John Dixon Executive Director Adults and Children ADPH Conference 21 st May 2010 How does partnership working between Health and Local Government Benefit my Role?

2 The Big Themes 2010  Personalisation  Families  Recession  Workforce  Integration/Integrated working

3 Personalisation  Personal Budgets 200,000  Personal Health Budgets Starting out  Key PPF Milestone Areas for April 2010: –Effective Partnerships with People using Services etc. –Self-Directed Support and Personal Budgets –Prevention and Cost-effective Services –Information and Advice –Local Commissioning

4 Recession  20% reductions in Local Authority Budgets  20bn in NHS  Pace of reductions?  Total Place – Cross party interest  Reshaping of public sector : takeover/merger or integrated working?  Tories promise to winnow out ‘bureaucrats’: SHAs/PCT’s/Field Forces/Regulators etc.

5 West Sussex Integration:Joint Adults and Children’s Department Integrated working:PCT and Council £200m pooled budgets/joint commissioning. Plans for £800m Seconded PCT Executive Director – Joint Commissioning Joint DPH and Commissioning Posts Personalisation:Personal Budgets from 1700 in Sept to 2600 in March 2010 Personal Health Budgets based on PbC : Carers, CHC, Children with Disabilities Families:Whole life disability service being developed.

6 Integration : The Policy “To make our vision for the future of care and support a reality… we need more joined up working between health, housing and social care services and between care and benefits services” Care & Support Green Paper “We need to reform adult social care services, improve integration with health and make services more preventive in nature… we will greatly increase the integration of services by doing more to shape them around patients and to ensure that the boundaries between organisations do not fragment care” NHS From Good to Great “At the heart of this is transforming patient pathways, leading to the integration of services and in some cases, the integration of organisations” NHS Operating Framework

7 Takes time.....more time...and more time Divided by a common language Don’t just move the desk chairs Health is not democratic Professional empires threatened NHS is wealthy relation Prescribed partnerships limited value Remember the added value

8 Integration : Top Facilitating Factors  Friendly relationships  Leadership  Commitment from the top  Joint strategy  Joint vision  Coterminosity  Additional funding  Patient and user focus  Front-line staff commitment

9 Integration : Top hindrances  Performance regimes  Financial pressures  Organisational complexity  Changing leadership  Financial complexity  Culture  Data and I.T.  National policies  Local history

10 So………….  None of the top 6 factors which help are mainly national  But the top 2 and 3 of the 5 factors which hinder are national  Only 20% of the factors which help are national issues  So the centre can probably do more harm than good – it can limit local ambition and progress but can probably do little to create and stimulate joint working

11 Effective Joint Commissioning All about patient/care pathways Best mix for patients of health/social care/Third Sector input From self-care to tertiary care Choice and control – from professionals to users/patients Transferring activity and finance within care pathways - the ‘5% plus’ test Joining the two commissioning frameworks Achieving: –user satisfaction –clinical outcomes –reconfiguration –financial sustainability

12 Familiar Problems, New Solutions Familiar problems Old solutionsNew solutions Working with users and carersFormal consultation on plans Nominal representation on planning groups User-led services Managing budget pressuresHolding vacancies Gate-keeping panels Slippage savings Central control Long-term strategic perspective Aligned operational and financial management Reliable delegated systems Workforce pressuresAgency staff Acting up/cover arrangements Posts left vacant Unmanaged workload Workforce strategy Improving skill mix Integrated teams Better forecasting information Modernising social servicesInnovative projects Focus on process/procedures Reinvesting in old services Incremental change Mainstream change via Best Value Commissioning ethos Defining critical success factors Evidence-based Getting the best from partnerships Joint planning forums Spending ring-fenced monies Sharing information about intentions Pooled budgets Joint commissioning Integrated frontline teams Joint management