Minutes:
The Interim Head of Programme Design for ECHS (Mark Davison) and the Strategic Commissioner—Programmes Team ECHS (Charles Oseghare) attended the meeting to provide an update around the Mental Health Contract with Oxleas. A copy of the Management Action Plan from Internal Audit had been tabled for information and reference.
The Chairman explained that he had wanted to look at the Mental Health Contract in detail as six Priority 1 (P1) recommendations had been identified by Internal Audit in April. It was felt that not enough attention had been given to the operation of the contract since its inception sixteen years ago; there were currently six years to run on the contract. The contract provided a number of assessment services, mental health and other interventions.
Mr Oseghare had been appointed to deliver against the Action Plan that had been developed subsequent to the audit. He had been tasked with looking at the wider contractual elements, KPIs, outcomes, and performance management. The relationship with Oxleas needed to be based on a clear understanding of objectives.
The Chairman pointed out that the problems with the contract were historic and systemic over the length of the contract. He expressed the view that the relationship with Oxleas was not good in that the relationship between contractor and commissioner was not clearly defined and that relationship modules had been missing. No Mental Health Board had existed. The contract was straightforward, but had not been worked out properly. CCNs (Change Control Notices) had not been put in place, and there was a lack of monitoring and control as well as a lack of formal measures to ensure delivery of services. These matters were concerning. In the light of all of this, the Chairman was worried that clients may have been receiving a sub-standard service. He was also concerned that LBB may not have been getting value for money.
It was noted that Mr Oseghare had set up a Mental Health Board shortly after his appointment in July 2018. The Board undertook a strategic and governance function. The monitoring of the S31 agreement was being done by the Director of Adult Social Care and the Programmes Team.
Mr Oseghare was meeting regularly with the CCG Management Team. He was now a few weeks away from being able to submit a new draft document to Oxleas for a new contract going forward.
Mr Davison was confident that LBB could now be very clear on what would be required from a new contract when the new commissioning process was commenced in 3-4 years time. The Chairman asked if all of the care plans had now been reviewed. It was clarified that all care plans in excess of £900.00 had now been reviewed.
The Chairman enquired what the timeframe was for reaching a finalised agreement with Oxleas. Mr Oseghare responded that it was anticipated that a final Deed of Variation would be in place by mid-January 2019. The Chairman was pleased with this, and the Vice Chairman commented that he felt that progress was being made. However, he did express concern that lessons from the previous audit of contracts had not been learned; he hoped that going forward these lessons could be built upon so that similar mistakes and shortcomings would not be repeated.
A discussion took place about the way that contracts were being monitored. The Director of Commissioning (Lesley Moore) highlighted that contract monitoring reports should be produced annually as a minimum requirement. A discussion took place as to how contracts were being monitored and whether or not this should be changed. Some contracts were not being monitored frequently enough.
The Assistant Director of Governance and Contracts (Laurence Downes) stated that he would circulate an instruction note regarding the monitoring of contracts, and which committees should undertake the monitoring and scrutiny. Ideally, the scrutiny/monitoring of contracts should fit in with PDS committee cycles.
Post Meeting Note:
An email from Mr Downes regarding the monitoring of contracts was disseminated to committee members on 17th December.
The Director of Commissioning expressed concern that ECHS and ECS were not undertaking the monitoring of contracts as frequently as required, and that this had been slipping for 2/3 years. Scrutiny committees should ask to see contract monitoring reports. It was noted that guidance was available for all managers regarding contract monitoring on the ‘Managers’ Toolkit’.
With respect to the Mental Health Contract, the Chairman asked if the role of the Business Support Officer had now been filled. Mr Davison explained that new business arrangements were in place, and a new performance management framework had been set up to collate data. It was also the case that two new Heads of Service were being recruited. Three new Interim Strategic Commissioners had also been recruited, although one had since moved on.
The Chairman asked if a paper could be drafted concerning ‘lessons learnt’ from the failures highlighted in the monitoring of the mental health contract with Oxleas. The paper should be disseminated for information as required, including a copy to the Director of Adult Social Care.
The Chairman thanked Mr Davison and Mr Oseghare for attending the meeting.
The Chairman expressed concern at what he perceived to be the failure of the Care Services PDS Committee to monitor the Mental Health contract properly. He was concerned that the contract had been operating without a Mental Health Board, and that service delivery was also not being monitored adequately.
RESOLVED that the update on the Mental Health Contract be noted and that a paper concerning lessons learnt be drafted for information and reference, and that a copy be provided to the Director of Adult Social Care.