1. health and fitness

Title of meeting:
Health & Social Care Decision Meeting
Date of meeting:
March 18th, 2015
Subject:
Better Care Fund (Integrated Locality Teams)
Report by:
Head of Adult Social Care
Wards affected:
All Wards
Key decision:
Yes
Full Council decision:
No
1.
Purpose of report
(i) To seek the approval of the Cabinet Member for Health and Social Care for plans to colocate and integrate existing community-based Adult Social Care teams with colleagues
from Solent Health Trust under the city's Better Care Fund (BCF) programme.
(ii) To outline the timetable for the planned changes and to set out the key future decision
points for the authority as the programme moves forward.
2.
Recommendations
(i) It is recommended that the Cabinet Member for Health & Social Care approve the BCF
plan to co-locate and (over time) integrate existing community Adult Social Care Teams
with colleagues from Solent Health as set out below.
(ii) It is recommended that the Cabinet Member for Health & Social Care approves the
broad timescales for change set out below and receives further reports in 2015/16 and
2016/17 to consider further integration as required.
3.
Background
3.1 - The Better Care Fund (BCF) is a £3.8 billion national programme established by
central government aimed at ensuring greater integration of health and social care. The
fund, although not 'new' money' looks to pool health and social care budgets in order to
support plans to develop capacity in community services and over time reduce demand in
acute hospital settings.
3.2 - The local BCF plan was developed jointly by PCC, the Portsmouth Clinical
Commissioning Group (CCG) and other key stakeholders and was signed-off by the city's
Health & Well-being Board (HWB). The first iteration of the plan was discussed by the
HWB in February 2014 and submitted to the Department of Health (DoH) in April 2014. An
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updated version of the plan was agreed by the HWB in September 2014 and submitted to
the DoH in line with national requirements.
3.3 - The Cabinet Member for Health and Social Care, in addition to participation in the
HWB, has previously received a report outlining the scope and objectives of the BCF
programme in March 2014.
3.4 - The programme covers a range of 'workstreams' aimed at pursuing deeper
integration between health and social care services in the city, as well as seeking to
improve the design of the overall system so that it is more responsive to resident's needs
and ensures that capacity is invested 'upstream' to prevent needs from escalating over
time. One of the key workstreams within BCF relates to 'Integrated Locality Teams'.
Under the BCF plan for integrated localities, we will move over time to co-locate and then
integrate staff teams from Adult Social Care with teams from Solent NHS Trust.
3.5 - The integrated localities project builds on earlier work in the city to integrate elements
of health and social care - for example Portsmouth Rehabilitation & Reablement Team
(PRRT), Continuing Health Care (CHC), and the virtual ward pilot schemes. Similarly,
community occupational therapy (OT) staff from both adult social care and Solent work are
co-located and work to a largely integrated model. However, social workers, OTs and
other staff employed by PCC currently work separately from colleagues in community
nursing, physiotherapy and older person's mental health (OPMH), all of which are provided
by Solent NHS. Although staff in all teams work hard to ensure good communication when
they are working with clients with multiple needs, this is made more difficult by the
differences in the working arrangements, which include:
Geographical model - adult social care community teams are split into North and South,
whereas nursing staff are split across three localities.
IT - social care and health teams record their interactions with clients on separate IT
systems that are not currently inter-operable.
Funding Model - Health services are free at the point of use, whereas adult social care
services can be chargeable, subject to means-testing.
Case management and assessment - All teams work to slightly different case
management and assessment processes and have their own data recording processes.
3.6 - It is agreed by PCC, Solent, and the CCG that there are potential opportunities
arising from a plan to integrate these teams at a local level, as the current system
generates some inefficiencies where clients need to be referred between
teams/disciplines.
3.7 - During 2014, a small project team drawn from PCC, Solent, the CCG, and including
primary care representation carried out demand analysis and scoping work in the north of
the city to identify what an integrated, person-centre, co-ordinated model of care could
look like. This work included analysis of existing data sources and a range of visits to
entry points within the health and social care system to 'listen' to demand - ie to
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understand how clients experienced making demands from the system. This work, as well
as research into similar projects elsewhere in the country, confirmed the logic of earlier
work carried out in Portsmouth looking at integrated models of health and social care. The
project team produced a report in January 2015 setting out a proposed model of integrated
care, which is summarised in the diagram attached as Appendix 1.
3.8 - Under this model, there would be three locality teams in the city (aligned with GP
clusters), in which a number of disciplines/teams would be part of the 'core' of the
integrated team model, including:
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Social workers
Occupational Therapists (OT)
Physiotherapists
Community Nursing
Community Geriatricians
Older Person's Mental Health
3.9 - These teams would be co-located and managed under a single combined line
management structure shared between PCC and Solent NHS. In addition to this, a range
of other elements of the health and social care system are included within the model, but
are not expected to be integrated with the core team at this stage. Finally, it is critical that
this model aligns appropriately with GP practices in the city. Various models of integration
between integrated locality teams and primary care have been adopted elsewhere and
further research, analysis, and discussion with stakeholders would be required in order to
ascertain the most appropriate model for Portsmouth.
3.10 - Under current planning, work will begin to recruit (from within existing staffing
resources) to the leadership roles for each locality team, with the aim of having managers
in post by April 2015. These roles, combining accountability for all disciplines in each
locality under a single manager, are seen as critical to the success of the project.
3.11 - In the first phase, the teams will be co-located in suitable sites in each of the three
locality areas and will provide services to clients registered with GPs in those areas.
Initially at least, the basic pattern of work for staff involved will remain the same, as will
services to clients. Once the teams are established as co-located entities with a single
management structure, a phased integration programme will follow. The integration will be
an iterative process, based around co-designing the model of delivery around a shared
purpose, involving service users. This will be expected to include: integrated triage and
case allocation; single assessment process; and, a shared performance framework. This
integration is expected to generate savings over time and ensure a better experience for
clients by avoiding fragmented approaches to care and support.
3.12 - Once developed, the integrated model will enable practitioners to operate in informal
teams around the client, with lead professionals able to pull on resources within the team
to assist in complex cases, rather than making formal referrals across organisational
boundaries, as at present. It is anticipated that work on integrating operational process will
continue into 2016/17.
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4.
Reasons for recommendations
4.1- It is agreed by Solent, PCC, and CCG that there are significant opportunities arising
from integration at the locality level. Not proceeding with this project would
therefore have an opportunity cost, but would also be inconsistent with the policy
direction set by central government in establishing the BCF programme nationally.
4.2 - Although all parties are agreed that the work needs to proceed with a degree of
caution and risk-awareness, there are nevertheless opportunities to improve the
experience of people using Health and Social Care services and investigate any financial
savings that could be made from this project through new staffing structures.
5.
Equality impact assessment (EIA)
A preliminary EIA has been carried out in respect of the recommendations included in this
report
6.
Legal implications
The provision of services under the Better Care Fund is governed by the relevant
legislation and Government policy as set out in the body of this report.
Because of the integration involved in this proposal, attention will need to be paid to the
employment aspects of the proposed changes and care taken in establishing management
and reporting responsibilities so as to minimise TUPE costs.
7.
Finance comments
Within the 15/16 BCF plan is the funding for the Community contract with Solent and the
staffing budget of the ASC fieldwork teams. It is anticipated that this funding is sufficient to
enable the integrated locality teams to be formed and the service delivered.
………………………………………………
Signed by:
Appendices:
Appendix 1 - Schematic of Integrated Locality Team Model
Background list of documents: Section 100D of the Local Government Act 1972
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The following documents disclose facts or matters, which have been relied upon to a
material extent by the author in preparing this report:
Title of document
Location
The recommendation(s) set out above were approved/ approved as amended/ deferred/
rejected by ……………………………… on ………………………………
………………………………………………
Signed by:
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