Memorandum of Understanding

ANNEX Memorandum of Understanding Between Milton Keynes Council And Central North West London NS oundation Trust (CNWL) In relation to the Provision of Adult Mental ealth and Dementia Services December 205

Introduction This Memorandum of Understanding (MoU) sets the terms and general understanding between Milton Keynes Council (the Council) and Central North West London NS oundation Trust (CNWL) under which adult mental health and dementia social care services for people with mental health problems will be delivered in partnership with secondary mental health services. Background A joint mental health service has been provided in Milton Keynes since October 2002. The initial agreement was between the Council and Milton Keynes Primary Care Trust the provider arm of which became Milton Keynes Community ealth Services (MK CS). In 202/3 NS Milton Keynes and Northants PCT and the shadow Milton Keynes Clinical Commissioning Group (MK CCG) carried out a Transforming Care Services (TCS) process which invited tenders for the services provided by MK CS from NS oundation Trusts located within a 50 mile radius of Milton Keynes. The contract was awarded to Central and North West London NS oundation Trust (CNWL) which took over operation of the adult mental health and dementia services in Milton Keynes on April 203. The health element of these services was detailed in the NS contract and service specifications and the delivery of social care services continued based on custom and practice established through the agreement signed in 2002 (as amended). The agreement allowed for pooled funds and flexibility of roles within staff teams. ealth staff were employed by the NS Trust and social care staff by the Council therefore there were no secondments in place and TUPE (Transfer of Undertakings (Protection of Employment) Regulations 2006) did not apply. In 203/4 and 204/5 the Council transferred funds for the social care elements of the Joint Mental ealth Services to MK CCG where the funds were pooled with the funding for the NS contract and paid to CNWL. A new S75 partnership agreement was required. It was decided that this would differ from the previous arrangement where funds were pooled with MK CCG and the Council proposed a provider-to-provider S75 agreement with CNWL which would entail the Council delegating its social care duties to CNWL but not pooling health and social care budgets. Therefore between April 205 and 30 September 205 Milton Keynes Council and CNWL were operating an arrangement which was similar to a S75 partnership 2

although the written agreement was yet to be formalised. The Council delegated its social care duties to CNWL and transferred funds to CNWL accordingly for the staffing budget, the social care placement budget and associated non-pay costs. During the negotiation of the S75 agreement both the Council and CNWL recognised that there were particular pressures on the joint mental health service including financial pressures and the need to transform mental health pathways as well as deliver social care duties under the Care Act 204. Therefore it was agreed by the Council and CNWL that it would not be appropriate to sign a S75 Partnership agreement which would involve pooling budgets and/or delegating the Council s social care duties at this point in time. It was agreed that a MoU should be put in place until such time as both parties reach a point when an integrated health and social care S75 partnership agreement can be put in place. This MoU demonstrates the clear commitment of the Council and CNWL to work together to provide good quality, responsive adult mental health and dementia services in Milton Keynes. Purpose and scope The purpose of this MoU is to formalise the arrangements for delivery of adult mental health and dementia services across Milton Keynes in preparation for a Section 75 partnership agreement. This MoU sets out the intentions of the partners to deliver health and social care services with the aim of fulfilling their respective statutory duties while working together to: Enable adults with care and support needs, due to mental ill health, achieve the outcomes that matter to them in their life. Build on the significant track record of the joint working of health and social care services in Milton Keynes, urther cultivate a shared vision for health and social care services oster innovation within the service Reduce and remove barriers to seamless service provision The objectives of the MoU are: ealth and social care expertise are brought together within co-located teams to provide services which are based on evidence and good practice. Service users and/or carers receive assessments, care plans, and packages of treatment, care, and support which have a holistic view of their needs with the aim of optimising mental health and well-being. 3

Intended outcomes: Services which respect service users rights and offer the least restrictive option, closer to home Clear, integrated care pathways which form part of a wider recovery programme and plan Engagement and partnership working with promoting suitable housing, positive social networks, community involvement, employment, education and training a. This MoU is not intended to be legally binding on either party to the agreement b. This MoU does not change the statutory responsibilities of either organisation regarding service provision. c. The parties agree to act at all times in good faith towards the other parties in relation to the operation of this MoU.. Joint Service Delivery arrangements Services in Scope The following adult mental health and dementia services fall within the scope of this MoU: Assessment and Short Term Intervention Team (ASTI) Recovery and Rehabilitation Service including Assertive Outreach and Early Intervention in Psychosis Short Term Treatment Team (personality disorder/ complex needs) Community Dementia Team Adult Mental ealth Practitioners (AMPs) Emergency Out of ours Adult Social Care Service Social Care Placement Budget Services not in Scope Services specified in the NS contract between Milton Keynes CCG and CNWL that are not in the Scope of this MoU: Acute ome Treatment Team (ATT) Campbell Centre Acute Inpatient Unit Cherrywood Rehabilitation Unit The Older Person s Assessment Service (TOPAS) Inpatient Unit Memory Assessment Service Improved Access to Psychological Therapy (IAPT) service ospital Liaison Service 4

a. Assessment to determine eligibility to social care and the provision of any identified care and support needs to people treated by services not in scope and/or their carers, will be provided through the services which are in scope. b. Clinicians in these services should refer people, and/or their carers, to the services within scope of this agreement where the provision of social care might help people to achieve the outcomes that matter to them in life, which treatment alone will not. Staff All social care staff will be employed by Milton Keynes Council with reporting lines through to the ead of Mental ealth Services and the Strategic Director / Director of Adult Social Services (DASS) while all health staff will be employed by CNWL with reporting lines through the Service Director Mental ealth and Divisional Director. Social Care Staff with Joint Mental ealth Service (at July) 5

Post Name or Vacant WTE MKC Grade Care Support Worker Carers Support Co-ord Carers Support Worker Carers Support Worker Carers Support Worker CCS Team Leader Customer Liaison Officer Customer Liaison Officer M ousing Advisor Rehabilitation Officer Senior Practitioner Senior Practitioner Senior Practitioner Senior Practitioner Social Work Assistant (orensic) (Reviews) OO AMP OO AMP /AMP /AMP Team Clerk 0.5 0.8 0.8 0.8 0.5 0.8 0.5 0.8 G D D G E E G I I I G D D 6

Accommodation Decisions regarding moving staff within existing accommodation or between properties need to be agreed by both MKC and CNWL. The existing arrangements in terms of where staff are based or in an agreed process of moving prior to st October 205 will be maintained Staff locations July 205 Service Address Landlord / Owner No. of MKC staff on site / in team (including vacancies) ASTI (Assessment and Short Term Intervention) Recovery and Rehabilitation Service Short Tern Team Service Community Dementia Team (due to move to Cripps Lodge autumn 205 Eaglestone ealth Centre MK ospital Campus MK6 5NG Westcroft ealth Centre Savile Lane Westcroft MK4 4EN 226 Queensway Bletchley MK2 2ET Civic Offices Saxon Gate East CMK MK9 3EJ MK UT 0 Westcroft GP 4 practice NS Property 4 Services Milton Keynes 6 Council 2. Governance Mental ealth Partnership Group A Mental ealth Partnership Group between the Council and CNWL will provide the oversight and performance management of the services in scope of the MoU. The Mental ealth Partnership Group is primarily concerned with the operational issues between the Council and CNWL in the delivery of a joint health and social care service for adult mental health and dementia. Membership will comprise Service Director, Mental ealth, CNWL and ead of Mental ealth Services, MKC and their nominated representatives with further membership to be reviewed. The Group will initially meet monthly through the transitional phase when new arrangements are being embedded. ollowing this period it is recommended that monthly meetings continue, with a quarterly escalation meeting to review progress involving the Divisional Director of CNWL, MKC DASS, Service Director CNWL and 7

MKC ead of Mental ealth Services. Dates and locations will be agreed and inserted as an addendum to this MoU. The Mental ealth Partnership Group will be accountable to the Council s Strategic Director, social care and ealth Partnerships (DASS) and CNWL s Divisional Director. Any operational issues which will significantly impact on the quality of the service and outcomes for service users and their carers including implementation of strategy and policy, commissioning intentions, efficiencies and performance targets need to be communicated to the Joint Commissioning Team and may be brought to the attention of the Joint Commissioning Board. The Mental ealth Partnership Group will be superseded by a Mental ealth Compliance Group and appropriate governance arrangements on agreement of a S75 partnership. Mental ealth Priorities Panel A Mental ealth Priorities Panel will be established and managed by Milton Keynes Council to ensure robust financial management of the Social Care Placement budget which will allocate resources for: 8

Direct payments and personalised packages of care Residential care Supported accommodation Out of area placements or new social care cases the priorities panel will scrutinise all referrals and advise on alternatives to supported accommodation or residential care. or health funded cases that may have reached the threshold for social care funding, the panel will review the case and offer a view to the Out Of County Panel. or cases which are presented at the Out of County Panel where the case is neither 00% health nor 00% social care funding splits will be dealt with on a case by case basis. If the funding split cannot be agreed at panel then the os and Service Director will decide the split in funding. Any disputes will be escalated to the DASS MKC and the Divisional Director CNWL 5. inance and Performance The Council will hold the budgets for social care services for adult mental health and dementia. The funding for 205/6 is 2,535,757 comprising Staffing budget 205/6 budget =,565,953 Budget transferred to CNWL until date when staffing responsibility and line management becomes responsibility of the Council a. The Staff Budget will continue to be transferred to CNWL whilst CNWL maintains management responsibility for Council staff. The Council will cease to transfer the budget when line management for staff transfers wholly to the Council on a mutually agreed date no later than 3 December 205 b. Any underspend on the staff budget from October 205 until the date when staff management and budget transfers to MKC will be ring-fenced by CNWL and passed over to MKC to contribute to the forecast overspend against the social care placement budget. The amount of the surplus in staffing will be agreed by both partners and will be the difference of recharged MKC staff costs compared to the daily pro-rata element of the annual budget of,565,953 c. Any overspend on the staff budget becomes the responsibility of MKC from the agreed date when MKC assumes responsibility the staffing budget and managing staff. 9

Social Care Placement Budget 205/6 budget = 79,54 Budget transferred to CWNL April 205 30 September 205 = 359,577 Budget to be retained by MKC date October 205 3 March 206 = 359,577 a. Responsibility for the social care placement budget will be transferred from CNWL to MKC from October 205. These will be derived from MKC s rameworki system and paid via MKC s Controcc system. No contribution will be made to CNWL for these, and no recharges claimed by MKC b. CNWL takes full responsibility for the budget and any overspend up to 30 September 205 c. rom October 205 and whilst the transfer of the budget is finalised no commitments will be made by CNWL against the social care placement budget without express prior agreement from MKC d. Existing placements that started before 30 September 205 but continue into October 205 and beyond, would see the costs split between CNWL (until 30 September 205) and MKC (from October 205). Non-Pay items 205/6 budget = 250,650 Budget transferred to CWNL April 205 30 September 205 = 25,325 Budget to be retained by MKC date October 205 3 March 206 = 25,325 a. Externally purchased care costs will be the responsibility of MKC with effect from 0 October 205. These will be derived from MKC s rameworki system and paid via MKC s Controcc system. No contribution will be made to CNWL for these, and no recharges claimed by MKC. b. Other costs directly incurred by MKC (e.g. Telephones, Insurances, Printing, Premises) will be the responsibility of MKC with effect from 0 October 205 and will no longer be recharged to CNWL. This will restrict the contribution for 205-6 to 0,000. No contribution will be made to CNWL for such costs after 30 September 205 and no recharges claimed by MKC. Equivalent costs directly incurred by CNWL will be its responsibility with effect from 0 October 205. c. MKC will discontinue its contribution to CNWL management costs with effect from 0 October 205. This will restrict the contribution for 205-6 to 40,325. 0

d. MKC will discontinue its additional contribution to CNWL (above the original offer) with effect from 0 October 205. This will restrict the additional contribution to 75,000 covering the period from April 205 to 30 September 205. 6. Risk Sharing a. Any underspend on the staff budget from October 205 until the date when staff management and budget transfers to MKC will be ring-fenced by CNWL and passed over to MKC to contribute to any overspend against the social care placement budget. The amount of the surplus in staffing will be agreed by both partners and will be the difference of recharged MKC staff costs compared to the daily pro-rata element of the annual budget of,565,953. b. Any overspend on the staff budget becomes the responsibility of MKC from the agreed date when MKC assumes responsibility of the staffing budget and managing staff. c. Once all budgets within the scope of this agreement have transferred to the Council there will be no sharing of financial risk until both parties enter into a S75 agreement. 7. Duration a. This MOU shall become effective upon signature by the authorised officials from the Council and CNWL and will remain in effect until superseded by a formal signed Section 75 agreement between the Council and CNWL. The target date for delivery of this is April 206. b. This MOU will automatically be terminated upon completion of the section 75 agreement covering joint mental health services; owever, each partner retains the right to terminate this agreement at any point, through the provision of a written notification and 3 months notice period. 8. Communications a. Parties commit to communicating openly and constructively and to sharing good practice. b. This co-operation will include the sharing of appropriate information and maintaining effective communication, where this will inform and improve the delivery of services. c. The parties acknowledge that there are a range of interested stakeholders, who have an important role to play in the integration of health and social care, and they agree that these stakeholders will be engaged and consulted as appropriate.

9. Confidentiality and data sharing a. The parties acknowledge their respective duties and obligations under the Data Protection Act 998 and the reedom of Information 2000 and shall give all reasonable assistance to each other where appropriate or necessary to comply with such duties. b. Subject to the above duties, the parties agree to share information with each other and with other organisations and individuals as appropriate. 0. Dispute Resolution a. In the event that issues and disputes arise under this MOU, the partners shall seek in good faith to resolve these informally. Any matter that cannot be resolved informally shall be escalated to the CNWL Divisional Director and Director Adult Social Services and where appropriate to the Joint Commissioning Board. b. If it cannot be resolved within 30 days by the JCB, then the matter shall be referred to the ealth and Wellbeing Board. Contact Information Milton Keynes Council Michael Bracey Corporate Director, People Saxon Court, 502 Avebury Boulevard, Milton Keynes, MK9 3S Tel: 0908 6969 E-mail: Michael.bracey@milton-keynes.gov.uk Central and North West London NS oundation Trust (CNWL) Lorna Payne Divisional Director Trust eadquarters, Stephenson ouse. 75 ampstead Road, London, NW 2PL Tel: 0908 243540 E-mail: lorna.payne@nhs.net 2

Signatures Date: Michael Bracey, Corporate Director, People or and on behalf of Milton Keynes Council Date: Lorna Payne Divisional Director or and on behalf of Central and North West London NS oundation Trust (CNWL) 3