Trust Board Part 1
Agenda
item
BD/16/145
Title
Secure Services
Memorandum of
Understanding
Date:
28 September 2016
Executive
Director lead
and presenter
Report author
Simon
Truelove
Jane Rowland, Head of
Business Strategy &
Christina Gradowski,
Associate Director of
Corporate Affairs
This report is for:
Decision
Discussion
To Note
x
x
History
Following the launch of the Five Year Forward View for Mental Health in February 2016,
NHS England invited applications from organisations interested in becoming a new care
model site for tertiary mental health services.
Across the South West, there are 9 providers of tertiary mental health services, with a
mix of private and NHS provision. AWP and Devon Partnership NHS Trust are the only
providers of medium secure services at Fromeside and Langdon Hospitals respectively.
AWP itself has 109 secure beds across both Fromeside and Wickham units.
All providers of secure services in the South West recognise that there has been a lack of
whole system working and, as a result, there has been significant under-provision of
secure care within the South West. At any one time, approximately 250 people from our
region are cared for outside the South West. This has an impact on patient experience,
outcomes and overall cost of service delivery.
Recognising these issues, the providers of services across the South West agreed to
work together to submit a joint application to be a new care model site. The aim of this
partnership is to deliver comprehensive medium and low secure services, both prereferral and post-discharge, that utilise proven innovations in care such as Pathfinder and
FIND to deliver a whole system pathway. It was agreed that for the purposes of the
application, contact with NHS England and receipt of additional funds, Devon Partnership
NHS Trust would act as the ‘lead’ organisation, acting on behalf of the wider consortium.
Devon Partnership will also employ the necessary project staff to support the programme.
It is important to note that this ‘lead’ arrangement does not signal that Devon Partnership
NHS Trust will take responsibility for commissioning and performance management of
other organisations in the partnership. Due to current VAT rules and associated
exemptions for NHS providers, the consortium as it stands cannot be directly
commissioned. It is expected that the vanguard programme overall will support the
development of a new tax approach which will be adopted once in place.
Our joint application was successful, and we are now starting the more detailed work
outlined in our proposal. To take this forward, organisations will need to supply patient
level outcomes and financial information, enabling a whole system view of the pathway
and provision to be developed.
In order to protect the interests of the Trust whilst continuing to work collaboratively, it is
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Avon and Wiltshire Mental Health Partnership Trust
important that there is a Memorandum of Understanding (MOU) between each member
of the consortium. This MOU should set out the rationale for the consortium, what it
covers, confidentiality and term.
The following impacts have been identified and assessed within this report
Equality
Quality
Privacy
Executive summary of key issues
A Memorandum of Understanding (MOU) has been drafted to ensure that the Trust is
sufficiently protected, and that sets out the expectations of each member of the
consortium in relation to the project. This has been developed by the Trust and has been
sent to the Partnership leads in Devon. It is expected that this will be discussed at the
first meeting of the Partnership Board, scheduled in October 2016 and where AWP is
represented by the Director of Operations.
The Finance and Planning Committee has discussed and approved the attached MOU.
The Board of Directors is asked to provide final approval, in line with Trust governance
processes.
As the project moves beyond the first phase of development, a more detailed Heads of
Terms will be required. This will be submitted to Finance and Planning Committee once
developed.
This report addresses these strategic priorities:
We will deliver the best care
x
We will support and develop our staff
We will continually improve what we do
We will use our resources wisely
We will be future focussed
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x
x
x
Avon and Wiltshire Mental Health Partnership Trust
1. Introduction
Improving access to mental health services, including secure care, is a core component of the
Five Year Forward View for Mental Health. NHS England has set out an ambitious programme of
work to address the existing fragmented pathways in secure care, increase provision of
community based services and trial new co-commissioning funding and service models. It
expects providers to work together to reduce avoidable admissions, support recovery for people
who have severe mental health problems and significant risk or safety issues, delivering care in
the least restrictive setting and as close to home as possible.
This secure programme will:
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Trial new models of care
Identify an optimal secure care pathway, including community interventions, and informed
by the experience of people in secure services
Scope the needs of those using mental health services, clarifying demand and capacity
Map existing service provision with an emphasis on preventing admissions and long term
recovery
Promote the implementation of personalised recovery-focused care planning in secure
inpatient services
It is expected that by 2020/21, there will be a stepped change in service provision, with people
moving more effectively in and out of secure services.
2. New models of care
NHS England announced in May 2016 that it was inviting applications from interested
organisations in supporting the development of new care models in tertiary mental health service
provision, linked with this programme. Recognising the existing good practice and opportunity to
develop and enhance relationships & services across a broader clinical network, a joint
application for this proposal was submitted by:
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Devon Partnership NHS Trust
2gether NHS Foundation Trust
Avon and Wiltshire Partnership NHS Trust
Cornwall Partnership NHS Foundation Trust
Dorset University NHS Foundation Trust
Livewell Southwest
Partnerships in Care
Somerset Partnership NHS Foundation Trust
Cygnet Healthcare
3. Benefits of working together
Collectively, providers within the identified consortium provide all secure services across the
south west peninsula. We have good working relationships with one another and across the wider
network of services, and we have achieved success in:

Reducing length of stay and costs across our services
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Avon and Wiltshire Mental Health Partnership Trust
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Improving patient experience, with excellent patient feedback
Increasing bed occupancy across the region
Development and implementation of Pathfinder and FIND
In bringing together our shared experience and expertise, we believe that we can provide a new
model of care across our clinical network that addresses the existing fragmentation in service
provision and commissioning. Through this, we expect to improve patient experience and
enhance the cost effectiveness of service provision. As part of this joint application, we are
seeking to:
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Manage the total budget for service provision, enabling us to allocate resources more
flexibly and effectively across our services
Combine inpatient care and outreach services, to enhance step-down and community
provision.
Improve access to: local secure services, outcomes focused care with clear plans and
timescales, effective monitoring of the quality of providers and support to provider in the
wider pathway to provider effective diversion from secure care and prompt access to stepdown services
Reduce capacity in secure care through improved access to local services and improved
pathways
Work together over a five year period to stabilise the current system and from there build
our new model of care
Identify the most cost-effective and operationally efficient organisational form to ensure
the future sustainability of our new model of care
Carry out systematic and rigorous evaluation of outcomes and benefits realisation
4. Potential structure and approach
We recognise that all national vanguards are seeking to address the current difficulties in creating
financially and operationally sustainable collaborations. We anticipate that guidance will be
released during the coming 12-18 months that may influence the structure of our collaboration.
We understand that, until this information is released, one provider in our consortium will need to
be established as the single point of contact for funding purposes and to coordinate relationships
with and submissions to NHS England leads. For the purposes of this programme, we have
nominated Devon Partnership NHS Trust to fulfil this role. Further work will be required to define
the future organisational form of our venture, and the most cost effective payment structure. This
will be part of our development work.
Early work to be carried out within the next three months includes:
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ratification and agreement of patient activity data
confirmation from commissioners on agreed contract price for 2016/17 and negotiation
process for 2017/18
coordinated response to commissioning intentions and negotiations for 2016/17
ratification and agreement of budget for the designated patient activity
governance arrangements and accountability with regard to clinical risk and budget
management
agreed process for managing conflicts of interest and disputes in short term including
escalation process
risk share and gain share agreements
agreed outcomes and deliverables
Devon Partnership NHS Trust will co-ordinate the associated due diligence process, which will be
conducted in partnership with NHS England, regional specialised commissioning and STP Leads.
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Avon and Wiltshire Mental Health Partnership Trust
5. Principles of working together
The parties wish to enter into this agreement in order to develop a new model of care as defined
by NHS England for secure mental health services.
This agreement will continue until the earlier of: (i) 31st March 2017 and (ii) the completion of a
legally binding agreement to implement the Proposal (Expiry).
This agreement sets out the terms under which the parties will collaborate. The parties
acknowledge that:
a) That parties entering into this agreement act equal partners and in ‘good faith’
b) Each party wishes confirms that discussions and information shared with the other parties
in relation to the joint offer remain secret and confidential
c) Each party has its own distinct governance arrangements and is accountable to its own
board of directors to adhere to key governance principles that partners are open,
transparent and accountable and will adhere to statutory requirements
d) Although the parties are individual organisations, each party acknowledges the
fundamental principle underpinning this joint approach is to work jointly with the other
parties to improve patient care through closer working and greater integration across the
system
e) The parties may unanimously consent to any additional organisations joining the
collaboration, and additional organisation which receives unanimous approval will be
required to enter into a non-disclosure agreement with the parties.
f)
Each party agrees to commit time and resource to the development of the model and to
ensure that the views and expertise of each organisation are reflected
g) Each party is entitled to exit the joint working arrangement and, in the event of any such
exit, agrees to: (i) confirm to the other parties that it would like to withdraw from the
collaboration at the earliest opportunity and (ii) keep all information relating to the
development of the model of care that may be considered commercially sensitive to the
exiting party, including the contents of this agreement, secret and confidential (iii) abiding
with competition law
h) The parties collectively agree to work together to develop a new model of care for secure
mental health services to inform the further development of a national model
i)
The parties undertake not to use the information shared (including activity information,
details of existing models of care within individual organisations or any other commercially
sensitive information) for any other purpose than to develop a new model of care for
secure mental health services
6. Named contacts
With this in mind, each party shall nominate an authorised officer who will (in addition to any other
activities agreed between the parties):
a) Formalise links between the parties to ensure effective communication and aligned
working
b) Provide a named contact for the purposes of conducting necessary due diligence
c) Ensure active participation in the programme of work, including swift supply of
information, to meet timescales as defined by NHS England
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Avon and Wiltshire Mental Health Partnership Trust
d) Play an active role in the participation of the future model of care across the wider network
Signed:
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Avon and Wiltshire Mental Health Partnership Trust