To approve the learning disability community health service contract currently commissioned by the council naturally expires on the 31 December and responsibility to commission the service is transferred back to the Clinical commissioning group (CCG) from the 1 January 2018.

The council currently commissions the learning disability community health service on behalf of Herefordshire Clinical Commissioning Group (CCG). The report proposes that this function, along with the associated budget, be returned to the CCG from 1 January 2018. The service is currently provided by 2gether NHS Foundation Trust. The learning disability community health service is a clinical service for which the CCG has statutory responsibility. When the former Primary Care Trust was abolished, responsibility for commissioning the service, along with the associated budget, remained with the council. This arrangement continued for historical reasons rather than from an assessment of where commissioning of the service and its functions would be best positioned. The proposed return of the function and budget to the CCG will simplify governance and facilitate synergies with other clinical services commissioned by the CCG from 2gether.

That:

(a)  lead commissioning responsibility for the learning disability community health service is transferred to Herefordshire Clinical Commissioning Group (CCG), along with the base budget of £970k, on 31 December 2017;

(b)  a one off payment of £30k is paid to 2gether NHS Foundation Trust due to additional service cost pressures from 1 April to 31 December 2017.

1.    The council could retain commissioning responsibility for the service, and undertake a re-procurement exercise with the intention of having a new contract in place on 31 December 2017. This approach is not recommended as it has become increasingly clear that the services being commissioned are primarily centred on the delivery of healthcare, with significant medical aspects, and the council does not have the necessary clinical expertise to ensure appropriate clinical standards are met. There are also synergies with the mental health services already commissioned by the CCG from 2gether. In addition, continuation of the current arrangement would mean that risks associated with cost pressures in the service remained with the council.

2.    The service could be decommissioned, with no further extension or reprocurement of the current contract. This would result in a gap in service during the time from when the council decommissioned it until the point where the CCG was able to recommission it. This is not recommended as this would prevent a smooth handover of responsibility from the council to the CCG, resulting in a significant loss of support for some of our most vulnerable residents. There is an ongoing need for the service to be delivered.

3.    The council could decide not pay the additional £30,000 to support the financial pressures identified by 2gether. This is not recommended as 2gether have not received any contract inflationary increase during the time the council has commissioned the service.