1. Integration, cooperation and partnerships
Care Act 2014

2. Outline of content Introduction
What the Act says and the duties that fall to local authorities
The duty to promote greater integration
The duty to cooperate
Integration, cooperation and partnerships in practice
Working together: examples
Summary
[Facilitators Note: You can navigate these slides using the underlined links, and the Home button at the bottom right of each slide will take you back to this slide.

3. Integration, cooperation and partnerships are not new concepts
NHS Reorganisation Act 1973
The New NHS: Modern, Dependable 1997
Health Act 1999
Independence Wellbeing and Choice 2005
National Health Service Act 2006
Health and Social Care Act 2012

4. Why integration, cooperation and partnerships?
Improves the service user experience
Eliminates duplication
Streamlines care pathways
Early intervention and prevention
Improves safeguarding

5. What do we mean by integration, cooperation and partnerships?
Integration: The combined set of methods, processes and models that seek to bring about improved coordination of care
Cooperation: Public organisations working in partnership to ensure a focus on the care and support and health and health-related needs of their local population
Partnership: A joint working arrangement where the partners: are otherwise independent bodies; agree to co-operate to achieve a common goal; create a new organisational structure or process to achieve this goal; plan and implement a joint programme; share information, risks and rewards

6. What does the Act say?
Sections 3, 6, 7 and 43 of the Act require that:
“A local authority must exercise its functions under this Part with a view to ensuring the integration of care and support provision with health provision and health-related provision”
“A local authority must co-operate with each of its relevant partners, and each relevant partner must co-operate with the authority, in the exercise of their functions relating to adults and carers”
“Local authorities and their partners must co-operate where this is needed in the case of specific individuals who have care and support needs”
“Each local authority must establish a Safeguarding Adults Board (SAB) for its area... The way in which a SAB must seek to achieve its objective is by co-ordinating and ensuring the effectiveness of what each of its members does.”

7. What is the vision?
“The vision is for integrated care and support that is person-centred, tailored to the needs and preferences of those needing care and support, carers and families.”
Care and Support Statutory Guidance October 2014

8. Under what circumstances?
This duty applies where the local authority considers that the integration of services will:
“promote the wellbeing of adults with care and support needs or of carers in its area;”
“contribute to the prevention or delay of the development by adults in its area of needs for care and support or the development by carers in its area of needs for support, or;”
“improve the quality of care and support for adults, and of support for carers, provided in its area (including the outcomes that are achieved from such provision).”

9. Other legislation
The Health and Social Care Act 2012 (Sections 13N and 14Z1) also states that the NHS also has a duty to promote and secure integrated care where it will improve the quality of services, and reduce inequalities in accessing services or improve outcomes.

10. The five aims of cooperation
Promoting wellbeing
Improving the quality of care (including the outcomes from such provision)
Smoothing the transition from children’s to adults’ services
Ensuring agencies work effectively together to safeguard adults at risk of abuse or neglect
Reviewing and learning lessons from cases where adults have experienced abuse or neglect

11. With whom should local authorities cooperate?
Cooperation
Local authorities
District Councils
Other authorities
Health
CCGs
Hospital trusts
NHS England
DWP
Police
Prisons and probation
Others

12. Cooperation in specific cases
The general principle is one of cooperation in the day to day delivery of care
But there might be a need for cooperation, in the case of individuals, which goes beyond the general requirement
If specific cooperation is requested, either from the local authority or by the local authority, the partner organisation must respond unless it is incompatible with their own functions and duties
A person or agency must comply with a request for information from a Safeguarding Adults Board under certain conditions regarding issues involving a safeguarding case

13. Integration, cooperation and partnership in practice
Partnership, cooperation and integration need to be key components of a local authority’s strategic approach. This may be with a range of organisations (including other local authority functions, public sector organisations and the independent and private sector) and occur in a number of ways:
Planning and commissioning
Assessment and information
Care delivery
Quality assurance

14. Working with health services
Integration and cooperation must be delivered in the context of improving care and support, in line with the duty to promote wellbeing, prevent or delay the development of needs and improve the quality of care
There is a reciprocal duty placed on the NHS, specifically any NHS body within the authority’s area including Clinical Commissioning Groups, hospital trusts and NHS England

15. The boundaries of co-operation
Local authorities have a duty to meet eligible needs for care and support
Local authorities have a duty to make enquiries in cases of abuse
But there are restrictions on what they can provide in terms of health care, for example:
Nursing care provided by registered nurses
NHS Continuing Healthcare funded care
All partners need to be clear about their own responsibilities, and how they fit together

16. Discharge of hospital patients with care and support needs: Delayed Transfers of Care (DTOC)
A key area for local authorities and the NHS to consider working together
Provisions are made within the Act to reflect current care and support landscape for people who have both health and social care needs
The NHS can seek reimbursement from Local Authorities for a DTOC. This is intended to act as an incentive to improve joint working

17. Working with housing
Suitable living accommodation is a key ingredient in promoting physical and emotional health and wellbeing
Housing can also prevent or delay care needs from arising; as well as support existing needs
Local authorities must provide information and advice on care and support and this must include housing services
Local authorities are not expected to provide all housing services but should “make effective use” of other statutory, voluntary and private resources

18. Working with employment, training and education services
The wellbeing principle includes participation in work, training and education and as such local authorities must consider this as part of their care and support functions
Local authorities must:
Consider the links between care and support, employment and welfare when planning and commissioning
Ensure good quality information and advice including eligibility for benefits, disability benefits and employment support
Consider education, training and support when working with individuals

19. Working together: examples of integration, cooperation and partnerships
Strategic planning by building better commissioning arrangements or joint commissioning teams
Commissioning integrated services, or jointly commissioning specific services such as advice and advocacy services
Assessments, information and advice such as integrated health, care and housing assessments
Delivery or provision of care via integrated community teams, or working with housing providers to ensure that adaptations support independence, reablement or recovery

20. Strategic planning Joint Strategic Needs Assessment (JSNA)
Joint Health and Wellbeing Strategies and commissioning strategies
Local Development Frameworks
Joint commissioning teams
Joint governance structures
Pooled budgets
Development of combined approaches to the market through joint market position statements

21. Commissioning across agencies
Separate - independently and without co-ordination
Parallel – with reference to
other agencies
Joint – in partnership by separate agencies
Combined – through a single
organisation or partnership
Agencies have separate approaches and do not liaise e.g. the financial impact of services and policies on other agencies is not considered
Agencies liaise over commissioning activities e.g. separate cost, benchmarking and market intelligence shared by agencies
Agencies work jointly on commissioning activities e.g. a jointly researched and produced market position statement
Single, combined functions or arrangements e.g. a single, integrated commissioning function

22. Integrating assessment and information
Joint information and advice service - based around the needs of the end user rather than around individual services or structures
Integrated assessment processes
“Care co-ordinators”
Integrating assessment and care planning for carers

23. Integrating service delivery
District nursing
Occupational therapy
Physiotherapy
Care and repair
Community alarm service
Reablement
Assistive technology
Home Care
The need to integrate provision to help keep people within the community

24. Summary
The Care Act ensures that people should experience provision that works well together and where each participant know what the others are doing and why
The responsibility goes wider than just integration and cooperation with health services but to other services that provide care and support
The duty to cooperate is not just one way, and involves both a general requirement to cooperate as well as a specific requirement in the case of individuals