Agenda Item No
The Vale of Glamorgan Council
Scrutiny Committee (Social Care and Health): 28th November, 2011
Report of the Director of Social Services
Delivering Integrated Social Care and Health Services to meet the needs of local people
Purpose of the Report
1. To update Scrutiny Committee 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 development of integrated health and social care services in the Vale of Glamorgan.
It is recommended that Scrutiny Committee:
1. Notes the content of this report.
2. Continues to receive six monthly updates, including delivery plans for individual workstreams.
Reasons for the Recommendations
1. To ensure that Scrutiny Committee is aware of the progress made to date and supports implementation of the actions agreed by the programme board.
2. To ensure that the Council's statutory responsibilities for delivering its social services functions are being scrutinised effectively.
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
Services for children with complex 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 a collaborative agreement which makes more explicit expectations of board members and the work they oversee. The agreement is attached at Appendix 1 and it was endorsed by Cabinet on 19th October 2011.
12. The collaborative 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. The Director of Social Services for the Vale of Glamorgan has been asked to take on the Senior Responsible Officer role for the programme board as a whole.
13. The collaborative agreement is helping 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.
14. 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 Scrutiny Committee in due course.
15. Welsh Government expectations in respect of integrating 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.
16. The Vale of Glamorgan provides social care services across two health board areas. The majority of patients are assisted by Cardiff and Vale University Health Board (C&V UHB) rather than Abertawe Bro Morgannwg University Health Board (ABMU). Primary care services in the Western Vale have been provided by C&V UHB since April 2011; however, Mental Health services and Maternity continue to be provided by ABMU. The situation regarding district nursing in the Western Vale is unchanged.
17. 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 is being implemented for adult mental health in which the two local authorities share an Operational Manager post. This post will be hosted by the Vale of Glamorgan but provide strategic management to both authorities. An external candidate has been recruited to the post. A model for integrated team management has been agreed and the recruitment process for these integrated CMHT managers has started. This role means added responsibilities for existing managers and so a training plan has been prepared for successful candidates.
18. 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 is being 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.
19. 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.
20. Historically, Older People's services have been less integrated. However, since January, a number of key 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. Recruitment to this post is underway for this post and it will complete the formation of an integrated locality management team with C&V UHB. A copy of the structure is attached at Appendix 2. A shared vision for Older People's service delivery is being developed with C&V UHB and Cardiff Adult Services. There is a n agreed programme of work in respect of joint commissioning and safe and timely discharge from hospital.
Resource Implications (Financial and Employment and Climate Change, if appropriate)
21. 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)
22. 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
23. There are no crime and disorder implications arising from this report.
Equal Opportunities Implications (to include Welsh Language issues)
24. There are no equal opportunities implications arising out of this report.
25. 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.
Consultation (including Ward Member Consultation)
Lance Carver, Head of Adult Services/Locality Manager
Philip Evans, Director of Social Services