.
8.13 Process management shall be undertaken according to approach of the organisation responsible for that element eof th service. For adult social care functions, the Assistant Director Health and Social Care shall be responsible for ensuring participation in the Way We Work Group for adult social care within Devon County Council and ensuring the
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implementation of any agreed changes within partnership structures.
8.14 Compliments and complaints, including statutory complaints, shall be managed according to the legislation and guidance applying to and policies and procedures of the organisation responsible for that function. Where the function is jointly provided, the procedures of both organisations shall be followed.
8.15 At this time, the commissioners intend that one approach to the delivery of integrated community‐based health and social care shall apply across the localities for which NHS Devon and Devon County Council are responsible, with geographic differences only where mutually and explicitly agreed.
8.16 To enable this, the Assistant Director Health and Social Care, the Deputy Assistant Directors (Northern and Eastern Devon) and the Cluster Managers shall continue to participate in the relevant leadership structures of the commissioning organisations, which in Devon County Council currently include:
Senior Leadership Team Corporate Leadership Team Plus Adult social care management meetings Cluster manager meetings
9. Finance
9.1 The 2011‐12 budget for social care for older people and people with physical disabilities in Devon to which this memorandum relates is appended in annex 10 for reference, with changes from the previous year noted.
9.2 For the integrated service, this budget needs to be viewed alongside the relevant NHS budgets, but budget management, reporting and accountability remain separate and will be discharged according to the regulations, policies and procedures of the budget holding organisation.
9.3 A breakdown by locality for commissioning budgets is appended in annex 11. The following methodology has been adopted in arriving at the apportionment of budget by locality:
in the first place, all commissioning budgets were allocated geographically according to GP practice populations; the changes to budgets detailed in annex 12 were then applied pro rata; finally, an adjustment was applied in respect of (only) residential and nursing budgets. requiring those xComple Care Teams which were purchasing more residential / nursing care than their allocation to bring their spend down to that allocation over a two year period On this basis, it is the intention that all budgets, including those for residential and nursing care, will be allocated according to GP practice populations by the start of the 2013‐ 14 financial year.
9.4. Budgets and specifications for the services provided through this agreement should be reviewed annually and agreed in advance of the start of a new financial year. Where a
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variation in real terms is proposed, this should be consulted on at least 90 days before the proposed date of change to enable an assessment of the impact to be made, and agreement on implementation to be reached.
9.5 No transfer of budgetary responsibilities is to take place under this memorandum of understanding but jointly appointed managers shall be held accountable for budget management according to the regulations of the budget holding authority whichever their employer.
9.6 No financial transfer between partners is necessitated by this agreement except that required by the joint funding of posts in the integrated management structure. Future iterations of this agreement should detail any further transfers of budget between the partners and the relevant Act which authorises such a transfer.
9.7 These budgets should identify the service areas which are the individual responsibility of each partner where the costs and income relating to these budgets, including any financial deviation from budget and commitments or obligations including any arising from legal proceedings, will accrue severally to the responsible partner.
9.8 These budgets should identify the service areas which are the joint responsibility of the partners where any commitment or obligations will jointly accrue to the partners on a proportionate basis.
9.9 The partners shall make suitable arrangements for financial and risk management, which address their joint and several responsibilities and liabilities as detailed in the above agreements. Performance of these arrangements will be reported through the Joint Strategic Commissioning Group at least quarterly and will be reviewed at least annually. For their several responsibilities, the accountability frameworks of the individual organisations will continue to apply.
9.10 Devon County Council will continue to manage its finances on the basis of a countywide budget, with jointly appointed managers across all localities and whichever their employer collectively accountable for countywide financial performance.
9.11 This is particularly significant given:
Spend by countywide services managed in partnership with one organisation will impact on the budget allocated to the partnership with another e.g. CareDirect. Risks regarding the pace of change towards locality budgets allocated according to analysis of need rather than historic spend Risks regarding the financial deliverability and sustainability of budget reductions
9.12 At the time of drafting this Memorandum discussion are underway, between Devon County Council, NHS Devon and the Care Trust in regard to the allocation of the monies to be transferred from NHS Devon to Devon County Council, under Section 256 of the 2006 NHS Act. This Memorandum has been developed and agreed without prejudice to those discussions which will be developed, agreed and recorded through other processes.
10. Quality and Performance
10.1 Devon County Council will remain responsible for the quality and performance of its adult social care services as assessed:
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through the National Indicator Set by the Care Quality Commission through any annual assessment, special review or inspection
10.2 Senior management responsibilities for elements of the National Indicator Set are allocated individually but overseen collectively and maintained on the Devon County Council intranet. Where appropriate, they may be allocated to joint managers of the integrated service employed by the NHS. In some cases, performance reference guides have been developed to assist senior managers in discharging these responsibilities.
10.3 The response to any performance or inspection requirements specified by the Care Quality Commission or any government department will be managed by Devon County Council and its staff but appropriately involve partners, including to joint managers of the integrated service employed by the NHS, who should ensure an appropriate and timely response.
10.4 Performance reporting on key service objectives will be undertaken through the Devon County Council and NHS performance management frameworks according to the area of service and the implementation of joint commissioning arrangements.
10.5 The performance framework for adult social care in Devon is summarised on the Devon County Council intranet and will be amended according to changes in government guidance including the finalisation of ‘Transparency in Outcomes: A Framework for Adult Social Care’
10.6 The performance of the integrated service shall be managed through:
Quarterly performance sessions at senior management level Invitation as required to the quarterly performance meeting with the Chief Executive of Devon County Council Invitation as required to report to any committee of the county council Monthly meetings between the Assistant Director Health and Social Care and her line manager in Devon County Council
10.7 Performance targets for the county, recorded in the adult social care scorecard, and locality shall be agreed at the outset of the financial year and subject to review thereafter. The Assistant Director Health and Social Care Devon shall manage operational performance by ensuring it is addressed through:
Regular meetings of Deputy Assistant Directors and cluster managers. Regular supervision and appraisal of Deputy Assistant Directors, cluster managers and Sensory Team manager. Ensuring regular supervision and appraisal of practice managers, and staff. Performance targets for each team, cluster and staff member should be agreed at the outset of the financial year and subject to review thereafter.
10.8 Operational managers in the integrated service, whether employed by Devon County Council or its partners, will be supported in performance management by the production and distribution of a range of social care performance reports as follows:
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Quarterly summary reports to the Senior Leadership Team and Chief Executive Monthly reports including a summary of operational performance indicators and activity for the integrated service by locality and structure and specialist reports on Direct Payments and REMAS activity Monthly joint and integrated scorecards and dashboards, Devon‐wide and locality based Weekly reports focussed on activity in Care Direct Plus centres and Complex Care Teams A range of specialist HR reports covering sickness absence and other reporting issues Embedded reports available through CareFirst Ad hoc reports available by request, prioritised according to available capacity A prototype business intelligence portal, currently enabling the interactive interrogation of information pertinent to personal budgets
10.9 Reporting on any performance concerns specific to Devon County Council will be to the responsible Cabinet Member and the Health and Adult Services Overview and Scrutiny Committee for Devon County Council.
10.10 In parallel with these arrangements performance against all targets and indicators, within services assigned to Northern Devon Healthcare Trust under this memorandum, will be subject to routine internal reporting (including reports to Northern Devon Healthcare Trust Board). This will enable Northern Devon Healthcare Trust to ensure the services for which it is accountable under this memorandum are delivering against the agreed outcomes and objectives.
10.12 In relation to the Care Quality Commission and the regulatory framework, the registering authority, Devon County Council or NHS, shall retain lead accountability for ensuring standards of care are achieved and coordinate any self‐assessment or inspection that may be required. It shall be the duty of the Assistant Director Health and Social Care to comply with and facilitate any such assessment and/or inspection process.
11. Confidentiality
11.1 The partners shall:
Keep confidential any information obtained in connection with this memorandum and personal Service User data subject to the Data Protection Act 1998; and Take appropriate technical and organisational measures against unauthorised or unlawful processing of such personal data and against accidental loss or destruction of or damage to such personal data; Respond to any Subject Access Request according to the procedures of the authority owning the data; Comply with any Information Sharing Protocol entered into by the authority owning the data.
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11.2 The partners shall keep confidential any information acquired through their conduct of this memorandum and will take all reasonable steps to ensure that their employees do not divulge such information to a third party, without the express consent of the responsible partner and the Service User, except in accordance with the requirements for external audit, as may be required by law or where such information is already in the public domain; or by legally constituted Information Sharing Protocols.
12. Freedom of Information
12.1 The partners agree that they will each cooperate with one another to enable any partner receiving a request for information under the Freedom of Information Act 2000 (“FoIA”) to respond to that request promptly and within the statutory timescales. This cooperation shall include but not be limited to finding, retrieving and supplying information held, directing requests to other partner as appropriate and responding to any requests by the partner receiving a request for comments or other assistance.
12.2 The procedure followed shall be that of the receiving organisation. Where a request is made to both organisations, both shall respond although in an agreed and coordinated manner. Consequently, partner organisations should alert each other to any FoIA requests they have received concerning the partnership or the services provided in partnership.
12.3 Any and all agreements between the partners as to confidentiality shall be subject to their duties under FoIA. No partner shall be in breach of any confidentiality paragraphs or agreements if it makes disclosures of information in accordance with the FoIA.
13. Human Resources
13.1 Terms and conditions of employment shall be those of their employing organisation.
13.2 Staff shall be managed using the policies and procedures of their employer. Managers in joint management posts should have an understanding of, and comply with, the policies and practices of the employer of the staff they manage including appraisal, supervision, absence management, conduct and capability.
13.3 Liabilities of employment associated with any employee will remain those of the employing organisation e.g. pensions, redundancies.
13.4 Nothing in this Agreement replaces the rights of the staff of each Participating Organisation from referring to the complaints or grievance procedure adopted by their Participating Organisation.
13.5 The costs of any jointly appointed posts will be divided 50:50 between the responsible commissioning organisations. In the case of the posts outlined in Annex 1, the commissioning organisations are NHS Devon and Devon County Council. Any variation to this agreement will be made between those commissioning organisations.
13.6 This 50:50 split should be retained for the baseline at transfer but any future increases should be the responsibility of the employing organisation, given likely differing financial and wage settlements.
13.7 Similarly, the costs of Personal Assistants to jointly appointed management posts will be
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divided 50:50 between the responsible commissioning organisations with hours of support allocated to an agreed equitable formula subject to annual review in line with other administrative support functions.
13.8 Secondments of staff between the partner organisations should be facilitated by separate and individual agreements.
14. Disputes Resolution
14.1 In the event of a dispute between the partners in connection with this memorandum the parties shall endeavour to resolve the dispute at the appropriate operational level.
14.2 Where the dispute cannot or fails to be resolved at an operational level, then the Chief Executives of the partners or their nominated representatives shall consider and resolve the dispute.
14.3 If the Chief Executives fail to resolve the dispute then the matter shall be referred to mediation on terms and by a mediator to be agreed by the partners.
14.4 If no agreement on mediation is reached, the matter shall be referred to the President of the Chartered Institute of Arbitrators whose decision shall be final.
14.5 The costs of arbitration shall be born equally between the Participating Organisations that are in dispute.
14.6 The arbitration procedure shall be conducted in accordance with the provisions of the Arbitration Act 1996 and the decision of the arbitrator shall be binding on the Participating Organisations that are in dispute.
15. Signatures
Chief Executive Devon County Council
Signed………………………………………………
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Date………………………………………………
Chief Executive Northern Devon Healthcare Trust
Signed…………………………………………….
Date…………………………………………………
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Annex 1 Organisational Structure
TO BE AMENDED FOR NDHCT
On 1st April 2011, the relevant posts are as follows: DASS – Devon County Council (Strategic Director, Services for People)
Chief Operating Officer
Assistant Director (Southern Devon)
PA to Assistant Director
Deputy Assistant Locality Director (CareDirect Plus)
PA to Deputy Assistant Locality Director (CareDirect Plus)
Deputy Assistant Locality Director
PA to Deputy Assistant Locality Director
Cluster Manager (Dawlish/Teignmouth/Teign Valley/South Dartmoor)
PA to Cluster Manager (Dawlish/Teignmouth /Teign Valley/South Dartmoor)
Cluster Manager (Newton Abbot)
PA to Cluster Manager (Newton Abbot)
Cluster Manager (Totnes/Dartmouth)
PA to Cluster Manager (Totnes/Dartmouth)
Cluster Manager (Ivybridge/Kingsbridge)
PA to Cluster Manager (Ivybridge/Kingsbridge)
Cluster Manager (Tavistock)
PA to Cluster Manager (Tavistock)
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Community Equipment Service Manager
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Annex 2 Locality Structure
Eastern Devon Area
Complex Care GP practices Population Total Adult cluster Team Practice 75+ Population
Tiverton area Castle Place (Tiv) 1192 14,214 Tiverton cluster complex care team Clare House (Tiv) 999 10,161 Sampford Peverell 186 1375
Bampton 426 3792
Mid Devon Medical Practice 498 4853 (L83023)
TOTAL 3301 34,395
Crediton area The Surgery, Bow 194 2398 Crediton and complex care Cullompton cluster team Cheriton Bishop 380 4480 Newcombes (Crediton) 594 6442
Chiddenbrook (Crediton) 616 6860
Cullompton College Surgery (Cullompton) 1220 13,802 complex care team Bramblehaies (Cullompton) 513 6419 Blackdown 871 7224
Wyndham House (Silverton) 392 3827
Exe Valley (Thorverton) 140 1355
4920 52,807
Exmouth and Claremont 1243 11,035 Exmouth & Budleigh Budleigh Salterton cluster complex care Haldon House 667 5523
team Imperial 432 3778
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Raleigh 426 4327
Rolle Medical Partnership 1704 12,767
Budleigh Salterton 1560 7736
Woodbury Surgery 308 3419
TOTAL 6340 48,585
Honiton and Honiton (Barber) 2022 16,526 Honiton and Ottery St Ottery St Mary Mary cluster complex care Honiton (Seamark) team Coleridge (OSM) 1753 15,927
TOTAL 3775 32,453
Axe Valley, Seaton & Colyton 1344 7011 Axe Valley, Seaton & Seaton & Sidmouth cluster Sidmouth Sid Valley 3211 14,470 complex care Townsend House (Seaton) 1254 6855 team Axminster 1580 10,700
TOTAL 7389 39,036
Exeter St Thomas Medical Group 1775 27,901 Exeter Adults cluster 1 complex care team A The Foxhayes Practice 111 3371
Exeter The Topsham Surgery 784 6728 complex care team B Pinhoe 924 9087 Ide Lane 808 8191
Hill Barton 221 3723
Chapel Platt 347 2303
TOTAL 4970 61,304
Exeter Mount Pleasant (L83033) 593 8744 Exeter Adults cluster 2 complex care team C Southernhay House 747 7557
Mount Pleasant L83066 619 7369 The Whipton Surgery 438 3693
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The Clock Tower Surgery 1 761
Exeter Barnfield Hill 551 7279 complex care team D St Leonards 580 7276 The Heavitree Practice 423 6214
The South Lawn Medical Practice 540 7523
Isca Medical Practice 642 5590
Wonford Green Surgery 229 5015
TOTAL 5363 70,467
Northern Devon
Complex Care GP practices Population Total Proposed Adult cluster Team Practice 75+ Population
Torrington and Torrington Health Centre 463 5257 Torrington, Holsworthy Holsworthy, area complex Castle Gardens Surgery 560 6481 care team Bideford and Northam Beech House (Shebbear) 187 1810 cluster Black Torrington Surgery 226 2205
Bradworthy Surgery 288 2856
Holsworthy Medical Centre 1028 10,029
Bideford and Bideford Medical Centre 1314 13,010 Northam area complex care The Wooda Surgery Bideford 795 8348 team The Health Centre, Northam 1223 10,586
Hartland Practice 238 2771
Fremington Medical Centre 821 6098
TOTAL 7143 69,451
Braunton and Caen Medical Centre, Braunton 1413 11,476 Braunton, Ilfracombe, Ilfracombe South Molton and area complex The Warwick Practice (Ilf) 806 9295 Chumleigh cluster t
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The Waterside Practice (Ilf) 902 9955
The Health Centre, Lynton 275 2649
South Molton East Street 592 5233 and Chumleigh area complex South Molton Health Centre 529 5251 care team Wallingbrook HC, Chumleigh 697 6440
TOTAL 5214 50,299
Barnstaple Boutport Medical Practice 332 5293 Barnstaple cluster complex care team and the Brannam 1270 12,833 Pathfinder Litchdon 1243 15,540 team Queens 612 7620
TOTAL 3457 41,286
Okehampton Hatherleigh 202 1975 area complex care team Devonshire House (North Tawton) 205 2264 Okehampton 1133 11,861
Okement 66 1217
Chagford 325 3089
The Health Centre M’hmpstead 366 3074
Total 2297 23,480
N.B. Okehampton / Moretonhampstead Complex Care Team have transferred from Southern.
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Annex 3 Services and Service Descriptions
The services and functions covered by this memorandum are shown in the table below:
Service Area Service Description Commissioning Arrangements 1 Complex Care The social care practitioners employed The Complex Care Teams and contracted by Devon County Teams are jointly Council to work both reactively and commissioned by DCC proactively with people with long-term and NHS Devon. conditions and complex needs. Agreed joint agency This group of staff comprise: specification. (i) DCC social care practitioners (ii) Voluntary sector representatives DCC/NHS Devon cluster (commissioned via DCC) dashboard is agreed (iii) Complex Care Team co-ordinators performance monitoring (employed by NHS and DCC) tool.
2 Intermediate Range of largely historically-determined Jointly commissioned by Care Services services, including: DCC and NHS Devon (i) Rapid response (ii) Community rehabilitation teams Joint agency (iii) Recuperative care specification under discussion between NHS (NOTE: NHS Devon will commission Devon and DCC. bed-based intermediate care from DCC by a separate arrangement) 3 Devolved (i) For the NHS: a range of support (i) NHS Devon Formatted: Bullets and Commissioning services, e.g. patient transport, medical commissioned Numbering services to support service delivery.
(ii) For DCC: a range of social care (ii) DCC commissioned services to meet peoples’ assessed needs e.g. day services, domiciliary services and residential/nursing care. (iii) Jointly commissioned (iii) For NHS Devon / DCC: community via NHS Devon / DCC equipment services. DCC with a pooled budget 4 Integrated Joint agency management posts Jointly commissioned by Formatted: Bullets and Management DCC and NHS Devon Numbering Structure Responsibility for employment terms and conditions and any attendant liabilities remain with employing organisation
Memorandum of Understanding DCC / NDHCT 2011 ~ 2014 24
Service Area Service Description Commissioning Arrangements 5 Countywide A specialist countywide team providing DCC commissioned. sensory team services to those who have impaired vision and/or hearing
NDHCT delivered to whole of Devon. These will be managed under the partnership agreement between DCC and NDHCT.
Memorandum of Understanding DCC / NDHCT 2011 ~ 2014 25
Annex 4 Specification for Complex Care Teams
This is currently being revised and will be finalised by August 1st 2011 and incorporated into this memorandum of understanding as per section 6.2.
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Annex 5 Specification for Sensory Team
This currently being revised and will be finalised by August 1st 2011 and incorporated into this memorandum of understanding as per section 6.2.
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Annex 6 Annual Strategic Agreement
This annex would be an agreement clarifying the requirements and expectations of each partner in the forthcoming year. As such it would include:
Strategic objectives Change priorities Performance outcomes Budget allocations Revenue Budget 2011/12 Chargeable Services – Rates 2011/12
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Annex 7 Interface Services The services and functions covered by this memorandum can only be provided by interfacing with other provider services as follows:
Service Area Service Description Provision Arrangements 1 Central DCC central team that coordinates DCC delivered. Safeguarding responses to safeguarding alerts, Team manages performance, assigns Adult safeguarding resources to whole home reviews and partnership policy and serious case reviews etc. guidance.
2 Care Direct A contact centre based model under DCC commissioned Plus single management but with 3 centres for delivery in eastern, southern and Management of services northern localities all to be managed for the whole of Devon under the terms of this agreement. will be under the partnership agreement This service delivers a social care with TCT management service (assessment, review, support planning, brokerage) for people with less complex needs.
The service will interface with Clusters and Complex Care Teams in northern and eastern localities which will be continue to supported by the centres in those localities.
3 Emergency A specialist countywide team providing DCC delivered Duty Team a social care out of hours service
4 Direct A specialist countywide team providing DCC delivered Payments Direct Payments advice and support 5 Personal A specialist countywide team providing DCC delivered Brokerage brokerage services for complex cases 6 Care Direct A specialist health, social care and DCC delivered benefits advice service based in the MyDevon customer service centre 7 Community Provision of equipment, aids and DCC and NHS Devon Formatted: Bullets and Equipment adaptations. commissioned Numbering Service Management of services for the whole of Devon will be under the partnership agreement with TCT
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Annex 8 County Council Support Service
The services and functions covered by this memorandum are currently sustained by interfacing with support services currently provided by Devon County Council, including:
Service Area Service Description Provision Arrangements 1 Administration Responsible for all DCC DCC delivered. and property administration services, including those to Complex Care Teams and CareDirect Plus.
Responsible for the management of all DCC properties including those used by CareDirect Plus and some Complex Care Teams 2 Finance Responsible for all financial support DCC delivered services. (corporate.)
Responsible for establishing and overseeing all financial policy and procedures. 3 Audit Responsible for all audit services to DCC delivered DCC functions. (corporate.)
Responsible for delivery of an annually agreed programme which may include audit of functions provided in partnership. 4 HR Responsible for all HR services to DCC delivered DCC employees. (corporate.)
HR terms & conditions, policies and procedures will be applied according to the employing organisation of the employee.
Likewise, employment liabilities will be the responsibility of the employing organisation of the employee.
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Service Area Service Description Provision Arrangements 5 ICT Responsibility for all ICT DCC delivered infrastructure services and systems (corporate.) to DCC employees.
ICT usage policies and procedures continue to apply to any user of DCC ICT infrastructure or systems.
The partnership between DCC and NHS Devon as commissioners remains committed to sharing information via (electronic) single assessment using FACE tools and integrated IT solutions 6 H&S Responsibility for health and safety DCC delivered inspection and advice for all DCC (corporate.) facilities and services.
Responsible for delivery of an annually agreed programme which may include audit of functions provided in partnership and from partner facilities. 7 Performance Responsibility for establishing the DCC delivered. performance framework for DCC functions, providing management information in support of agreed frameworks and coordinating any CQC assessment and inspection activity. Providing regular information feeds to enable the production of the Integrated Cluster Performance Dashboard 8 Workforce Responsibility for the training and DCC delivered Development development of all DCC employees. (corporate.) 9 Customer Responsibility for coordinating DCC delivered. services responses to compliments and complaints, including statutory complaints, for all adult social care services. 10 Information Responsibility for coordinating DCC delivered Governance Subject Access Requests and (corporate.) ensuring compliance with Data Protection and Freedom of Information legislation
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Annex 9 Budget 2011‐12
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Annex 10 Budget by Locality 2011‐12
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Annex 11 CCT Budget Summaries
CCT's Summary - 2011/12 Budget compared to Projected Outturn (as per FYE Month 11) Including £1.0m contingency
TOTAL - SOUTHERN
£000 2011/12 Budget 20,186 Projected Outurn (FYE Month 11) 22,524 Over / (Under) Spend 2,338
Main Variations: Budget Proj spend Variation
£000 £000 £000 Residential / Nursing 9,875 11,996 2,121 In house Res Care income (1,359) (1,176) 183 Domiciliary Care 6,394 6,657 263 In house Dom Care income (358) (308) 50 Day care 468 534 66 Direct Payments 2,792 2,593 (199) Others 2,374 2,228 (146) 20,186 22,524 2,338
TOTAL - NORTHERN TOTAL - EASTERN TOTAL - NORTH / EAST
£000 £000 £000 2011/12 Budget 12,430 31,800 44,230 Projected Outurn (FYE Month 11) 12,570 29,802 42,372 Over / (Under) Spend 140 (1,998) (1,858)
Main Variations: Budget Proj spend Variation Budget Proj spend Variation Budget Proj spend Variation
£000 £000 £000 £000 £000 £000 £000 £000 £000 Residential / Nursing 6,802 6,311 (491) 13,504 13,916 412 20,306 20,227 (79) In house Res Care income (1,440) (1,459) (19) (2,281) (2,183) 98 (3,721) (3,642) 79 Domiciliary Care 3,886 4,151 265 11,170 9,236 (1,934) 15,056 13,387 (1,669) In house Dom Care income (266) (132) 134 (585) (361) 224 (851) (493) 358 Day care (21) (43) (22) 848 514 (334) 827 471 (356) Direct Payments 1,878 2,018 140 4,548 4,043 (505) 6,426 6,061 (365) Others 1,591 1,724 133 4,596 4,637 41 6,187 6,361 174 12,430 12,570 140 31,800 29,802 (1,998) 44,230 42,372 (1,858)
COUNTY
£000 2011/12 Budget 12,430 Projected Outurn (FYE Month 11) 12,570 Over / (Under) Spend 140
Main Variations: Budget Proj spend Variation
£000 £000 £000 Residential / Nursing 30,181 32,223 2,042 In house Res Care income (5,080) (4,818) 262 Domiciliary Care 21,450 20,044 (1,406) In house Dom Care income (1,209) (801) 408 Day care 1,295 1,005 (290) Direct Payments 9,218 8,654 (564) Others 8,561 8,589 28 64,416 64,896 480
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Annex 12 Terms of Reference for ‘Strategic Partnership Meeting’
The terms of reference for this meeting (see section 8.4) will be negotiated and agreed by the 31st May 2011.
As a minimum these meetings will involve the Strategic Director for People Services (Devon County Council) and the Chief Executive (Northern Devon Healthcare Trust), terms of reference for these meetings (including clarification of the full membership) will be agreed by the 31st May 2011 and appended to this Memorandum as Annex 12.
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