Agenda Item No
The Vale of Glamorgan Council
Cabinet Meeting: 19th October, 2011
Report of the Cabinet Member for Social Care and Health
Delivering Integrated Social Care and Health Services to meet the needs of local people
Purpose of the Report
1. To update Cabinet on the progress made by the formal programme board which is overseeing the operational integration of selected health and social care services across the Vale of Glamorgan and Cardiff.
It is recommended that Cabinet:
1. Notes the content of this report.
2. Continues to receive minutes from meetings of the programme board.
3. Endorses the collaborative agreement at Annex 1, which will be used to guide the way in which all three partner organisations work together in delivering a range of services for the local community.
Reasons for the Recommendations
1. & 2. To ensure that Cabinet is aware of the progress made to date and supports
implementation of the actions agreed by the programme board.
3. To ensure that the Council's expectations of the programme board are set out
clearly and explicitly.
2. The Welsh Assembly Government has reaffirmed its stance that social services are a core part of local government and that there is no intention currently for reducing the number of local authorities. However, this is accompanied by strong expectations of a step change in the scale of collaboration between social services directorates and between social services and other key services, especially the NHS. The overall intention is to produce a new, citizen-centred approach to social care and health, which will address local priorities and focus on developing integrated preventative and community-based services that will reduce reliance on institutional care.
3. Across the Vale of Glamorgan and Cardiff, the two local authorities and the University Local Health Board recognised the need for prompt action in developing integrated health and social care services which are seamless, co-ordinated and responsive - where there is evidence that this will better enable the delivery of high quality care that meets the needs of local communities within existing resources. For this reason, the three organisations agreed to create a programme board to ensure that local government and the NHS in this area work collaboratively in delivering change, within current statutory and organisational governance arrangements. Cabinet endorsed this approach on 17th March, 2010.
4. The integrating health and social care services (IH&SC) programme board co-ordinates agreed projects, defines the outcomes expected and provides the overarching leadership required to manage significant programmes of change. The main tasks of the board are, through the oversight of key projects, to:
· identify, by means of appropriate needs assessment, priority areas for improvement which require strengthened joint working to achieve better outcomes within existing resources;
· provide a framework to enable the operational integration of services across health and social care (to include workforce planning, resource planning, etc); and
· ensure that local government and health professionals are able to work jointly within statutory and organisational governance arrangements that provide a framework of clear accountability.
5. The programme board met for the first time in June 2010 and now meets every other month. A number of priority workstreams have been agreed.
· Mental Health Services
· Older People’s Services
· Learning Disability Services
· Substance Misuse Services
· Services for children with complex needs
· Services for adults with complex care needs.
6. Lead responsibility for moving these workstreams forward is shared between the three sponsoring organisations. Each of them is led by a Senior Responsible Officer (SRO), at Executive Director level within the Cardiff and Vale UHB and at Head of Service level within the local authorities. The SRO is responsible for the overall delivery of projects within their workstream, reporting progress to the IHSC programme board. Each SRO is developing a delivery plan, setting out how the key projects will be taken forward and establishing milestones for delivery.
7. Chairmanship of the programme board rotates between non-officer members of the three statutory organisations: David Francis (Chair, Cardiff and Vale UHB), Councillor Dorothy Turner (Vale of Glamorgan Council) and Councillor Kirsty Davies (Cardiff Council). The programme board is made up of senior corporate officers from the three statutory organisations as well as representatives from both third sector umbrella organisations (VCVS and VAC), recognising the key role of the third sector in moving towards more integrated models of care. At each meeting of the programme board, the SROs provide an update on the progress being made and the issues requiring resolution at a senior level.
Relevant Issues and Options
8. Cabinet routinely receives the minutes of programme board meetings. These demonstrate significant progress in some of the workstreams whereas others are relatively new and still at an early stage of development. We have seen more shared planning, joint commissioning and procurement, unified service provision, joint appointments and co-location of staff.
9. The pace of change is increasing but not yet to the level required, given the need to consider reorganising radically the way in which some social care and health services are organised and delivered. We need to respond quickly and effectively to growing demand for services (resulting from demographic growth, higher expectations by citizens, changing family structures and higher numbers of people with long standing and complex disabilities), increasing costs of care and decreasing resources.
10. Health care and social care systems contain a series of inherent differences in finance, administration, arrangements for providers, clinical orientation, targets and performance measures, eligibility, access and benefits which make integration difficult. This can lead to:
· crisis responses, blaming other organisations and cost shunting;
· lack of a shared agenda among decision makers;
· silo working and a retreat into defending organisational sovereignty; and
· a clash of cultures and conflicting interests.
11. For this reason, the programme board has been working hard to reach agreement on shared values, strong sponsorship for integration at a high level within all three organisations and identification of common difficulties and mutually beneficial outcomes. However, given the scale of the challenges that lie ahead and the potential obstacles, members of the board acknowledge the need to become more purposeful and effective. For this reason, they have endorsed the collaborative agreement which makes more explicit expectations of board members and the work they oversee. The agreement specifies expected outcomes, underpinned by more rigorous governance and performance management arrangements. Each of the organisations makes a specific commitment to contributing more resources to the work. It has been agreed that the Director of Social Services for the Vale of Glamorgan will take on the Senior Responsible Officer role for the programme board as a whole.
12. The collaborative agreement will help to ensure that the programme board is better equipped to fulfil the expectations of the three sponsoring organisations. The benefits of collaboration and integrated services can be considerable - economies of scale, shared skills, more efficient use of resources (reduced management costs, back office savings), whole systems planning, achieving the cultural change within organisations needed to produce more seamless and co-ordinated care, etc. However, the programme board recognises that these benefits can be lost because the possible costs of partnership working are not managed well enough - absence of a sound business case, proliferation of meetings, the slow pace of consensual change, problems not owned by the individual organisations, issues about governance, etc.
13. One possible answer in the area of health and social care services is to use more extensively the range of powers and arrangements which provide a statutory basis for integration and collaborative working. This includes Sections 33, 34 and 58of the NHS Act (Wales) 2006, Section 25 of the Children Act 2004 and Section 34 agreements as set out in the Children and Families (Wales) Measure 2010. The programme board recently held a workshop to consider the merits of these more formalised mechanisms to ensure agile and effective collaboration. The outcomes of any further work will be reported to Cabinet in due course.
Resource Implications (Financial and Employment and Climate Change, if appropriate)
14. There is a commitment from all the organisations that the integration projects will be delivered within existing resources and generate efficiency savings. As part of discussions at Chief Executive level about an increase commitment to the work of the programme board itself, each partner agreed to identify staff resources from existing budgets for this purpose. The UHB and Cardiff Council agreed to provide one full time equivalent and the Vale 0.5 FTE. This cost will be met from the budget for the Social Services Directorate.
Legal Implications (to Include Human Rights Implications)
15. The programme board exercises management control of the overall integration programme without affecting current executive and scrutiny arrangements for social services in the Vale of Glamorgan.
Crime and Disorder Implications
16. There are no crime and disorder implications arising from this report.
Equal Opportunities Implications (to include Welsh Language issues)
17. There are no equal opportunities implications arising out of this report.
18. Key objectives of the Council addressed by this report are;
· to make the Vale a safe and healthy place in which individuals, children and families can live their lives to the full; and
· to manage the Council's workforce, money and assets efficiently and effectively in order to maximise its ability to achieve its service aims.
Policy Framework and Budget
19. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
Relevant Scrutiny Committee
21. Social Care and Health.
Report of the Cabinet Meeting, 17th March, 2010
Corporate Management Team
Director of Social Services