Health and social care integration in North East Lincolnshire Bev Compton Caroline Barley OED definition of integration: 1, the action or process of integrating 2, the intermixing of people or things that were previously segregated

What are we going to talk about? A brief overview of our integrated arrangements and strategy for adult social care An honest view of the challenges and opportunities Further developments - building prevention and community capacity

Where are we...(Map)

“Rather than comic book heroes, it is often local heroes and the efforts of individual staff that produce co-ordinated care” Andrea Sutcliffe 06/13 “People don’t want health care or social care, they just want the best care. This is a vital step in creating a truly joined up system that puts people first” N.Lamb 06/13 “People will see health and social care fully joined-up by 2018” DoH 05/13 “Unlike proposals for integration south of the border, they will require structural change: councils and health boards would be mandated to set up an "integration authority" in every area which would manage an integrated budget” CC 05/13 “Integration is about cultures, behaviours & values rather than structural integration” NHS Confed & ADASS 2013 What are people saying about Integration & does it fit with our experience and architecture?

What did we do In 2007 we created a Care Trust Plus. Adult social care services transferred to the new organisation and children’s health and health improvement services The council retained statutory DASS responsibilities including policy development, strategy and decision making. We don’t have a “client” function

March legal agreement with the CCG replaces the CTP The CCG manages: – operational budgets – the delivery of the strategy – provider contracts – market shaping – performance and quality and assures the council of the delivery of the strategy.

About the CCG as adult social care commissioner Doesn’t provide any services. The only integrated commissioning CCG in the country. Has 50 clinically led staff and are not internally spilt into ASC and Health. Commissions integrated provision under single contracts.

Adult social care strategy 4 themes: Managing demand Raising income Market re-shaping Efficiency

Children’s Trust: Navigo: NE Lincolnshire Council The NHS Commissioning Board NE Lincolnshire Clinical Commissioning Group (CCG) Integrated commissioning The Social care commissioning cycle The Health commissioning cycle Analysis Review Do Plan Analysis Review Do Plan Community hubs for the development of prevention and ‘staying healthy’ (priority groups 3 & 4) Working across Council responsibilities & Public Health The local care market – delivering or supporting people with P1 through to P4 needs Care Plus: Community health services; Intermediate Tier services (P2) General Practice: Treatment; Gatekeeping; Sign-posting. CSS Micro commissioning and supporting personalised care Health provision – acute and specialist provision including NLAG, Out of Area and other potential providers SW Practice: Safeguarding; Access (A3); Case mgt (P1). The commissioning approach in North East Lincolnshire SCG Health & Wellbeing Board 1: Health and Wellbeing 2: Local Strategic Commissioning 3: Micro-commissioning and market management

Integrated provision NE Lincolnshire Council NE Lincolnshire Clinical Commissioning Group (CCG) Integrated commissioning The Social care commissioning cycle The health commissioning cycle Health prevention (priority groups 3 & 4) Working across Council responsibilities & Public Health The local care market – delivering or supporting people with P1 through to P4 needs General Practice: Treatment; Gate-keeping; Sign-posting. Micro commissioning and supporting personalised care Health provision – acute and specialist provision Social work practice: Safeguarding; Access (A3); Case mgt (P1). The commissioning approach SG Health & Wellbeing Board

The transformation journey for the social care market in North East Lincolnshire /0812/1317/18 Eligible Not eligible Older people People with a physical disability People with a Learning Disability People with Mental Health needs ‘Traditional’ options of home care or admission to a care home Few alternatives unless you can pay privately Older people Staying Healthy [P4] Prevention services [P3] Intermediate Tier [P2] Flexible market informed by choice through individual budgets [P1] The journey ‘itinerary’: Early investment in the intermediate tier; Market development for quality & value for money; Developing choice through personalisation; Supporting self care; Developing provision by the third sector; Ensuring safety; Enabling supported living when safe and chosen; Managing demand; Neighbourhood responses; Robust financial and performance management; Understanding and managing a system. People with Mental Health needs People with a physical disability People with a Learning Disability

Service provision Community services and mental health services are provided by independent social enterprises - Care Plus and NAVIGO Social work assessment, case management and safeguarding is provided by an independent social enterprise called FOCUS. Residential care provided via a number of individual arrangements with private homes

What has this allowed us to do? Commission an integrated intermediate care service. Integrate learning and physical disability services from one provider. Stipulate and monitor how organisations should work together. Common terms and conditions Common culture, single leadership Integrated assessments Integrated approach to prevention, information and advice.

What has this allowed us to do? Created a single point of access an “offer for all”. Created a single electronic care record Smarter contracting and procurement Designing a “whole system” with a single strategy and action plan. Talking to providers with one voice Designing an integrated personal budget

Lessons learned Be clear about your starting point and what your shared agenda is Identify early what you are seeking to achieve Be clear about roles, responsibilities and accountabilities Watch the language! Relationship building is a key part of the governance; governance won’t work without strong, high quality relationships

Food for thought- Challenges to integration Organisational disintegration Example: Cancer Pathway in North East Lincolnshire Previously the whole journey was commissioned by the CTP/PCT 1.Prevention/awareness (smoking cessation) - North East Lincolnshire council 2.GP Appointment – North Yorkshire and Humberside area team 3.GP Referral to Hospital - CCG 4.Admission pre diagnosis - CCG 5.Treatment post diagnosis – South Yorkshire area team 6.Community Care Assessment - CCG 7.Community Nursing/GP support - CCG