Terms of Reference Mental Health

Terms of Reference Mental Health

Mental Health Joint Management Group

This sheet must be completed and attached to the front of all papers to JMG so that the paper submitted is one continuous document.

Date of Meeting: 10th February 2013 / Paper No: DRAFT
Title of Report:
Revised Terms of reference for Mental Health Social care placements
Is this paper for: (please tick) / Information & decision / YES
Purpose of Report:
To seek Provider JMG agreement to revised TOR for Mental Health Purchasing Panel
Action Required:
To note the report and agree the revised TOR

Equality Impact Assessment:

Screening undertaken: Not required

Outcome of screening:

Author:Graham Whitwell – Head of Social Care
Date: 14.12.12

Terms ofReference Mental Health Purchasing Panel

1.0Remit of the Mental Health Purchasing Panel:

1.1

To support and decide the delivery ofhigh quality social and health care to Service Users and Carers giving good value for money on the basis that that recovery and empowerment of Service Users and Carers is at the heart of practice, maximising independence at all times.

To promote high quality integrated health and social care that supports the recovery and empowerment of people with severe mental illness and those who care for them.

1.2

To assess and approve applications for social care funding on the basis they support:

  • Recovery
  • Independence
  • Personalised care
  • Value for money

1.3

To manage the Mental Health Purchasing Panel within integrated mental health services as a part of the wider family of Adult Social Care making sure that the interfaces between Adult Social Care services are cooperative and joined up when indicated by the service users needs.

1.4

To manage the Social Care Pathway within Oxford Health’s integrated mental health services supporting service users to move through the pathway inpatient services, the Support to Independent Living service (including Keeping People Well) and community services assisting people to maximise their recovery.

To ensure that the work of the Mental Health Purchasing Panel supports integration as part of health and social care to achieve the best possible outcomes for service users and the people who care for them.

1.5

To manage the social care purchasing budgets.

2.0 The specific objectives of the Purchasing Panel are:

2.1

To receive and consider applications for funding of care packages for clients with health and social care needs. Where the Fair Access to Care and Serious and Enduring Mental Illness criteria are met the Panel will make recommendations to the Authorising Managers regarding resource allocation. Resource may only be allocated at Panel when it is within the delegated authorisation levels of the PCT Representative (see paper on Delegation of Authority for the Funding Panel in Appendix 5).

2.2

To operate within the allocated budgets

2.3

To report the performance of the services provided through spot purchasing and SIL block funded services to the Provider JMG on a monthly basis.

2.4

To monitor, audit and ensure that Social and Health care funding is agreed for service users who are suffering from serious mental illness and for their carers

2.5

To purchase services which provide good value for money for the Service Users and Carerswhich meet their needs.

2.6

To provide data on budgets and social care outcomes which support the Provider JMG to work with Commissioners to develop services to better meet the needs of service users and carers.

2.7

To establish and maintain regular communication with Team Managers, Senior Practitioners and Care Coordinators through quarterly Purchasing Panel Workshops with Care Coordinators and Team Managers to communicate, exchange views and develop practice.

2.8

To ensure service users referred from both community and hospital settings are considered equally on the basis of need.

2.9

To maintain regular audits and reports from the Purchasing Panel Tracker system which regularly inform Care Coordinators and Team Managers to support them to provide quality social care services.

The Purchasing Panel will have no obligation to consider any applications without prior information given in writing and with the prescribed forms as published on OH intranet.

3.0 Governance

3.1Choice statement

Following the policy statements within the local continuing health care policy (Appendix 1 Continuing Health Care Equity and Choice Policy 2009) and national guidance the following principles will be followed in the decision making processes.

  • The Purchasing Panel has the duty to consider the best use of resources for the eligible mental health population of Oxfordshire whilst meeting the health and social care needs of an individual. Therefore, options will always be considered to meet the identified needs of an individual who is eligible for funding, and the panel will always consider the most cost effective option to meet the needs.
  • The Equality of individuals will be upheld and any agreements will not be discriminatory
  • The Panel has a prime responsibility that services it commissions are safe, and the safety, welfare and any potential risks to the individual are taken in to account in care purchased.
  • The personalisation of support for individuals are central to decision making once the other principles above have been assured

3.2Eligibility Criteria.

Applications for Health and Social Care funding will be considered for individuals in line with the Eligibility Criteria below for the following categories of applicants:

3.2.1. Adults of Working Age (16 -65)

CRITERION 1

Adult Mental Health Service Users aged between 18 and 65 who have been assessed as having eitherCritical or Substantial Needs under the Fair Access to Care criteria. (Ref. OCC’s F.A.C Grid appended APPENDIX 2.)

CRITERION 2

Both the Fair Access to Care and Serious and Enduring Mental Illness criteria will be used in Purchasing Panel deciding to allocate funding.

CRITERION 3

Adult Mental Health Service Users who are subject to Section 117 MHA and require a joint package of health and social care services to support their recovery.(Appendix 3 Section 117 policy and protocol)

CRITERION 4

Adult Mental Health Service Users who are ordinarily resident in Oxfordshire Or are judged to be so entitled under the Responsible Commissioner’s Guidance (DH)

CRITERION 5

There are service users whose complex social care needs require a joint approach to funding across Adult Social Care and joint working and shared funding will be required.

CRITERION 6

Adult Mental Health Service Users who are subject to Section 3 MHA who require specialist inpatient treatment that has not been purchased by the LA or PCT under any other agreements

3.2.3Carers

CRITERION 1

Carers who provide regular and substantial care for service users who are between 18 – 65 years of age and meet their critical and substantial needs criteria.

3.3Financial accountability and support

3.3.1

The Social Care budget will be managed in line with budget projections and the Purchasing Panel will authorise placements / care packages and funding to a level of £385 per week. Funding decisions over this limit will be referred to the Assistant Director Adults at Oxfordshire Clinical Commissioning Group.

3.3.3The Purchasing Panel will be supported by a Finance Officer from he OCC Finance Team.

3.3.4

There will be clear reporting arrangements within both the Provider and Commissioning JMG’sfrom OCC and PCT Finance Officers in line with JMG meeting cycles to ensure good joint financial governance and management of the budgets.

3.3.5

The Chairperson and the OCC/OCCG Commissioning Officer will work jointlyon behalf of the Provider and Commissioning JMG’s and be responsible for the day to day budget management making sure that the spot and block funded services maximise the available resources.

3.3.6

The Chairperson and the OCC/OCCG Commissioning Officer will work closely with the designated OCC Finance Officer to maximise budgets and resources.

3.3.7

The Chairperson and OCC/OCCG Commissioning Officer will achieve efficient, seamless escalation of authority to sign off ‘no end dated’ Annex 2’s and sign off of high cost packages above the financial scheme of delegation to the Deputy Director for Adults within OCCG.

4.0 Management of pressures and resources

The Purchasing Panel will manage the balance of demand of applications to meet service user’s needs with the financial resources of the budgets at its disposal.

The Purchasing Panel will inform Provider and Commissioning JMG’s of demand for resources which exceed the capacity of the allocated spot and block funded resources.

The Purchasing Panel will routinely review the service user Priority List at Panel to ensure that demand for services is acknowledged, recorded and reported.

The Chairperson and the OCC/OCCG Commissioning Officer will be responsible for escalating concerns regarding overspending, reporting formally to the Commissioning JMG on both the pattern of overspending and the actions being undertaken to bring the budget in line. Any report of this kind will need to demonstrate the impact of any overspends on delivery of services to service users and the people who care for them..

5.0 Management of Service and Carer Complaints

The OH Complaints procedure is currently invoked to manage the concerns of service users, carers and external organisations on behalf of OCC in the integrated services arrangements governed by the Health Act Section 75 Agreement governing the service.

In the event of a complaint being made the relevant party will be sent a copy of, and advised about, the OBMH Complaints Procedure.( Appendix 6: OBMH Complaints procedure)

6.0 Management of Purchasing Panel disagreements

In the majority of cases presented to the Purchasing Panel consensus will be achieved about decisions to recommend or decide to fund the needs of Service Users.

Where there are disagreements between Adult Social Care teams the joint Policy – Delivering Social Care across Service Boundaries will be enacted by the Purchasing Panel Chairperson.

In the event of a disagreement regarding funding the Purchasing Panel Chairpersonwill take advice and supervision from the OCC Deputy Director of Adult Social Care and the Oxford Health Clinical Director / Adult Services.

7.0 Membership

Head of Social Care – OH/OCC – Chairperson

Associate Head of Social Care – Deputy Chairperson

Commissioning Officer – OCC/OCCG

Mental Health Services Contract Manager

Senior Review Practitioner - OH

Finance Manager (or Deputy) - OCC

Consultant Psychiatrist – OH

Team Managers by rotation - OH

Panel Administrator.

The Panel will only be deemed to be quorate if the core members are present. These are:

  • The Chairperson or Deputy Chairpersonplus the Mental Health Services Project Manager or Mental Health Contracts Manager

8.0 Responsibilities of Core members

Chairperson – Social Care Clinician(Head of Social Care or Associate Head of Social Care)

  • Agrees the Agenda with the Panel Administrator.
  • Chairs the meeting to maintain governance and consensus coordinating the skills and knowledge of the membership.
  • Contributes to decision making.
  • Ensures that the assessments and reviews of service users needs are decided to provide, re-provide or maintain services which are consistent with the needs assessed and reviewed.
  • Ensures feedback to applicants and reviewers about the decisions of Panel.
  • Ensures that reports on the performance of social care services are regularly on the agenda of both Provider ( PAF and Balanced Scorecard quarterly) and Commissioning JMG’s.(Balanced Scorecard –six monthly in Joint JMG’s)
  • Decides out of Panel applications making sure that decisions are brought back through the next available Panel.
  • Ensures service user confidentiality is protected

Commissioning Officer – OCC/OCCG

  • Contributes comparable placements and costs
  • Advises on blocks and availability.
  • Advises on the SIL Contract in relation to what it funds and provides.
  • Leads on commissioning and contracting services by design to maximise budgets and the capacity of block contracted services to provide effective local services.
  • Manages the SIL Contract.
  • Manages the Mental Health Contracts Manager to negotiate value for money within Spot Funded placements.
  • Manages the Mental Health Contracts Manager to review the quality of care provided by spot purchase providers.

Associate Head of Social Care

  • Provides advice on clinical issues
  • Screens referrals and writes summaries
  • Contributes to decision making and risk management
  • Manages the audit and review process.
  • Manages the reporting cycle to Provider and Commissioning JMG’s.
  • Decides Out of Panel applications making sure that decisions are brought back through the next available Panel.

Mental Health Services Contracts Manager

  • Supports the Panel to make decisions with regard to quality with the skills and knowledge of spot and block contracted providers.
  • Oversees the quality of spot funded providers.
  • Negotiates value for money placements with spot providers.
  • Works closely with Care Coordinators and the Senior Practitioner Recovery and Review regarding individual cases making sure that interventions are coordinated.

Finance Officer

  • Reports the current budget projection at the time of Panel in line with the OCC cycle of budget sign off with the Deputy Director of Adult Social Care.
  • Reports concerns about finance issues on individual service users and carers, supporting the Social Care Pathway Team to address those concerns.
  • Supports the Social Care Pathway Team to reconcile budgets.
  • Communicates internally within the wider OCC Finance Team to resolve problems of finance.
  • Communicates with the OCCG opposite number regarding matters of funding which affect Social Care funding and the Commissioning JMG Pooled budget.
  • Works together with the Purchasing Panel to take any appropriate actions required to manage the budget to achieve budget balance.

9.0 Distribution of Notes and meeting frequency

Notes of the Panel Meetings will be distributed to:

  • Panel Members
  • Heads of Community and Inpatient Services.
  • Service Managers for Adult Community and Inpatient Services.
  • Team Managers – Community Mental Health Teams

Frequency of Meetings: Fortnightly

Venue: The Adult/Older Adults Management Offices

Version: 4.0Date agreed: 07/01/10 Review date: 01 March 2013

Dated:10/02/12GW/JP

10.0Appendices

Appendix 1 Choice and Equality

Appendix 2: Fairer Access to Care

Appendix 3 Section 117 Joint protocol and policy

Documents attached to following JMG paper

Appendix 4: Older People Section 117 health Flowchart

Appendix 5: Delegation of Authority for the Funding Panel doc

Appendix 6: Oxford Health Complaints Procedure

Appendix 7: Flow Chart

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