The Care Together Programme a local authority perspective on integration

Ben Jay

Assistant Director (Finance)

Tameside MBC

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content

• the Care Together Programme

• Background issues

• Reflections and learning

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THE CARE TOGETHER PROGRAMME

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Care Together - Why

We are a discrete community serving a population of c250, 000 citizens •Some strong social networks•Long history of good partnership working.•Poor but improving health outcomes but still significant health and social care needs.Healthy life expectancy at birth is currently 57.4 years for males in Tameside and 56.6 years for females in Tameside. This is significantly lower than the England averages. Circulatory diseases including heart disease are the commonest cause of early death and rates are 55% higher than the national averagePremature death through lung cancer is 54% higher than the national averageHigh levels of social isolation in some of our communitiesWe are living with the consequences of tobacco being one of our biggest industries in 1950s and 60sForecast deficit of £74m by 2018/2019 if we do not act now

A Radically Different Way of Delivering Care

All parties recognise that “doing nothing” is not an option It is widely acknowledged that a radical and forward thinking IC care model is

the optimal solution bringing social, primary, community and hospital services together for:

A focus on wellness Supporting people to manage their own health and make healthy choices Proactive care and properly resourced general practice Care organised and delivered around people in their own home and

communities A range of hospital services available locally only for the most acutely ill,

working in partnership with neighbouring hospitals

TGHHospital Provider

Hospital Provider

Hospital Provider

Hospital Provider

Community

Primary

Social Care

WellbeingVertical Integration – services delivered at locality level

Horizontal Integration – Healthier Together in respect of a number of specialties

Care Together - How: Commissioner preferred (ICO) model

Following our option appraisal work commissioners have agreed a fully Integrated Care approach and organisation is the preferred model for Tameside & Glossop citizens:

Designing a new model of care

Proactive & Preventative Care

Women’s & Children’s

Integrated Urgent Care

Elective CareAcute

Specification

Gt. Manchester Conurbation

Patient Flows

Service Specification based on Care Design Groups

Estates IM&T Workforce & Education

Comms & Engagement Transport Joint

Intelligence

Enabling Workstreams

Issues to considerGovernanceLeadershipLegislationCultureBehavioursList basedGeneral Practice

Finance & Contracting

FINANCIAL AND GOVERNANCE ISSUES

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Governance for the Pooled Budget

Commissioning Executive(Providing Strategic Oversight)

Governing Body Executive Cabinet

Joint Finance Management Team

CCG Internal Gov.

Process

TMBC Internal Gov.

Process

= Decision making powers

= Recommendation Only

= Limited Delegated Authority

Key:

MBCCCG

CTP

Financial content of the pool

• Ongoing budgets for admitted services/service clusters

• Risk pool (to manage unforeseen costs)• Investment pool (One-off budgets to support

service redesign)– Capital investment (eg ICT)– Revenue investment (eg workforce change, double

running of acute/community services for a limited period)

• Pooled funds hosted by Tameside MBC

The Outline Business Cases (OBCs)

Phase 1

▪ Community, Home & Hospital Enhanced Care Team (CHHECT)

▪ Specialist LTC – Respiratory

▪ Musculoskeletal

▪ Dementia

▪ Ophthalmology

Phase 2

Phase 3 Phase 4

▪ Stroke & Neuro Rehabilitation

▪ All Age Learning Disability

▪ Palliative Support Service

▪ Local Community Care Team

▪ Wellness Offer

▪ Sexual Health

▪ Substance Misuse

▪ Cancer

▪ Carers

▪ Health Improvement

▪ Telehealth & Telecare

▪ Specialist Accommodation

▪ Children

▪ Specialist LTC – Cardiology

▪ Joint Equipment Service

▪ All Age Mental Health

▪ General Surgery

▪ Diagnostics

▪ Safeguarding

▪ Admission Avoidance: Minors

Implications…

 Work stream 2014/15 Budget Recurrent Future Budget % Change Expected Savings

CHHECT – total 85,642,518 65,227,774 -23.8% -20,414,744

Dementia 8,183,791 7,689,658 -6.0% -494,133

Respiratory 8,978,911 8,049,625 -10.3% -929,286

MSK 27,036,051 24,120,465 -10.8% -2,915,586

Ophthalmology 7,460,528 6,925,398 -7.2% -535,130

Total Phase 1 137,301,799 112,012,920 -18.4% -25,288,879

All Age Learning Disability 25,651,711 23,545,633 -8.2% -2,106,078

Palliative Support Service 1,354,716 1,354,716 0.0% 0

Stroke & Neuro Rehab 3,404,946 3,169,166 -6.9% -235,780

Local Community Care Team 19,806,010 16,240,928 -18.0% -3,565,082

Total Phase 2 50,217,383 44,310,443 -11.8% -5,906,940

Total Phases 1 & 2 187,519,182 156,323,363 -16.6% -31,195,819

Audit, assurance, quality, data

• Proposals already being discussed with external auditors– Development of approach to single pool that will satisfy

both assurance regimes (Monitor/TDA AND LA)

• Jointly commissioned activities will require clear performance framework and regular reporting

Entering and exiting the pool

• To gain entry to the pool– Business case and financial plan; commissioner

agreement; identified lead commissioner; case for change

• Rolling position agreed in both budget processes• To exit the pool

– Unmanageable over spending (demand pressure) and/or Inadequate clinical or care standards

– Recommendation of CFOs and the Joint Finance Management Team to the Commissioning Executive

– Exit strategy; goes down well with auditors…

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REFLECTIONS/LEARNING

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Reflections and Learning

• Partnership; Communication & Myth-busting– council attitudes; NHS attitudes; partnership behaviours

• Hosting with the council; common concerns• Governance; HFMA guidance and its application• Working with watchdogs• Devolution

– Not a take-over; an unparalleled opportunity.– Governance heavy. Of necessity.

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