2. How do we ensure the successful uptake and spread of provider innovation across the NHS?
Chair: Matthew Winn, Chief Executive, Cambridgeshire Community Services NHS Trust
Speakers: Kath Evans, Head of Planning and Delivery - Hospital to Home Programme, NHS England
Karen Howell, Chief Executive, Wirral Community NHS Foundation Trust
Nick Hulme, Chief Executive, The Ipswich Hospital NHS Trust

3. Bringing community based care centre-stage
Kath Evans Head of Planning Delivery

4. Three priorities for frailty
Change in approach to health & social care for older people
Preventing poor outcomes through active ageing
Quality improvement in acute & community services

5. Proposed Service model
Current position
10 Year Vision
Proposed Service model
Ageing population
2040 nearly one in seven will be over 75
Frailty prevalence increasing
A person with mild frailty has twice the mortality risk of a fit older person at the same age
Currently people with frailty don’t always get the care they need in the right setting and at the right time
Hospital interventions for some people with frailty are limited in efficacy
Opportunities for prevention
There are currently 4000 hospital admissions a day for people with frailty
Intermediate care gap
National audit data (NAIC 2017) suggests intermediate care capacity needs to double
An NHS priority
To help older people stay healthy and live independently in their communities: work already underway
The NHS now has an opportunity to be world leading in our approach to population ageing & caring for older people
Implementing at scale support for people in community settings
Working with social care we will take a new joined up approach
Using population segmentation to focus appropriate care on the needs of older people vulnerable to the effects of frailty
We will continue to support older people with advancing frailty in their communities to the end of their life
Ageing Well (MDT) Service
Urgent Community Response and Recovery Service
Enhanced health in Care Homes (EHCH)
Implementation will be developed from existing and best practice in an adoption and improvement approach.

7. Meaningful Integration - Health and Social Care 9 October 2018
Karen Howell
Chief Executive
Wirral Community NHS Foundation Trust

8. Towards Integration – our Starting Point
Improving outcomes for local residents – Trust in unique position Primary driver not just about efficiencies
Understand and embrace – integration rather than absorption
National and local context provided ideal landscape –Board and Local Authority intentions
Recognition of inter-dependencies between health and care Benefits – personalised and strength based approach
Our journey took two years with key stages: co-location, stakeholder engagement, consultation and business case

9. Our Integration Journey… So Far
5 year Section 75 contract – signed June 2017
Delegated responsibility for range of Care Act Duties
Transfer of 220 Adult Social Care staff to Trust
Draw down of £58m Community Care budget – 1.5m efficiencies achieved in first year 2017/18
Pre transfer performance maintained or improved
Positive feedback from residents, staff and commissioners
Safe Transfer Stabilisation Transformation

10. Critical Success Factors
Strategic leadership from Chief Executive - identified as organisational priority
Appointment of Associate Director Adult Social Care – statutory oversight and guidance for Board
Early engagement of staff and unions – professional identity
Dedicated programme management with two tier governance structure
Attention to detail – independent due diligence around potential deal breakers – pensions, performance expectations, financial resource
Early establishment of professional standards, Partnership Governance Board and robust contract monitoring

11. Initial time scales slipped due to complex nature of negotiation
Earlier Development of Service Specification / Operating model would have assisted – more detailed required at point of due diligence.
Challenge of transferring non NHS services should not be underestimated, including complexity of ‘Purple Book compared to Agenda for Change’.
Challenges around transitional buy back arrangements – eg Recruitment

12. Integration and Beyond
Longer term view of Green Paper and regulation – peer review
System wide transformation priorities – Neighbourhood, Place Based Care
Recruitment of NED for Social Care
Internal transformation phase for Health and Social Care - development of integrated operating models, integrated leadership roles and digital strategy
Contract developments – pooled com-care budgets
Staff development, culture, governance alignment and strengthening

13. Meaningful Integration – What Really Matters
“I was pleased that I didn’t get passed from pillar to post and that I had 1 worker to deal with, thank you as it has reduced the stress”
Local Resident
“Integration has allowed us to learn from each other and improve our skills , this then improves the way we carry out our job role and this benefits all service users.”
“I feel more positive when visiting clients as I can give them a clearer picture of what's available to them “ - Practitioner
“Relationships with health colleagues have improved significantly” “I really enjoy integrated working and feel it benefits my role immensely.”
And we continue to test ……..
”Demonstrates a continued good evidence of robust approach to professional standards and compliance, linking with clinical governance” Commissioner
“It was a really good service, I had visits from enablers , office staff and Occupational Therapists, who all ensured I was able to manage”
Resident

15. Integration Plan - First 100 Days

16. How do we ensure the successful uptake and spread of provider innovation across the NHS?
Speakers: Nick Hulme, Chief Executive, The Ipswich Hospital NHS Trust