Decision details

The County Council is playing an important role in the development of the three NHS Sustainability and Transformation Plans (STPs) across Surrey.

The Plans have to be completed and signed off by partners ahead of submission on 21 October 2016.

This report provides an update on the emerging STPs and asks for delegated authority for the Chief Executive in consultation with the Leader and Cabinet Member for Wellbeing and Health, to sign off the STPs on behalf of the County Council.

RESOLVED:

It is recommended that the Cabinet agree that:

1.    Surrey County Council will continue to jointly commission the Specialist School Nursing service with Surrey Clinical Commissioning Groups.

2.    the speech and language therapy service for special schools and specialist settings will be transferred to Surrey County Council alongside the mainstream school service from April 2017

3.    That approximately 64 staff will transfer across to Surrey County Council from April 2017.

Reasons for Decisions

Speech and Language Therapy

In February 2014, Cabinet agreed to issue new contracts to Virgin Care Services Ltd and CSH Surrey Ltd for an additional three years whilst joint commissioning arrangements were agreed with Health. These contracts expire in March 2017; therefore there is a requirement for new service arrangements to be in place from April 2017.

In May, 2015, Cabinet agreed the following decisions regarding the future joint commissioning and delivery of a Speech and Language Therapy Service in Surrey:

1.    that the Cabinet approves the draft commissioning strategy and the five joint commissioning principles within the strategy;

2.    that the Cabinet agrees in principle to the realignment of commissioning responsibilities for the Council and Surrey Clinical Commissioning Groups;

3.    that the Cabinet agrees for work to continue in developing a detailed costing model for a new speech and language therapy service. At this stage it is estimated to mean an increase of £377,000 in the Council’s budget, to be made available from the Schools’ High Need Block and will be subject to Schools Forum approval in June; and

4.    that the Cabinet agrees that the new speech and language therapy service should be procured through devolving funding directly to special schools and specialist centres and bringing the mainstream service in-house to the Council. This service will be fully in place from September 2016.

The joint commissioning strategy agreed between Surrey County Council (SCC) and Surrey Clinical Commissioning Groups (CCG) means the realignment of commissioning responsibilities for each organisation. SCC will become responsible for commissioning the school aged services and Surrey CCGs will re-direct resource into Early Years. 

This Cabinet paper sets out further changes to the proposals detailed in the May 2015 Cabinet paper. These changes are:

·         postponing the implementation date from September 2016 to April 2017. This date was put back whilst discussions took place with current providers of the service. Following further dialogue, both providers were satisfied that their concerns were being addressed and implementation could progress; and

·         bringing the service for specialist settings (Surrey special schools and specialist centres) into SCC to sit alongside the mainstream service.

A jointly commissioned service that brings the school-aged service into SCC will offer the following benefits. These include:

·         a service that achieves value for money – where the therapy service will be educationally focused and child-centred;

·         reducing the gap in accessing speech and language therapy input between children and young people who have an Education, Health and Care plan and those that do not;

·         offering a school-based delivery model rather than a health-focused one, will enable therapists to focus their time on supporting the child and school;

·         removing barriers in accessing the service, for example, restrictions relating to where a child might live or which GP the child is registered with will no longer apply;

·         investment into the early years service which reduces waiting times from referral and intervention, building trust and confidence in the system for families and reducing the number of children entering school with speech, language and communication needs;

·         jointly commissioned speech and language therapy services across Surrey for children and young people aged 0-25 years;

·         a service model which has been evidenced to work in other local authority areas and that has an impact on achieving positive outcomes for children and young people;

·         clear commissioning principles and arrangements in place with Education and Health, including funding responsibilities; and

·         improving the school offer in state funded provision, therefore instilling trust and confidence for families in the local school provision and reducing Surrey’s reliance on the non-maintained and independent sector.

The Children and Families Act 2014 is clear that most speech, language and communication needs form part of a child’s overall education needs and are not health related. On-going contract management of the current speech and language therapy services in Surrey has not been able to reshape a Health managed service into one that can provide schools with what they need to embed this service into their education offer for children and young people. In the new service, working days and leave will be organised around the school day and entitlement to the service will no longer be based on where a child lives or which GP a child is registered with. Recruitment, selection and training of therapy staff that is managed by an education service will ensure that staff are equipped with the skills and understanding to support schools and children and young people in the classroom. In addition, aspects of record keeping and training mandated by the Health service will no longer apply, freeing up therapists’ time to provide direct therapy support.

A jointly commissioned service between SCC and Surrey CCGs across Surrey will provide an equitable and consistent offer for children and young people aged 0-25 years. This means that children and young people will access the service based on need regardless of whether they have a statutory plan in place or not.

Approximately 64 staff will be transferring across to SCC from April 2017 and Cabinet should be reassured that a key set of principles with regards to TUPE are being applied to the process.

Special School Nursing Service

There was reference in the May 2015 Cabinet paper that the Council would cease funding of this service and resources would be re-directed into the new speech and language therapy service. This was ultimately not possible as the service would be effectively decommissioned. Instead, SCC negotiated a 50:50 funding arrangement with CCGs, improving the SCC position from the current funding of 66%.

The SEND 2020 programme focuses on the importance of developing local provision for children and young people with Special Educational Needs and Disabilities (SEND) through joint partnership with Health. Jointly commissioning the Special School Nursing Service supports the new SEND joint inspection framework and SEND Performance scorecard.