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					Jcpb item 10 – appendix A



Item 10 – Appendix A

Section 28a Funding: Background Information

1.     What is Section 28a Funding?

This is money passed under Section 28a of the National Health Act 1977 to
the County Council for the provision of social care for people who otherwise
would be the responsibility of the NHS. This is in recognition of the fact that
most people in long stay hospitals had social care rather than health care
needs and that this was the care they were receiving. However the funding
from the Government at the time sat within Health. The resettlement
programme was seen as a way of moving the funding to social care in
recognition that this is where the service would be most appropriately
provided.

Evidence that the people in hospital were receiving social rather than health
care is the fact that when resettled virtually all of them went into registered
residential homes rather than registered nursing homes.

There was acknowledgement that this funding was not only for the actual
people who moved between services but also for the people who in the past
would have been admitted to long stay hospitals but who would now move to
social care settings.

During the programme to close the long stay hospitals both capital and
revenue passed across for agreed schemes and individuals.

2.     Overall budget that was originally tied up in long stay hospitals

Not all the funding passed from the then health authorities to the County
Council, but for each person resettled a top slice was taken. This was
passed to the community health services to augment their services to cater for
the increased demand brought about by the people moving out of hospital and
for the people who under these new arrangements would not be going into
hospital.

Also not all the money from the final phase of closing the hospitals left the
health services. A significant amount passed to HPT to provide the services
developed on the Harperbury site that enabled to the old Harperbury to finally
close its doors. During the hospital closure programme other funding passed
to HPT to run services at 305 Ware Road and the Community Support Unit in
Watford.

3.     Legal arrangements

The legal arrangements are set out in a signed, sealed and dated section 28a
agreement.
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Under RECITALS the section 28a agreement sets out that the parties (health
and social care) „have agreed to work together, with a view to arranging care
in the community for all the people with a learning disability or long term
mental health problems, who were likely to have received long term care in
hospital‟ - i.e. acknowledging that this funding covers the people who would
not now be going into hospital. The agreement goes on to state that the
„parties recognise that, in accordance with central government policies, the
Health Authority will have to provide funding to the Council for the purposes of
providing adequate care in the community for such people, using its powers
under section 28a of the National Health Service Act 1977.

The final statement under recitals is that „the parties wish to cooperate to
achieve improvements in the choice, flexibility and continuity of health and
social services available to meet the needs of such people and their carers by
developing joint strategies. The parties commit themselves to finding means
through negotiation, to ensure that available funding is used in the most
efficient and effective way, and that constraints on the parties to this
Agreement should not detract from the services offered to residents.

The work on the section 28a legal agreement was instigated by the then Joint
Commissioning Board with high level representation of the then health
authorities and the then social services department. Principles for this funding
were agreed by members and recorded in meeting minutes. Additionally JCT
produced a Learning Disability Statement in June 1999 which made reference
to the arrangements for section 28a funding and gave a commitment for this
money to be ring fenced. In 1999 a discussion document on the use and
funding of vacancies in learning disability homes was produced and formally
adopted as practice by the JCB. This was updated in 2001 and again formally
adopted. The updated paper raised the issue of funding for section 28a
clients whose physical health care needs change and they then meet the
continuing care criteria and the paper includes the statement that „JCB
endorsed the policy (7 June 2001) that these people are funded by continuing
care‟.

4.    How did the money move across?

Funding arrangements are complex, and changed over time. For the earliest
resettlements a capitation allowance was made irrespective of care costs, so
for some people these could represent a surplus, or others a deficit, especially
as care needs changed. For later resettlements actual costs were paid, and
these were adjusted as care costs changed.

5.    Old long stay status and its implications

A further complexity is that some people (those entering long stay hospitals
prior to 1972) were deemed “old long stay”. For these people when they die
the Government takes back funding and reallocates this to even up funding
for learning disability services across the country. There have been 3 yearly
censuses to readjust the funding. In Hertfordshire, because we had the three
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long stay hospitals within our border and many people when they left the
hospital stayed in Hertfordshire rather than returning to their area of origin, we
tend to be net losers on the old long stay redistribution.

There has been a proposal to Liam Byrne that these censuses will cease, but
we have no had a formal decision on this yet, thought the unofficial word is
that the proposal will be accepted.
.
At present money is reallocated via the learning disability development fund
(LDDF). This money passes to PCTs and then on to the Joint Commissioning
Team. The Government set priorities for the spend of this money and we
have to account for this via the annual Delivery and Improvement process.
The spend is therefore closely monitored.

It should be noted that some of the priorities relate to health priorities and a
significant amount of the LDDF money passes to HPT (e.g. to develop
intensive support teams to keep people in their community settings) to meet
these priorities. Also about £50,000 passes to Watford and 3 Rivers PCT for
the employment of a Health Facilitation Co-ordinator to take forward the
Valuing People required work on health action plans and health
improvement.

In should also be noted that people with learning disabilities in health settings
benefit significantly from some of the money that passes to ACS. Examples
of this are person centred planning where people in long term health settings
are a priority for person centred plans and also advocacy where funding
passes to POhWER to provide a dedicated service to people in health
settings.




Judith Jackson
Planning and Commissioning Manager

				
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