Health and Social Care: improving outcomes and creating a sustainable future David Pearson Deputy Chief Executive and Corporate Director of Adult Social Care, Health and Public Protection, Nottinghamshire County Council

Development of Health and Wellbeing Board in Nottinghamshire Early Implementer - shadow Board meeting since May 2011 Accountability for public service strategy for services to people Prepared to have difficult conversations Committed to early agreement on priorities for to support CCG authorisation - JSNA refresh completed by April 2012 and Health and Wellbeing Strategy completed by July 2012 Health and Wellbeing Board Implementation Group to drive change Endorsed Health Select Committee recommendation on commissioning – ‘everything in scope’ - confirmed in report to HWB May 2012 Integration strategies considering the whole health and local government budget

Health & Wellbeing Board Supporting Structures Health and Wellbeing Board Nottinghamshire Safeguarding Children Board Health & Wellbeing Implementation Group Range of Strategic Commissioning Groups (Adults) Health Protection Strategic Commissioning Group Health and Wellbeing Strategy, JSNA & Outcomes Group Nottinghamshire Safeguarding Adult Board Children’s Trust Executive * Public and Provider Engagement linked to each Commissioning Group, including Voluntary & Independent Sector. Provider & Stakeholder Network established to promote wider engagement * As a Statutory Board, the Children’s Trust Executive has independent accountability arrangements Range of Strategic Commissioning Groups (Children)

Integrating Health and Social Care?

Integrated commissioning – why is it important? When it works the public gets a more coherent response Reducing budgets within local government and health but increasing demand and costs Need to manage demand better and understand cost of health and social care interventions – ill considered integration can cost more Need to work on interventions that help people get as close as possible to level of function they had prior to crisis – focus on independence rather than provision of care Care and Support Minister - Norman Lamb - plans to ‘push integration as hard as I can’ –‘If health and wellbeing boards are no more than committees then we will have failed’ Integration ‘pioneers’

Integrated commissioning – why is it important? Third of expenditure in health and local government economy will need to be saved and recycled over 4 year period - £600m out of £1.8bn Health performance impacts on local government expenditure –20% of people with hip replacements end up with a continence problem – a significant factor in admissions to residential care Obesity, tobacco, alcohol and substance misuse – big issues nationally End of Life Care – 63% of people want to die at home; only 10% do People with dementia admitted to hospital with physical difficulties stay longer and have worse health outcomes 70% of people in hospital over 65 - evidence is 30-40% could be cared for elsewhere

Nottinghamshire Health and Wellbeing Board – a leadership role In September 2011 presentation to Board gained a collective understanding of need in relation to dementia and agreement of the required action to address this –secured £1.5m as a direct result of raising the profile of dementia and identifying the level of unmet need Supporting structure for the Board facilitated the plan for delivery –integrated commissioning group agreed an approach for investing funding in Mental Health Intermediate Care Services and Dementia Memory Assessment Services (with social care support) Approach promotes joint and integrated working –dedicated social workers have been identified to support the intermediate care services Fred’s story shows what has been achieved as a result of the Board discussion

Fred’s story 76 year old, widowed Misses his wife ‘who kept things organised’ Locks himself out of house Medication for hypertension and depression Has had a few falls Referred to social care by son

Fred’s story: part 2 Mental Health Intermediate Care Service Assistive technology ‘Just Checking’ system to assess daily routine Fred helped to improve safety around the home Community matron oversees physical health Fred continues to live at home with support

Priorities for Nottinghamshire Health and Wellbeing Board Improved support for Carers - Compass workers Expand Mental Health Intermediate Care Continue reviews of antipsychotic medication Introduce quality standard for dementia services in care homes Dementia Care Matters programme being rolled out to selected care homes Continue workforce development and staff training Dementia: the Health and Wellbeing Board perspective

Examples of Commissioning Redesign of and tender for new mental health support services – the project board included representatives from Nottinghamshire County Council and district /borough Strategic Housing. A piece of work was undertaken involving 30 service users and their current service providers to help design the service specification. Mental Health Supported Living: alternatives to residential rehabilitation and secure units - highly innovative working with health partners to jointly assess and deliver improved care pathways, service models and outcomes, with partnership agreements about funding that support both agencies and avoid ‘cost shunting’ Mental Health Intermediate Care Services for Older People (MHICS) - a time limited intensive service for older people with mental health problems and/or dementia, which is provided in the community through district multi-disciplinary teams. Urgent Community Support Service (UCCS) Rushcliffe - the result of joint commissioning by one of Nottinghamshire’s CCGs and the County Council. This is a crisis avoidance/response service providing both health and social care through a team of generic workers from East Midlands Crossroads

Examples of Commissioning Care, Support and Enablement Tender – supported living and outreach services for adults with learning disabilities, Asperger’s, mental health issues and physical disabilities – a tender process to re-establish an approved list for the above services. Carers and service users were fully involved in the tender. Integrated Community Equipment Service (ICES) - the arrangements are made under a section 75 agreement of the 2006 National Health Service Act and include Nottingham City Council, NHS Nottingham City, NHS Nottinghamshire County and NHS Bassetlaw, with Nottinghamshire County Council being the lead commissioner A2A (Access to Advocacy, Specialist Advice & Representation) - all health and social care agencies across Nottinghamshire County and City Council worked with providers to develop a new information, advice and advocacy model now delivered by one organisation with a single point of access. The approach was nominated for the 2011/12 CIPS Supply Management Awards, Best Public Procurement Project.

The key to success Leaders are able to share and articulate a clear and unified vision The outcomes required are identified Resources and activity are aligned to meet the outcomes

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