1. Luton Whole Systems Integration Project Initiation Document CCG Board Update - June 2013

2. Contents 1.Case for change 2.Defining what integration means 3.What is the vision for services? 4.The strategic programme approach to integration

3. CASE FOR CHANGE Whole Systems Integration

4. Context 4 The challenge Rising demand: Luton’s older people population is expected to increase by 27% by 2030 Limited resources: Savings targets for 2013/14 are £4.2m for Children’s services, £3.7m for ASC and £9.8m for the CCG Fundamental structural changes are taking place nationally across health, adults’ and children’s services The opportunity Luton contains a single CCG, which has co-terminus boundaries with the Council Luton has a single acute Hospital The CCG and Council have developed good relationships and have already made progress on integration Health and Wellbeing strategy outcomes Priority outcome 1 Every child and young person has a healthy start in life Priority outcome 2 Reduced health inequalities in Luton Priority outcome 3 Healthier and more independent adults and older people

5. Case for change LBC and LCCG face the challenge of reducing national resources, local funding pressures, local demand pressures and a recognition that the current service model cannot achieve desired outcomes. Strategic opportunity to redesign services focusing on independence, early help and prevention, delivering improved outcomes at a lower cost. Limited financial envelope available especially in the context of the complex needs of the local population resulting in increased demand. Case for change to redesign the service model from the point of view of the patient or service user. A number of contracts across the whole systems economy which are due to be re-commissioned over the short and medium term presenting an opportunity for integration in these areas. The main examples are: -SEPT contract – South Essex Partnership Trust Contract for Mental Health -CCS contract - Cambridge Community Services Contract

6. Benefits of integration Improve outcomes Pathways are seamless and easy for the user to navigate. This will help to avoid the consequences of fragmented care, which can include avoidable emergency acute admissions, uncoordinated assessments, and unsuitable packages of health and social care Single view of the patient/service user across the economy improving the responsiveness of services to meet needs Single point of access Improve outcomes Pathways are seamless and easy for the user to navigate. This will help to avoid the consequences of fragmented care, which can include avoidable emergency acute admissions, uncoordinated assessments, and unsuitable packages of health and social care Single view of the patient/service user across the economy improving the responsiveness of services to meet needs Single point of access Financial benefits Shared management and other overhead costs (e.g. ICT and estates) as well as rationalised support functions Integrated service would enable financial benefits through: - Care closer to home that is person-centred, shifting care away from the acute sector - Consolidating management structures - Improving productivity - Removal of duplication - Improved targeting of resources Financial benefits Shared management and other overhead costs (e.g. ICT and estates) as well as rationalised support functions Integrated service would enable financial benefits through: - Care closer to home that is person-centred, shifting care away from the acute sector - Consolidating management structures - Improving productivity - Removal of duplication - Improved targeting of resources Quality and performance Increase the range of capability within both organisations allowing a high degree of tailoring of services according to individual needs An integrated service would allow joint working across the system increasing performance by focusing all resources on shared goals Pooling resources will protect resources devoted to core commissioning as for example support staff are used to assist an integrated team. Shared knowledge and IT enabling one view of population needs so commisisonining is more effective. Quality and performance Increase the range of capability within both organisations allowing a high degree of tailoring of services according to individual needs An integrated service would allow joint working across the system increasing performance by focusing all resources on shared goals Pooling resources will protect resources devoted to core commissioning as for example support staff are used to assist an integrated team. Shared knowledge and IT enabling one view of population needs so commisisonining is more effective.

7. Financial challenge Luton Borough CouncilLuton CCG Luton Borough Council face a funding reduction in the next CSR that is 18%. LBC are experiencing heightened demand pressures, which along with reduced funding is leading to pressure on Adults’ and Children’s services. Luton CCG is facing a challenge in adapting to a period of significant structural and financial challenge, as well as the pressure of providing healthcare to a growing population without a matching increase in funding. In 2013/14, LCCG are projected to overspend by £13m, and only £9.8m of QIPP targets have been identified to date, leaving a gap of £3.2m. The current year QIPP plan indicates that LCCG has reached the limits of tactical cost reduction Both organisations have reached the limits of what can be achieved as a single organisation; to meet the financial and demand pressures of the next five years, the two organisations will need to work closely to redesign commissioning and provision.

8. DEFINING WHAT INTEGRATION MEANS Whole Systems Integration

9. What are the objectives of integration? To reduce health inequalities and improve outcomes for service users, patients and carers. This will be enabled through: A planned move of resources towards prevention and early intervention away from avoidable treatment and care. Increased community and primary care investment to enable this to be a first choice for service users where appropriate. This shift will enable a reduction in the cost of service provision to meet the financial challenge faced by the Council and CCG.

10. What services will be impacted by integration? The services for consideration for ‘Whole Systems Integration’ are: LBC Adults Services (including some community living services, excluding housing) LBC Children’s services Health services Public Health services across both adults and children fdjfjf Services to be directly reconfigured - £174m These services will be redesigned as part of the whole system reconfiguration. They include, for example, residential care, district nursing, children with disability services and public health. Services that are impacted by integration - £96m These services will not undergo a redesign but the redesign will explicitly aim to impact activity levels, expenditure levels or quality of service. These include, for example, Accident and Emergency services. Services that are interdependent but not directly impacted - £76m These services will not be reconfigured or explicitly targeted for change. There may be indirect impacts through a more preventative model e.g. reduced expenditure on medicines but this will not be the explicit aim of the redesign.

11. WHAT IS THE VISION FOR SERVICES? Whole Systems Integration

12. Vision of service transition Mapping services across four ‘bundle’ areas depicts the vision for a change in activity over time as services are re-designed in an integrated way.

13. Vision for services focussed on Adults

14. Vision for services focussed on Children

15. THE STRATEGIC AND PROGRAMME APPROACH TO INTEGRATION Whole Systems Integration

16. How will services be redesigned? In order to move away from viewing services in silos four ‘Service bundle’ areas have been developed. Wellness - Universal or preventative services Early intervention - Targeted services for those who may be at risk in the future Help at home - Services for adults who need support in the community and children on the edge of care Specialist - Services for children in care and for adults and children who cannot be supported in the community, including acute the sector

17. What are the immediate opportunities A number of opportunities which are of a priority to the LBC and LCCG have been highlighted through the course of this project CART (Reablement team) - Early Intervention. Opportunity for a fully integrated team with pooled budgets and integrated management structures Intermediate Care Review - Early Intervention. Intermediate care pathway assessed starting with a review of bed capacity and capability across the system Children with disabilities – Specialist. Joint commissioning across a number of areas such as Children’s OT and speech and language therapy CCG Commissions Council for local services – Cross cutting. LCCG commissions LBC to provide some components of commissioning support. Enable LCCG to benefit from the local knowledge of population needs and shared infrastructure. Integrated commissioning of mental health service focused on independence and prevention – Early Intervention. Commissioning arrangement with single contractual relationship

18. What is the programme approach? Future programme phases will involve conducting an options appraisal around specific opportunities. From this process there will be a number of options agreed for each bundle area.

19. Proposed governance structures The proposed governance structure and delivery team for the future programme of work is outlined below.

20. Next steps 1.Sign off of Project Initiation Document at CCG board and Council Executive team 2.Agree resource requirements for next phase of work across CCG and Council 3.Identify lead officers for programme workstreams 4.Submit ‘Pioneer bid’ for Luton