Transcript Health and Social Care Act: a source of tension or an

Health and Social Care:
improving outcomes and creating
a sustainable future
David Pearson
Deputy Chief Executive and Corporate Director of
Adult Social Care, Health and Public Protection,
Nottinghamshire County Council
Development of Health and Wellbeing
Board in Nottinghamshire
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Early Implementer - shadow Board meeting since May 2011
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Accountability for public service strategy for services to people
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Prepared to have difficult conversations
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Committed to early agreement on priorities for 2012-13 to support CCG
authorisation - JSNA refresh completed by April 2012 and Health and Wellbeing
Strategy completed by July 2012
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Health and Wellbeing Board Implementation Group to drive change
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Endorsed Health Select Committee recommendation on commissioning –
‘everything in scope’ - confirmed in report to HWB May 2012
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Integration strategies considering the whole health and local government
budget
Health & Wellbeing Board
Supporting Structures
Health and Wellbeing
Board
* As a Statutory Board, the
Children’s Trust Executive
has
independent
accountability arrangements
Nottinghamshire
Safeguarding
Children Board
Children’s
Trust
Executive *
Range of Strategic
Commissioning
Groups
(Children)
Health & Wellbeing
Implementation
Group
Nottinghamshire
Safeguarding
Adult Board
Range of
Strategic
Commissioning
Groups
(Adults)
Health and
Wellbeing
Strategy, JSNA
& Outcomes
Group
Health
Protection
Strategic
Commissioning
Group
Public and Provider Engagement linked to each Commissioning Group,
including Voluntary & Independent Sector.
Provider & Stakeholder Network established to promote wider engagement
Integrating Health and Social Care?
Integrated commissioning – why is it
important?
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When it works the public gets a more coherent response
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Reducing budgets within local government and health but increasing demand
and costs
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Need to manage demand better and understand cost of health and social care
interventions – ill considered integration can cost more
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Need to work on interventions that help people get as close as possible to level
of function they had prior to crisis – focus on independence rather than
provision of care
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Care and Support Minister - Norman Lamb - plans to ‘push integration as hard
as I can’
– ‘If health and wellbeing boards are no more than committees then we will
have failed’
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Integration ‘pioneers’
Integrated commissioning – why is it
important?
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Third of expenditure in health and local government economy will need to be
saved and recycled over 4 year period - £600m out of £1.8bn
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Health performance impacts on local government expenditure
– 20% of people with hip replacements end up with a continence problem – a
significant factor in admissions to residential care
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Obesity, tobacco, alcohol and substance misuse – big issues nationally
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End of Life Care – 63% of people want to die at home; only 10% do
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People with dementia admitted to hospital with physical difficulties stay longer
and have worse health outcomes
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70% of people in hospital over 65 - evidence is 30-40% could be cared for
elsewhere
Nottinghamshire Health and Wellbeing Board –
a leadership role
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In September 2011 presentation to Board gained a collective understanding of
need in relation to dementia and agreement of the required action to address
this
– secured £1.5m as a direct result of raising the profile of dementia and
identifying the level of unmet need
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Supporting structure for the Board facilitated the plan for delivery
– integrated commissioning group agreed an approach for investing funding
in Mental Health Intermediate Care Services and Dementia Memory
Assessment Services (with social care support)
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Approach promotes joint and integrated working
– dedicated social workers have been identified to support the intermediate
care services
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Fred’s story shows what has been achieved as a result of the Board discussion
Fred’s story
• 76 year old, widowed
• Misses his wife ‘who kept
things organised’
• Locks himself out of house
• Medication for hypertension
and depression
• Has had a few falls
• Referred to social care by son
Fred’s story: part 2
• Mental Health Intermediate
Care Service
• Assistive technology ‘Just
Checking’ system to assess
daily routine
• Fred helped to improve safety
around the home
• Community matron oversees
physical health
• Fred continues to live at home
with support
Priorities for Nottinghamshire Health and Wellbeing
Board 2013-14
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Improved support for Carers - Compass workers
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Expand Mental Health Intermediate Care
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Continue reviews of antipsychotic medication
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Introduce quality standard for dementia services in care homes
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Dementia Care Matters programme being rolled out to selected care
homes
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Continue workforce development and staff training
Dementia: the Health and Wellbeing Board perspective
Examples of Commissioning
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Redesign of and tender for new mental health support services – the project
board included representatives from Nottinghamshire County Council and district
/borough Strategic Housing. A piece of work was undertaken involving 30 service
users and their current service providers to help design the service specification.
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Mental Health Supported Living: alternatives to residential rehabilitation and
secure units - highly innovative working with health partners to jointly assess and
deliver improved care pathways, service models and outcomes, with partnership
agreements about funding that support both agencies and avoid ‘cost shunting’
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Mental Health Intermediate Care Services for Older People (MHICS) - a time
limited intensive service for older people with mental health problems and/or
dementia, which is provided in the community through district multi-disciplinary
teams.
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Urgent Community Support Service (UCCS) Rushcliffe - the result of joint
commissioning by one of Nottinghamshire’s CCGs and the County Council. This is a
crisis avoidance/response service providing both health and social care through a
team of generic workers from East Midlands Crossroads
Examples of Commissioning
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Care, Support and Enablement Tender – supported living and outreach
services for adults with learning disabilities, Asperger’s, mental health
issues and physical disabilities – a tender process to re-establish an
approved list for the above services. Carers and service users were fully
involved in the tender.
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Integrated Community Equipment Service (ICES) - the arrangements are
made under a section 75 agreement of the 2006 National Health Service
Act and include Nottingham City Council, NHS Nottingham City, NHS
Nottinghamshire County and NHS Bassetlaw, with Nottinghamshire County
Council being the lead commissioner
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A2A (Access to Advocacy, Specialist Advice & Representation) - all
health and social care agencies across Nottinghamshire County and City
Council worked with providers to develop a new information, advice and
advocacy model now delivered by one organisation with a single point of
access. The approach was nominated for the 2011/12 CIPS Supply
Management Awards, Best Public Procurement Project.
The key to success
• Leaders are able to share and articulate a clear
and unified vision
• The outcomes required are identified
• Resources and activity are aligned to meet the
outcomes
Questions and comments