1. Health and Social Care Draft Integration Scheme Consultation Briefing Jan/Feb 2015

2. Aims of briefing 1.Background and rationale 2.What is in the Draft Integration Scheme 3.Explain what can be influenced 4.Lay out high-level timeline and next steps.

3. Illustration of need for integration c. 300 people currently unable to leave hospital Levels of personal independence Unit Cost Step Down Reablement  Operations cancelled  Risk of Hospital Acquired Infection  Slower recovery Residential care Care at home Self care Community Health  GP’s  District Nurses  Limited capacity  Process delays  Reactive rather than responsive

4. Background Policy announced by the Minister 2011 Consultation Spring/Summer 2012 Act comes into force April 2014 Regs and Orders enacted. Guidance still emerging in Dec 14 Community Health Partnership (CHP) subsumed by integration April 2015 Draft Integration Schemes for Consultation Final Integration Schemes submitted 31 March 2015 SG expected response – end June 15 IJB created before 31/1/16

5. Integration Planning Principles Deliver services to improve wellbeing of service users in a way: integrated from point of view of recipient; takes account of different needs/characteristics of people and in different areas; respects rights and dignity; takes account of views of service users their community and local practitioners; is planned and led locally engaged with local practitioners/clinicians; better anticipates need; and makes the best use of facilities people and resources.

7. Draft Scheme What does it include...

8. Not all elements can be influenced. The Summary explains why. Aims and Outcomes Choice of Integration Model IJB governance arrangements NHS and Social Care functions delegated to the IJB Support to prepare the Strategic Plan Local operational delivery How performance will be provided Clinical and Care Governance * Operational Role of the Chief Officer Workforce Development Financial Management and Processes Participation and Engagement Information Sharing and data handling Complaints Claims Risk Management Dispute Resolution What the integration scheme covers:

9. Integration Joint Board (IJB) Integration Joint Board (IJB) Delegate functions & money New authority created by Government. NHS & CEC appoint voting Board members. Has all powers and duties to make decisions within the scope of the delegated functions and budget. We must delegate specific functions and can delegate others The IJB does not employ any staff or own any assets. It appoints the Chief Officer (CO), who may be seconded from either NHS or CEC. The CO will have a duel role, to instruct NHS & CEC to deliver and resource functions, and deliver operationally in line with these instructions. The Model - Integration Joint Board (IJB) The IJB is wholly responsible for planning health and social care for the local population.

10. Integration Joint Board Integration Joint Board Service Delivery Service Delivery Model A - Integration Joint Board (IJB) The IJB creates and approves a 3 year Strategic Plan (incl.a resource plan). The IJB must consult NHS & CEC on the plan. Note, the published plan can then only be changed if BOTH parties agree to step in. This has finance associated with it. The IJB receives ALL it’s funding from NHS & CEC, and therefore NHS & CEC continue to carry the financial risk. IJB is accountable for the delivery of outcomes and principles and overseeing the delivery of functions

11. NHS functions that will be delegated Hospital services (includes associated services – e.g. AHPs) A&E general medicine geriatric medicine rehabilitation medicine respiratory medicine psychiatry of learning disability palliative care hospital services provided by GPs mental health services provided in a hospital with exception of forensic mental health services Services relating to an addiction or dependence on any substance. Community Health Services District Nursing Services relating to an addiction or dependence on any substance. Services provided by AHPs Public dental service Primary medical services (GP)* General dental services* Ophthalmic services* Pharmaceutical services* Out-of-Hours primary medical services Community geriatric medicine Palliative care Mental health services Continence services Kidney dialysis Services to promote public health

12. Social Care functions that will be delegated Residential Care –Older People Extra Care Housing and Sheltered Housing (Housing Support provided) Intermediate Care Supported Housing-Learning Disability Rehabilitation-Mental Health Day Services and Local Area Coordination-LD; Older People; Mental Health Care at home services and Reablement –All client groups Rapid Response Telecare Respite services-all client groups Quality assurance and Contracts Assessment and Care Management-incl. OT services Specialist Services-Sensory Impairment, Drugs and Alcohol. Not delegating Criminal Justice or Childrens’ services*

13. IJB budget Current Budget CEC Social Care £203M NHS Community £295M NHS ‘acute’ – est £90M How will this be done?

14. Next Steps to integration

15. Strategic Plan Co-produced – Statutory list of those to engage Detailed strategic needs assessment Local plan element and local planning Directs service change Integrates service planning across health and adult social care Instruction to Council and NHS Lothian flow Directs the IJB resources Will become an ongoing process.

16. Principles for localities People/family- centred services Empower managers, staff and local people to engage in the provision of services for the local area Create environment for local collaboration and innovation Create environment to foster community asset-based responses Tackle ‘demand- failure’ (revolving door) Support the balance between reducing costs but meeting people’s needs in the best way possible 4 common areas creates partnership approach across public sector

17. 31 March 2015 2 February 2015 4 November 2014 9 October 2014 7 August 2014 23 July 2014 Today Analysis of benefits of each model option Approval of model selection Negotiation of key terms of Integration Scheme Approval of draft Integration Scheme 3 month consultation of Integration Scheme Approval of changes resulting from consultation 31 March 2016 SG review of proposed scheme 30 June 2015 31 July 2015 1 November 2015 1 December 2015 Implement new governance model & approve draft Strategic Plan 3 month consultation of Strategic Plan Revise and approve Strategic Plan Implementation of Strategic Plan including any organisational changes to delivery Critical Path FocusDevelopment of Integration Scheme Development of Strategic Plan Implementation Plan Tactical operational issue resolution

18. How to Comment Papers available: –Council Papers online for corporate Policy and Strategy Committee on 20/1/15 –Council’s Consultation Hub https://consultationhub.edinburgh.gov.uk/hsc/draft-integration-scheme- consultation/consult_view