VSNW Conference October 2014

Better Care and Integration Sue Lightup – Strategic Director, Salford City Council and Chair of ADASS NW

The Better Care Fund

• A Mechanism to move money round the system – NHS and Social Care, largely from acute care into community and social care • Recognises the interdependencies of the whole system • Responsibility of the Health and Wellbeing Board • To achieve integrated health and social care, better outcomes and performance related • There are 7 national conditions, including a 3.5% reduction in admissions, 7 day a week working

Better Care fund – the story so far!

• Joined up discussions • First submission – draft/early version March 14 • Formal submission signed off by HWBB - April 14 • Consternation – June 14 • New conditions set out -July 14 • All plans to be resubmitted – Sept 14 • Followed by national assessment, moderation, categorisation and staggered implementation dependent on the category assigned • Process - Process – Process! And Painful.

What’s the point – the theory and the practice

• Creating better outcomes with much less resources • Reforming Health and Social Care – locally, regionally and nationally • Increasing personalisation and co-production • A sustainable system? • Shifting emphasis from deficit to assets base • An extended pathway of support including community resilience • A clear sense of place

Moving on

• Strong and Effective Leadership across the whole system – individually and in HWBB’s • Innovation • Letting go • New relationships • Much harder if you aren’t co-terminus or your hospital hasn’t agreed, if you are in financial deficit, or special measures • Outcomes has to be the key driver

Financial Benefits of close relationships to Salford residents

• Prior to 2010 – risk pooling in joint budget reduced likelihood of overspending – 10 years more stability than many others • Handover of historic £6m to LD funding in 2009 • A variety of section 75 agreements • Formal agreement to NHS funding transfer – 2011/12 – 2012/13 – 2013/14 – Plus one off not recurrent support from PCT – Transfer of PH - £19m one of highest levels in GM – Alliance agreement in 2014

What’s been agreed to date

• PSR across GM involving the re shaping of hospital provision, primary care and council/social care.

• History of strong partnership working in section 75 a arrangements. Covers more than many other councils • Section 236 transfers in the last few years from NHS • Better Care fund and integration approach as part of an Alliance between the Council, the CCG, Salford Royal and GMW Mental Health trust • To achieve better outcomes for Sally Ford, an improved experience for her, and a reduction in demand, therefore cost.

Relationship with the Voluntary Sector

• Interdependent • Complex • Yet rich in depth and tone • Flexible enough?

• Encouraging enough?

• Honest about what can be achieved?

• Competitive for limited resources but still able to challenge • Independendence

Place: Greater Manchester Health and Social Care system

• • • • • • • • • 2.6 million people 10 local authorities 1 Combined Authority 12 CCGs 8 acute trusts with 10 A&E departments (including 3 Teaching Trusts) 4 NHS Trusts in the FT pipeline 1 specialist cancer trust 4 Mental Health Trusts 1 ambulance trust • £6bn health & social care spend