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DRAFT-–-MAY-BOARD-PAPER

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					Report to PCT Board – May 2007

1. Introduction The aim of this paper is to update and inform Board members of progress toward establishing a Mental Health partnership provider trust for Walsall and Dudley. 2. Background and Local Context The West Midlands has an unusually high proportion of its Mental Health services being provided by PCTs. However, this is changing and the majority of areas within the region are now covered by specialist mental health provider organisations. In January 2005, senior officers from the Black Country PCTs, Local Authorities and Sandwell Mental Health Care Trust formed a Project Board to review the configuration of mental health services in the Black Country. The original intention was to develop plans for a single specialist mental health provider organisation for the Black Country. Subsequently however, both Wolverhampton and Sandwell decided not to take part in these plans. The PCTs and Local Authorities of both Dudley and Walsall agreed to continue to explore the preferred option of a single mental health partnership organisation.

3. Drivers for Change Firstly, there is a general drive toward the creation of specialist mental health provider organisations due to:    The National Service Framework for Mental Health indicated that service developments and improvements were more likely to be achieved within the context of a specialist organisation. Mental Health services are being encouraged to develop ‘Foundation Trust’ status along with other acute and specialist services and so would need to exist as a robust provider organisation in order to apply for FT status. There is a view that mental health services may benefit from the dedicated focus, attention and expertise which a specialist trust provides, rather than being part of an organisation which has a number of other functions and priorities.

Secondly, the Department of Health document ‘Commissioning a Patient-Led NHS’ (CPLNHS) published in July 2005 set a course for the future direction of PCTs which was to focus on commissioning healthcare services for their population. CPLNHS recommended strongly that PCTs should no longer provide healthcare services directly. Following an initial ‘back-track’ due to the controversy which this statement first caused, the direction of travel for PCTs is now very much to divest themselves of provider services and focus upon their commissioning function. In summary then, there is a need to make appropriate and robust alternative arrangements for mental health services which ensure that services are protected

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and that service users receive the highest quality care. There is a strong feeling among many local stakeholders that this process of proactive planning for the future which respects and reflects the needs of our local community is significantly preferable to ‘being done to’- that is, possibly having a solution imposed.

4. Business Case Given the scale of actual and planned service changes and reconfigurations within the NHS, the Department of Health recently commissioned Sir Ian Carruthers (formerly Acting Chief Executive of the NHS) to review all proposals and make recommendations about appropriate processes for taking forward reconfiguration proposals. The main recommendations of the Carruthers report were as follows:       Reasons for change should be built on a clear evidence base of clinical and patient benefits. Clinical and staff involvement in developing proposals is critical. Good preparation and understanding of reconfiguration processes is essential. Strong coherence and co-ordination of local proposals is essential. PCTS should be at the centre of major service change. Communications need to be strengthened – ‘plain English’ consultation documents etc. New leadership teams should review all inherited schemes.

One key change is the requirement to submit a business case to the Strategic Health Authority in advance of the approval to progress to consultation. The business case needs to include:           A detailed outline of proposal(s). The objectives to be achieved with clearly defined benefits realisation plans for patients, carers and the wider community. Cost benefit analysis Clear plans to communicate during all stages (pre-, during and post consultation) detailing handling arrangements for communication and implementation) A plan setting out the proposed consultation process. A financial framework to handle the transition, manage the change and ensure benefits are realised. A description of the grain and acceleration of reform(s), including Payment By Results, use of the independent sector, productivity metrics. Plans detailing how these changes will be implemented, including establishment of services to support the change, such as transport strategies, and resourcing (including staffing) requirements A timetable for pre-consultation, consultation, and implementation/ delivery. A risk assessment and management strategy and associated contingency arrangements.

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We are currently at the stage of developing this business case and compiling the required level of detail to meet these requirements. 5. Partnership Development Board The Development Board which oversees the detailed preparations of the plans continues to meet on a monthly basis. The Board has wide-ranging membership including managers and clinicians from both PCTs, senior representative from both Local Authorities and the project Director. A staff briefing is written following each Board meeting and circulated to all PCT and Local Authority staff.

6. Areas of Work There is a great deal of work being undertaken in a number of areas in preparation for the business case and the consultation, including: HR: We have compiled a list of NHS staff who are directly involved in the provision of mental health services in both Walsall and Dudley. Mike Jones (Director of Human Resources and Organisational Development for Dudley PCT) who is leading this area of work has organised a meeting involving the lead officers and staff side leads from both PCTs and Local Authorities to agree a way forward for Local Authority Mental Health staff. Finance: A significant amount of work is being done in both PCTs to dis-aggregate mental health costs. The most detailed work at this stage is in discussing and agreeing an appropriate share of corporate overhead costs. Communications and Consultation: A consultation plan has been developed and is ready for implementation once approval is received. We are currently undertaking an informal pre-consultation process to build further on the pre-consultation work which was done last year in order to gauge initial stakeholder views.

7. Recommendation The Board is asked to note the contents of this report.

MARSHA INGRAM Project Director May 2007

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