Draft Assurance Framework for the Delivery of Social Care in Integrated Mental Health Services

Appendix 1

Assurance Framework for the Delivery of Social Care in Integrated Mental Health Services in London

Hannah Doody and Andy Nash- Mental Health Programme Leads

Denise Snow- Business Development and Network Manager

January 2014

This final document draws upon earlier work developed in association with Robin Lorimer –

and the Pilot sites of Boroughs and Trusts for testing the Assurance Framework.

Boroughs of Enfield and Barnet with Barnet, Enfield and Haringey MH NHS Trust

Boroughs of Camden and Islington with Camden Islington NHS foundation Trust

Boroughs of Barking and Dagenham and Havering and WalthamForest with North East London NHS Foundation Trust.

Borough of Kingston with South West London & St. Georges Mental Heath Trust

Borough of Bexley with Oxleas NHS Foundation trust

Boroughs of Hackney with East London NHS Foundation trust

Borough of Harrow with CNWL

Contents

1.Introduction

2.Background

3. Domains

4.Assurance Framework Draft Matrix

1. Introduction

This Assurance Framework is a tool for Directors of Adult Social Services (DASS) to monitor the delivery of social care in integrated mental health services and to meet the legal requirements of a S75 partnership arrangement. It provides the Local Authority and Mental Health Trust with a mechanism for monitoring service delivery and the effectiveness of partnership working; it is designed to minimise risks for both organisations.

The Framework setsout a joint vision and shared purpose that is agreed by the individual Boroughs and Trust provider.

It is informed by local and national best practiceand has been extensively tested in 11 pilot sites across London.

The Assurance Framework consists of five domains providing clarity about the role and function of adult social care in mental health in London. It effectively describes what needs to be in place for DASS’s and Mental Health Trust CEOs to assure themselves that they are meeting their respective responsibilities.

This document should be read in conjunction with the draft S75 basic guide which sets out the detail and legal background to formal partnership agreements between the NHS and Local Authorities.

2. Background

NHS bodies and local authorities are not automatically established to undertake each other’s roles but may, through the use of formal arrangements, act as a “host” for managing another’s functions on a day to day basis as set out in the formal arrangement.

Section 75 is not a contract nor an operational model or a transfer of functions.

It is a partnership of equal control whereby one partner can act as a “host” to manage the delegated functions, including statutory functions of both partners who remain equally responsible and accountable for those functions being carried out in a suitable manner.

3. Domains

Service and Aims and Objectives

Partnership arrangements between Local Authorities and Mental Health Trusts are in placeto enable partners to design and deliver services around the needs of service users.
The jointly agreed aims and objectives incorporate the Adult Social Care Outcomes Framework across the NHS, Public Health and Adult Social Care to improve the quality of services in mental health.
The delegated health related care functions from the LA to the MH Trust are discharged in a manner that improves outcomes for service users and meets the requirements of the partnership agreement as set out in the governance schedule in the S75 agreement.

The Agreement sets out the following:

Scope of the mental health services in the borough covered by the partnership.
Description of the services.
Location of the services.
How services are accessed, access and hours of operation, to include out of hours provision.
Agreed criteria for access to borough residents in need of services.
Links to other non-partnership services.
Services provided for carers.
Principles and Approach to Delivery of Functions.
Jointly Agreed Service Improvement Objectives.
Jointly agreed tasks for the “host partner” to undertake.
Processes for the Delivery of Frontline Services.

Good Practice example- scoping exercise on current service identifying any service gaps and develop a local Mental Health Strategy setting out the joint aims and objectives of the service and joint workforce.It should cover the key principles for the service, social work service, user groups, provision, priorities, the AMHP service, legal framework and key relationships

2.Workforce

Ensure Professional Mental Health Social Work leadership is provided at both Borough/locality level (in line with the Social Work Reform Programme) and also at Trust wide, Executive or Senior Management Level where the NHS hosts social work services.
Ensure mental health social workers delivering social care functions of the Local Authority have the same or equivalent access as direct Council employees to relevant information systems, resources, services and intelligence about the local communities.
Develop Social Work as a unified profession, while supporting the development of local professional social work specialism’s as required.
Set out core functions of office , administration staff and management.
The workforce affected by the partnership arrangements are consulted with as part of the planning of the agreement.
The roles and responsibilities of mental health social work in an integrated team are developed with the support of the College of Social Work.
Social care staff, as part of their induction to the service, understands the arrangements forsecondment and terms of employment under s113 of the Local Government Act.
Personnel, Management, and Structure are set out to include:

Staffing according to wte, staff numbers and professional groups lists from each partner.
Roles and Profession of each Partner’s Establishment.
Integrated/Managed Establishment.
Secondment Arrangements.
Secondment Agreement.
TUPE arrangements if required.
Recruitment Protocol.
Job Descriptions and person specifications are fit for purpose.
Duties and Responsibilities of Staff in Integrated Teams.
Terms and Conditions of Employment.
HR Process for the Partners.
Role of “Host Partner” in day to day management.

Good Practice example-incorporation of The College of Social Work guidelines on the role of mental health social workers and the LSCP management tool on the role of social workers in mental health. For social work development- set up a local social work forum chaired by the lead social work professional.

3.Social Care Outcomes

Working with individuals and carers to achieve positive outcomes

Social Care Outcomes that measures how well integrated services provide care and support.
Outcomes that measures quality of access and contact.
Outcomes that measure experience of care and support to live full and independent lives.
Services that are preventative and personalised and recovery focused.
Outcomes for safeguarding vulnerable adults and protecting them from avoidable harm.
Outcomes for access and quality of services to carers.

Good Practice example-

Incorporate the Adult Social Care Outcomes Framework, NHS Outcome Frameworks and Public Health

Develop arrangements for service users and carers to participate in accessing Personal Budgets

Outcomes framework to deliver;

A positive approach to service users potential
The need for access – to physical care, mental health care and social care to increase life expectancy
Safety- safe personalised care planning and “safe from harm”
Accommodation – a home to feel safe and belong
Income- access to income and resources to meet fundamental needs
Relationships- supportive and close relationships including family and friends
Participation-engagement in social and community activities
Opportunities- positive contribution, participation in education, training, work or volunteering or other meaningful activity
Choice and Control- exercise the right to have choice and control on how individuals live their life
Resilience- sense of self worth and have the resilience and ability to cope when things change or go wrong
Fulfilment- rights and dignity are respected to live a fulfilled life

4.Governance and Key Performance Indicators

Good governance and regular reviewing of the Assurance Framework will ensure that it is meeting its purpose.
It will need to be formally agreed and have clarity about how long the agreement is in place for.

It may help to establish a formal group charged with the overall governance of the agreement to include:

Role.
Terms of Reference.
Membership.
Level of authority for decision making etc.
Agreement of changes and variations within the scheme of delegation of individual officer organisations.
Annual review.
Adoption of new annual schedules on objectives, scope of service, financial and performance arrangements.

Key performance Indicators reporting needs to evidence the objectives and outcomes as described above.
Reports ASCOF measures for people with mental health needs in contact with integrated services.
Reporting should also indicate the effect of integration on the service as a whole for example the impact on in-patient admissions and discharges.
Local Authorities and Trusts should establish the suitability of data from their respective data systems to avoid duplication and also agree the frequency of data reporting.
Reports to Trust Board and Health and Wellbeing Boards

Good practice examples-

Agree/weekly/fortnightly joint QA meetings with joint shared values for case presentation, planning and outcomes.
Develop and agree a governance schedule covering key indicators and outcomes.
Staff access and knowledge of IT systems for both health and social care

5. Resources

The partners need to agree on the options available to them that they wish to use under the partnership arrangement in order to deliver their local objectives.

In brief, the full ranges of available S75 options available to partners are the options of:

Lead Commissioning - the partners can agree to delegate commissioning of a service to one lead organisation to be commissioned by it alongside its own, but not necessarily unless they wish, as a part of a pooled fund.
Pooled Funds - the ability for partners each to contribute agreed funds to a single pot, to be spent on agreed projects for designated services delivery and without a boundary between LA and NHS care.
Integrated Provision - the partners can join together their staff, resources, and management structures to integrate the provision of a service at a managerial level or all of the way down to the front line functions of staff being integrated.

For further understanding on ‘‘integration’ please note that it can take two forms: Managed Resources (delegation) or Integrated Functions (Pooled Fund) both forms are detailed in the draft S75 Basic Guide.

Resources and Finance Procedures to include:

Details of Financial Contributions for Staff Budgets, Goods and Services from both partners.
How the contributions are made up.
Budget Breakdown by Team, Service, Area etc.
Role of “host partner”.
Finance Performance.
A Risk Management Plan.
Information Reporting.
Accounting.
Accountability.
Principles governing Budget Setting, Payroll and Accounting for the use of Resources.
Agenda for Regular Review and Monitoring- Monthly/Quarterly Review.
Support Available eg: Payroll, Finance Departments, IT Functions.

Good Practice Example-

Develop a financial memorandum of Understanding
Develop norms for staffing levels
Clear understanding of history of posts and where financial responsibility sits

For Further information on the Assurance Framework please contact;

Hannah Doody at

Andy Nash at

Assurance Framework Matrix Example for the delivery of Social Care in Integrated Mental Health Services

The attached matrix example can be used and adapted locally as a tool for governance and review of the five domains of the draft Assurance Framework.A risk management plan can be used to share, avoid, reduce or accept the risk.

Domain 1: Service and Aims and Objectives

Compliance Link / RISK ID / Responsible persons / Governing review group / Principal risk / Controls in place to manage risk / Inherent / original risk / Internal assurances on controls / External assurances on controls / Gaps in controls* / Gaps in assurance
Domain 2,3,4 and 5
s75 of the National Health Service Act 2006/Partnership
working arrangements
Service description and aims and objectives
Adult Social Care Outcomes Framework / Individual borough / Assistant Directors / Senior Managers / Head of Social Work
Finance Manager
IT Manager
Governance membership / s75 governing group / Review both framework and s75.
Review monthly for first 3 months and then quarterly.
Overall annual review and update of objectives / Individual borough / Dependent on individual borough risk
Risk management plan to share, avoid, reduce or accept the risk associated with domain / Clear partnership arrangements outlining delegated duties by LAs to MH Trust as set out in s75 partnership arrangements.
DASS and MH CEO’s agree a set of principles and values which underpin a joint vision for mental health services in the borough.
Monitoring arrangements for delivery of working arrangements and governance of the assurance framework including dispute resolution as set out in the s75 partnership arrangements.
Feedback from governing group to DASS. / Scrutinised through HOSC and Cabinet Members.
Quarterly updates on delivery of objectives.
Partnership arrangements and Assurance Framework will be used in discussions with CCGs and other emerging structures to influence local commissioning. / Individual boroughs / Individual boroughs
Compliance Link / RISK ID / Responsible persons / Governing review group / Principal risk / Controls in place to manage risk / Inherent / original risk / Internal assurances on controls / External assurances on controls / Gaps in controls* / Gaps in assurance
Domain 1 and 5
113 of the Local Government Act 1972/staff secondment arrangements
College of Social Work’s Professional Capabilities Framework
S75 schedule, workforce and integrated management
MH Act / Individual borough / Assistant Directors / Senior Managers / Head of Social Work
Finance Manager
IT Manager
Governance membership / s75 governing group / Review both framework and s75.
Review monthly for first 3 months and then quarterly.
Overall annual review and update of objectives / Individual borough / Dependent on individual borough risk
Risk management plan to share, avoid, reduce or accept the risk associated with domain / Clear leadership and development for social care staff.
Management reporting line and supervision for AMHPs.
Social Care leads forum / Scrutinised through HOSC and Cabinet Members
Quarterly updates on delivery of objectives
Delivering social care tasks to meet council priorities, improving outcomes for service users as set out in the partnership agreement /safeguarding and SDS.
Structure for leadership for social work and professional supervision and development.
Links to College of social Work / Individual boroughs / Individual boroughs

Domain 2: Workforce

Domain 3: Social Care Outcomes

Compliance Link / RISK ID / Responsible persons / Governing review group / Principal risk / Controls in place to manage risk / Inherent / original risk / Internal assurances on controls / External assurances on controls / Gaps in controls* / Gaps in assurance
Domain 1 and 4
Adult Social Care Outcomes Framework
NHS Outcomes Framework
LA health related functions
S75 partnership arrangements
Carers Act / Individual borough / Assistant Directors / Senior Managers / Head of Social Work
Finance Manager
IT Manager
Governance membership / s75 governing group / Review both framework and s75.
Review monthly for first 3 months and then quarterly.
Overall annual review and update of objectives / Individual borough / Dependent on individual borough risk
Risk management plan to share, avoid, reduce or accept the risk associated with domain / Identified social care data to measure outcomes, meaningful activity and measures of productivity as set out in S75 partnership arrangements.
Establish suitability of data from both trust and borough IT systems
Clear accountability through the governance group for reporting
Any future procurement of IT systems to consider requirements from both the trust and borough on data / Scrutinised through HOSC and Cabinet Members
Quarterly updates on delivery of objectives
Placement panel for personal budgets
Quarterly reports to adult safeguarding board / Individual boroughs / Individual boroughs

Domain 4: Governance and Key Performance Indicators

Compliance Link / RISK ID / Responsible persons / Governing review group / Principal risk / Controls in place to manage risk / Inherent / original risk / Internal assurances on controls / External assurances on controls / Gaps in controls* / Gaps in assurance
Domain 1 and 3
Adult Social Care Outcomes Framework
NHS Outcomes Framework
S75 partnership arrangements
Clinical Governance Structures within the Trust / Individual borough / Assistant Directors / Senior Managers / Head of Social Work
IT Manager
Governance Group / Review both framework and s75.
Review monthly for first 3 months and then quarterly.
Overall annual review and update of objectives and outcomes / Individual borough / Dependent on individual borough risk
Risk management plan to share, avoid, reduce or accept the risk associated with domain. / Identified social care data to measure outcomes, meaningful activity and measures of productivity as set out in S75 partnership arrangements.
Establish suitability of data from both trust and borough IT systems
Clear accountability through the governance group for reporting
Any future procurement of IT systems to consider requirements from both the trust and borough on data / Scrutinised through HOSC and Cabinet Members
Quarterly updates on delivery of objectives
Placement panel for personal budgets
Quarterly reports to adult safeguarding board / Individual boroughs / Individual boroughs

Domain 5: Resources