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Meeting: |
Executive |
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Meeting date: |
14 November 2024 |
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Report of: |
DASS Sara Storey |
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Portfolio of: |
Cllr Steels Walshaw – Executive Member for Adult Social Care |
Decision Report:
York Mental Health Hub
Commissioning Arrangements Options Paper
Subject of
Report
1. The Connecting our City Project is a multi-agency project aimed at improving mental health and wellbeing in York. The Project team are hosted by City of York Council (CYC) and the Project has largely been funded through NHS Community Mental Health Transformation (CMHT) Funding.
2. CYC currently hold York’s allocation of CMHT moneys and commission on behalf of the York mental health partnership (YMHP) (see Annex A Summary of Grants and Funding). We hold several contracts and grant agreements using the NHS transformation funding, primarily funding voluntary sector (VS) provision with the York Mental Health hub (located at 30 Clarence Street) and pathway to recovery team.
3. This includes peer support, social prescribing and carer support.
4. All agreements include clear milestones and outcomes. All providers submit quarterly reports to the Connecting our City Steering Group. The Project team also meet every 6 weeks with providers to monitor progress and address any issues or support required.
5. Due to the success of the mental health hub developments, additional NHS funding has been secured for up to 2 further hubs in the city. One of these is part of a national pilot funded by NHS England.
6. A decision is required on how to commission the current hub provision post April 2025 when most of the current agreements end and the Voluntary sector provision for the remaining two hubs. This decision is required to enable us to have staff recruited and in post for the opening of hub 2 (24/7) currently estimated to be April 2025.
7. Timescales for the 24/7 hub, implemented by NHS England (NHSE), are extremely tight with expectation that provision is up and running within this financial year. Voluntary sector providers were a key part of the partnership expression of interest and form the majority of the staffing. These roles cannot be recruited until funding arrangements are confirmed. Any delay to recruitment risks an inability to deliver the project on time and potential claw back of funds by NHSE.
8. This was a partnership bid, developed and submitted by partners who form the staff base of the hub team. Therefore, there is an expectation that partners who were part of the successful bid will be the providers within the hub model.
9. Hub one opened in May 2024 after being prototyped and then paused and has recently re-opened and it still in a soft launch period, gradually taking new people into the service. As it is not fully operational, the provision is still in its infancy as is the current team. Disruption to providers at this stage would be ill-timed as there has not been sufficient time to allow the team or the model to establish, to agree staffing structures and service specification or for proof of concept.
10. Disruption to providers at this stage would inevitably result in losing key members of the team and ultimately the current hub having to pause work destabilising the system. York has been on an important journey of learning to develop this model and there has not yet been sufficient time to allow this to establish, to agree staffing structures, service specification or for proof of concept.
11. We require consistency of provision across all hubs to be able to measure the effectiveness and respond quickly to change.
12. Long term planning is currently underway to establish the needs of all three hubs so that a future integrated commissioning model can be developed. However, due to the current timescales and stage of hub development, we are seeking to establish an interim two-year arrangement with the existing voluntary sector providers to maintain consistency of provision across the city. This would be without inviting competition and the total value of all of the agreements is over £500,000. Therefore a decision is required at Executive level.
Benefits and Challenges
13. There are benefits to CYC continuing to commission the mental health hub provision as CYC already holds the existing agreements and hosts the project team. The project team are responsible for developing the hub model and establishing future commissioning arrangements. This will also allow funding to be carried over financial years should there be recruitment delays ensuring maximum use of available funds for York. The Project Team are also hosted by CYC and monitor contracts and grant agreements from partners, which enables the team to evidence the impact of the roles within the model and collect data on the outputs.
14. The proposed grant agreements can be delivered within the required timeframes and will allow time and flexibility to embed the hub model and create a clear specification for after the 2-year period. After this 2-year period, we will review service and future requirements under either the Procurement Act 2023 or the Provider Selection Regime in order to determine the most appropriate commissioning route to ensure the best outcomes for the residents of York and the council achieves Value for Money.
15. Grants will need to comply with the council’s Contract Procedure Rules (CPR 4) and a Best Value form completed to explain the decision for not inviting competition.
16. Grant agreements will need to be prepared by Legal Services and will need to be properly assessed to make sure they are in line with subsidy control principles – this will take time due to limited capacity and resource within the Legal Team.
17. The York Mental Health Hub developments are a high-profile project with significant system engagement across York. Uncertainty around funding arrangements for voluntary sector partners creates instability amongst the existing hub team and risks staff retention if decisions are delayed. This would compromise the ability of the hub to meet key performance indicators due to lack of capacity.
18. As hub one only opened in May 2024, after being prototyped, the provision is still in its infancy as is the current team. Disruption to providers at this stage would inevitably result in losing key members of the team and ultimately the current hub having to close. This risks destabilising the system.
19. The NHS England funded project is expected to be delivered within an extremely short timeframe and any delay to voluntary sector partner funding arrangements will delay recruitment and thus delivery of the project. This could result in NHSE clawing funding back as well as reputational damage.
20. Risk of challenge for directly awarding grants to existing providers has been mitigated as far as possible through the rationale of allowing sufficient time to embed and refine the hub model. The two-year agreements will allow for sufficient time to develop a robust model and specification as well as to confirm future funding and resource commitments. This will allow for a review of service and future requirements under either the Procurement Act 2023 or the Provider Selection Regime in order to determine the most appropriate commissioning route to ensure the best outcomes for the residents of York and the council achieves Value for Money.
21. The funding for all hubs comes via the NHS.
22. For all of the above options, the mental health hub is operating a ‘co-located’ model whereby employing organisations retain responsibility for staff, with staff reporting on a day to day basis to the hub manager. Therefore, staff employed through the grant agreements will be voluntary sector employees. There are no TUPE implications for CYC as any transfer as a result of a change in provider would be the responsibility of the individual organisations involved.
Policy Basis for Decision
23. This decision complies with both the Health and wellbeing and Cost of Living priorities within the Council Plan. The project looks to improve access to mental health and wellbeing support, ensure open access, person centred and flexible support. Integrated models of care allow best use of resources, avoid duplication and avert more costly acute and crisis services. Offering flexible support within the community will increase accessibility for groups who are currently underrepresented within mental health services.
24. The model also seeks to address the health inequalities for people with a severe mental illness by improving access to physical health support, addressing the social determinants of mental health and building community connectedness.
25. Advice has been taken from both procurement and legal colleagues regarding compliance with the Contract Procedure Rules. Risk to the council is lower as the Contract Procedure Rule requirements for grants aren’t as prescribed for the award of Grants as they are for the award of contracts.
Financial Strategy Implications
26. These are all Health funding sources which are/will be passported to the Council to manage. Funding for two of the three hubs is recurrent funding. The 24/7 pilot funding is for 2 years. Discussions are happening at both a place and ICS level about how this model can be sustained after the 2-year period. Some of this will rely upon the realignment of existing resource within mental health services and transformation plans are already being developed to support this within the relevant organisations.
27. The recommended two-year agreements will allow for sufficient time to develop a robust model and specification and to refine the costs and workforce required.
28. The hub development work aligns with other developments in relation to integrated community service provision and Integrated Neighbourhood Teams for which joint funding arrangements are being developed.
Recommendation and Reasons
29. Executive are recommended to:
· approve Option 3, namely the issuing of 2-year term grant agreements by CYC to the existing voluntary sector providers, without a competitive process, and to delegate authority to the Corporate Director - Adults and Integration, in consultation with the Chief Finance Officer and the Director of Governance, to take such steps as are necessary to determine the provisions of, award and enter into the resulting grant funding agreements.
Reason(s): This allows for a flexible interim arrangement in compliance with the Subsidy Control Act 2022, the Financial Regulations under Appendix 10a of CYC’s Constitution and the Contract Procedure Rules under Appendix 11 of CYC’s Constitution. This option can be delivered within the required timeframes. The two-year agreements will allow for sufficient time to develop a robust model and specification as well as to confirm future funding and resource commitments. This will allow for a review of service and future requirements under either the Procurement Act 2023 or the Provider Selection Regime in order to determine the most appropriate commissioning route to ensure the best outcomes for the residents of York and the council achieves Value for Money.
Background
30. The Connecting our City Project is a multi-agency project aimed at improving mental health and wellbeing in York. The Project team are hosted by City of York Council (CYC) and the Project has largely been funded through NHS Community Mental Health Transformation (CMHT) Funding.
31. One of the key priorities for the Project was to establish a Trieste style mental health hub model for York. These hubs will offer a range of support in a flexible manner with a multi-agency team, that are able to be responsive and enable early intervention to prevent a decline in mental health. The Hub is able to support a person to develop a network of community assets to support them to thrive in their local communities.
32. The hub model was codesigned in April 2022 as part of a detailed process involving people with lived experience and a range of practitioners from across organisations in York. The model was then prototyped supporting a small number of individuals from January 2023 with a team including clinicians, social care, peer support, recovery workers, carer support and social prescribing.
33. A prototype report (see Annex B York’s Hub Journey) was published which demonstrated significant benefits. For the individuals accessing support:
· the team were able to offer support to people who have previously struggled to access what they needed;
· 24 of the 33 people (72.7%) at the Hub achieved progress directly connected to their reasons for seeking support at the time;
· 11 of 13 obtained ReQol scores had improved, meaning 84.6% of those from whom data was obtained had displayed reliable improvements;
· Case studies demonstrated a dramatic reduction in use of crisis, A&E, and interactions with the police for those people being supported by the hub;
· The physical space and community acted as an important enabler, means of belonging and social support in itself.
34. For the hub team:
· They appreciated the permission to work flexibly and within a more flattened hierarchy;
· People valued the team's flexible approach as well as being given options for formal or more informal support;
· The team empowered people to be able to better manage their own crisis through co-developing support;
· The team have been able to work more in alignment with their own personal values;
· Being a part of change was an appeal for the team.
35. A quote from an individual who received support:
“They're trying to get me to come and use it as like a Hub, like a place to build friendships and interact with and get support from people, whether it be people in the cafe or people in the office. If you're having a bad week, you can turn up and go ‘D, can I just speak to you for 10 minutes please because I'm having a bit of a bad day or a bad week, and as long as he hasn't got appointments that happens. The relaxed nature of the place is its strength because it's not like you have to wait weeks and weeks to see someone you can literally drop in, reach out.”
36. Alongside the successes, the hub experienced some key challenges and in September 2023 the hub was paused to allow time to establish a more robust governance structure and to recruit to a permanent fully staffed team. The hub reopened at the end of May 2024 at 30 Clarence Street and from September 2024 has integrated with the Mental Health Recovery Service (See Annex B – York’s Hub Journey). Due to the challenges experienced within prototyping, we have been operating a phased approach to opening to ensure that the team can manage demand. However, the hub is already showing positive outcomes both for individuals and the system.
37. The aim of the mental health hub model is that individuals are able to access a range of support, that is flexible to meet needs at the point they need it. In order for us to be able to offer this support across the City and develop this as an integrated model of mental health support, we need to establish three hubs. Citywide hub coverage would allow the realignment of health and social care resources and ensure sustainability for this model.
38. Therefore, we were delighted to have had the opportunity to apply for national NHS England funding for a 24/7 mental health hub in the West of the City (Acomb, Holgate & Westfield). Yorks bid was successful, and we have secured £2.4m over two years for this pilot which sees investment in 6 sites across the country.
39. We have also submitted a bid for NHS Service Development Funding of £498k (recurring) which would allow us to establish a third hub. This funding is to be confirmed.
40. York’s hub development journey and the partnership approach to this, continues to attract significant national and local interest. We have recently hosted visits to the current hub from key leaders within the Department for Health and Social Care (Director and Deputy Director of Mental Health) and Rachel Maskell MP.
41. To date, City of York Council have held York’s allocation of CMHT moneys and commissioned on behalf of the partnership. Totalling £695k (recurring). We hold a number of contracts and grant agreements, as above, using the transformation funding, primarily funding provision with the York MH hub and pathway to recovery team. CYC holding this funding has supported significant flexibility and ensured maximum use of all available funding for York.
42. These contracts and agreements were established during the prototype phases of both the hub and pathway to recovery. All providers were originally subject to an expression of interest process which included a project brief, expressions of interest being submitted, a partnership panel scoring submissions based on agreed criteria and interviewing providers.
43. A decision is required on how to commission the current hub provision post April 2025 when most of the current agreements end and the Voluntary sector provision for the remaining two hubs. This decision is required to enable us to have staff recruited and in post for the opening of hub 2 (24/7) currently estimated to be April 2025.
44. Timescales for the 24/7 hub, implemented by NHS England (NHSE), are extremely tight with expectation that provision is up and running within this financial year. Voluntary sector providers were a key part of the partnership expression of interest and form the majority of the staffing. These roles cannot be recruited until funding arrangements are confirmed.
45. This was a partnership bid, developed and submitted by partners who form the staff base of the hub team. Therefore, there is an expectation that partners who were part of the successful bid will be the providers within the hub model.
46. As hub one only opened in May 2024, after being prototyped, the provision is still in its infancy as is the current team. Supporting a multi-agency co-located team to operate seamlessly is complex. It has taken significant work and time to orientate the current team, develop operational procedures and working practices. This work is ongoing. Disruption to providers at this stage would inevitably result in losing key members of the team and ultimately the current hub having to close. This would destabilise the system. York has been on an important journey of learning to develop this model and there has not yet been sufficient time to allow this to establish, to agree staffing structures and service specification or for proof of concept.
47. We are seeking to explore the mechanism by which we can establish agreements for minimum of 2 years, with the existing VS providers, to allow us to embed the model across 3 hubs and prove concept as well as to establish a collaborative future commissioning and provision model.
48. Following the 2-year period, we will have a much clearer understanding of available funds and a robust specification for delivery of the model. This will allow for a review of service and future requirements under either the Procurement Act 2023 or the Provider Selection Regime in order to determine the most appropriate commissioning route to ensure the best outcomes for the residents of York.
49. A workshop to consider future commissioning models is planned for 24th October 2024. This workshop will consider the options below and recommend a future commissioning model which will be developed and planned over the 2-year period. An update following this workshop will be brought back to the joint commissioning forum.
50. A summary of the options that have been considered is below.
Consultation Analysis
51. The development of the York Community Mental Health Hubs involved an in-depth codesign process with representation from clinicians, social work, local area coordination, voluntary sector, and over 50% lived experience and carers. The core principles that emerged from this process continue to guide the development of the York hub model, including the desire to embed lived experience leadership. Monthly conversation cafes provide ongoing dialogue and involvement as the project develops. The project also has a dedicated Coproduction Champion providing ongoing opportunities for involvement and engagement as well as a System Change Lead who works alongside voluntary sector colleagues to support and improve commissioning practice.