Agenda item

Section 33 legal agreement for the frailty service.

Context:

The committee were presented with the Gwent Frailty Programme Section 33 Renewal, which informed members on the proposal to review and renew the Section 33 agreement (Health Act 1999) between Aneurin Bevan University Health board and the five local authorities– Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen.

Sufficient information would be received by the five organisations as part of the collaboration agreement.  S33 was not appended to the report but would be available if required by members.

The report had been considered by the joint partnership and would be subject to the scrutiny and executive process. 

Key Issues:

The Gwent Frailty Programme (GFP) is a transformational programme between the five neighbouring local authorities in the former Gwent area and Aneurin Bevan University Health Board (ABUHB). Its aim is to provide services to frail people across the area in a way that is person centred and focused on the needs of individuals, rather than organisations. It is regarded by the Welsh Government as one of Wales’ iconic projects, and has been backed by repayable Invest to save funding of £6.3 million.

Gwent Frailty has been developed in recognition that many aspects of current models of health and social care provision are unsustainable and that more effective whole system working is necessary to address increasing demand for services which meet frail individuals’ needs.

The five local authorities (Blaenau Gwent, Caerphilly, Monmouthshire, Newport and Torfaen) engaged in the Frailty Programme with Aneurin Bevan University Health Board (ABUHB) agreed a Section 33 agreement from 2011/12 – 2013/14.

The formula for funding agreed was that ABUHB agreed to contribute 77% of the additional investment required, with the other 23% additional investment agreed to be contributed by local authorities.

The formula for I2S payback was in simple terms based on the anticipated savings each of the partners would receive from the investment. For local authorities that was expected to be in terms of reduced packages of care and care home beds. For ABUHB savings were expected from reductions in bed day usage.

The review of the programme has also been guided by two external reviews, the Cordis Bright Review (commissioned by the GJFC in July 2014 and previously reported to Adult Select Committee), and the Wales Audit Office (WAO) review published in December 2015 (and to be reported to Adult Select Committee’s across the whole partnership at a date to be arranged)

The WAO report (Dec 2015) concluded that...’the Programme has demonstrated positive regional cross-sector partnership working to tackle growing community based needs, but it has not evidenced tangible outcomes, which will be important as partners determine the future of the Programme.’

The Cordis Bright review:

The GFJC received and confirmed the report and 4 key challenges emerged from the review:

·         Acknowledgment that cash releasing savings were unlikely, but cost avoidance may have been achieved.

·         The need to shift to a consistent service model across Gwent, based on the most effective evidence based approach.

·         The need for better information and performance capture to allow evaluation to be performed and develop future targets for CRTs, including service efficiencies.

·         Establish a single Frailty Director to manage the service and its development aligned to the recommendations of the review and future direction for Frailty in Gwent.

The introduction of the Frailty Programme Director has been established and is helping guide the programme.

The Programme Director will also become the designated budget holder at programme level but will delegate to the Community Resource Teams (CRT)/Integrated Service Teams (IST) Managers at an operational level, with some budget accountability being held by ABUHB Community Divisional Nurses and Local Authority Head of Service.

Locality Delivery Plans (LDP) will be introduced for 2016/17 which will include a service delivery statement, resources and all associated costs for the five county boroughs.  The CRT/IST will report monthly to the Programme Director on financial and delivery performance. This process is the first stage in the revised governance process.

Member Scrutiny:

Following presentation of the report Members were invited to comment, during which time the following points were noted:

• The Chairman thanked officers for information that had been presented.
• Members commended the team and recognised their good knowledge, in being influential players moving forward.  Particular praise was given in relation to how budget pressures had been considered and addressed well in advance.  It was hoped that this direction would continue for the future.
• The Cabinet member highlighted the value and pride in how the Social Care and Wellbeing act had been significant.  One underpinning philosophy, was having individual at the centre of everything, organisations and partnerships had collaborated in agreeing the best way forward for the individual.
• In terms of assessing value for money and quantifying savings achieved, this had been difficult due to the nature of the service.  The important factors were to consider what the service would look like if no changes had been made.  Demographics had been a significant factor, there had been dramatic reductions in institutional care.   
• The committee acknowledged the amount of work that had gone into the service area and welcomed that the improved service had resulted in reduced hospital admissions.
• Members suggested that the use of the word ‘frailty’ could be changed, as it was not representative of all service users.  Officers confirmed that the title was, ‘people are happily independent’ and use of frailty was avoided where possible.
• The purpose of the service was that people within the system were supported and this reflected reality.  Quantative measurement was not possible, the service benefits would be identified through case studies, experience, client videos and outcomes.
• There had been challenges in respect of addressing regulators expectation of ‘tangible outcomes’ and specific financial benefits.
• The committee recognised that the service demonstrated impact and outcomes for individuals, in accordance with a set of principles and values.  The importance of the service delivery was significant.
• Members welcomed that changes would be made and that culture change would occur across the five authorities.

Recommendations:

1.    Adult Select Committee are asked to consider the proposals outlined which have been agreed by the Gwent Joint Frailty Committee (GJFC) and present recommendations to Cabinet about how Monmouthshire County Council should proceed.

The proposal and associated changes form a package of measures to improve the sustainability of the service and include:

·         ABUHB and each Local Authority individually confirming its financial contribution to the Frailty Programme, recurrently, for at least the period of the loan repayment (up to and including financial year 2020/21) – this will include declared and ex-Invest to Save (I2S) funding for pooling. This will require a firm commitment from 2016/17 and onward budgets, with a longer term financial plan being developed and agreed, to ensure value is achieved from the investment and efficiency improvements.

·         A programme of efficiency savings shared by partner organisations on the basis of relative I2S funding contributions to ensure overall programme costs are managed within agreed budget funding levels.

·         Any Partner proposing to disinvest in the frailty programme must not shift a service burden to another partner and will be subject to the terms of the Section 33 agreement.