Agenda Item No
The Vale of Glamorgan Council
Cabinet Meeting : 18th April, 2012
Report of the Cabinet Member for Social and Care Services
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; and
· the implementation plan for developing integrated health and social care services for older people.
It is recommended that Cabinet :
1. Notes the content of this report.
Reasons for the Recommendations
1. To ensure that Cabinet is aware of the progress made to date and supports implementation of the actions agreed by the programme board.
2. A number of Local Health Boards (LHBs) provide NHS services in the Vale of Glamorgan. The majority of patients are assisted by Cardiff and Vale University Health Board (C&V UHB). Since April 2011, primary care services in the Western Vale have been provided by C&V UHB but the Abertawe Bro Morgannwg University Health Board (ABMU) continues to take responsibility for Mental Health and Maternity services. ABMU is also the provider of specialist NHS services to people in the Vale of Glamorgan who have a learning disability and Cwm Taff LHB manages Child and Adolescent Mental health Services (CAMHS) across the region.
3. The Welsh Government has considerable 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. Demands for greater integration of health and social care services have been reinforced by recent publication of two strategic documents ' Sustainable Social Services: A Framework for Action) and 'Setting the Direction (Primary and Community Services Strategic Development Programme)'. Closer integration is expected to deliver the following:
· better quality services for the population;
· more responsive services, with reduced waiting times;
· reduced duplication between services; and
· less demand for institutional care.
4. Across the Vale of Glamorgan and Cardiff, the two local authorities and the University Local Health Board recognised at an early stage the need for 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 which would 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.
5. 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, IT systems, 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.
6. The programme board meets every other month. A number of priority workstreams have been agreed.
· Mental Health services
· Older People’s services
· Learning Disability services
· Services for children with complex needs.
7. 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 has developed a delivery plan, setting out how the key projects will be taken forward and establishing milestones for delivery.
8. Chairmanship of the programme board rotates on an annual basis between non-officer members of the three statutory organisations: currently 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.
9. 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.
10. The pace of change is increasing but not yet to the level required, given the need to consider changing 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.
11. 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. 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.
12. For this reason, the programme board has been working hard to reach agreement on shared values, to ensure strong sponsorship for integration at a high level within all three organisations and to identify common difficulties and mutually beneficial outcomes. It produced a collaborative agreement which makes more explicit expectations of board members and the work they oversee. The agreement was endorsed by Cabinet on 19th October 2011.
13. Each of the organisations made a commitment to contributing specific resources to the work. The Director of Social Services for the Vale of Glamorgan has taken on the Senior Responsible Officer role for the programme board as a whole. The collaborative agreement is helping to ensure that the programme board is better equipped to fulfil the expectations of the three sponsoring organisations. It specifies expected outcomes, underpinned by more rigorous governance and performance management arrangements. There are now whole-system, detailed action plans for all four priority areas, with tangible progress made in addressing some longstanding service concerns.
14. Mental health services for adults in the community are co-located in Community Mental Health Teams (CMHTs). These teams provide health services and social care services from the same sites and they are in place across the Vale of Glamorgan and Cardiff. A new management structure has been implemented for adult mental health in which the two local authorities share an Operational Manager post. This post is hosted by the Vale of Glamorgan but provide strategic management to both authorities. A model for integrated team management has been agreed and the recruitment process for these integrated CMHT managers is nearly completed. This role means added responsibilities for existing managers and so a training plan has been prepared for successful candidates.
15. Health and social care Learning Disability assessment and care management services have also been co-located for some time. A joint Operational Manager post for both local authorities has been created and this post will be hosted by Cardiff Adult Services. A proposal for greater integration has been developed and it is being considered by all the partners including ABMU and C&V UHB.
16. In respect of services for children with complex needs, the focus is two fold:
· establishing joint, multi-disciplinary assessment processes and practices (to include Continuing Health Care) and integrating care/support plans and reviewing arrangements; and
· agreeing joint, multi-disciplinary processes for making decisions about resource allocation (including equipment, services and placements) and developing a joint commissioning strategy.
17. Substance Misuse services for Adult Social Care in the Vale are provided by Cardiff Adult Services. Significant progress has been made in developing a single point of access to all services across Health, Social Care and the third sector. Community Safety Partnerships play a key role in these services.
Relevant Issues and Options
18. The Chairman of the programme board is David Francis stepped down as Chair of the C&V UHB at the end of March. Recognising the potential for significant changes in programme board membership over the next few months, he has set out a Legacy Statement, summarising developments to date and possible next steps. This is attached at Appendix 1. The incoming Chair of C&V UHB is being invited to chair the programme board for the next 6 months to help manage a period of transition.
19. Historically, Older People's services have been less integrated than areas such as Mental Health and Learning Disability. However, in the past year, a number of important developments have taken place in the Vale of Glamorgan.
· The Vale Intermediate Care Service (VICS, formerly Homecare)) has been co-located with Community Rehabilitation (Health therapies) at Barry Hospital since the 1st of October. This has created a Community Resource Service, a development led by the Vale Locality team and facilitated through the joint appointment (Head of Adult Services/Locality Manager) with C&V UHB. The new service is already generating significant improvements. Information passes between therapists and so they can better identify where visits are most necessary and thereby save staff time. Service users are less confused as they experience a more co-ordinated approach, rather than visits by many different professions all appearing to have a different agenda. Linking review information is allowing more accurate assessment for future planning and time is being saved in organising aids and adaptations.
· The restructuring of teams and management posts in Adult Services has created an Operational Manager post for the Vale Locality as a whole, responsible for older people's services and for services to people with physical disabilities. Appointment to this post has allowed the Head of Service to complete the formation of an integrated locality management team with C&V UHB. A copy of the structure is attached at Appendix 2.
20. The programme board has agreed to give particular priority to the older people's services workstream over the next year and the Service Delivery Programme has been renamed 'The Wyn Campaign'. From September to March 2012, the Campaign achieved the following:
· an agreed vision across the partner agencies;
· an agreed new model of service delivery for frail older people;
· agreed outcomes-based performance indicators;
· a better understanding of the provision of public and third sector community-based services across the Vale of Glamorgan and Cardiff, and the gaps which need to be addressed in order to implement the new model;
· the embedding of key pathways into the new model including Falls, Dementia, and End of Life Care;
· outline proposals for Phase 2 of the Community Resource Teams in order to provide a more complete crisis response to avoid unnecessary admission to hospital and facilitate early discharge;
· implementation of a Proof of Concept pilot for a Frail Older Persons Advice and Liaison (FOPAL) service. This will identify frail older people in the Emergency Unit, provide a prompt Comprehensive Geriatric Assessment and multidisciplinary plan, returning patients back to the community and CRTs wherever possible;
· an agreed model for an Integrated Complex Discharge Support Team and detailed implementation plan;
· work commissioned from Oxford Brookes University’s Institute of Public Care (financed by Welsh Government) to produce a Joint Market Position Statement for longer-term care.
21. This is an ambitious transformational change programme and the Implementation Plan for 2012-2013, set out in Appendix 3, will see the Campaign gather further momentum. Plans include further development of:
· universal services, including a focus on public health priorities, early identification of frail older people in the community to facilitate pro-active signposting and information giving, and effective support for unpaid carers before crisis point is reached;
· targeted interventions including improved crisis response in the community, improved hospital experience via key pathways, and more effective medicines management in the community;
· joint commissioning for longer-term care, incorporating and building on the work of the Institute of Public Care, and exploring options for formalised partnership arrangements.
Resource Implications (Financial and Employment and Climate Change, if appropriate)
22. There is a commitment from all the organisations that the integration projects agreed to date will be delivered within existing resources and generate efficiency savings. Officers are currently exploring a possible 'Spend to Save' proposal in respect of services associated with the Wyn Campaign.
Legal Implications (to Include Human Rights Implications)
23. 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
24. There are no crime and disorder implications arising from this report.
Equal Opportunities Implications (to include Welsh Language issues)
25. There are no equal opportunities implications arising out of this report.
26. 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;
· to manage the Council's workforce, money and assets efficiently and effectively in order to maximise its ability to achieve its service aims; and
· delivery of the Social Services Change Plan 2011-2014.
Consultation (including Ward Member Consultation)
Relevant Scrutiny Committee
28. Social Care and Health
Phil Evans, Director of Social Services
Corporate Management Team
Philip J. Evans, Director of Social Services