PUBLIC – NOT TO BE REMOVED UNTIL END OF BOARD MEETING

Report to the Meeting of the Oxford Health NHS Foundation Trust

Board of Directors

26 November 2020

Update to Board on the development of Provider Collaboratives

For: Discussion

Executive Summary

Strategic Objectives: Deliver the best possible clinical care & health outcomes Be a sustainable & partner-focused healthcare provider

The Long-Term Plan sets an ambition for the development of NHS-led Provider Collaboratives in Mental Health designed to manage whole pathways of care on regional footprints for specialised services. Under these arrangements, identified lead providers will take clinical pathway and financial responsibility for the delivery of services with the intention of improving access, developing community alternatives to admission and where admission is clinically appropriate, ensuring community support post-discharge. This paper provides an update to Board on our progress to date. Oxford Health NHS Foundation Trust (OHFT) has established and led 3 New Care Model Wave 1 and 2 pilot sites since their inception in 2017. All 3 were successful in their application to progress to Provider Collaborative status in July 2019, with OHFT approved as the Lead Provider. All 3 have developed considerably over this period, operating in “shadow form” with contracts remaining with NHSE Specialised Commissioning.

The Thames Valley and Wessex Adult Secure and Thames Valley Tier 4 CAMHS Provider Collaboratives, were placed on the Fast Track workstream to go live as of 1st April 2020. The HOPE Adult Eating Disorders Provider Collaborative was placed on the Development Track workstream to go live as of 1st October 2021.

BOD 67/2020(Agenda item: 08)

As a result of COVID-19 NHSE/I announced in March 2020 that the “go live” date for Fast Track Provider Collaboratives had been delayed until 1st October 2020 at the earliest. In July and August 2020 at the partner organizations’ CEO Steering Group, a decision was taken to further delay the go live date for both Fast Track Provider Collaboratives. Although these were operating in shadow form, delays in receiving financial and contracting information from NHSE had not enabled robust and appropriate due diligence to be completed to inform the final business cases and Board approval processes. NHSE/I have therefore placed the Thames Valley Adult Secure and Thames Valley Tier 4 CAMHS Provider Collaboratives on the Main Track workstream with a revised planned go live date of 1st April 2021.

The Thames Valley and Wessex Adult Secure and Thames Valley Tier 4 CAMHS Provider Collaboratives therefore continue in shadow form with NHSE/I although there is considerable commitment to resolving any outstanding matters to ensure there are no further delays given the considerable progress made on improving clinical pathways and shared governance.

Following completion of the financial and contractual due diligences processes, we expect the Adult Secure and Tier 4 CAMHS Provider Collaborative business cases to be presented to the Financial and Investment Committee on 19th January 2021 and the OHFT Board on 27th January 2021 where it is anticipated that formal approval will be sought to progress to “go live status” on 1st April 2021. This paper outlines the work required and progress made to date to develop the financial, contracting and clinical oversight approaches as lead provider. This timeline also enables our Provider Collaborative partner organisations to then take forward approval processes within their own governance. To this end, Provider Collaborative Partnership arrangements are being refreshed to ensure alignment with Heads of Agreement by the end of December.

Similar due diligence and formal approval processes will be followed thereafter to support the development of the HOPE Eating Disorders Provider Collaborative.

The Board has previously endorsed OHFT participation as a partner within an emerging Provider Collaborative, the South East High

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Intensity Service Mental Health Service (HIS) for veterans. This will provide an intensive clinical service to the most vulnerable veterans with complex social and mental health needs, including crisis care and inpatient support through an NHS led Provider Collaborative partnership with Armed Forces charities. Solent NHS Trust were awarded Lead Provider status in July 2020 and the Trust has been working with our neighbour Berkshire Health Foundation Trust (BHFT) and Solent on the clinical model and implementation of the new pathways. The timeline for a ‘go live’ date is yet to be agreed and we are working with partners to enter into the required Partnership Agreement.

RecommendationThe Board is asked to note progress and work underway, specifically:

Thames Valley and Wessex Adult Secure Provider Collaborative and Thames Valley Tier 4 CAMHS Provider Collaborative

The Board notes the key achievements to date, progress on the completion of due diligence processes and the milestones required for Board approval processes.

The Board notes the ongoing work with Provider Collaborative members to refresh the Provider Collaborative Partnership Agreements to align with the Heads of Agreement by 31 December 2020.

The Board notes that the full business cases will be presented to the Finance and Investment Committee on 19th January 2021 and OHFT Board on 27th January 2021 where it is anticipated that a formal decision will be made on progressing to Provider Collaborative status on 1st April 2021, with OHFT as Lead Provider.

HOPE Adult Eating Disorders Provider Collaborative

The Board notes that the HOPE Adult Eating Disorders Provider Collaborative is on the Development Track with a provisional timescale for go live in October 2021. The Provider Collaborative Partnership Agreement timeline for ratification by all partners is noted as 31st July 2021.

South East High Intensity Mental Health Service pathfinder (HIS) for veterans

The Board notes the collaborative work undertaken to ensure that the veteran’s clinical model meets the needs of the BOB ICS

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population and agree that we enter into the Provider Collaborative Partnership Agreement that will follow.

Author and Title: Karen Drabble, Head of Thames Valley and Wessex Adult Secure Provider Collaborative Lead Executive Director:Mark Hancock, Medical Director

1. A risk assessment has been undertaken around the legal issues that this report presents and there are no issues that need to be referred to the Trust Solicitors]

2. Strategic Objectives/Priorities – this report relates to or provides assurance and evidence against the following Strategic Objective(s)/Priority(ies) of the Trust 1) Deliver the best care possible within available resources2) Deliver care in the most efficient way3) Attract, retain and develop outstanding staff4) Remain financially sustainable5) Collaborate with stakeholders to create integrated health

systems

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SITUATIONThis paper outlines the drivers for NHS England/ Improvement’s (NHSE/I) ambition within the NHS Long Term Plan to mainstream the New Care Models approach for specialised mental health, learning disability and autism services, enabling local service providers to work together under NHS-led Provider Collaboratives, taking on responsibility for managing the budget and patient pathways for specialised mental health care for people within a defined network area.

The paper provides a high level overview of the progress of the Provider Collaborative specialist mental health programmes; three (3) of which Oxford Health NHS Foundation Trust (OHFT) is the Lead Provider; and one (1) of which OHFT is a partner provider within an emerging Provider Collaborative.

This paper provides an overview of the current operational progress of each Provider Collaborative, and the financial, contractual and quality due diligence processes that are being undertaken , and timelines, in order to present the final business cases to the OHFT Board for approval for Provider Collaborative go live status.

BACKGROUNDNHS Planning Guidance 2016/17-2020/21 introduced an opportunity for secondary mental health providers, working collaboratively as local networks, to manage budgets for tertiary mental health services currently being held by NHS England Specialised Commissioning and the Five Year Forward View for Mental Health set out the rationale for developing new models of care for mental health.

As detailed in the NHS Long Term Plan in April 2019 NHS England and NHS Improvement’s (NHSE/I) ambition is to mainstream the New Care Models approach for specialised mental health, learning disability and autism services by 2023/24, enabling local service providers to work together under NHS-led Provider Collaboratives, taking on responsibility for managing the budget and patient pathways for specialised mental health care for people within a defined network area.

The drivers for the Provider Collaborative programme, outlined in the NHS Long Term Plan are:

Improve the pathway of care for patients, making it more seamless across traditional boundaries

Improve outcomes & experience for people they serve, with particular improvements in advancing inequalities

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Make services locally led – with co-produced leadership between experts by experience and experts by profession

Be empowered to innovate and improve services whilst maintaining consistency in clinical standards and quality

Improve value for money in specialised mental health spending and reinvest savings in alternatives to inpatient care

Oxford Health NHS Foundation Trust (OHFT) is Lead Provider for 3 Phase 1 Provider Collaboratives, as detailed below:

1. The Thames Valley and Wessex Adult Secure Provider Collaborative

The Thames Valley and Wessex was established as a New Care Model pilot site, led by Oxford Health NHS Foundation Trust (OHFT) in 2017. Following an Adult Secure Mental Health Provider Collaboration submission, OHFT was selected and approved as the Lead Provider, for the Thames Valley and Wessex Adult Secure Provider Collaborative in July 2019; and was on the Fast Track workstream to go live as of 1st

April 2020. As a result of COVID-19 and delays in receiving outstanding finance and contracting information to enable the required due diligence and governance processes with partners to be carried out properly, a decision was taken at an exception CEO steering group meeting on 13th August 2020, for the Provider Collaborative to defer to the Main Track workstream to go live as of 1st April 2021.

The Provider Collaborative will consist of the following providers of specialist mental health care totaling 245 beds, noting that the tertiary mental health providers are Dorset Healthcare University NHS Foundation Trust, Oxford Health NHS Foundation Trust and Southern Health NHS Foundation Trust:

• Berkshire Healthcare NHS FT • Central and North West London NHS FT • Dorset Healthcare University NHS FT • Isle of Wight NHS Trust • Oxford Health NHS FT • Solent NHS Trust • Southern Health NHS FT • Elysium Healthcare (Independent Sector provider)• Priory Healthcare (Independent Sector provider)• Response (voluntary sector provider promoting independent and

community living).

Key achievements:In the first 2 years of the New Care Model operating in shadow form (FY18 -20), the Provider Collaborative achieved:

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Repatriation of 72 patients from out of area placements into network beds;

Net reduction of 48 patients in adult secure mental health care (323 patients 1st April 2018 > 275 patients as of 1st April 2020);

Net reduction of 14,803 occupied bed days and associated reduction in length of stay in the last year (FY18 -20);

Piloting new services – Wave 2 NHSE/I Specialist Community Forensic Team pilot within Southern Health NHS Foundation Trust (18 month pilot due to complete 31st March 2021);

Aligned the learning disability and autism clinical pathways within the Adult Secure Provider Collaborative as of 1st April 2020;

Completed TUPE of identified staff from NHSE/I to OHFT as Lead Provider as of 1st April 2020.

Strengthened the Provider Collaborative governance processes and systems and progressed quality functions to meet the requirements of the Quality Maturity Framework.

Key risks: As part of financial due diligence processes the Provider

Collaborative needs to fully understand the financial and quality risks posed through the application of the Pathway Fund for learning disability and autism secure services (previously known as the Financial Transfer Agreement) following go live.

Strategic bed plan requirements for learning disability and autism secure care. To mitigate this risk a Health Needs Assessment has been commissioned in collaboration with Kent, Surrey and Sussex Adult Secure Provider Collaborative and NHSE/I to inform future commissioning requirements.

2. Thames Valley Tier 4 CAMHS Provider CollaborativeThe Thames Valley Tier 4 CAMHS was established as a Wave 2 New Care Model pilot site, led by Oxford Health NHS Foundation Trust (OHFT) in 2018, and went live in shadow form with NHSE/I on 1st April 2019. Following a Tier 4 CAMHS Mental Health Provider Collaboration submission, OHFT was selected and approved as the Lead Provider, for the Thames Valley Tier 4 CAMHS Provider Collaborative in July 2019; and was on the Fast Track workstream to go live as of 1st April 2020. As a result of determining demand and capacity across the network; progressing a viable bed plan and agreed double running costs for the network and South region, COVID-19 and delays in receiving outstanding finance and contracting information to enable the required due diligence and governance processes with partners to be carried out properly, a decision was taken at the July 2020 CEO steering group meeting , for the Provider Collaborative to defer to the Main Track workstream to go live as of 1st April 2021.

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The Provider Collaborative will consist of the following providers of specialist Tier 4 CAMHS mental health care totaling 99 beds, noting the inclusion of Southern Health NHS Foundation Trust due to the provision of CAMHS low secure services which are a regional (South) resource:

• Berkshire Healthcare NHS FT • Gloucester Health and Care NHS FT• The Huntercombe Group• Oxford Health NHS FT • Southern Health NHS FT

It should be noted that the Priory Group were previously part of the network, however they have recently closed their Tier 4 CAMHS units in Bristol and have subsequently left the Provider Collaborative.

Key achievements: Within 2019 the Provider Collaborative had reduced out of area

placements from 24 patients to only 7 patients being placed out of area, with a corresponding reduction in distance from home;

Financially the Provider Collaborative broke even in its first year FY19-20;

Strengthened the Provider Collaborative governance processes and systems and progressed quality functions to meet the requirements of the Quality Maturity Framework.

Recruited to all Case Manager roles previously held within NHSE/I, monies transferred to OHFT to facilitate recruitment 1st

April 2020.

Key Risks:The Provider Collaborative has noted an increase in the volume of referrals and an increase in acuity of those referrals within FY20-21. The closure of Tier 4 CAMHS beds within the South region and COVID-19 have had a significant impact, with out of area placements increasing in recent months.

In order to mitigate the reduction in Tier 4 CAMHS beds the following actions have been taken:

The NHSE SE Regional team have implemented a gateway system for all Independent Providers across the South East with the aim of reducing the volume of out of area placements and ensuring that south east CAMHS patients are prioritized for available beds within the South East region.

The Provider Collaborative is finalising a demand and capacity piece of work across the network to determine the required Tier 4 CAMHS bed plan requirements.

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Regionally there is a shortage of PICU beds. The planned OHFT PICU unit in FY21-22 will improve this position.

3. HOPE (Healthy Outcomes for People with Eating Disorders) Adult Eating Disorders Provider Collaborative

The HOPE Adult Eating Disorders Provider Collaborative was established as a Wave 1 New Care Model pilot site, led by Oxford Health NHS Foundation Trust (OHFT) in April 2017, and went live in shadow form with NHSE/I on 1st April 2017. Following an Adult Eating Disorders Mental Health Provider Collaboration submission, OHFT was selected and approved as the Lead Provider, for the HOPE Adult Eating Disorders Provider Collaborative in July 2019; and is on the Development Track to go live as of 1st October 2021.

The Provider Collaborative will consist of the following providers of specialist Adult Eating Disorder mental health care totaling 30 beds:

• Berkshire Healthcare NHS FT • Gloucester Health and Care NHS FT• Oxford Health NHS FT • Priory Group

It should be noted that the network size reduced in November 2019, following review of the network geography covered with NHSE/I to ensure the viability of neighbouring Provider Collaboratives.

Key achievements: Strengthened the Provider Collaborative governance processes

and systems and progressed quality functions to meet the requirements of the Quality Maturity Framework.

Key Risks: The Provider Collaborative has seen an increase in the volume of

referrals and clinical acuity in FY20-21, with 10-24 patients at any time being supported in the community with low BMI’s of 11/12 waiting for access to specialist eating disorder beds. As a Provider Collaborative we are concerned that we are becoming conditioned to this level of risk, and these risks are being escalated to the Trust Board. 

In turn this is leading to increased acuity within the specialist eating disorder beds and increased lengths of stay.

NHSE/I accept that there is a national shortage of specialist eating disorder beds and have commissioned a national demand and capacity project. However, the South East NHSE/I Regional team and the South East Provider Collaboratives have raised concerns that the proposed

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review is not robust and will not address the issues highlighted. A network demand and capacity review has been undertaken that demonstrates the volume of additional beds required to meet the known and latent demand in the South East and will be shared with NHSE/I.

In addition to OHFT leading on 3 Provider Collaboratives, aligned to the commitments of the NHS Long Term Plan the Trust is a key partner within the South East region High Intensity Mental Health Service (HIS) pathfinder for veterans.

4. South East High Intensity Mental Health Service pathfinder (HIS) for Veterans

The South East HIS for veterans will provide an intensive clinical service to the most vulnerable veterans with complex social and mental health needs, including crisis care and inpatient support through an NHS led Provider Collaborative partnership with Armed Forces charities.

The Provider Collaborative will work within the South East Region, together with Armed Forces charities on the integration and development of the service. This will include working directly with the Veterans Mental Health Transition, Intervention and Liaison Service (TILS) and Complex Treatment Service (CTS) to provide:

Improved Crisis access and provision Veteran informed inpatient services Care coordination Support for families and carers

In preparation for this, in late 2019, OHFT worked with Berkshire Healthcare NHS Foundation Trust (BHFT), the regional South-Central Veterans Mental Health provider and other NHS and Armed Forces charity organisations to co create a clinical model and support BHFT’s business case to be Lead Provider.

Following an NHSE/I am commissioning process the contract was awarded to Solent NHS Trust in collaboration with the Armed Forces Charites, Walking with the Wounded and All Call Signs. Since July 2020, OHFT have worked with Solent NHS Trust to agree a clinical model that would appropriately meet the clinical needs of our veteran population in the Buckingham, Oxfordshire and Berkshire (BOB) Integrated Care System (ICS). The Provider Collaborative will consist of the following providers:

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Berkshire Healthcare NHS Foundation Trust Sussex Partnership NHS Foundation Trust Isle of Wight NHS Trust Kent and Medway NHS and Social Care Partnership Trust Surrey and Borders Partnership NHS Foundation Trust Solent NHS Trust South Central Ambulance Service NHS Foundation Trust South East Coast Ambulance Service NHS Foundation Trust Southern Health NHS Foundation Trust All Call Signs Walking with the Wounded

ASSESSMENT

Provider Collaboratives – OHFT as Lead ProviderThe Thames Valley and Wessex Adult Secure Provider Collaborative and Thames Valley Tier 4 CAMHS Provider Collaborative will continue in shadow form with NHSE/I on the Main Track workstream until the revised “go live” date of 1st April 2021, and the HOPE Adult Eating Disorders Provider Collaborative on the Development Track until the revised go live date of 1st October 2021, undertaking a critical system leadership role with a continued focus on improving care pathways.

The following assessment outlines the approach of the Provider Collaborates in completing the financial, contractual and quality due diligence processes; strengthening governance processes and ensuring that the Provider Collaborative commissioning teams are operational ahead of go live.

1. Provider Collaborative Financial ApproachAs previously stated, none of the 3 Provider Collaboratives of which OHFT is Lead Provider will progress to full Provider Collaborative go live status in FY20-21, and will remain in shadow form with NHSE/I.

For Fast Track Provider Collaboratives which have been operating in shadow form as a New Care Model, the financial approach would be based on the Lead Provider’s M1-9 FY19/20 Agreement of Balances return adjusted for investments and running costs prior to FY20-21 where they were not included in the Agreement of Balances.

For FY20-21 all providers of specialised mental health services will have a block contract based on FY19-20 spend in line with the rest of the NHS. For Lead Providers of Provider Collaboratives in ‘shadow form’ this would mean only receiving the income for their services directly provided and not the entire Provider Collaborative income.

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For all 3 Provider Collaboratives any generated net savings are a nominal figure, the extent to which they are available for re-investment is uncertain given the national COVID financial regime in FY20-21,however the indications are that further investment supported by FY20-21 savings will not be available without approval from NHSE.

The revised Provider Collaborative budgets for Adult Secure and Tier 4 CAMHS were received from the National NHSE/I Finance team on 9th October 2020 and are currently subject to joint OHFT and Regional NHSE/I finance review to ensure robust and appropriate due diligence. The outstanding issues to complete financial due diligence are as follows:

Adult Secure Provider Collaborative (£77m financial budget) Pathway Fund (Financial Transfer Agreement) validation for the

learning disability and autism patient cohort - £1.7m Extra Packages of Care validation for the learning disability and

autism patient cohort - £1.6m Evenlode pump prime funding - £0.2m FIND Team recurrent funding - £0.6m FY20 inflation on £7.5m investment, £0.4m Non activity related PAM items - £1.0m

For the Adult Secure and Tier 4 CAMHS Provider Collaboratives clarity is required on the intended NHS Provider uplift amount for FY21-22, that is whether 1.4% or 2.8% will be applied.

Tier 4 CAMHS Provider Collaborative (£21m financial budget) Growth in excess of NHSE assumptions Latent demand Double running costs Extra Packages of Care validation OHFT PICU provision FY 21-22 not within current envelope

HOPE Adult Eating Disorder Provider Collaborative (£6m financial budget)The initial Provider Collaborative budget for the Eating Disorders Provider Collaborative was received from the National NHSE/I Finance team in October 2020. In agreement with the Regional NHSE/I finance team review and due diligence processes will take place once the Tier 4 CAMHS financial due diligence has been completed. The main issues to be addressed as part of due diligence will be:

Ensuring that the budget considers geography changes associated with CCG mergers in the South West

Viability of the Eating Disorders Provider Collaborative in respect of available specialist inpatient capacity

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Extra Packages of Care validation

For all 3 Provider Collaboratives clarity is required on the intended NHS Provider uplift for FY21-22, that is whether 1.4% or 2.8% will be applied.

2. Provider Collaborative Quality ApproachThe Quality Maturity Framework clearly sets out the Provider Collaboratives responsibilities in terms of quality assurance and improvement and delineation of commissioning from the Lead Provider activities.

Pending go live all 3 Provider Collaboratives are collaboratively working with the South East NHSE/I Regional quality team to oversee the quality of providers across the Provider Collaborative, operating at level 2 (Normalising Level) of the Quality Maturity Framework. The Adult Secure and Tier 4 CAMHS Provider Collaboratives continue to operate quality assurance and oversight processes whilst developing the networks quality assurance and improvement framework and approach. This includes ensuring there is:

Day to day responsibility for high quality services being delivered across the Provider Collaboratives demonstrating good patient experience and outcomes;

Robust systems of governance with visible mechanisms of quality assurance from Ward to Board and into the Provider Collaborative Partnership Board;

Robust escalation and risk appropriate responses for notification and management of concerns to include any adverse events/ incidents/ safeguarding/ inability to meet service specifications, across the Provider Collaborative, managed via the Lead Provider;

Provider Collaborate delegated responsibilities for all elements of commissioning.

It should be noted that NHSE/I retain statutory accountability deriving assurance via this framework. Following go live the Provider Collaboratives will formally lead and take responsibility for quality assurance and improvement, following agreement with NHSE/I that the Provider Collaborative meets level 1 (established and optimising) of the framework.

3. Provider Collaborative Contracting ApproachThe Adult Secure and Tier 4 CAMHS contractual arrangements are on track to achieve the planned 1st April 2021 go live timelines. However, it should be noted that finalisation of the prime contracts and sub-contracts will be dependent upon delivery of:

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Final business cases agreed by all Provider Collaborative partners to inform arrangements by 31st December 2020;

Completion of OHFT and NHSE/I regional finance due diligence workstreams for each Provider Collaborative by 31st December 2020;

Prime contract Price and Activity matrix for both Main Track Provider Collaboratives by 31st December 2020;

Finalisation and signature of the Provider Collaborative Heads of Agreement and Partnership Agreements by 31st December 2020;

Publication of the FY 21-22 NHS Standard Mental Health model contract by early March 2021 at the latest.

Provider Collaborative Prime Contracts FY20-21:The Adult Secure and Tier 4 CAMHS Provider Collaborative Heads of Agreement have been jointly developed with NHSE/I to include the principles agreed to date with OHFT Executives, as a document to be relied upon within the prime contract. The Provider Collaborative Heads of Agreement will govern the extended shadow period from 1st April 2020 until the Main Track Provider Collaborative prime contracts are signed, with no requirement for signed Management Agreements in FY20-21. These will require signature by OHFT and NHSE/I by 31st December 2020.

The Adult Eating Disorder Provider Collaborative Management Agreement has been jointly developed with NHSE/I to govern the extended shadow period of FY20-21. This will require signature by OHFT and NHSE/I by 31st December 2020.

Provider Collaborative Mental Health Model Contracts inclusive of the Provider Collaborative Price and Activity Matrix (PAM):OHFT recommenced building the model contract for the OHFT Provider Collaboratives in October 2020. The contract terms will be 3 years duration for the Adult Secure and Tier 4 CAMHS Provider Collaboratives (1st April 2021 – 31st March 2024) and 2.5 years for the Adult Eating Disorder Provider Collaborative (1st October 2021 – 31st March 2024), with the sub-contractor terms being locally determined to enable Provider Collaborative commissioning flexibility.

The final Provider Collaborative budgets for Adult Secure and Tier 4 CAMHS were received from the National NHSE/I Finance team in October 2020 and are currently subject to joint OHFT and Regional NHSE/I finance review to ensure robust and appropriate due diligence. The final OHFT (Lead Provider) Provider Collaborative PAM is awaited from NHSE/I. Completion of OHFT financial due diligence is required in order to confirm the prime contract and sub-contract values and

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enable progression of the prime contracts, single action tender waivers and sub-contract builds. The prime contract will require agreement and signature by OHFT and NHSE/I by 31st March 2021.

Partnership AgreementsIt should be noted that the New Care Model Collaboration Agreements remain valid and continue to apply until each of the Provider Collaboratives go live.

The Adult Secure and Tier 4 CAMHS Main Track Provider Collaboratives are progressing final revised versions of the Partnership Agreements to ensure they fully reflect partner membership; rebranding codesigned with service users/carers; final governance structures terms of reference; final risk and gain share approaches agreed with partners and the approach to the learning disability and autism pathway fund (previously known as the Financial Transfer Agreement). It is noted that the Partnership Agreements should be agreed and signed by all partner members by 31st December 2020 to align with the Heads of Agreement.

The Adult Eating Disorder Provider Collaborative are progressing the final draft of the Partnership Agreement, which will require agreement and sign off by all partner members by 31st July 2021.

Provider Collaborative Partnership Information Governance A nationally mandated contract variation order was circulated by NHSE/I in November 2019 and has been signed by all specialized mental health providers referenced within all the Provider Collaborative partnership agreements. The contract schedule 2G and F variation provides the national legal framework for sharing information and commissioning data across the Provider Collaboratives.

Sub-ContractsFor all the sub/contracts between OHFT as Lead Provider and Provider Collaborative provider partners, a mandated NHSE/I template is to be used with anticipated publication of the template in early March 2021. The Adult Secure and Tier 4 CAMHS Provider Collaborative sub-contracts should be agreed and signed by 31st March 2021, and Adult Eating Disorders by 30th September 2021. A 3 month long stop period is available for each sub-contract if required.

The final budgets for the Adult Secure and Tier 4 CAMHS Provider Collaboratives were received in October 2020, enabling OHFT, as commissioner, to commence sub-contract PAM development in liaison with partners as an integral part of financial due diligence and in accordance with a system approach to roll over all provider

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bed/occupancy levels in Year 1 of the contract, in order that provision is not destabilised. Service Development Improvement Plans (SDIP); Data Quality Improvement Plans (DQIP) and CQUIN are under development and contract negotiation with partner providers.

Sub-Contractor Direct AgreementsAs a Lead Provider there is a requirement to have sub-contractor direct agreements between NHSE/I, OHFT as Lead Provider and partner sub-contractors to enable step in rights if the Lead Provider contract is terminated, using a mandated national template. Agreement and signature of the direct agreements will be aligned to those of the sub-contracts, with a 3 month long stop period available if required.

Out of Area PlacementsFor all 3 Provider Collaboratives, the out of area Provider Collaborative patient placements will be formalised under sub-contract arrangements. Scoping has been completed for Adult Secure and Tier 4 CAMHS Provider Collaboratives, entering contracting discussions with the host/placing Provider Collaborative and mental health providers as appropriate. Agreement and signature of the direct agreements will be aligned to those of the sub-contracts, with a 3 month long stop period available if required.

Provider Collaborative Quality Reporting / Prime Contract complianceIn readiness for go live, the Adult Secure Provider Collaboratives have reviewed all contractual reporting and oversight processes and have commenced monthly aggregate reporting to NHSE/I Regional team from November 2020, and chairing and administration of partner provider contract quality review meetings.The Tier 4 CAMHS Provider Collaborative are reviewing quality requirements and developing shadow form reporting processes with partner providers, to commence in Q4 FY20-21. The Adult Eating Disorder Provider Collaborative is on hold until April 2021 (go live of Adult Secure and Tier4 CAMHS Provider Collaboratives) in order to apply lessons learnt.

4. Provider Collaborative Business CasesDraft business cases have been progressed in collaboration with partners from each of the Provider Collaboratives, outlining the case for change, clinical and business models. These were presented to the NHSE/I Provider Collaborative Approval Panel in December 2019 with agreement to finalise the business cases once the financial due diligence had been appropriately completed and to progress through OHFT and partner Board approval processes ahead of go live timelines. All other aspects of the final business cases have been completed, and

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substantive recruitment has completed to all operational and quality roles within the Adult Secure Provider Collaborative programme team and recruitment being progressed to complete the Tier 4 CAMHS Provider Collaborative programme team.

As previously outlined following completion of the financial and contractual due diligences processes the Adult Secure and Tier 4 CAMHS Provider Collaborative business cases will be presented to the Financial and Investment Committee on 19th January 2021 and the OHFT Board on 27th January 2021 where it is anticipated that formal approval will be sought to progress to go live status on 1st April 2021.

The suggested revised timeline for securing Board and partners’ Board approval is detailed in the table below:

Proposed Provider Collaborative revised “go live” timeline

Adult Secure

Tier 4 CAMHS

HOPE

OHFT (Lead Provider) agree the Prime Contract and PAM with NHSE

31st December

2020

31st

December 2020

TBC

Revised Partnership Agreement with Provider Collaborative partners

31st December

2020

31st

December 2020

TBC

OHFT Financial and Investment Committee

19th January 2021

19th January 2021

TBC

CEO Steering Group – Final business case

January 2021 January 2021 TBC

OHFT Board approval 27th January 2021

27th January 2021

TBC

Submission final business case to NHSE/I

January 2021 January 2021 TBC

Relevant Partner Board approval February 2021

February 2021

TBC

Sub-contract and Direct Agreements with Provider Collaborative partners

31st March 2021

31st March 2021

TBC

Prime contract (OHFT as Lead Provider) signed with agreed long stop

31st March 2021

31st March 2021

TBC

Provider Collaborative “Go Live” 1st April 2021 1st April 2021 TBC

South East High Intensity Mental Health Service pathfinder (HIS) for Veterans

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In July 2020, Solent NHS Trust were awarded Lead Provider status, to lead the South East HIS Veterans Provider Collaborative. Prior to the contract award OHFT had no previous consultation with Solent NHS Trust or collaboration on the model proposed and business case submitted to NHSE/I.

Following contract award in the summer of 2020, OHFT and other provider partners noted that the proposed clinical model, crisis model and other operational interdependencies did not appear to meet the needs of the veteran population within the Buckingham, Oxfordshire and Berkshire (BOB) Integrated Care System (ICS).

Over the past 3 months, OHFT have worked with Solent NHS Trust, partner providers and the BOB system to agree an adapted clinical model that would appropriately meet the clinical needs of the veteran population in the BOB ICS.

OHFT and BHFT presented the adapted clinical model (see appendix 1), to Solent NHS Trust and NHSE/I on 22nd October 2020. With some minor agreeable changes, the clinical model was accepted on 9th November 2020 as a variation to the original Solent NHS Trust model for the BOB ICS. OHFT is awaiting an updated Partnership Agreement to reflect these changes. OHFT continue to work closely with BHFT to support the recruitment and implementation of the HIS BOB model.

As BHFT are the South-Central Regional provider for Veterans Mental Health Transition, Intervention and Liaison Service (TILS) and Complex Treatment Service (CTS), the proposal is that BHFT recruit to the 1.0 wte post allocated to OHFT (approximate funds 60k).

The timeline for a ‘go live’ date is yet to be agreed as OHFT are awaiting sight of the amended Partnership Agreement. Solent NHS Trust have funding until March 2022.

RECOMMENDATIONS

Thames Valley and Wessex Adult Secure Provider Collaborative and Thames Valley Tier 4 CAMHS Provider Collaborative

It is recommended that the Board notes the key achievements to date, progress on the completion of due diligence processes and the milestones required for Board approval processes.

The Board approves the decision to seek signature of all Provider Collaborative members to the Provider Collaborative Partnership

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Agreements to align with the Heads of Agreement by 31 December 2020.

The Board notes that the full business cases will be presented to the Finance and Investment Committee on 19th January 2021 and OHFT Board on 27th January 2021 where it is anticipated that a formal decision will be made on progressing to Provider Collaborative status on 1st April 2021, with OHFT as Lead Provider.

HOPE Adult Eating Disorders Provider Collaborative

The Board notes that the HOPE Adult Eating Disorders Provider Collaborative is on the Development Track with a provisional timescale for go live in October 2021. The Provider Collaborative Partnership Agreement timeline for ratification by all partners is noted as 31st July 2021.

South East High Intensity Mental Health Service pathfinder (HIS) for veterans

It is recommended that the Board notes the collaborative work undertaken to ensure that the veteran’s clinical model meets the needs of the BOB ICS population, and that assuming the Provider Collaborative Partnership Agreement reflects the changes that were agreed on 9th November 2020, OHFT proceed to become a key partner within the Provider Collaborative.

It is recommended that the Board agrees that working as the BOB ICS, BHFT recruit and are responsible for the delivery of HIS on behalf of OHFT.

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Appendix 1

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