Agenda Item No. 6
The Vale of Glamorgan Council
Healthy Living and Social Care Scrutiny Committee: 15th January, 2018
Report of the Director of Social Services
Update on the Cardiff and Vale of Glamorgan Regional Partnership Board
Purpose of the Report
- To update Members on the work of the Cardiff and Vale of Glamorgan Regional Partnership Board in relation to the integration of health and social care.
That Scrutiny Committee:
- Notes the work being undertaken by the Cardiff and Vale of Glamorgan Regional Partnership Board.
- Consider the Draft Cardiff and Vale of Glamorgan Area Plan for Care and Support Needs 2018-2023.
- Consider the Draft Market Position Statement and Commissioning Strategy for Older People Services 2017-2022.
- Receives annual updates on the work of the Board.
Reason for the Recommendations
To apprise Members of the progress made with regard to the Cardiff and Vale of Glamorgan Regional Partnership Board and the development of the Cardiff and Vale of Glamorgan Area Plan for Care and Support Needs 2018-2023.
- Part 9 of the Social Services and Well-being (Wales) Act 2014 (SSWWA) requires Local Authorities to make arrangements to promote co-operation with their relevant partners and others, in relation to adults with needs for care and support, carers and children.
- Part 9 of the Act also provides for partnership arrangements between Local Authorities and Local Health Boards (LHBs) for the discharge of their functions. It also provides Welsh Ministers with regulation powers in relation to formal partnership arrangements (including pooled funds) and partnership boards.
- Local Authorities and LHBs are required to establish Regional Partnership Boards (RPBs) to manage and develop services to secure strategic planning and partnership working between local authorities and LHBs and to ensure effective services, care and support are in place to best meet the needs of their respective populations.
- The objectives of the RPBs are to ensure that the partnership bodies work effectively together to:
- Respond to the population needs assessment carried out in accordance with Section 14 of the Act; and
- Implement the plans for each of the Local Authority areas which are covered by the board, which Local Authorities and LHBs are each required to prepare and publish under Section 14 of the Act.
- Ensure the partnership bodies provide sufficient resources for the partnership arrangements.
- Promote the establishment of pooled funds where appropriate.
- RPBs also need to prioritise the integration of services in relation to older people with complex needs and long term conditions, including dementia; People with learning disabilities; Carers; including young carers; Integrated Family Support Services; and Children with complex needs due to disability or illness.
- The SSWWA came into force on 6th April 2016 and the Cardiff and Vale of Glamorgan Regional Partnership Board (CVGRPB) met for the first time on 22nd April 2016. The Terms of Reference, Membership and Governance Structure can be seen in Appendices 1 and 2.
Relevant Issues and Options
- Since the establishment of the CVGRPB in April 2016 the Board has progressed a number of key pieces of work in line with Part 9 of the SSWWA.
- As required by the Act, the CVGRPB published a regional population needs assessment on 31st March 2017. The assessment brought together information from public surveys, focus group interviews with local residents, surveys with professionals and organisations providing care and support and population data.
- Key findings identified by the assessment included the need to increase citizen involvement in shaping services, promoting and improving access to high quality information and advice, improving access to low level and specialist mental health care and support, improving public transport to better access services; and providing appropriate housing and community environments to enable people to remain independent.
Cardiff and Vale of Glamorgan Area Plan for Care and Support Needs 2018-2023
- In response to the findings of the Population Needs Assessment a review was undertaken in relation to all suggested areas for action. This was done against existing or planned activity in current partnerships or organisational delivery mechanisms across the region to identify where this work is already being progressed. As a result, an Area Plan (Appendix 3) and Action Plan (Appendix 4) has been developed which sets out the priority areas for action to meet the identified needs within the Population Assessment.
- The development of the Draft Plan has been undertaken alongside the production of the Well-being Plans in both the Vale of Glamorgan and Cardiff to ensure alignment. Public consultation also took place between 23rd October and 3rd December 2017 and involved attendance at community events and venues and an on-line survey. Key themes emerging from the consultation included:
- Positive feedback regarding the draft content, such as both reports being people focused and targeting the main (vulnerable) population groups across the region.
- Requests for greater reference to the issue of homelessness and how the Plans propose to address this issue.
- Requests for some additional relevant strategies / areas of work not currently included in the Area Action Plan to be added, such as 'Ageing Well in Wales', the 'Carers Strategic Action Plan' and the remodelling of specialist NHS learning disability services.
- Requests for some additional specific actions to be added, including a focus on falls prevention in relation to older people, and how we can support (unpaid) carers who work.
- The Draft Action Plan has been updated to reflect the consultation feedback and will be subject to approval at the CVGRPB on 1st February 2018, followed by the decision making processes of the two Local Authorities and Cardiff and Vale UHB in February and March 2018.
Joint Commissioning and Pooled Budgets
- Part 9 of the SSWWA requires Local Authorities and the Local Health Board for each region to establish and maintain pooled funds in relation to the exercise of care home accommodation functions by 6th April 2018. The purpose of the pooled funds arrangements is to ensure that Local Health Boards and Local Authorities work together to maximise their influence to shape the future development of services. This includes ensuring there is sufficient capacity and an appropriate range of good quality services to respond to demand.
- A proposed approach to establishing a no risk sharing pooled budget across the region from April 2018 is due to be considered by Cabinet on 22nd January 2018 and which will initially focus on care accommodation for older people (over 65), including those whose care is funded by NHS Continuing Health Care (NHS CHC), Funded Nursing Care (FNC) and Local Authority funded long term care home placements.
- However, whilst there will be one pooled budget in place, the processes for commissioning and payment for services will still remain with the three organisations as at present, with each partner continuing to be responsible for their own budget and expenditure. The accountability for the functions of the statutory bodies remains with each individual organisation, in accordance with the Part 9 Guidance under SSWWA 2014.
- In addition to the requirement for pooled funds in relation to care home accommodation functions, Local Authorities and Health Boards are also expected to:
- Agree an appropriate integrated market position statement and commissioning strategy.
- Agree a common contract and specification (for use between the care home providers and the statutory bodies).
- Develop an integrated approach to agreeing fees with providers.
- Develop an integrated approach to quality assurance.
- A Market Position Statement and Commissioning Strategy (Appendix 5) has been completed by the Partnership and which contains information on:
- Current and projected local demographics, expenditure and activity levels;
- The types of service partners will be investing / disinvesting in;
- The vision for how partners wish to respond to the changing needs for care and support in the future.
- The Market Position Statement and Commissioning Strategy has been developed around four key 'design principles' which partners will be expected to consider and support when developing future services. These include:
- What Matters to Me - Listening and working with people in need of care and support to jointly find solutions to meet their needs;
- Home First - Enabling people to live at home, or as close to home as possible, in accommodation appropriate to their needs and where they can live well, thrive and remain independent;
- Sustainable and Prudent Use of Resources - Promoting prevention and early intervention, and developing quality outcomes and value for money solutions which meet care and support needs;
- Avoiding Harm, Waste and Variation - To ensure high quality care across all services.
- Following a stakeholder workshop in July 2017 involving over 80 people from health, housing and social care (including third sector and providers) feedback and additional information has been incorporated into the completed document. The Strategy was approved by the CVGRPB in November 2017 and it is now subject to approval by Cabinet on 22nd January 2018.
- Work is continuing in relation to the development of a common contract and specification; an integrated approach to fee setting and an integrated approach to quality assurance and it is anticipated that these elements will be completed in 2018/19.
Integrated Care Fund
- The Welsh Government's Integrated Care Fund (ICF) has been provided to Regional Partnership Boards to assist in the integration of health, social care, housing and third sectors services. Its purpose is to improve the outcomes and well-being of people with care and support needs and their carers, with particular emphasis on frail and older people; learning disabilities and children with complex needs; carers; Welsh Community Care and Information System and the Integrated Autism Service. Governance of the work is provided by the CVGRPB in line with Welsh Government Guidance.
- In 2017/18 the Welsh Government has allocated £6.272m of revenue and £1.291m capital funding to the CVGRPB. A programme management approach has been implemented to ensure delivery of a series of projects to meet ICF aims and objectives. As part of the funding a number of services in the Vale of Glamorgan are supported which include:
- Single Point of Access - Telephone service facilitating co-ordinated access to Vale of Glamorgan Council, third sector and various region-wide community health services such as District Nursing.
- Ty Dyfan Residential Home - provision of a 6 bedded reablement facility.
- Third Sector Preventative Services.
- Accommodation Solutions - Multi-disciplinary team of Accommodation Solutions Officers and Occupational Therapists, working with hospital staff to assess and plan for individual housing needs in preparation for their discharge. The scheme includes provision of step up / step down accommodation to prevent admissions and expedite discharge.
- Integrated Discharge Service - Provision of social workers, social work assistants and Third Sector Discharge Support Officers to provide enhanced ward-based discharge support.
- Services to support people with learning disabilities and children with complex needs including respite; supported accommodation; enhanced day opportunities; independent living.
- Establishment of the Integrated Autism Service.
- Implementation of the Welsh Community Care Information System.
- Quarterly reports on progress are submitted to the Welsh Government and end of year outcomes will form part of the CVGRPB Annual Report in May 2018.
- A key focus of the CVGRPB has been on patient flow and reducing the number of delayed transfers of care. A delayed transfer of care (DToC) is when a hospital inpatient is ready to move to the next stage of care, but for one or more reasons is unable to do so. DToC can harm the wellbeing of those who suffer them and can have a negative impact on their independence. It also has an adverse effect on the wider health and social care system as delays can potentially deprive others from receiving timely care.
- Following increased partnership working and additional investment through the ICF the number of delays as of October 2017 were 54 across Cardiff and Vale of Glamorgan (16 from Vale of Glamorgan, 34 from Cardiff and 4 from out of area). 2 of the 16 delays for Vale of Glamorgan residents were recorded as social care reasons, 7 for health reasons and 9 for other reasons. Overall this is a 31% decrease on the same period in 2016 (78 delays) and the lowest level in three years.
- The SSWWA (Part 2, Section 16) introduces a duty on Local Authorities and Local Health Boards to promote the development, in their area, of not for profit organisations to provide care and support for carers, and preventative services. These models include social enterprises, co-operative organisations, co-operative arrangements, user-led services and the third sector.
- Local Authorities with Local Health Board providers must also establish regional forums to support social value based providers to develop a shared understanding of the common agenda, and to share and develop good practice. The aim of the forum is to encourage a flourishing social value sector which is able and willing to fulfil service delivery opportunities.
- Following a workshop in May 2017 a 'virtual Forum' has been established across Cardiff and Vale of Glamorgan which aims to promote social value and social enterprises through sharing best practice and focussed workshops on key issues. In September 2017 a joint event was held with the Wales Co-operative Centre and Social Business Wales in regard to 'Understanding Procurement to Deliver Innovative Public Services'. The event was well attended by both commissioners and providers and work is being taken forward to consider future joint commissioning opportunities and encouragement of alternative delivery models.
- To support the work of the CVGRPB a number of 'Social Value Champions' have been appointed following an application process. The Champions include representatives from third sector organisations across the priority areas for integration and who will work with Partnership to help co-produce different approaches to engaging with providers to promote increased social value.
Resource Implications (Financial and Employment)
- There are no resource implications arising directly from this report.
Sustainability and Climate Change Implications
- There is no sustainability or climate change implications arising directly from this report.
Legal Implications (to include Human Rights Implications)
- The work outlined in this report sets out the progress of the CVGRPB in meeting the requirements of Part 9 of the SSWWA. There is a requirement on Local Authorities to establish and maintain pooled funds in relation to:
- The exercise of their care home accommodation;
- The exercise of family support function;
- Such of their specified functions as they decide they will exercise jointly in consequence of the assessment carried out under Section 14 of the Act or any plans prepared under Section 14(a) of the Act.
Crime and Disorder Implications
34. There are no crime and disorder implications arising directly from this report.
Equal Opportunities Implications (to include Welsh Language issues)
35. Work undertaken by the CVGRPB positively impacts on vulnerable groups including older people over 65 years, people with learning disabilities, children with complex needs and carers.
36. This report is consistent with the Corporate Plan 2016-2020: Well-being Outcome 4: An Active and Healthy Vale - Objective 8: Safeguarding those who are vulnerable and promoting independent living.
Policy Framework and Budget
37. This is a matter for Executive decision.
Consultation (including Ward Member Consultation)
38. The issue relates to all areas of the Vale of Glamorgan. Therefore, there has been no individual ward consultation in relation to this matter.
Relevant Scrutiny Committee
39. Healthy Living and Social Care
Social Services and Well-being (Wales) Act 2014 - Part 9 Statutory Guidance (Partnership Arrangements)
Appendices 1-2: Regional Partnership Board Terms of Reference, Membership and Governance Structure
Appendices 3-4: Draft Cardiff and Vale of Glamorgan Area Plan and Action Plan for Care and Support Needs 2018-2023
Appendix 5: Draft Market Position Statement and Commissioning Strategy for Older People Services 2017-2022
Rachel Jones, Assistant Director - Integrating Health and Social Care
Lance Carver, Director of Social Services
Lance Carver, Director of Social Services