How do we ensure the successful uptake and spread of provider innovation across the NHS? Chair: Matthew Winn, Chief Executive, Cambridgeshire Community Services NHS Trust Speakers: Kath Evans, Head of Planning and Delivery - Hospital to Home Programme, NHS England Karen Howell, Chief Executive, Wirral Community NHS Foundation Trust Nick Hulme, Chief Executive, The Ipswich Hospital NHS Trust

Bringing community based care centre-stage Kath Evans Head of Planning Delivery twitter @kathevans2015

Three priorities for frailty Change in approach to health & social care for older people Preventing poor outcomes through active ageing Quality improvement in acute & community services

Proposed Service model Current position 10 Year Vision Proposed Service model Ageing population 2040 nearly one in seven will be over 75 Frailty prevalence increasing A person with mild frailty has twice the mortality risk of a fit older person at the same age Currently people with frailty don’t always get the care they need in the right setting and at the right time Hospital interventions for some people with frailty are limited in efficacy Opportunities for prevention There are currently 4000 hospital admissions a day for people with frailty Intermediate care gap National audit data (NAIC 2017) suggests intermediate care capacity needs to double An NHS priority To help older people stay healthy and live independently in their communities: work already underway The NHS now has an opportunity to be world leading in our approach to population ageing & caring for older people Implementing at scale support for people in community settings Working with social care we will take a new joined up approach Using population segmentation to focus appropriate care on the needs of older people vulnerable to the effects of frailty We will continue to support older people with advancing frailty in their communities to the end of their life Ageing Well (MDT) Service Urgent Community Response and Recovery Service Enhanced health in Care Homes (EHCH) Implementation will be developed from existing and best practice in an adoption and improvement approach.

Meaningful Integration - Health and Social Care 9 October 2018 Karen Howell Chief Executive Wirral Community NHS Foundation Trust

Towards Integration – our Starting Point Improving outcomes for local residents – Trust in unique position Primary driver not just about efficiencies Understand and embrace – integration rather than absorption National and local context provided ideal landscape –Board and Local Authority intentions Recognition of inter-dependencies between health and care Benefits – personalised and strength based approach Our journey took two years with key stages: co-location, stakeholder engagement, consultation and business case

Our Integration Journey… So Far 5 year Section 75 contract – signed June 2017 Delegated responsibility for range of Care Act Duties Transfer of 220 Adult Social Care staff to Trust Draw down of £58m Community Care budget – 1.5m efficiencies achieved in first year 2017/18 Pre transfer performance maintained or improved Positive feedback from residents, staff and commissioners Safe Transfer 2017 Stabilisation 2017-18 Transformation 2018 -2020

Critical Success Factors Strategic leadership from Chief Executive - identified as organisational priority Appointment of Associate Director Adult Social Care – statutory oversight and guidance for Board Early engagement of staff and unions – professional identity Dedicated programme management with two tier governance structure Attention to detail – independent due diligence around potential deal breakers – pensions, performance expectations, financial resource Early establishment of professional standards, Partnership Governance Board and robust contract monitoring

Initial time scales slipped due to complex nature of negotiation Earlier Development of Service Specification / Operating model would have assisted – more detailed required at point of due diligence. Challenge of transferring non NHS services should not be underestimated, including complexity of ‘Purple Book compared to Agenda for Change’. Challenges around transitional buy back arrangements – eg Recruitment

Integration and Beyond Longer term view of Green Paper and regulation – peer review System wide transformation priorities – Neighbourhood, Place Based Care Recruitment of NED for Social Care Internal transformation phase for Health and Social Care - development of integrated operating models, integrated leadership roles and digital strategy Contract developments – pooled com-care budgets Staff development, culture, governance alignment and strengthening

Meaningful Integration – What Really Matters “I was pleased that I didn’t get passed from pillar to post and that I had 1 worker to deal with, thank you as it has reduced the stress” Local Resident “Integration has allowed us to learn from each other and improve our skills , this then improves the way we carry out our job role and this benefits all service users.” “I feel more positive when visiting clients as I can give them a clearer picture of what's available to them “ - Practitioner “Relationships with health colleagues have improved significantly” “I really enjoy integrated working and feel it benefits my role immensely.” And we continue to test …….. ”Demonstrates a continued good evidence of robust approach to professional standards and compliance, linking with clinical governance” Commissioner “It was a really good service, I had visits from enablers , office staff and Occupational Therapists, who all ensured I was able to manage” Resident

Integration Plan - First 100 Days

How do we ensure the successful uptake and spread of provider innovation across the NHS? Speakers: Nick Hulme, Chief Executive, The Ipswich Hospital NHS Trust