Transcript Feedback from last Forum

Management Forum
July 8th 2013
Health and Social Care Integration
Walsall Social Care and Inclusion – going forward
John Bolton
Interim Executive Director
Feedback from last Forum
Over 80% of those completing the evaluation form said that:
 the event overall was either good or very good
 the opportunity to understand our progress to date in
terms of promoting self directed support was good
 the opportunity to consider medium term financial plan
was good
www.walsall.gov.uk
Feedback from last forum
But almost a third of you completing the evaluation form
were unclear what outcomes there would be for …
 yourself
 your service
 our Directorate
… and very few of you completed the evaluation form, so
please remember to do so at the end of today’s event
www.walsall.gov.uk
General Feedback
 Good to have opportunity to share/challenge
perceptions/views
 Would have been good to have had information on what
the Directorate was working on
 Would have been useful to hear from the ADs about
current developments and initiatives in their services
 Want senior managers to join the tables!
www.walsall.gov.uk
How could the event have been more effective?
You said … give us more notice of these events
We did … publish the date of the November event
You said … give us more information in advance
We did … send today’s programme and slides out earlier
You said … presentations don’t take enough account of the role
and understanding of workers in partner organisations
We did … make sure there are presentations today which
address the roles of colleagues in DWMHT and JCU
www.walsall.gov.uk
How could the event have been more effective?
You said … give us an opportunity to put forward questions to
the Director and ADs
We did … include this in today’s event, though we expect you
to come up with solutions too!
You said … let us put forward topics for future Forums
We did … arrange for a suggestions wall today, so please
make sure to use it for your ideas on items for November’s
event
www.walsall.gov.uk
Last Meeting…..
We looked at the agenda going forward – emphasis on
getting prevention right in the operating model and getting
personal budgets right.
Fresh challenges of the money – we considered all of your
suggestions and have started to work them up into solid
proposals (I read every sheet personally) – some of them
are about improving and changing our practice – e.g.
Building our preventive services – others are really difficult
political decisions – e.g. Charging or redundancies
Now we will focus on reducing admissions to residential care
– through better intermediate care; better care pathways
for dementia and reprovision for younger adults
www.walsall.gov.uk
Diagnostic and Early Intervention Phase
Hospital
discharge
requiring
support
Intermediate Care Services – residential and
community (reablement)
Inquiry to
Adult
Social care
Divert to
Community/
Voluntary sector
Information and
Advice
Safeguarding
assessment
Preventive Services
Community Alarms
Equipment – telecare, Aids to
daily living – Independent Living
Centre
Community Social Workers
Neighbourhood Community
Officers
Sensory Impairment Services
Housing Related Support Services
Community and Voluntary Sector
- Carers
Health - falls prevention
Employment
Assessment
for longer
term care
www.walsall.gov.uk
Assessment and Long Term Interventions
Assessment
for longer
term
support
Resources
Allocation
And Support
Planning
With a Focus
on Outcomes
= Personal
Budgets
Review
What are the interventions that will help this person become
more independent? – Reprovision programme – Living well with
Dementia – Expert Patient for a long-term condition – Prepare
for employment
Outcomes
delivered through
- Direct Payment
with DP Support
Services/ PAs /
Community/
Family support
Managed Accounts
– outcomes
delivered by access
to services –
Domiciliary Care /
Day /Residential/
Shared Lives/
www.walsall.gov.uk
Four key priorities going forward
 Building the operating model – get preventive services to
deliver
 Build on the personal budgets – get both Direct Payments
and Managed Accounts working for everyone
 Work collaboratively with partners – noticeably Health
 Start being prepared for the possible financial challenges
ahead.
www.walsall.gov.uk
Relationship between Strategic Commissioning and the
Operational Commissioning role of Access, Assessment
and Care Management
Andy Rust – Head of Commissioning
Suzanne Joyner – Head of Community Care
Walsall CCG
Strategic Commissioning
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Whole Health and Social Care System
Need Supply Demand Analysis
Market Shaping
Menu of Services
Improving Quality
Regulation
Service Specification
Contract Management / Accreditation
Contract Monitoring / Holding to Account
Safeguarding
Clinical Improvement
Walsall CCG
Operational Commissioning
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Individual Case Management
Whole Family
Person Centred
Personalisation
Social Workers/Occupational Therapists/Reablement
Safeguarding
Walsall CCG
Relationship Between Strategic and Operational Commissioning
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How do we effectively capture collective intelligence
about gaps in the market from individual/operational case
management and communicate to strategic
commissioners?
How do we effectively communicate new market options to
case managers / individual service users?
How do we use feedback captured during review and
reassessment processes on quality issues in the market
so that we can take those issues up with the market?
How do we relate strategic commissioning concerns to
individual case management?
Walsall CCG
Mental Health Services
Partnerships
Commissioning
Social Work
The Partnership with the
Mental Health Trust
Peter Davis
Head of Service
Walsall Social Care & Inclusion
Context
• A single organisation delivering services to children, adults and older
people in a seamless way
• Need to integrate organisations with different governance arrangements,
organisational structures, funding and cultures
• Sense that Mental Health was “bolted” onto the local agenda
• No holistic consideration of wider care pathway, especially for older adults
www.walsall.gov.uk
Local Benefits
• Change to silo working
• Senior managers have a greater understanding of how each organisation works
• Development of a formal joint approach to planning and strategic management;
via Partnership Operation Group (POG) and Partnership Board
• Middle managers become more involved in changes
• Better front line integration and senior managers working together
www.walsall.gov.uk
Service User benefits
• Greater uptake and offer of Personal Budgets with wider choice
of alternatives to residential care
• Prompt and consistent decision making via panel arrangements
• Increased involvement of the third sector
www.walsall.gov.uk
The future benefits
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Understand gaps in community based provision and commission accordingly
Improve engagement with service users and carers with consistent consultation and
communications mechanisms
Give people control and choice over their care and support packages
Develop a shared outcome focussed evidence base for treatment and support services
Plan and manage the impact of decreasing resources
Develop metrics around the quality of Section 75 arrangements
Improve the range of community based preventative services
Understand the needs of the Section 75 workforce
Develop strategic partnerships with statutory, commercial and voluntary sector agencies
www.walsall.gov.uk
Marcus Law
Commissioning Development Manager
Summary of
commissioners’ role
• Budget management and ensuring VfM
• Market development
• Promote independence, prevention and early
intervention
• Reinvestment in appropriate services
• Contractual and performance management
Mental Health Vision
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Whole population mental health & wellbeing
Early interventions
Intensive support
Time limited targeted interventions
Recovery focus
Supported discharge
Signposting
• Above fits with the Councils Operating Model
Mental Health
Forecasted Expenditure split between NHS and LA (£) 2013/14
7,375,025, 18%
NHS
LA
32,643,268, 82%
Adult Mental Health
• Key achievements to date
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Personal budgets – rolled out successfully
Developed Supported living schemes
Developed S117 policy which has enabled discharge for over 100 MH users from S117
aftercare – removes them from MH services. As well as moving others responsibility to
other LA’s and PCT’s.
Closure of poor provision in day services, residential and nursing care sector
Brought service users back from out of area placements
New prevention services such as Rethink community model, Big White Wall and Kooth.
New specialist hospital and rehab provision built in Walsall for detained and complex users
New PICU service built in collaboration with Black Country commissioners – High quality,
local and short stays
Assertive review panel – stepped down care and support for many individuals enabling
them to return to community without support or move to supported living or extra care
schemes
Payment By Results data – model worked on with SHA colleagues to establish key reports
from MHMDS through partnership working with DWMHT
Enabling greater independence, shorter stays in care, offering a wider menu of
services and achieving savings by implementing above
Adult Mental Health
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Achievements to date cont’d:
 New specialist hospital and rehab provision built in Walsall for detained and
complex users
 New PICU service built in collaboration with Black Country commissioners – High
quality, local and short stays
 Assertive review panel – stepped down care and support for many individuals
enabling them to return to community without support or move to supported living or
extra care schemes
 Improved review practice by DWMHT staff by implementing assertive review
process
 Pathway improved -Reduced length of stays in hospital, rehab, nursing and
community packages.
 Wider range of services now available and more appropriate selection based on
need and preference
 Payment By Results data – model worked on with SHA colleagues to establish key
reports from MHMDS through partnership working with DWMHT
 Review of psychiatric liaison services
 Enabling greater independence, offering a wider menu of services and
achieving savings by implementing above
Efficiencies achieved
2010/11 - 2012/13
2010/11
Organisation Part year Full year
effect
effect
£
£
2011/12
Part year Full year
effect
effect
£
2012/13
Part year
Full year
effect
effect
£
£
Cumulative on year
savings
Full year effect
£
£
SC+I
70,994
121,382
126,139
361,712
52,205
97,702
580,796
NHS
347,551
537,730
279,186
608,069
171,600
213,200
1,358,999
Total
418,545
659,112
405,105
964,061
405,105
964,061
1,939,794
NB - Year 2011/12 and 2012/13 refers to additional savings to that of
2010/11 and not recurring savings from previous years
Adult Mental Health
 Continuing redesign of secondary mental health services (MH
Trust)
 Create a wellbeing and recovery service hub:
Create new preventative services with closer links to the
community, GP’s creating improved pathway for users
Enhance existing recovery college provision
 Ongoing work on NHS Payment By Results (PBR) in MH – build
new tariffs/contracts for services based on cluster activity in the
future along with outcome based monitoring
 Redesign of existing crisis and respite provision
 Strive to achieve ‘cultural shift’ in all providers to promote
recovery and independence that is both effective and efficient
Adult Mental Health
• The team
• Commissioning Engagement Manager across
Dudley and Walsall (Walsall Team Manager)
– Anet Baker
• CAMHs commissioner
– Alicia Wood
• Adult commissioners
– Marcus Law & Mark Williams
• Older Adults Programme Manager Lead
– Michael Hurt
The role of the social worker
in the Mental Health Trust
Santokh Dulai – Walsall Council
Hassan Omar -DWMHP
The Ten Essential Shared Capabilities: A Framework for the Whole of the
Mental Health Workforce (National Institute for Mental Health in England and
Sainsbury Centre for Mental Health – 2004)
• Professional groups expected to retain their distinctive
roles though the demand for change is increasing
• Professionals to focus on shared elements of good
practice
• Much of this has been historically associated with social
work
www.walsall.gov.uk
Shared capabilities for Mental Health practitioners
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Working in Partnership.
Respecting Diversity.
Practising Ethically.
Challenging Inequality.
Promoting Recovery.
Identifying People's Needs and Strengths.
Providing Service User Centred Care.
Making a Difference.
Promoting Safety and Positive Risk Taking
Personal Development and Learning
www.walsall.gov.uk
What do we bring to the integrated model?
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The social model of mental illness v medical (symptoms)
Context / normalisation
Prevention rather then cure
Instil hope
Recovery and empowerment
Promote dignity
Human worth
Social justice
Principles and social perspectives of the recovery model
www.walsall.gov.uk
Table Exercise
What should my
service be doing to
further integrate with
Health?
www.walsall.gov.uk
Table Exercise
Current issues and challenges?
Solutions?
How can EDMT support you?
Sharing success and good practice
www.walsall.gov.uk
Evaluation
www.walsall.gov.uk
Management Forum
July 8th 2013
Health and Social Care Integration