1. Lessons learned on improving health and social care between PCTs and Local Authorities A short presentation by Keith Skerman

2. Background to discussion –personal lessons –recent national policy Cultural change + workforce Developing health + social care: joint commissioning + integrated provision Governance in the care sector Some technical issues Agenda

3. Personal Lessons Health + Social Care career – seamless service Joint approach LA/NHS as Director SS Swindon Interim in LAs + PCTs since 2005 – Lambeth, Aberdeen, Staffordshire, Milton Keynes, Luton NHS Workforce Review Team focus on integrated services

4. Recent Policy Background DH World Class Commissioning (WCC) –PCT separation –NHS market development DH Putting People First (PPF) –Personal budget + Personalisation agenda –Choice + control 9 NHS DH guidance documents Nov 08-Jan 09 NHS Operating Framework (incl. collaboration + competition) Transforming Community Services Safeguarding reviews –Adult + children Care Quality Commission (CQC) starts April 09

5. Cultural Change & Workforce Focus on customers (patients, users, carers) Shift from “professional gift” to “in control” Care sector as key player in local economies Sustainable improvement + quality dependent upon investment in workforce Stepped approach to change associated with consistent focus on outcomes not process Choice + competition with joint commissioning

6. Developing Health + Social Care 1)Commissioning (WCC) – NHS focus upon market management + PCT separation for VFM - Joint commissioning issues with LAs led by NHS? Care pathway reviews, Patient experience, Security of supply versus Competition/choice 2)Provision – personalisation/choice impact upon health + social care, versus integrated services? - Impact of mixed NHS economy/ WCC procurement on patient outcomes, + workforce

7. Governance In The Care Sector Coherence in community + political governance of care sector i.e. is there a thread from LSP/LAA to frontline services for health and social care? Joint Commissioning accountability – officers with NEDs + Members, + with users/carers Ownership and involvement in models of provision + innovation– NHS FT, PBCs, Social Enterprises, Direct Services, ?customer focus Quality – user/carer experience + outcomes

8. Some Technical Issues Access to capital, + developing assets (such as property, ICT) in credit crunch Shared services for integrated care providers ICT support to users + carers for self assessment, brokerage, telecare/health Access to commercial expertise ( providers + commissioners procurement) in care market “Due diligence” techniques + support in new providers to support sustainable solutions