1. All-Age Integrated Commissioning Strategy (Health and Wellbeing) CAS Voluntary Sector Forum workshop 17 July 2014

2. Vision
The Southwark Health and Wellbeing Board have set three main broad priorities in order to deliver better health and care outcomes for Southwark residents. Those priorities are:
Giving every child and young person the best start in life
Building healthier and more resilient communities and tackling the root causes of ill health
Improving the experience and outcomes for our most vulnerable residents and enabling them to live more independent lives
The council therefore wants to ensure that all Southwark residents, irrespective of their age or any other defining characteristic, has the opportunity to:
Live as independently as possible
Living in a in a good state of emotional and economic well being.
Have access to the full economic, cultural and social life that Southwark has to offer
Actively contribute, where they can, to the wider community
Southwark council recognises that people living with one or more long term conditions should not be defined simply as a specific medical condition or older person, they need to be seen as an individual with reasonable aspirations to live as an active member of their community.
Southwark Council supports the social model of disability, whereby disability is caused by the way society is organised, rather than a person’s impairment or difference and it looks at ways of removing barriers to life choices. When barriers are removed, disabled people can be independent and equal in society, with real choice and control over their lives.
Prevention is now at the forefront of practice as a priority of delaying and reducing the need for care and support. This is about working to shift to a model of enabling people to be able to ‘do for themselves’ before a time of crisis or significant deterioration in ability. The council is aiming to support and maintain resident’s abilities to engage positively in their own communities and have a far greater emphasis on managing their own health and social care needs over traditional models of care as they encounter and engage with services and professionals.
This strategy recognises that part of being an expert commissioner means moving to commissioning for outcomes – i.e. in order to give greater opportunity for providers to arrange their services in more flexible and innovative ways, and that the focus should be on outcomes, instead of the traditional approach of specifying inputs and outputs.

3. National and Local Context
The Care Act
The Children and Families Act
Local Direction on Integration
Financial Implications
The Care Bill will place a greater emphasis upon Local Authorities developing a more personalised market that responds to the evolving needs of people requiring support, irrespective of whether the state pays for their support (through a personal budget) or they pay for it themselves. We will also require a local market with a stronger emphasis upon promoting independent and resilience and is well equipped to support people with complex needs in their own homes and avoid unnecessary placement in institutional settings. The Care Bill also introduces issues in relation to human rights and the quality of care being provided to vulnerable people, as well as a need for the council to consider how it commissions advocacy services and provides support for self funders in the future.
The reforms to services for children with Special Educational Needs and Disabilities (SEND) that will be required when the Children and Families Act is implemented will require a significant shift in the commissioner role from that of a large contractor to one of market developer as individuals take up their right to personal budgets and become their own commissioners. We will place a greater focus on integrated commissioning across health, education and social care to align with the more integrated approach to assessment and support process. We will ensure that our published Local Offer includes the range of services and support parents and young people tell us they want to access in Southwark.

4. Strategic Commissioning Intentions
Personalised health and social care services that are able to follow a resident through their lifetime
Improve resilience of communities, families and individuals to support residents to maintain / regain their independence and be able to live in their home
Identify and commission effective preventative / early action services that reduce the need for specialist services
Quality specialist services for those that require support when no longer able to live in their own home
Commission for quality and improved outcomes for our residents, utilising views expressed from residents on the services they receive to develop and inform future approaches
Develop a diverse, innovative and adaptable health and social care market
Develop a single integrated approach to commissioning services wherever possible
These are planned to be delivered within a framework that incorporates person centred philosophy, maximises independence, choice and control, strengthens information governance, deepens safeguarding principles, mitigates the risk of financial contraction, and uses lean thinking and best value.
The priority outcomes will be met through the strategic commissioning of services by Southwark Council and CCG working collaboratively wherever possible.

5. Co-production
Co-production is a meeting of minds coming together to find a shared solution.
In practice, it involves residents and their family / carers, who use services being consulted, included, working together and influencing from the start to the end of any project that affects them.
Within the council’s aims and objectives for co-production it will transform the perception of people from passive recipients of services and burdens on the system into one where they are equal partners in designing and delivering services, and provides opportunities to recognise and grow people’s capabilities and actively support them to put these to use with individuals and communities.

6. All Age Disabilities
Target more support to younger children with disabilities and their families. Providing information, advice, support and signposting at the point of diagnosis.
Commission support to enable more young people to succeed into adulthood and education or employment, including creating real opportunities for employment for disabled young people and adults
Still maintaining a focus on increasing independent living opportunities including returning people to the borough (Winterbourne View response)
Developing a range of supported living opportunities that can respond to the individual needs of people whose needs challenge services who are returning to the borough
Improve the market for “day opportunities” offering wider range of support in the key areas of employment; education; community engagement; and sport and leisure

7. All Age Long Term Conditions
Supporting the shift in the balance of care away from a current over reliance on institutional care, through:
24 hour integrated community support which is increasingly locality based
Ongoing emphasis upon reablement and promoting resilience and self care
Improving person centred care, through a well trained, motivated provider sector
Where applicable modernising and/or developing specialist buildings
Meaningful and therapeutic day opportunities

8. All Age Prevention
An all-age accommodation approach to reduce the reliance on institutional forms of care
Assistive technology and an Integrated community equipment service that supports individuals to maintain their independence
Implementation of the joint carers strategy alongside the CCG
Commissioning of a comprehensive and effective information, advice and advocacy offer
Universal Preventative interventions that improve access to support, health and wellbeing and social interaction, promote healthy lifestyles and positive health benefits
Enabling residents to manage their own health and social care needs

9. Developing Southwark’s Market Position Statement
Jane Senior – Market Development Manager

10. What is a Market Position Statement (MPS)?
An MPS sets out the Council’s approach towards shaping and developing the local care and support market in order to ensure sufficient supply, to meet the re quirements of individual choice and population demand.

11. What does it look like? Concise market facing document Evidence based
Market Development Plan
Supports providers to make informed decisions about developing their businesses in Southwark.
Complements Southwark’s All Age Commissioning Strategy

12. How are we developing the MPS in Southwark?
Supply Mapping and Analysis
Demand Analysis
Profile of Spend
Service User and Provider Engagement
Market Analysis
Strategic Drivers – Local and National
Supplier Relationship Management

13. Group Exercise What information would you most like to see in the MPS?
What are the key challenges faced by the VCS?
How would you like the Council to respond to these challenges?

14. Focussing on Personal Budgets
Peta Smith – Commissioning Manager
Children’s and Adult’s Services

15. What’s new Children and Families Act Care Act Personal Health Budgets
Integrated Personal Commissioning
Increased take up of Direct Payments
We have a programme of change that is being managed under a project management approach. There are a number of key workstreams in the project, including market development.
We have to review our whole internal processes – how do we ensure our assessments are properly outcome focussed? How does the assessment translate into an indicative budget? Who will do support planning? Who agrees/ signs off the support plan.
We will be using the processes that have been developed for adults to date, but checking that they cover the needs of children and families – may then be some adjustments. We don’t have everything right!
Learning:
Good quality assessments and creative, well planned support plans are key to the success of personalisation.
It takes time. 18 months for our first PB because we didn’t have our processes in place. But it will take time to get our processes right even though we are learning from ASC journey
Four years in and we still don’t have everyone with a creative and flexible support plan – we have had to accept that some changes have had to be incremental to match our internal change, or the change possible in the market (e.g. Choice ISF)

16. Children and Families Bill - SEND
Integrated assessments (education, health and social care – EHC) and integrated commissioning (health and local authority)
Duty to publish a Local Offer
Right to request a Personal Budget
We have a programme of change that is being managed under a project management approach. There are a number of key workstreams in the project, including market development.
We have to review our whole internal processes – how do we ensure our assessments are properly outcome focussed? How does the assessment translate into an indicative budget? Who will do support planning? Who agrees/ signs off the support plan.
We will be using the processes that have been developed for adults to date, but checking that they cover the needs of children and families – may then be some adjustments. We don’t have everything right!
Learning:
Good quality assessments and creative, well planned support plans are key to the success of personalisation.
It takes time. 18 months for our first PB because we didn’t have our processes in place. But it will take time to get our processes right even though we are learning from ASC journey
Four years in and we still don’t have everyone with a creative and flexible support plan – we have had to accept that some changes have had to be incremental to match our internal change, or the change possible in the market (e.g. Choice ISF)

17. Local Offer – what is it
Purpose of the local offer is to enable parents and young people to see more clearly what services are available in their area and how to access them.
Covers provision for 0-25 years, across education, health and social care
Being developed in partnership with parents and young people in the borough

18. Local Offer - Impact
Opportunity to promote your service (0-25 & parents?)
Opportunity to understand what other organisations there are and where there are gaps in service provision
Will be promoted by the council and partners as the “go to place” for information so very important you are on there
Opportunity to reach more people
We will be circulating information on how to get your organisation on the Southwark offer via CAS later this month.

19. Care Act Continued focus and momentum for PBs
We will have more contact with self funders
Big focus on information and advice

20. Personal Health Budgets
Currently – have a right to request if you have a continuing healthcare need
From April 2015 – if you have a long term condition
Small changes nationally to date

21. Integrated Personal Commissioning
New announcement
Bringing Health and Social Care PB into an integrated budget and spending to meet shared outcomes
Blurs the lines
Pilots April 2015

22. More people on Direct Payments
Increasing month by month
377 and counting!

23. Personal Budgets – Possible Impacts 1
Opportunity to increase business
Good service, but limited to volume of work commissioned
Not commissioned by the council, so don’t get referrals
Opportunity to provide support in new and different ways
Respond to requests from people who use your service
Not defined by the Council – by the personal budget holder
Opportunity to focus on individual outcomes
Increased focus on quality and customer satisfaction

24. Personal Budgets – Possible Impacts 2
Changes to core funding
Develop new costing models – cost per person; per session; per week etc
New income streams – how to manage
More diverse market – more individual focussed; micro-providers?

25. Personal Budgets – Planning
What do your service users want?
What parts of your services can you make more individualised (and what can’t you)?
Who are your competitors? And who are your collaborators?
The market of organisations offering services is increasing
Think about what makes you unique
Promote your services
Respond to what people say they want/ need
Understand the costs of your service and how you can be competitive
Make sure you are utilising the Local Offer and other information directories