Health and Social Care Integration Helen Taylor – Director for Integrated Commissioning & Vulnerable People Essex County Council

Why Integration? Law – the Care Act provides a mandate for more formalised, integrated ways of working between the two sectors, including a duty for local councils to promote integration. Politics (!) – all of the main political parties have endorsed health and social care integration to some degree, e.g. pooling budgets, ‘whole person’ care, social care to be transferred to Department of Health or devolution of health commissioing to local government etc. Current provision doesn’t work effectively - domiciliary, residential and nursing care has traditionally been commissioned and funded separately by Essex County Council and the NHS leading to differing price structures, cost shunting, lack of quality provision, and poor market engagement and development. Breaking down the silos of primary care, hospitals and social care established in

Why Integration? People - It’s the right thing to do for patients and service users. They care about the service that is provided, not how we organise ourselves to commission and deliver it. Integrated care means person centred, coordinated care Sam’s Story (King’s Fund animation) 3

Integration is multifaceted: Health and social care budgets Care pathways Organisations – structural, governance and MDT working Single assessments Care co-ordination Outcomes based packages of care – including both paid for and free support Packages of care involving more than just health and social care, crucially anchored in and involving local communities And needs to be considered against the backdrop of Individually controlled budgets 4

Examples of Integration Child and Adolescent Mental Health services: –The seven Essex and Unitary CCGs, Essex County Council, Southend Council and Thurrock Council have been working closely to jointly re- commission integrated, targeted and specialist mental health services for children and young people. –This will deliver a new redesigned service model based on the findings from needs assessment and consultation with young people, clinicians and stakeholders. Residential and Nursing procurement (Sponsor of the IRN Project): –ECC and the five Essex CCGs are working together to jointly re- commission care in a residential setting. –Just finished a series of market engagement event with providers across the county –Our initial step is to undertake a short term procurement to allow for the convergence of different starting places for ECC and CCGs –Longer term we would look at options to fully integrate the commissioning and placement of care services. 5

Integrated Residential and Nursing (IRN) The aim of this project is to procure care in a residential setting. This includes: –Residential placements for adults with personal care needs; –Funded Nursing Care (FNC); –Adults who are eligible for NHS funded care (CHC). Joint sponsorship with joint commissioning intentions: –Focus on improving quality –Approach the market with a “single voice” –Create a diverse, equitable, stable and sustainable market within the financial envelope –Timely advice and information provided to residents The CCGs and ECC are at different starting points with the care and nursing market and so we are developing short term and long term integration ambitions. 6

IRN - Short term ambition Short term ambitions: Development of a standard specification to be used across all care and nursing homes Agreed standard set of quality KPIs to be used by all homes New Spot contract arrangement for all CCG placements based on the standard specification Two or three year contract against a short term framework enabling us to build greater integration into the longer term solution. The short term approach will include options for an extension of the contract, if needed, to ensure the long term approach meets future needs. Greater understanding of the care provision across both health and social care Review quality monitoring arrangements Likely to tender in May with contract award in Sep/Oct 7

IRN – long term ambitions The short term approach will be superseded by the longer term approach if this piece of work reaches its completion before the expiry of the short term contract. In the long term we will work towards an integrated commissioning approach to shape the future of local care provision to meet changing demands. The detail is yet to be fully determined, but could include: –Standard contract, specification and KPIs –Standardised pricing structure –Joint performance management of all suppliers, driving up quality –Integrated placement service –Market development, e.g. right beds, right locations Any views where we could further integrate? 8

Integration – Providers’ interests? Whilst health and social care integration will provide direct benefits to the service user/patient and the organisations involved, why should providers care?: –Direct access to combined domiciliary, residential and nursing market worth over £250m –More choice for the customer – market competition –Improved transparency of care provision – easier to price –Improved processes to reduce duplication and simplify administration for providers –Ensure standards are equal across all suppliers –Providing a level playing field across all sectors of the care market –Embed an ethos of progression with a focus on reablement and rehabilitation –Clarity on commissioning requirements across the market 9

Some cross cutting issues to work together on 1.Quality: with increasingly complicated packages of care we need to be looking at whole pathways, and the individual’s personal experience rather than location or provider. 2.Market dynamics : with ever more integrated services, changes in structure and funding increasingly impacting on the other. How can we keep all the balls in the air? 3.The workforce: current challenges with both capacity and capability for an increasingly complex set of needs. Shortages in both areas is affecting both quality and price. What can we be doing to help you? 4.Efficiency and transformation – need to think differently/find new solutions 5.Personalisation to support new models of care. 10

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