RISK SUMMIT ADASS YORKSHIRE & HUMBERSIDE

RISK SUMMIT A overall picture of risk in all 15 councils over the last 5 months An overview of the common risks across the region – the regions top 10 risks Have the risks changed from the picture that was emerging in November? What areas need regional support for mitigation – top 3 priority areas? We need a reality check – are these today’s risks? Compliment, feed into and shape the regional work programme/improvement plan Outcomes of today – Share and understand the common risks we are facing, Identify the priority areas for regional focus Shape the regional work programme to support improvement

TEASC RISK AWARENESS ASSESSMENT Yorkshire & Humberside – Overall Analysis Dave Roddis – ADASS Y&H Sector Led Improvement Support Officer

TEASC RISK AWARENESS TOOL

KIRKLEES AND YORK EXPERIENCE Initial Feelings: Valuable stock-take Intensive need to find a way of streamlining Requires external challenge Find a way it can become a ‘live’ tool and not just an annual assessment Feels like a mini peer review – language of risk is more acceptable than areas of weakness. Shared Risks: Care Act Phase 2 The Budget and future efficiency agenda Acute Sector and System Resilience Deprivation of Liberties Workforce Capacity - Health and Social Care Quality of External Provider and Market Failure Integration and partnership with Health

RISK AWARENESS IN Y&H Pilot Phase – Kirklees and York (June to August 2015) – endorsed Adopted by Y & H DASS’ in September 2015, regional approach – regional overview All 15 Councils carried out the assessment – a variety of approaches Launched at NCAS Conference – October 2015 – amended! Open and honest conversations – ‘risk rather that areas of weakness’ Internal use - Identification of key risks and mitigating actions Some consultation with lead members and Chief Executive, Sign off from DASS Emerging Top 10 in November – DASS Branch Meeting Phase of external challenge agreed – some still outstanding Completed draft assessments between August and November, DASS sign off from all over the last 2 months But does it reflect today’s risks?

RISK ASSESSMENT OUTPUTS AND SECTOR LED IMPROVEMENT Councils have: Self-assessed Identified key risks/mitigation – risk register? Informed key strategies & plans Identified where regional and peer support is needed Identified need for peer challenge Through Sector Led Improvement regionally we have: Used this as the foundation of the SLI MOU approved by Chief Executives Identified and delivered master classes Targeted peer support Informed peer challenge programme Developed the regional account Started to develop the concept of a live ‘risk dashboard’ through S&P Agreed to use the overview to inform the future regional work programme

REGIONAL COMMON RISKS What keeps us awake at night?

DOMAIN 1 – LEADERSHIP & GOVERNANCE Budget Pressures Senior Management Changes Capacity to deal with demands Service Quality Joint Working with Health No External Assessment of Services

DOMAIN 2 – PERFORMANCE & OUTCOMES (INCL. SAFEGUARDING) Safeguarding DOLs Making Safeguarding Personal/Safeguarding Arrangements No External View/Challenge on Safeguarding Performance Hospital Discharges – DTOC Direct Payments/Self Directed Support Admissions to Residential Care Pressures on Front Line Reviews and Assessments DOL’s and Safeguarding Pressures and Demands New ways of working – coping with constant change

DOMAIN 3 – COMMISSIONING & QUALITY Service Quality Quality of care homes and the risk of Home Closure Market Failure of Home Care Lack of QA and Contracting Resources Care Quality Commission Inspection Impact Market Position Nursing Care Capacity Long Term Sustainability of the Market Lack of Alternative Provision – Extra Care, Supported Living

DOMAIN 4 – NATIONAL PRIORITIES AND PARTNERSHIPS Partnerships within the NHS Integration/Joint Working Relationship issues Governance Data Sharing Quality Issues Better Care Fund Winter Pressures Other National Priorities Care Act Compliance Transforming Care

DOMAIN 5 – RESOURCES AND WORKFORCE MANAGEMENT Use of Resources National Living Wage/Cost of Care Budget - Delivery of Savings Targets Future Savings Plan Overspends Running out of Reserves Workforce Management Workforce Capacity Recruitment Nursing Care Shortages DOL’S Transformation/Culture Change Reducing Workforce Tesco/Aldi Effect Impact on the Quality of Care Can the Independent Sector Cope?

DOMAIN 6 – CULTURE & CHALLENGE Participation in SLI Local Account Development Local Performance Management New IT Systems Being Developed Performance Management and Reporting Arrangements Peer Review / External Challenge Member Scrutiny Organisation culture and development Workforce Transformation Staff Vacancies

NOT ALL DOOM AND GLOOM!!! Adult Social Care is clearly visible in Councils Making Safeguarding Personal is being embraced with ambition When something goes wrong – you act!! Great stories of how you support the most vulnerable Innovation is apparent – commissioning, working with vol. sector, learning from customers Relationships improving with CQC to improve quality of care Commissioning for Better Outcomes is widely used as a tool for improvement Integration is firmly on the agenda Delayed Transfers of Care – You have plans in place, despite the scrutiny!! Adult Social Care has been broadly protected so far….. Winterbourne has been taken seriously – real commitment for it not to happen here Sector Led Improvement embraced – you see the benefits, buddy arrangements All produce a local account – not every region can say that Recognition that co-production is critical to future service delivery and improvement Lots of good practice that needs to be shared

THE REGIONAL ACCOUNT

TOP 10 REGIONAL RISKS 1.DOL’s 2.Quality of Care / CQC 3.The Budget 4.Workforce Capacity / Nursing Provision 5.National Living Wage / Cost of Care 6.Hospital Discharges / DTOC 7.Integration / BCF 8.MSP / Safeguarding Arrangements 9.Reviews and Assessments 10.No External View and Challenge

DOL’S WORKFORCE CAPACITY BUDGET SAFEGUARDING ARRANGEMENTS DTOC/HOSPITAL DISCHARGE QUALITY – CARE HOMES DTOC/HOSPITAL DISCHARGE SAFEGUARDING ARRANGEMENTS INTEGRATION/BCF NATIONAL LIVING WAGE QUALITY – CARE HOMES

KEY REGIONAL RISK & FUTURE FOCUS TABLE DISCUSSION & VOTING Based on the risk assessment and your risk’s today: Q1 - What are the top 3 risks we need to address as a region? Q2 – Factoring in your risks today, what else do you think the region should have a focus on?

PLACE YOUR VOTES NOW!!! Top 3 Priority Areas for Regional Focus 1.The Budget 2.Integration / BCF 3.Workforce Capacity

Better Care Fund Update for YH ADASS 11 February 2016 Moira Wilson - LGA Care and Health Improvement Adviser

Current guidance position  LGA and ADASS part of guidance author groups  DH/DCLG policy guidance released 8th Jan  NHS technical planning guidance outstanding – issues within DH and NHS England  This is holding up release of assurance guidance  Also holding up CCGs having full understanding of their budgets as they relate to BCF  LGA and ADASS pressing for outcome – joint letter sent to Jon Rouse last week

Improvements from 15/16  Pay for performance has been removed  Protection of adult social care condition has been maintained  Burden of planning, assurance and performance management processes have been reduced  Additional resource have been secured to support LG's part in the assurance process

Current local/regional activity  Localities to be drafting plans  Use draft guidance and template sent out by Mark Lloyd to Chief Executives in his bulletin of 15 th Jan  CCG can estimate budgets safely, so planning not held up  By 8 th Feb (or shortly after) localities to have agreed financial transfer to LG from NHS  Regions to be putting joint LG/NHS assurance process in place – ready for 8 th Feb

Support  LGA and ADASS national leadership/negotiation  Links with NHS England Better Care Manager (North)  LGA Assistant Director – Care and Health Integration, fortnightly calls  LGA CHIA  Better Care Advisors and KPMG’s wider offer

COMPREHENSIVE SPENDING REVIEW NHS vs Local Gov. settlement Social Care Precept BCF Integration plans Public Health