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Consultation on the Integration of services between Staffordshire County Council and the proposed Staffordshire & Stoke-on-Trent Partnership NHS Trust

Consultation Document

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Foreword This document is the final step in consulting with you about how we should organise health and social care services within Staffordshire in the future. It is issued by the three Staffordshire PCTs and Staffordshire County Council; it does not include services provided by Stoke-on-Trent City Council.

Nationally there are changes as to how community health services are provided which has meant that a new Staffordshire and Stoke-on-Trent Partnership NHS Trust (the “new Trust”) will be formed from the community provider services of the NHS North Staffordshire, NHS Stoke on Trent and South Staffordshire PCTs. In addition the county council and the three Staffordshire PCTs/new Trust (when formed) would like to develop further their relationship by integrating some adult social care services provided by the county council with the community health services that the new Trust will provide and so we have been listening to your views as our plans have been developed.

Unlike some transfers of services from local authorities to health bodies our proposals are not an outsourcing project. As a Partnership Trust the new Trust will give equal consideration to both health and social care needs of people within an integrated management structure. Health services will continue to be free at the point of delivery but people will contribute to their social care as they do now.

In proposing to integrate, we are motivated by a passion to put patients and customers first and to focus on delivering high-quality services safely and efficiently. In this document we explain why we consider that integrating social care services with community health services offers real gains to you and what we consider the benefits would be. We have been thinking about how the system would best work and whilst there are a number of ways that these types of arrangements can be made we are keen to maximise the investment in front line services by working together.

Our proposals for integration would happen at a time of significant challenge for all public services, especially community health and social care services. We recognise that over the next few years the growth in demand for our services will be increasing and we need to be innovative in our thinking and excellent in our organisation of services to meet that challenge. Our proposals in this consultation document show what we are planning to do and we hope that you will understand why we consider that our proposals to integrate are in your best interests.

A key to our success will be to work in partnership with others. The real scope for improvements in services lies in ensuring that for every patient and customer we are providing the right care in the right place at the right time, supported by the most efficient processes, regardless of which part of our system provides the service.

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We have already had some success in providing services which are in partnership across health and social care but we are keen to drive this further developing an increasingly integrated approach to supporting customers and patients helping where at all possible those with multiple and complex needs; including physical disabilities.

We fundamentally believe that greater integration of health and social care services is really important and beneficial but your views on this are crucial before any decisions are made. We have shaped our vision carefully. This document outlines our proposals for how we believe the scope for closer working to improve both the quality and efficiency of the care we provide can be realised. We need to make sure you have had a final opportunity to comment on these ideas.

Without this integrated approach and support, the evidence suggests (see bibliography) that frail elderly people and some patients with complex needs are admitted to hospital too frequently, unnecessarily or are admitted to permanent care homes, when this is not what they want or need. This can often be avoidable and is not always in the best interests of the person and their family.

We very much want you to share in this vision and if you wish to give us your views we invite you to please read on and provide us with your opinions. We have also provided some questions in this document to help you.

Graham Urwin Chief Executive Staffordshire Cluster of PCTs

Matthew Ellis Stuart Poynor

Cabinet Member for Adults’ Wellbeing, Staffordshire County Council

Stuart Poynor Chief Executive Officer Staffordshire & Stoke-on-Trent Partnership NHS Trust

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What’s this all about? In order to improve health and wellbeing outcomes for residents the Coalition Government has encouraged health and social care services to work together with examples ranging from joint and closer working arrangements to fully integrating services under the management of one organisation. This consultation document sets out the vision of Staffordshire County Council and the three Staffordshire PCTs for the future of some Adult Social Care services.

The purpose of this document is to provide information on the options being considered and the benefits that the county council and the PCTs believe arise from these. This will allow us to properly consult with the public on how you would like to see your services managed in the future. We are keen to hear from all sections of our population and in particular those who have direct experience of the services from a user, carer or professional perspective.

The Transforming Community Services initiative required the three Staffordshire PCTs to consider how best the services they managed directly (provider services) could be better organised in the future. They have proposed that a new NHS Partnership be established. This has been subject to considerable discussion and engagement with the public and their representatives since October of last year and it is anticipated that the new Trust will established later in the year.

In parallel to the debate on the provision of community health services a series of discussions on changing how some Adult Social Care services are provided has been developing and we are now at a point where these have been sufficiently thought through to present a range of options to you.

Why are we doing this? Many people find the maze of health, and social care services confusing. People with more than one long term condition, often with complex needs, may be visited or contacted by a number of different people from different departments in different organisations who may not fully understand the individual’s holistic needs.

National policy initiatives (see bibliography) are promoting the development of integrated care models by setting out a clear vision with the aims of:

• Maximising people’s quality of life, independence and control.

• Improving service system efficiency for service users with complex needs by taking a ‘whole-system’ approach, where services recognise their interdependencies and plan together to provide a comprehensive range of services for a local population.

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• Establishing clear links between these services and providing ways of tailoring services and care to the individual older person and their carer.

Additionally these policy initiatives in health and social care proactively promote integrated care models through:

• Adequate resourcing to ensure a balanced service system where there are good primary and community care (health and social care) services, as well as acute health and residential care provision.

• Awarding responsibilities for integration to organisations and individuals through funding, and regulatory, legal and other measures − including incentives to promote integration – for example, by allowing for budget pooling or special funding for integrated services.

• Coherent regulatory and inspection systems for health and social care services that do not duplicate one another and promote integrated practice and service models.

Furthermore these policy initiatives are joined up with other work such as:

How Government provided funds support the development of balanced service systems and are not directed to acute health care at the expense of prevention, primary and community services. The announcement by Andrew Lansley on April 8th 2011 on health funds supporting social care developments is an example of this. He said:

“Re-ablement will give opportunities for the NHS and councils, by working together locally, to make savings. Services of this kind have shown dramatic benefits in supporting people and cutting readmission to hospital. Our objective is for people to be once again independent, in their own homes.”

• Developments in how housing systems and policies work allows for integrated approaches with health and social services to support older people to live in the community in flexible, adaptive, accessible housing with appropriate services.

In addition much support for family carers to strengthen integration between formal and informal systems of care is now in place across the country. The Government is requiring local authorities and health organisations to support carers in their role both as care givers and as individuals with their own needs, ensuring practical measures to support carers to care as well as financial benefits, tax allowances and pensions that recognise carers’ contributions and compensate individuals for missed opportunities.

The national picture supports integrated approaches that are centred on older people, their carers and physically disabled people both in the way in which they are planned, delivered and in their quality. This involves supporting innovative approaches that offer choice, flexibility and control by older people and physically disabled people.

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In Staffordshire the number and proportion of the population with health and social care needs are increasing as the population ages. For example, later in life many people may be living with more than one long term condition and an increasing number of people will have dementia; people with cognitive and physical needs may be vulnerable and require integrated, personalised responses from statutory and third sector providers of care and support.

The elderly population in Staffordshire is projected to rise significantly. The number of people aged over 65 is projected to increase by 26% by 2020 and by 52% by 2030. This will undoubtedly have a significant impact on demand for community health and social care services. Details on this are set out below:

Population projections Change in population

% change in population

Age group

2010 2020 2030 2020 2030 2020 2030

0-64 880,500 873,600 867,700 -6,900 -12,800 -0.8% -1.5%

65+ 193,600 244,800 294,700 51,200 101,100 26.4% 52.2%

Following assessment, and where a person is entitled to community care services the county council either provides services directly, or commissions services for people on their behalf, or allocates and monitors ‘Direct Payments’ and ‘Personal Budgets’.

Our focus will increasingly be on self-management by service users supported by better information, often shared electronically with appropriate professional support. This will help improve communication for patients, service users, professionals and staff working within and between integrated teams. Staffordshire County Council will soon launch its ‘Staffordshire Cares’ initiative which provides a point of first contact for people making lifestyle, leisure, social and practical choices as their health circumstances change or are likely to change.

‘Staffordshire Cares’ will allow people to find information, in one place, which helps maintain an individual’s independence and ability to live as normal a life as possible whether coping with a disability, other health challenges or simply getting that bit older.

We want the individual (their family and/or carers) to be central to the care planning process and the work of the integrated community care team. This should result in increased personalisation of care and improved patient (and family) experience.

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Multi-disciplinary integrated community teams, together with third sector contributors, will be key to the delivery of improved health and social care outcomes; increased participation and compliance with treatment; reduced length of stays in hospital; reduced unplanned admissions to institutional care and acute hospitals and improved patient/service user and carer satisfaction.

A number of joint events have been held to explore what could be achieved by working together differently and have defined the following key areas where better organisation and management would be important:

• Developing a shared vision for the partnership.

• Creating strategic leadership and focus across the partnership.

• Measuring the impact of new care models on the system.

• Moving from clinical and managerial service managers to system managers.

In addition many managers and frontline staff have been exploring specific ideas on how the various functions of the new Trust and the county council could be brought together and what evidence nationally exists to support these ideas. The NHS Confederation and the Kings Fund have undertaken two separate assessments of integrated care models and found integration beneficial but requiring a lot of hard work to set up successfully (see bibliography). This has been very successful in looking at what options are open to the management teams to re-design the services in the future and how the staff would feel about working in new ways.

What do we want to achieve? We wish to see both social care and health services delivered in such a way as to improve the following:

• How well you can access the required support.

• How quickly the service responds to your needs.

• How the people in the service are organised to help you.

• How we make our resources and funding provide the broadest range of services.

• How you feel about the services you receive, use and control; including those you manage through your personal budget.

We will be consulting between 9th May 2011 and 20th June 2011. Should you require extra time in order to provide your response to us, then please contact us as set out in the Feedback Form towards the back of this document and your request will be considered.

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This consultation document provides you with information on the ways we might do things in the future and we want as many people as possible involved. However this is not a consultation about the formation of the new Trust but whether some adult Social Care services and Health services should be integrated.

What have you told us before about services? There have been many different examples of the local health and social care sectors seeking the views of the public on how services should be organised. Two particular exercises are relevant to this consultation. The first is the engagement exercise during October and November 2010 on how services would benefit from more integration. The second is independent research carried out by the Picker Institute, a health research charity, which looked at intermediate care in 2009.

Both the health organisations and the county council listen to their public in a range of ways. These are at the centre of our proposed change; Staffordshire people have told us that they want to:

• Be able to access services more easily, regardless of where they live in the county.

• Be able to access high quality personalised care.

• Have increased choice and control over their care.

• Remain independent in their homes for as long as they possibly can.

• Be able to influence the way services are planned, designed and delivered.

• Be treated with dignity and respect and to be treated equally.

• Deal with carers who look after all their needs.

This is backed up by the Picker Institute research which brought groups of people into focus groups to talk about intermediate healthcare and then followed up with discussions on integrating and combining health and social care operational services. They reported:

• Very strong support for the existing services from service users;

• Strong but qualified support for the idea from potential users of an integrated community-based service;

• Some concerns that some patients may prefer traditional hospital care;

• Some concerns that care under this model should not be seen as either second best nor cost (or target) driven;

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• A lack of clarity among patients and healthcare professionals about the range of current services available and how they fit together;

• Some confusion from service users and professionals about the availability of and uses for beds in the community hospitals and nursing homes to avoid admission or help discharge.This reflects uncertainty about types and location and access criteria;

• Little understanding from the public about the multi-disciplinary nature of the care available, but recognising that there is potential for further joint working between different health and social care professionals;

• Healthcare professionals delivering care closer to home feel a lack of awareness and potential of their services from some primary and secondary care clinicians - although untested this may be as a result of a lack of visibility and joint commissioning or silo working.

All of these themes can be identified across other consultation and engagement exercises by the organisations and are reflected within the minutes of the meetings of the county council’s Health Scrutiny committee. The minutes of these meetings can be accessed via the county council, and the Health Scrutiny committee who have received many reports on how our thinking is developing are very supportive of our ideas.

In the engagement exercise the themes above were again commonplace but we have really welcomed the direct comments we received from members of the public and representatives of other sectors such as voluntary organisations; below is a sample of some of these.

Quotes from the engagement exercise

“Main things you want from NHS or Social Care Consistency of service and personnel - particularly when dealing with dementia sufferers (carers helping with my mother) Recognition when it isn’t, an explanation/apology. Recognition of the fact that the patient/user’s life is affected by the change.” Member of the public

“The issue of access to services is not simply physical access but is much wider. Services must be fully accessible to all therefore all barriers to access need to be assessed and addressed to ensure this equality of access for all.” Voluntary Sector representative

“Patients need clear pathways about different options/services available and better care co-ordination to avoid duplication of work.” Member of the public

Later in the document we describe our proposals and show you the benefits that some approaches will deliver; but it’s your comments on these we want to hear.

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What Services does this consultation involve?

Not all services provided by the county council’s adult social care services are included in this consultation. Additionally, not all community health services intended to be provided by the new Trust are included either.

In this section we have set out what is included and later how we propose to manage these in the future.

However we consider that some of these adult social care services and community health services will benefit from remaining in their current configuration for the time being and we have excluded them from these proposals. This means that the county council will continue to commission and/or provide the following client services:

• Learning Disabilities.

• Mental Health (this is primarily for people under 65).

• Substance Misuse.

We have included a diagram on page 12 to show you the full range of services the county council provide in Adult Social Care and then describe which services form part of this consultation. Those functions that are in green boxes are excluded from this consultation and will remain within the county council.

The new Trust will amalgamate all the community health services that have previously been managed within the PCT ‘provider arms’. These will include services such as district nursing, community therapy services, community matrons and specialist services such as podiatry; with the two exceptions below.

The PCTs believe that the two community hospitals in Lichfield and Tamworth and the primary Mental Health team in East Staffordshire would be more aligned to the services of other health providers in the future. They undertook an evaluation of other providers of care to consider this. They have now confirmed they will be managed in the future by Burton Hospitals NHS Foundation Trust and South Staffordshire and Shropshire Healthcare NHS Foundation Trust respectively.

In addition the county council will retain all responsibility for commissioning Adult Social Care services, although we will seek to work closely with health commissioners and GPs, to decide what outcomes we expect from all our providers. Examples of this include safer communities and ‘place shaping’ of the communities to make sure a full range of services are provided by individual providers, or as part of a cross agency initiative in areas such as crime reduction and youth offending.

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This consultation involves services currently costing circa £150 million pounds and is proposed to include the following:

Enablement Services

Enablement Services are a mixture of professionally and vocationally trained staff who provide direct care and support in a person’s home, or with the person who for a short time may be based in a community based bed for up to 12 weeks. They also co-ordinate the rehabilitation of the person to get them back on their feet and able to manage in their own home, as they did before they were ill.They liaise with NHS staff in many different settings and are key to preventing people needing hospital admission because their ability to care for their social requirements is at risk, and they support people coming out of hospital who have lost some of their physical or mental skills during their illness. They will work very closely with health colleagues to help their client access the health care support they need.

Enablement teams also have an important role to play in discharge management from acute hospitals, community hospitals or short term residential care. They provide a co-ordinated input to help people return safely to their homes and to regain some of the confidence and ability to self care we often lose in hospital. They will work with other agencies to make sure that clients are properly assessed for on-going care packages, introduce people to local lunch clubs etc to avoid isolation and work with clients and their carers to help them understand where they can lead a life as independently as possible.

Community Support Services

Care staff that support people in their own homes for a short period of time (and up to a maximum of 12 weeks) under the guidance and care plans drawn up by Enablement Teams are to be considered within these proposals. These are staff who will work with individuals to regain their skills and confidence following a period of illness, and possibly a hospital stay.

On-going Health and Social Care Support

For people who need significant on going health and social care support.

Adults of all ages who have a long term illness or condition may be entitled to support to live the life they choose. This could include support to carry out the daily tasks of living that many of us take for granted or support to access work, education or leisure activities. Initially this requires a full assessment to be undertaken. If following assessment relevant individuals are entitled to services, a relevant key professional would then work with each individual to develop and agree a plan for how they would like to be supported. An integrated service would ensure that each individual has a named member of staff or key worker who would co ordinate all the ongoing health and social care that they need. In an integrated service this could be a social worker, nurse or other appropriate professional. They would see that any appropriate specialist care guides the support plan to make sure

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it fits in practically with the rest of the agreed care. Whether people need short term or long term support, the aim is to make that support as personal to that individual as possible so as to enable them to take as much control over their lives as possible. Many people now use a ‘Direct Payment’ or a ‘Personalised Budget’ which gives them the freedom and flexibility to remain as in control of the care and support they need to live the life they choose as far as possible.

Equipment Services

Many clients require short or long term equipment loans or adaptations to their homes. Currently both the health service and the county council issue equipment, with the county council’s equipment service also assessing and providing adaptations in certain circumstances. Loans of equipment are normally for the short term and are arranged through an assessment of need by both health and social care staff.

Brighton House

Brighton House is a county council home accommodating up to 28 elderly people requiring care. Categories of registration include limited numbers of people with dementia care needs, or a physical disability or people with mental health needs. A re-ablement unit is staffed separately from the remainder of the home and personnel involved include occupational therapists, physiotherapists, social workers and other professionals. This unit is there to provide a short term alternative to admission to a healthcare bed when people need that little extra support while services and support in their homes are arranged and they are able to return to their normal lives.

So what might this mean to you? We will describe the advantages and disadvantages of the differing ways forward available to us below. However we would like to broadly set out some thoughts about where we are and how we see the future.

All public services have been expected to become more efficient and deliver better services over the past decade and more; we welcome this expectation. The county council and the National Health Service in Staffordshire have worked hard to improve access, responsiveness and the personalisation of services in the past few years but we want to do better.

• We have reduced the number of short term (less than 24 hours) admissions to acute hospitals; in one area a team managed 280 patients that would have been likely to be admitted to an acute hospital in a six-month period.

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• In some conditions we have reduced the length of time in hospital by providing more care in the local community.

• We have started to reduce the need for long term residential and nursing care by greater alignment of community health and social care teams.

• The introduction of integrated support workers and the introduction of new joint teams in some areas has reduced the number of individual professionals visiting service users.

• We are piloting a new ‘hub’ system to improve access to community health services and the county council are about to launch the ‘Staffordshire Cares’ centre in June 2011.

We do recognise that a change of this nature would demand considerable management of change and that some people might see this as a disadvantage. There is no doubt that the amount of time and the need to manage carefully this type of transformation would increase the demands on our staff and the management teams. However we have not only recognised this but have considerable experience in dealing with these challenges.

The new Trust and the county council would seek to ensure that any change programme that emerges following this consultation is supported by the right team with clear plans that are shared with our staff to make sure they are fully informed. The short term stress that any integration may place on the new Trust or management teams is, in our view, outweighed by the longer term gains envisaged under our proposals.

Below is a diagram that sets out the benefits that we expect to be realised by our proposals and breaks down the elements of the proposals that will support these.

The publications in the bibliography explain the importance of getting health and social care working together on a more integrated basis; we have listed some of the main points below:

Benefits

• Services based on people/carers and the community’s needs, values and definition of quality of life.

• Building networks that enable people from different agencies/backgrounds to place more emphasis on what people need rather than organisational boundaries about what can be provided.

• Co-ordinated access to services, simple to understand and use, which is rapid and responsive and spans both organisations. Help is provided to guide people through the system.

• A reduction in duplication of workforce, administrative tasks by frontline staff and

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Integrated Health &

Social Care Provider

Better ways of working and

supporting staff

Different models of care to help independence

and remaining at home

Increased productivity by releasing skilled staff to what they

are trained to do. Improve flexibility of budget use by key workers

Reduce overhead costs e.g. payroll. Increased size of the organisation gives

economies of scale, streamlining processes for efficiency.

Best use of the buildings owned by the NHS and Local Authority. Easier access to services and people if they are in one place. Reduced cost of housing staff by modern working

methods.

Better information through new ‘hubs’ and points of contact.

Clearer seamless pathways in Primary, Community and Social Care.

A fully co-ordinated approach to adaptations in people’s homes and

equipment provision. Improved support to house older people effectively if required.

Assistive technology & equipment.

Culture supporting review of care & maximisation of independence. Seamless & planned pathways in hospital discharge.

Integrated Neighbourhood Teams.

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support functions may create more effective services to manage the increasing demand going forward.

• A less confusing range of services and people to interact with when you are at your most vulnerable.

• A single assessment process with a focus on rapid response.

We have included below a hypothetical ‘before and after’ scenario that shows what could happen when someone who lives in a set of circumstances that they can cope with suffers a change that to most people might be minor like a neighbour going on holiday, getting a bad bout of flu or suffering from a little fall. To some people though these are much more serious and we have described below before and after case studies that show how we might improve things in the future; meet Wendy. Wendy is a person we created to show how the proposed changes will make life easier for many people.

Wendy is a 73-year-old widow who lives alone and has no family members to contact in times of crisis. Luckily Wendy has a close relationship with her next door neighbour Jane; Jane is Wendy’s informal carer.

Wendy is known to Social Care Services as she has had some equipment in the past, she occasionally sees her GP and has seen the district nurse several times after a fall. She is a frail elderly lady but she has no chronic conditions and can move around her bungalow with care. Wendy looks after herself and she is a feisty and independent thinking lady whose life has been spent helping others. She doesn’t need a lot of help from Jane except for some cleaning and shopping but she is adamant she will not be a burden to anyone.

At a point during the day she falls in her home. She manages to get herself into her chair but by the evening Wendy is suffering from quite a bit of pain in her chest and contacts Jane requesting her help. Jane goes next door and offers her support.

Jane suspects fractured ribs and rings the Out of Hours GP service. One of the GPs confirms Jane can give Wendy some paracetamol and double checks that Wendy doesn’t need a visit. Wendy says the pain has eased but she will sleep in her chair, Jane makes her comfy and stays overnight. Wendy has an uncomfortable night and is very worried in the morning as she can’t move easily but does not want to go to hospital.

Wendy’s GP makes a home visit; Jane is aware that Wendy is registered with the district nurse so contacts the team to request a commode. When the GP visits she prescribes stronger pain relief and requests an X-ray. Wendy cannot look after herself so the GP then asks for a social care assessment and visit to help Wendy with her immediate personal care needs.

Jane leaves for work expecting everything to work out during the day.

When she gets back that evening Jane finds nothing has happened. She is told that a

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referral has been made but this has not been processed yet and it will take some time to work through the system.

A night nurse does arrive at 10:30pm to find Wendy unsettled and badly positioned in her chair, she does her best to get her comfy and move her to her bed and says she will chase up the referrals in the morning; the night nurse did wonder if Wendy would be better off in a hospital. Wendy refused to consider this. The request for a commode has not yet been processed so Wendy is struggling to get to the toilet.

The next morning a physiotherapist, an intermediate care nurse and a social worker all visit separately. They individually re-assure her and can help with some immediate needs. The social worker contacts a local care provider to pop in and arrange some food, the physiotherapist gave her a TENS machine for pain and the nurse told her she would arrange a bed in a nursing home so Wendy can recover and be cared for.

However they found that they couldn’t co-ordinate things because they had separate systems and processes; the social worker needed to check how quickly some home care could be arranged and the nurse had to wait for a referral to be approved for the bed. This would all take a day or two. Sadly later that day it was clear that Wendy was getting worse at home and her admission to an acute hospital bed was necessary. Wendy stayed in hospital for a week and returned home with appropriate support but feeling much more vulnerable and lacking in confidence to manage simple things at home that she had taken for granted before.

What we are proposing would change Wendy’s experience. Some of what we need to make things better are already in development and some will be achieved if we can work more effectively together; let’s see how it might work.

We take up Wendy’s story at the point she falls in her home.

She manages to get herself into her chair and by the evening Wendy is suffering quite a bit of pain in her chest and contacts Jane requesting her help. Jane goes next door and gives Wendy some basic pain relief.

Later it becomes clear that Wendy needs further assessment and improved pain relief, so Jane calls the out of hours service who through‘ the hub,’ arranges an experienced district nurse to come out quickly to assess Wendy. This nurse is part of a rapid response team who deal with people who need urgent support to help prevent them going into hospital or to provide short term support to get them home again.

A couple of hours later an initial visit by the district nurse is made.

She identifies the following needs:

• Pain relief.

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• Moving around, particularly to her bed and chair.

• She is going to struggle to cook and wash and get to the toilet.

An initial visit by the homecare team is planned for that evening and they feed and move Wendy to her bed and settle her. A further visit is confirmed for a night visit to check on Wendy and provide more pain relief.

In the morning the same care worker visits with a colleague to mobilise Wendy and check her condition, they are concerned that she is unable to move to the toilet during the day and night, they ask for a district nurse visit to assess her. This is arranged for that afternoon and the district nurse decides that with better pain management Wendy should manage to transfer to a commode by the bed. She contacts the equipment store and a commode arrives that evening.

When previously three different professionals had visited and tried their best to mobilise their services we reach the point where Wendy is still in discomfort a couple of days after the fall. However this time she is more comfortable in her chair with a commode nearby, using pressure reliving cushions and has eaten a small breakfast after her morning pain relief started to work. She has spent the morning watching television with her TENS machine operating. She is expecting her lunchtime visit from the home care team and has the number of ‘the hub’ if there is an emergency.

By the next day Wendy feels well enough to have a discussion with the key worker who has been assigned to her and whose job it is is to see how she might be supported in future; including getting any benefits she might be entitled to. The key worker makes sure that the correct assessments are carried out and relevant specialists such as occupational therapists are involved if that is needed.

The team consider with the provision of an alarm system to call for help in an emergency and some support on mobility with minor equipment provision to help open cans, make it easier to lift pans and move to the bathroom to use the shower more easily that Wendy should be back looking after herself in a couple of weeks. This approach to rehabilitating Wendy is what she wants and ensures she gets back to her previous level of wellness as soon as possible.

The rapid response team’s input is reduced slowly in the week following her recovery and the quicker assessment process and responsiveness of the integrated service means that Wendy feels safe in her home and is getting over the shock of her fall and how frightening she had found that.

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How might we achieve this?

What might health and social care integration look like

Staying as we are There are local agreements to make services better but limited strategy for joint working in the future. At an operational level some joint working exists but these services are still separatley managed.

Integrated Services

Closer Joint Working

Our Proposed Way Forward

Staying as we are

We have considered staying as we are, but we consider that this would not be a desirable way forward. While there are many existing examples across the county of successful joint working between health and the county council, such as the rapid joint intervention teams in North Staffordshire who provide immediate care in urgent circumstances, there are potential inefficiencies that are inherent in all public services if they remain separate. These include increased levels of bureaucracy, duplication of roles and separate approval routes for similar types of service are all inefficiencies that may result.

The new Trust and the county council will put their money together to provide services and oversee this to ensure it provides focussed and integrated care

There is commitment, shared vision and aims across services, but separation at the executive level with operational budgets dealt with independently

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From the point of view of patients/service users this often means that they are assessed and/or provided with services by several different people, from different organisations, who (while their intentions are good) do not always work together. This can sometimes be frustrating and has been known to lead to delay (e.g. delays in patients being discharged from hospital).

Furthermore, at an organisational level, two separate public bodies working almost independently and operating separately managed services would be subject to (not least) different management, budget setting and priority setting processes.

In our view, there are many potential benefits to service provision that can be achieved through closer partnership working (as described earlier in this document) and are likely to lead to an improvement in the way in which the new Trust’s and the county council’s functions are exercised.

Closer joint working between existing organisations

One possibility is for the new Trust and the county council to work together more closely across a wider range of services, but retain budget setting control and management within their separate organisations – essentially do more of the partnership working described above, but without integrating staff, management, buildings, support functions (e.g. payroll) and service provision.

This potential way forward could be done by both organisations agreeing defined aims and outcomes and further agreeing to act together in terms of service provision, spending and performance management in order to achieve those jointly agreed aims and objectives (i.e. better service provision). This approach is sometimes called an ‘aligned budget’ approach, and is often a prelude to full integration. The advantage of this approach is that partnership working can be done piece-by-piece in relation to specific defined services and in the unlikely event that relations between the two organisations deteriorated, it would be easy for either to exit from the arrangements.

However, possible disadvantages of this approach could be that there is no legal obligation/commitment on either organisation to spend their budgets or provide services in the agreed joined-up way. This approach does not provide for the parties to enter into an agreement/partnership arrangements under section 75 of the National Health Service Act 2006 and relies on trust and mutual consent between the two organisations. Arrangements of this type would not, in our view, sufficiently bring the two organisations together. Furthermore, there would be little accountability if one organisation were not to perform as agreed. We do not consider that this approach would be appropriate for integrating on a large scale across a wide range of services.

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Integrated services

What we propose is that we should integrate those community health services and the Adult Social Care services we stated were covered by this consultation.

We are proposing to enter into partnership arrangements under one section 75 agreement, so that the new Trust is capable of providing integrated community health and adult social care services (except for services relating primarily to Learning Disabilities, Mental Health and Substance Misuse which will remain with the county council).

Both the new Trust and the county council will put their money together (to be managed by the new Trust but overseen by both organisations) in order to spend it on both community heath and adult social care services in a more focussed and ‘integrated’ way. An example of this would be in respect of assessments, so instead of two organisations currently doing particular parts of an assessment, the new Trust should be able to carry out a quicker assessment, which we consider would mean the task could be completed in one visit, unless specialist opinion was also required.

In addition, it is envisaged that social care employees (including managers from Adult Social Care) will transfer to become employees of the new Trust. As all the relevant employees would be working together in one organisation (and often the same building), we consider that this would likely lead to an improvement in the way in which those functions are exercised. Why do we consider this?

Well, one reason is that there would be a simpler access route for customers and patients and those referring them will find it easier instead of wondering which organisation they should contact. Currently, it is not always clear which organisation is providing which specific services as many seem similar but are currently provided by different organisations. We also consider that integration would lead to a reduction in the duplication of work. As well as improvements to ‘frontline’ services and assessments we also believe that a reduction in management and ‘back office’ costs should be a benefit of this approach.

Additionally, integration should lead to more co-operation between Health and Social Care, such as in relation to hospital discharges. While currently both Health and Adult Social Care are required to work together in approving the discharge of a patient from hospital who also is entitled to social care services, it does not always happen smoothly. We consider that it would be beneficial for patients/service users if those concerned with arranging hospital discharges work in the same organisation, perhaps in the same building, with the same manager, using the same forms/documents, and having access to the same information systems, so that they can work together to better fulfil their duties. We further consider that we would secure more effective sharing of information, peer input and discussion than presently can be achieved solely by virtue of people working in closer proximity to each other.

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So what do you think? We are keen to hear your views on our proposals for partnership between the county council and the NHS to provide integrated community care services. Your feedback is important to us and we promise to listen to all of the comments and ideas received. You can feedback in a number of ways:

• Online – please send us your comments by completing a feedback form online by visiting: http://tinyurl.com/AdultSocialCareConsultation

• Email – please email your views to: consultation@ssotp.nhs.uk

• By post – please write in or send us your comments by completing the feedback form below and returning to:

Adult Social Care Consultation

1st Floor, Morston House, The Midway, Newcastle-under-Lyme

Staffordshire, ST5 1QG

Please note we will not acknowledge receipt of individual feedback forms

You can also tell us what you think by attending one of our Consultation Events detailed below:

As all venues have a limited capacity, attendance at these meetings is on a first-come, first served basis. It is important that you book a place in advance and let us know if you have any special requirements.

Venue Date Details How to book your place

Burton Albion Football Club

8th June 2011 6pm-8pm

Pirelli Stadium, Princess Way, Burton on Trent, Staffordshire, DE13 0AR

Please call 01543 303030 or email: davebenge@ldcvs.org.uk

Rugeley Rose Theatre

10th June 2011 9:30am – 11:30am

Rugeley Rose Theatre, Taylors Lane, Rugeley, Staffordshire WS15 2AA

Please call 01543 303030 or email: davebenge@ldcvs.org.uk

Port Vale Football Club

13th June 2011 2pm – 4pm

Hamil Road Burslem, ST6 1AW

Please call 01782 401045 or email: colin.anderson@stoke.nhs.uk

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What do you think of our proposed changes?

How do you think these proposals may impact on you and/or your family?

How do you think these proposals may impact on your organisation, the people you care for and the services that you might provide to them?

Feedback Form(Please use a separate sheet if necessary)

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About you

To help us understand views on the proposals we would value the following optional details. You do not have to complete this section, but it would be very helpful if you did as the information will help us make sure we reach as many people as possible.

Your age Under 18 18-30 31-49 50-64 65+

Your gender Male Female

What would you like us to consider in the development of a joint approach to delivering care to local people?

Please let us know other comments you have on our proposals?

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Your ethnicity

White - British

White - Irish

White - Any other White background

Mixed - White & Asian

Mixed - Any other Mixed background

Mixed - White and Black African

Mixed - White and Black Caribbean

Black or Black British - Caribbean

Black or Black British - African

Black or Black British - Any other Black Background

Asian or Asian British - Indian

Asian or Asian British - Bangladeshi

Asian or Asian British - Pakistani

Asian or Asian British - Any other Asian background

Chinese

Other ethnic group (please state)

Are you: (Please tick) A service user A relative of a service user A health professional A carer A social care professional Partner organisation Community group Elected member Other (please specify)

Do you have any long-standing illness, disability or infirmity? (Long standing means anything that has affected you, or is likely to affect you, over a period of time.) Yes No

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Please add your personal details (information provided here will not be published).

Your name

Organisation (if applicable)

Address

Postcode

Date

Thank you for sharing your views. It is the intention of the project team to publish a summary document of the responses received.

All comments must be received by us by 4.30pm on 20th June 2011. Responses will be taken into consideration by Staffordshire County Council, the public board meetings of the PCTs, and the public meetings of the Shadow Board of the Staffordshire and Stoke-on-Trent Partnership NHS Trust. Details of these meetings will be advertised in due course. If you require further time to respond, please contact us in one of the above ways and we will endeavour to provide you with this opportunity and include your views in later meetings as part of the overall decision making process.

The information that you provide as a response to this consultation will be processed in accordance with the Data Protection Act 1998. We may need to share your response to the consultation with the Staffordshire County Council who are a partner organisation for this consultation. Any information that we share will be shared in accordance with Information Sharing Protocol which each of the PCTs and the county council have signed. It sets out how we will use that information, how we will retain it and for how long we will keep it.

Assistance More information will be available at the public meetings or online at: www.staffordshire.gov.uk/integration www.stokepct.nhs.uk/voice/consultations www.northstaffordshire.nhs.uk/get-involved/transforming-community-services/ www.southstaffordshirepct.nhs.uk/HaveYourSay/activeConsultations.asp

If you would like this leaflet and/or the feedback form in another language or format (e.g. large text), please telephone 0845 602 6772 Ex. 1668 or write to:

Adult Social Care Consultation 1st Floor, Morston House, The Midway, Newcastle-under-Lyme, Staffordshire ST5 1QG

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Bibliography:

Department of Health. Section 242 NHS Act 2006. The Duty to Involve and good involvement practice

Department of Health. Real Involvement (October 2008). Working with people to improve health services

Audit Commission (2009), Means to an end:

Kings Fund (2010) Integrated Care: London

NHS Confederation (March 2010), Putting our heads together: what makes senior joint posts work?

NHS Confederation (June 2010), Where next for health and social integration?

HM Government (May 2010), The Coalition: our programme for government:

HM Treasury and CLG (March 2010), Total Place: a whole area approach to public service:

Department of Health (July 2010) The NHS White Paper, Equity and excellence: Liberating the NHS

NHS North Staffordshire, NHS Stoke on Trent, South Staffordshire PCT. (Dec 2010) Evaluation Report of Engagement. Staffordshire

The Picker institute (2008): report to South Staffordshire PCT (east locality)

The Kings Fund: (March 2011) Integrating health and social care in Torbay:

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Glossary Acute: Acute care facilities provide both outpatient and inpatient care for patients who have chronic or potentially severe medical conditions or whose problems cannot be served by medical staff at a doctor’s office. Some populations need care that cannot be provided by most medical facilities; this is where acute care facilities fill a gap. Acute care services are designed to restore patients to a higher level of functioning

Transforming Community Services: a programme that aims to improve community services so that they can provide modern personalised and responsive care of a consistently high standard.

Health Scrutiny committee: a committee of Staffordshire County Council which has the power to review and scrutinise matters relating to health services in its area and make reports and recommendations..

Commissioning: the process of specifying, securing and monitoring of services to meet the people’s needs at a strategic level. This applies to all services, whether they are provided by the local authority, NHS, other public agencies or by the Private or Third Sector (Audit Commission – Making Ends Meet, 2003)

Assessment: in terms of social care the process whereby the county council assesses a person to see whether they are eligible for community care services in Staffordshire. In terms of health services the process whereby patients are assessed for continuing healthcare needs under the relevant statutes and directions.

Care Package: a group of services brought together to achieve one or more objectives of a person’s care plan.

Service User: an individual who is in receipt of services from health and/or adult social care.

Community Care Services/Social Care Services: means those services that the county council has decided that a person is entitled to receive following a Community Care Assessment. Such services include services that are provided under:

(a) Part III of the National Assistance Act 1948; (b) section 45 of the Health Services and Public Health Act 1968; (c) section 254 of and schedule 20 to the National Health Service Act 2006; (d) section 117 of the Mental Health Act 1983; and (e) section 2 of the Chronically Sick and Disabled Persons Act 1970.

Community Health Services: means those services not provided by an acute hospital, wether in the hospital or by its employees outside of the hospital.

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Notes

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Notes

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