1. Integrated working in Mid-Nottinghamshire
Promoting health and independence, hospital avoidance and reablement

2. Adult Social care alignment with NHS services in Mid-Nottinghamshire
Nottinghamshire County (excluding City) :
3 health planning units
3 acute trusts, 1 healthcare trust
7 District Councils, 6 CCGs
3 referral pathways into Adult Social Care – Customer Service Centre, Hospital teams, Integrated Care Teams in Mid and South Nottinghamshire
Mid-Nottinghamshire Adult Social Care :
7 social workers embedded within the 7 Local Integrated Care Team
Short Term Independence Service (STIS) – M & A, N &S.
7 Older Adults social work assessment teams, aligned to LICT boundaries
1 hospital team covering 3 hospitals (1 acute, 2 community)
3 Community Learning Disability Teams, 3 Mental Health Teams, 3 Physical Disability Teams
18 Assessment flats and 15 assessment beds

3. Community Health and Social Care partnership developments since 2015
Catch-up meetings between senior managers every 2 months
Meetings of LICT Managers and OA assessment team managers every quarter
Pilot to embed Start Reablement provider staff within 2 LICTs, Feb – Aug 16
Audit of referrals from Call for Care to NCC Customer Service Centre, Oct 16 – Feb 17
Pilot to test demand for urgent social care assessment and provision at weekends, January to March 2017
LGA funded external evaluation of the Social Care role within integrated care teams, carried out by Nottingham Trent University – interim report June 17, final report expected Nov 17.
Early discussions about holistic working at unqualified level, reviewing the “Wavy Line” document, creative use of social care assessment beds/flats

4. Short Term Independence Service (STIS)
Problem to be solved :
Services across health and social care to support people needing “intermediate care” / step-up or step-down / START Reablement were fragmented, as social care staff working with these people were dispersed across 9 teams in Mid-Nottinghamshire. There was no common approach, clarity of purpose or opportunity to share learning and support each other. Staff did not work flexibly across the various different services.
Solution :
Existing social care staff and budgets were reconfigured during 16/17 to create new “STIS” teams across the County. Total 83 fte posts, with 54 fte in the START Reablement provider service.
Now – there are two STIS teams in Mansfield and Ashfield (one for assessment staff and one for START Reablement provider staff), launched in March There is one STIS team in Newark and Sherwood combining assessment and Start Reablement staff. This team was launched in July 2017.
The aim of the service is to support the ethos of “Home First” by creating a more flexible and responsive social care service that can manage the demand from hospitals as well as the community, and also align to the emerging health models of care eg in Mid Notts - Local integrated care teams, Intensive Home Support, Call for Care, Discharge to Assess.

5. Expected benefits of creating the STIS teams
Improved clarity of purpose, aims and objectives – clearer for service users, staff and other partner agencies
Opportunity to implement the Adult Social Care Strategy more consistently – a relentless focus on reablement, promotion of independence and early intervention to prevent a crisis
Improved lines of communication across staff and organisational boundaries
Improved flexibility of resources, with staff no longer working in specific silos but supporting each other across localities
Flexible approach which can evolve as the new care models develop and change
Management can maintain a strategic overview of this provision
Provides one source for Internal/National Reporting of reablement within Mosaic

6. Is it all perfect ? Not yet ! Current challenges….
Finding time to attend meetings is difficult in between operational priorities
Staff vacancies in SW posts affect LICTs – need a more aligned model as a whole, not reliant on just one worker
STIS teams are in early stages of development
It would be really helpful to be able to access key information held on each other’s systems – it’s not impossible but will be difficult
Culture - Health colleagues sometimes try to “prescribe” social care solutions. Risk averse attitudes - we have local evidence of “over-prescribing” when hospital patients are discharged (in line with national LGA study)
Discussions about who should do what continue eg. Non-weight bearing patients
Need to find savings but not lose the best gains from integrated working