Commissioning Integrated Rehabilitation and Re-ablement Services? Cath Attlee and Ray Boateng 1

What is commissioning? “Commissioning is the process used by local authorities and NHS bodies to arrange services for their local population. It is the process of translating local aspirations and assessed needs, by specifying and procuring services for their local population, into services for people that use them. “Our aims are:  To deliver the best possible social and healthcare and wellbeing outcomes, including promoting equality  To provide the best possible health and care provision  To achieve this within the best use of available resources” Department of Health 2

Outcomes Based User Led Identifying needs and what works? Specifying services to meet needs Monitoring quality and impact - whether meeting needs Develop or procure services through a contract The Commissioning Cycle Users define outcomes Flexible contracts Users contact providers User self assessment - community surveys - monitoring use of direct payments - what works? Wider, more flexible market. Outcome based contracts. User feedback - does it work? Outcomesa dded together to see whether service is good. What does it involve? 3

Why integrated commissioning? People using health and care services do not differentiate between service providers or commissioners - their care needs can be more effectively met by close working between health and social care commissioners and integrated provision to prevent duplication and gaps We serve one population and require the same information to identify and meet their needs. 4

Why integrated commissioning? The delivery of greater health and wellbeing cannot be achieved by the NHS alone - it must involve the local authority who are responsible for so many wider determinants of health: housing, leisure, environment, community safety as well as social care and children's services. Prevention and early intervention can save the whole economy money 5

Integrated commissioning in Tri-borough Joint commissioning programmes between the local authorities and Clinical Commissioning Group for:  Older people - eg specialist housing programmes  Learning disabilities - eg community LD teams  Mental health - eg access to employment services  Equipment  Carers  Homeless health 6

Integration Transformation Fund New imperative for NHS and Local Authorities to commission integrated services from Central challenge and funding - local plan Some existing funding - some new Some on same formula - some new approaches Some confirmed - some dependent on performance Success against:  Delayed transfers of care  Emergency admissions  Effectiveness of re-ablement  Admissions to residential and nursing care  Patient and service user experience 7

New areas being explored for integration in Tri-borough Community Independence Services Re-ablement and Rehabilitation / Intermediate Care Commissioning Residential and Nursing Home Placements 8

What do we mean by intermediate care? Prevention Services for people with poor physical or mental health to avoid unplanned or unnecessary admissions to hospital or residential care Can include short-term and longer-term (time- limited) support Rehabilitation Services for people with poor physical or mental health to help them get better or improve their function Re-ablement To help them accommodate their illness by learning or re- learning the skills necessary for daily living 9

Community Independence service rehab, re- ablement, & rapid response Current service pathways for prevention, rehabilitation and re-ablement Hospital Referral Community Referral Referral to individual teams Neuro - rehab & long-term Rehab Adult Social care Falls Stroke Community nursing Other specialist services e.g diabetes, SALT etc Onward referral & assessment by individual teams Long-term care Rehab, interim and transitional beds 10

Issues with current pathways Referral routes still an issue Lack of clarity of what services can provide Multiple assessments Bouncing back referrals Waiting times from referral to service access Internal referral – within services Silo provision and inertia Different funding streams for services 11

Vision for integrated intermediate care Jointly worked up investment across tri-borough - based on needs assessment for intermediate care Supports people to maintain maximum control In-reach in all care settings Tightly integrated service, provided by a single organisation across tri-borough Single service - applying a single operating model Single accountable Service Manager Single set of outcomes 12

Vision for integrated intermediate care Supported by the following: Make Single Point of Access to service work better One single referral for all services, and seamless hand-offs within the teams Clearer and effective service pathways An assured process of how the service collects data and measures its performance Independent audit of user experience in service Communication of what service can and cannot offer 13

Next steps Integrated budgets Common specification showing benefit to service users Business case showing benefit to both NHS and Local Authority Integrated provision working within wider system of hospitals, community services, primary care, local communities 14

Questions for Discussion How do current commissioning arrangements prevent or make it difficult for providers to offer integrated services? What does the emphasis on integrated commissioning and provision mean for health and social care providers? Do your organisation have an Infection Control Policy? Do you know who provides infection control service in your organisation? ICT? DIPC? Who do you report to if you have a breach of infection control? How would you manage an outbreak? What is your role? 15