Management Forum

July 8th 2013

Health and Social Care Integration

Walsall Social Care and Inclusion – going forward

John BoltonInterim Executive Director

www.walsall.gov.uk

Feedback from last Forum

Over 80% of those completing the evaluation form said that:

the event overall was either good or very good

the opportunity to understand our progress to date in terms of promoting self directed support was good

the opportunity to consider medium term financial plan was good

www.walsall.gov.uk

Feedback from last forum

But almost a third of you completing the evaluation form were unclear what outcomes there would be for …

yourself

your service

our Directorate

… and very few of you completed the evaluation form, so please remember to do so at the end of today’s event

www.walsall.gov.uk

General Feedback

Good to have opportunity to share/challenge perceptions/views

Would have been good to have had information on what the Directorate was working on

Would have been useful to hear from the ADs about current developments and initiatives in their services

Want senior managers to join the tables!

www.walsall.gov.uk

How could the event have been more effective?

You said … give us more notice of these events

We did … publish the date of the November event

You said … give us more information in advance

We did … send today’s programme and slides out earlier

You said … presentations don’t take enough account of the role and understanding of workers in

partner organisations

We did … make sure there are presentations today which address the roles of colleagues in

DWMHT and JCU

www.walsall.gov.uk

How could the event have been more effective?

You said … give us an opportunity to put forward questions to the Director and ADs

We did … include this in today’s event, though we expect you to come up with solutions too!

You said … let us put forward topics for future Forums

We did … arrange for a suggestions wall today, so please make sure to use it for your ideas on items for November’s event

www.walsall.gov.uk

Last Meeting…..

We looked at the agenda going forward – emphasis on getting prevention right in the operating model and getting personal budgets right.

Fresh challenges of the money – we considered all of your suggestions and have started to work them up into solid proposals (I read every sheet personally) – some of them are about improving and changing our practice – e.g. Building our preventive services – others are really difficult political decisions – e.g. Charging or redundancies

Now we will focus on reducing admissions to residential care – through better intermediate care; better care pathways for dementia and reprovision for younger adults

www.walsall.gov.uk

Inquiry to Adult Social care

Hospital discharge requiring support

Intermediate Care Services – residential and community (reablement)

Preventive ServicesCommunity AlarmsEquipment – telecare, Aids to daily living – Independent Living CentreCommunity Social WorkersNeighbourhood Community OfficersSensory Impairment ServicesHousing Related Support ServicesCommunity and Voluntary Sector - CarersHealth - falls preventionEmployment

Assessment for longer term care

Safeguarding assessment

Divert to Community/ Voluntary sector Information and Advice

Diagnostic and Early Intervention Phase

www.walsall.gov.uk

Assessment for longer term support

Resources AllocationAnd Support PlanningWith a Focus on Outcomes = Personal Budgets

Outcomes delivered through - Direct Payment with DP Support Services/ PAs / Community/ Family support

Managed Accounts – outcomes delivered by access to services –Domiciliary Care / Day /Residential/ Shared Lives/

Assessment and Long Term Interventions

What are the interventions that will help this person become more independent? – Reprovision programme – Living well with Dementia – Expert Patient for a long-term condition – Prepare for employment

Review

www.walsall.gov.uk

Four key priorities going forward

Building the operating model – get preventive services to deliver

Build on the personal budgets – get both Direct Payments and Managed Accounts working for everyone

Work collaboratively with partners – noticeably Health Start being prepared for the possible financial challenges

ahead.

Walsall CCG

Relationship between Strategic Commissioning and the Operational Commissioning role of Access, Assessment

and Care Management

Andy Rust – Head of CommissioningSuzanne Joyner – Head of Community Care

Walsall CCG

Strategic Commissioning

• Whole Health and Social Care System

• Need Supply Demand Analysis

• Market Shaping

• Menu of Services

• Improving Quality

• Regulation

• Service Specification

• Contract Management / Accreditation

• Contract Monitoring / Holding to Account

• Safeguarding

• Clinical Improvement

Walsall CCG

Operational Commissioning

• Individual Case Management

• Whole Family

• Person Centred

• Personalisation

• Social Workers/Occupational Therapists/Reablement

• Safeguarding

Walsall CCG

Relationship Between Strategic and Operational Commissioning

• How do we effectively capture collective intelligence about gaps in the market from individual/operational case management and communicate to strategic commissioners?

• How do we effectively communicate new market options to case managers / individual service users?

• How do we use feedback captured during review and reassessment processes on quality issues in the market so that we can take those issues up with the market?

• How do we relate strategic commissioning concerns to individual case management?

Mental Health Services

PartnershipsCommissioning

Social Work

The Partnership with the Mental Health Trust

Peter Davis Head of Service

Walsall Social Care & Inclusion

www.walsall.gov.uk

Context

• A single organisation delivering services to children, adults and older people in a seamless way

• Need to integrate organisations with different governance arrangements, organisational structures, funding and cultures • Sense that Mental Health was “bolted” onto the local agenda

• No holistic consideration of wider care pathway, especially for older adults

www.walsall.gov.uk

Local Benefits

• Change to silo working

• Senior managers have a greater understanding of how each organisation works

• Development of a formal joint approach to planning and strategic management; via Partnership Operation Group (POG) and Partnership Board

• Middle managers become more involved in changes

• Better front line integration and senior managers working together

www.walsall.gov.uk

Service User benefits

• Greater uptake and offer of Personal Budgets with wider choice of alternatives to residential care

• Prompt and consistent decision making via panel arrangements

• Increased involvement of the third sector

www.walsall.gov.uk

The future benefits

• Understand gaps in community based provision and commission accordingly• Improve engagement with service users and carers with consistent consultation and

communications mechanisms• Give people control and choice over their care and support packages• Develop a shared outcome focussed evidence base for treatment and support services• Plan and manage the impact of decreasing resources• Develop metrics around the quality of Section 75 arrangements• Improve the range of community based preventative services • Understand the needs of the Section 75 workforce • Develop strategic partnerships with statutory, commercial and voluntary sector agencies

Mental Health

Commissioning

In Walsall

Marcus LawCommissioning Development Manager

• Budget management and ensuring VfM

• Market development

• Promote independence, prevention and early intervention

• Reinvestment in appropriate services

• Contractual and performance management

Summary of commissioners’ role

• Whole population mental health & wellbeing• Early interventions• Intensive support• Time limited targeted interventions • Recovery focus• Supported discharge• Signposting

• Above fits with the Councils Operating Model

Mental Health Vision

Mental Health

32643268.12; 82%

7375024.87; 18%

Forecasted Expenditure split between NHS and LA (£) 2013/14

NHSLA

Adult Mental Health• Key achievements to date

Personal budgets – rolled out successfully Developed Supported living schemes Developed S117 policy which has enabled discharge for over 100 MH users from S117

aftercare – removes them from MH services. As well as moving others responsibility to other LA’s and PCT’s.

Closure of poor provision in day services, residential and nursing care sector Brought service users back from out of area placements New prevention services such as Rethink community model, Big White Wall and Kooth. New specialist hospital and rehab provision built in Walsall for detained and complex users New PICU service built in collaboration with Black Country commissioners – High quality,

local and short stays Assertive review panel – stepped down care and support for many individuals enabling them

to return to community without support or move to supported living or extra care schemes Payment By Results data – model worked on with SHA colleagues to establish key reports

from MHMDS through partnership working with DWMHT Enabling greater independence, shorter stays in care, offering a wider menu of

services and achieving savings by implementing above

Adult Mental Health• Achievements to date cont’d:

New specialist hospital and rehab provision built in Walsall for detained and complex users

New PICU service built in collaboration with Black Country commissioners – High quality, local and short stays

Assertive review panel – stepped down care and support for many individuals enabling them to return to community without support or move to supported living or extra care schemes

Improved review practice by DWMHT staff by implementing assertive review process Pathway improved -Reduced length of stays in hospital, rehab, nursing and

community packages. Wider range of services now available and more appropriate selection based on

need and preference Payment By Results data – model worked on with SHA colleagues to establish key

reports from MHMDS through partnership working with DWMHT Review of psychiatric liaison services Enabling greater independence, offering a wider menu of services and

achieving savings by implementing above

Efficiencies achieved 2010/11 - 2012/13

  2010/11   2011/12   2012/13Cumulative on year

savingsOrganisation Part year

effectFull year effect

  Part year effect

Full year effect

  Part year effect

Full year effect

Full year effect

  £ £   £ £   £ £ £

SC+I 70,994 121,382  126,139 361,712   52,205 97,702 580,796

NHS 347,551 537,730  279,186 608,069   171,600 213,200 1,358,999

                   

Total 418,545 659,112  405,105 964,061   405,105 964,061 1,939,794                   

NB - Year 2011/12 and 2012/13 refers to additional savings to that of 2010/11 and not recurring savings from previous years

Adult Mental Health

Continuing redesign of secondary mental health services (MH Trust)

Create a wellbeing and recovery service hub:Create new preventative services with closer links to the community, GP’s creating improved pathway for usersEnhance existing recovery college provision

Ongoing work on NHS Payment By Results (PBR) in MH – build new tariffs/contracts for services based on cluster activity in the future along with outcome based monitoring

Redesign of existing crisis and respite provision Strive to achieve ‘cultural shift’ in all providers to promote

recovery and independence that is both effective and efficient

Future services and redesign work

Adult Mental Health

• The team• Commissioning Engagement Manager across

Dudley and Walsall (Walsall Team Manager)– Anet Baker

• CAMHs commissioner– Alicia Wood

• Adult commissioners– Marcus Law & Mark Williams

• Older Adults Programme Manager Lead– Michael Hurt

The role of the social worker

in the Mental Health Trust

Santokh Dulai – Walsall CouncilHassan Omar -DWMHP

www.walsall.gov.uk

The Ten Essential Shared Capabilities: A Framework for the Whole of the Mental Health Workforce (National Institute for Mental Health in England andSainsbury Centre for Mental Health – 2004)

• Professional groups expected to retain their distinctive roles though the demand for change is increasing

• Professionals to focus on shared elements of good practice

• Much of this has been historically associated with social work

www.walsall.gov.uk

Shared capabilities for Mental Health practitioners

• Working in Partnership. • Respecting Diversity. • Practising Ethically. • Challenging Inequality.• Promoting Recovery.• Identifying People's Needs and Strengths.• Providing Service User Centred Care. • Making a Difference. • Promoting Safety and Positive Risk Taking• Personal Development and Learning

www.walsall.gov.uk

What do we bring to the integrated model?

• The social model of mental illness v medical (symptoms)• Context / normalisation • Prevention rather then cure• Instil hope • Recovery and empowerment• Promote dignity• Human worth• Social justice • Principles and social perspectives of the recovery model

www.walsall.gov.uk

Table Exercise

What should my service be doing to further integrate with Health?

www.walsall.gov.uk

Table Exercise

Current issues and challenges?Solutions?How can EDMT support you?

Sharing success and good practice

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Evaluation

Management Forum

July 8th 2013

Health and Social Care Integration