VSNW Conference October 2014 Better Care and Integration Sue Lightup – Strategic Director, Salford City Council and Chair of ADASS NW

The Better Care Fund A Mechanism to move money round the system – NHS and Social Care, largely from acute care into community and social care Recognises the interdependencies of the whole system Responsibility of the Health and Wellbeing Board To achieve integrated health and social care, better outcomes and performance related There are 7 national conditions, including a 3.5% reduction in admissions, 7 day a week working

Better Care fund – the story so far! Joined up discussions First submission – draft/early version March 14 Formal submission signed off by HWBB - April 14 Consternation – June 14 New conditions set out -July 14 All plans to be resubmitted – Sept 14 Followed by national assessment, moderation, categorisation and staggered implementation dependent on the category assigned Process - Process – Process! And Painful.

What’s the point – the theory and the practice Creating better outcomes with much less resources Reforming Health and Social Care – locally, regionally and nationally Increasing personalisation and co-production A sustainable system? Shifting emphasis from deficit to assets base An extended pathway of support including community resilience A clear sense of place

Moving on Strong and Effective Leadership across the whole system – individually and in HWBB’s Innovation Letting go New relationships Much harder if you aren’t co-terminus or your hospital hasn’t agreed, if you are in financial deficit, or special measures Outcomes has to be the key driver

Financial Benefits of close relationships to Salford residents Prior to 2010 – risk pooling in joint budget reduced likelihood of overspending – 10 years more stability than many others Handover of historic £6m to LD funding in 2009 A variety of section 75 agreements Formal agreement to NHS funding transfer –2011/12 –2012/13 –2013/14 –Plus one off not recurrent support from PCT –Transfer of PH - £19m one of highest levels in GM –Alliance agreement in 2014

What’s been agreed to date PSR across GM involving the re shaping of hospital provision, primary care and council/social care. History of strong partnership working in section 75 a arrangements. Covers more than many other councils Section 236 transfers in the last few years from NHS Better Care fund and integration approach as part of an Alliance between the Council, the CCG, Salford Royal and GMW Mental Health trust To achieve better outcomes for Sally Ford, an improved experience for her, and a reduction in demand, therefore cost.

Relationship with the Voluntary Sector Interdependent Complex Yet rich in depth and tone Flexible enough? Encouraging enough? Honest about what can be achieved? Competitive for limited resources but still able to challenge Independendence

Place: Greater Manchester Health and Social Care system 2.6 million people 10 local authorities 1 Combined Authority 12 CCGs 8 acute trusts with 10 A&E departments (including 3 Teaching Trusts) 4 NHS Trusts in the FT pipeline 1 specialist cancer trust 4 Mental Health Trusts 1 ambulance trust £6bn health & social care spend