Health and Social Care Integration – Delivering the Outcomes Leadership and Clinical/Care Governance in an integrated CHCP - A perspective from Inverclyde Derrick Pearce - Service Manager ICHCP Cathy Roarty – Professional Nurse Advisor NHSGGC Jane Cantley – Service Manager ICHCP Brian Polding Clyde – Development Worker, Scottish Care Ian Bruce – Executive Officer, CVS Inverclyde

Aims Introduce Inverclyde CHCP Reflect on forming the CHCP and creating structures to support safe and effective service What we have in place to ensure safety and efficiency/ quality Operational Examples Discussion

Inverclyde CHCP Covers the towns of Greenock, Gourock and Port Glasgow Serves a population of around 79,000 people High levels of deprivation and health and social inequality Higher than average incidence of ill health and poverty High levels of community participation and engagement Strong feelings of community Strong history of on the ground joint working – some joint services since 2001 Well established and proactive 3 rd sector

Inverclyde CHCP Parent organisations are Inverclyde Council and NHS Greater Glasgow and Clyde Around 1500 staff (two thirds Council staff, one third NHS staff) Organised into four service sector areas: Health and Community Care; Children and Families and Criminal Justice; Mental Health Addictions and Homelessness; Planning, Health Improvement and Commissioning Established in October 2010 Fully integrated management structure, down to team leader level Includes some inpatient services

Our key drivers in relation to governance and practice leadership NHS Quality Strategy Changing Lives and Practice Governance Framework Professional specific codes and regulations Public Bodies (Joint Working) (Scotland) Bill, 2013 “We are going to do this… there will be a law – and people will have no other option, so integration will have to be done” (Scottish Parliament Health and Sport Committee, 2013)

Reflections on integration Need for strong professional identity Need to maintain practice standards Need to ensure safe and effective service interventions Need to deliver as a new entity in both parent organisations Need to demonstrate the value of integration – operationally for our community, as a partner, financially…

Reflections “Whatever the type, breadth or degree of integration aimed at, the challenge is often the implementation in practice. However, the process of integration, in itself is also described as multi faceted in nature, requiring the integration of structures, processes, cultures and social relationships” (Minkman, 2012)

Reflections “… one of the greatest challenges [of integration] will be the difficulties of bringing together two large groups of staff who have their own cultures, systems of governance, terms and conditions…” (UNISON)

What we have in place to ensure safety and efficiently/ quality Based on the Changing Lives Practice Governance Framework: Risk, Discretion and Decision Making Self and Self Regulation Developing Knowledge and Skills Guidance, Consultation and Supervision Information Sharing and Joint Working

Risk, Discretion and Decision Making Risk management framework and Integrated Risk Registers (to team level) Revised care planning and review models Clinical and Care Governance Committee Integrated Health and Safety Committee Protection Committees and associated structures Joint performance framework – Joint Organisational Performance Review and Quarterly Service Performance Reviews Intention for local large scale event to review governance and practice oversight in context of CHCP – early Quality Assurance Framework in development

Self and Self Regulation Practice Governance Group Practitioners Forum Whistle blowing/ incident reporting Peer Review and Self Assessment Practice teaching and assessment Personal development and growth Trust Networks with 3 rd sector and Provider Fora “you know you’ve cracked it when there is only one kettle in the kitchen” (Sullivan and Williams, 2002)

Developing Knowledge and Skills eKSF/ Appraisals and Development Frameworks CHCP Training and Development Team/ Centre Integrated staff developing programme and reporting (extended to 3 rd sector and independent sector) CHCP Development Group and Practice Development Sub-group Practice Development Staff Cross sectoral training and development “joint working is [about] creating new ways of thinking and models of care bespoke to joint working. This means that there is a need to focus attention on how knowledge is created rather than just upon how knowledge is exchanged” (Hubbard and Themessl-Hubbard)

Guidance, Consultation and Supervision Chief Social Work Officer/ Clinical Director/ Professional Advisors General management/ professional leadership Integrated people involvement structures and framework Staff Supervision developments Reflective practice developments Healthy Working Lives – staff wellbeing Joint Staff Partnership Forum – staff governance

Information Sharing and Joint Working Data sharing agreement/ partnership System integration Electronic IAF Shareable assessment Working with 3 rd and independent sector “[there needs to be time] for a Social Worker and a District Nurse to sit down and explain to each other the limits of practice within their regulatory bodies, and what they [are] allowed to do and not to do to enable proper joint work” (RCN)

Operational Examples An integrated approach to palliative care in Inverclyde Healthy Children Programme GIRFEC Public Protection Dementia Friendly Inverclyde/ Dementia Strategy

An integrated approach to palliative care in Inverclyde Partnership: NHS community nursing teams – including out of hours Local Authority Homecare teams Third Sector - Local hospice Local District General Hospital Work programme includes: Joint training on principles of palliative care, assessment, care planning and delivery of services Joint commissioning of research and evaluation to scope issues and make recommendations Review and implementation of recommendations (most in place) Development of patient pathways

Healthy Children Programme Local Implementation Group Joint SW and Health practitioner development days GIRFEC Implementation group - with local interagency groups for Named Person, Lead Professional, National Practice Model and Child’s Plan. Parenting initiatives Early Years Collaborative

Discussion… For further info from any of our team please contact: or call on