1. 9 th July, 2008. The Sedgefield Adult Community Care Partnership ‘Housing Health and Social Care Planning & Delivery- Local Examples’ Dennis Scarr Head of Community Services Sedgefield Borough Council Julie Waterworth Community Partnership Manager Sedgefield Adult Partnership

2. Policy Framework NHS Plan National Service Framework – Older Persons Planning and Performance Framework: Local Delivery Plans Supporting People Agenda

3. A case for improved integrated working in local communities We are sometimes providing the wrong services at the wrong time to the wrong people -we need to review how and where we spend our resources The rate of changes in health care must link to changes in social care and housing provision- The key providers must co-ordinate their service changes more effectively We are still driving a reactive approach to care and housing provision- we need to develop enhanced preventative services Not developing the types of care services needed in the future fast enough - we are too slow! Low overall user expectation -user expectations will increase in both needs & wants 33% increase in people needing care services in next 10 years- demand is increasing more quickly than ever before Govt will no longer tolerate poor performance or slow progress- cash rewards are available to those willing to change

4. Scope – Who Are the Users The communities we serve - specifically All adults over the age of 18 who are vulnerable due to: Physical ill health including those with continuing health care needs Physical frailty/disability including sensory impairment Older People with mental health problems

5. Users and Carers said ‘We have to be prepared to Challenge the ‘Professionals’ Who Think They Know Best ….. We Actually Do Know What Is best for Us’ ’10 Years of Talk and Glossy Brochures about Integration of Services.. Enough Talk…Just Do It!!’ User carer workshops 2003

6. S.S.D. HOUSING N.H.S. Aids & Adaptations

7. Overview Of The Design For The Sedgefield Partnership Voluntary agreement to operate in integrated way – not a care trust Integrated working managed by a partnership board 5 geographic integrated teams based around natural communities Co-location of staff from each organisation Appropriate access to services 24/7 Meeting community needs from prevention to direct service provision A one stop service team, capable of delivering both efficient care to people and effective preventive actions within their local community

8. Health Staff 46 District Nurses Social Services Staff 20 Social Workers/Social Work Assistants (Adults) Borough Council Staff 5 Supported Housing Officers Business Support 11 Business Support Officers Total budget of approx £12.5m (Non staff £.5m, Staffing £2m, Commissioning £10m) 5 Geographically Based Teams

9. Aim of Adult Community Care Partnership :- As a way of implementing integrated working between Health, Social services and the Local council in the prevention of illness provision of care promotion of Health To local people and the communities they live in.

10. Key workstream areas n IT n HR n Training n Performance Management n Finance n Business support n Legal n Accommodation n Communications

11. Activities within the integrated teams Care Management Process  Allocation of Referral/work within the team  Assessing Need – Individual and Community  Planning Care Packages  Implementing Care Plans Commissioning Services to meet health, social and accommodation needs/Managing Suppliers/ Service Delivery  Monitoring/Reviewing of on going cases Providing  Nursing Care  Health Promotion  Social Care  Housing Support Services  Adaptations  Therapy Support  Decoration/Maintenance Support  Rehabilitation and Intermediate Care  Voluntary Agency Links  Prevention

12. Challenges  Culture Differences - Staff - Agencies  Delegated Powers- Local Decision Making ‘v’ Corporate  One size fits All?  Professional Boundaries and Leadership  Finance – The ‘Fair’ Share Debate  Terms and Conditions, Policies and Procedures  Professional Development  I.T Systems  Learning other professions  Maintaining focus on the service user

13. Successes  Flexible, open referral route into system  Single Assessment  Common processes to assess needs  Users and carers receiving holistic support and can actually see improved performance  Shared I.T System to store data and run the service  Housing Support  Telecare  Telehealth  Extra Care - Allocations Integration – in one place not Virtual

14. Aspirations from Front line Staff  Wider skill mix - Mental health - OT’s  Pooled / shared budgets

15. Case Examples  Hospital discharge  Sheltered Housing  Telecare  Telehealth  Extra Housing

16. White Paper: Our Health, Our Care, Our Say Sedgefield Integration Model Model of Good Practice

17. The World Moves On – Experiment or Pathfinder ? 2007 Integration Review to establish model of Integration to roll out across County Durham.