Health and Wellbeing Board’saims for integration

25 July 2013Joe Fowler, Director of Commissioning, Sheffield City

Council Tim Furness, Director of Business Planning and

Partnerships, NHS Sheffield Clinical Commissioning Group

• People in Sheffield have told us that more integrated care and services is what they want and would improve their experience.• History of working together in Sheffield, for

example Future Shape Children’s Health, Right First Time, Successful Families.• Government policy: opportunity to bid to be

an integration ‘pioneer’.• Rising demand for health and social care but

reduced funding.

Background and context

What does integration mean?• “The act of combining or adding parts to make

a unified whole….”

Why do it? • We can use our money where is most needed and has most benefit.

• People have told us this is what they want and that it would bring about better care and outcomes for them.

• It will produce a more efficient and effective health and wellbeing system in Sheffield, which produces financial efficiencies.

Our vision for integrated care• People, families and communities in Sheffield support

each other to improve and maintain their wellbeing and independence.

• Services focussed on a person’s need without organisational boundaries getting in the way.

• Expert help available to help people take control of their own care so that it is genuinely person-centred, and complements and builds on the assets they have.

• Organisations in Sheffield work together to help people, families and communities to build and strengthen the support they provide to each other.

How might this look?• People helping people help themselves.• Integrated community working – for example, the

Community Support Worker pilot.• Intermediate care – Right First Time.• Long-term care – joining budgets with one single plan

from health, social care, housing, education, etc.

How might this look?• There is already a lot of working together on

integrated care in Sheffield.• For example, Right First Time, Future Shape Children’s

Health and Successful Families programmes. We want to bring together budgets and planning to help this to happen.

Case study 1 – John• John is a 9 year old child with a significant learning disability

and social and communication needs. He lives at home and attends a special school in Sheffield.

• His care plan and team work in a multi-disciplinary way to support a consistent delivery of care through home, school and respite.

• Specialist teams have worked together to develop one core plan to meet John’s communication needs. The carers within the respite service and the SEN support team at school have been trained in how to communicate with John and how his sensory processing works.

• John has been enabled and encouraged to communicate his needs. This helped reduce anxiety and negative behaviour.

Case study 2 – Alec • Alec was going to A&E on a repeated basis. He has

chronic health problems and has recently had pneumonia.

• He lives in a flat in poor condition with no heating or insulation. The Community Support Worker gave him guidance to complete a tenancy application and accompanied him to a meeting at the Housing Office so that he could move to live near people who would support him in managing his condition.

• He was encouraged to go on several health walks in the area and started doing some volunteering.

Case study 3 – George and Florence• George and Florence were identified by a risk stratification

system as being at a higher risk of needing hospital care. An integrated care plan was put in place by George’s GP and developed with a range of social care and health professionals.

• A district nurse identifies that George is at risk of falling in his own home and tries to work out the many reasons why this might be. In George’s case some adaptations are need in his home. Additional care and rehabilitation is put in place.

• The GP reviews George’s plan with a range of professionals until everything is more stable. Extra support is provided for Florence so she can care for him.

What are we planning to do?• Integrate commissioning responsibilities to support our

transformation programmes• This might bring together budgets, decision making,

governance and delivery arrangements• Substantial elements of health and social care• But also might be a case for elements of housing, education,

community services budgets

• Looking for a long term arrangement• Pioneer support to help us develop a clear case for change• And robust terms of agreement between SCC and CCG

Who is involved in working this out?• Sheffield’s Health and Wellbeing Board.• Sheffield City Council.• NHS Sheffield Clinical Commissioning Group.• Healthwatch Sheffield and members of the public.• Service users and their families.• Large providers.• Small providers.• You?

• ‘Integration Advisory Group’ – up to 20 ‘advisors’ who will be involved on an ad hoc basis with designing what integration means in Sheffield.

What is involved?• A detailed plan for moving forward with this work.• Clearer governance structures (e.g. making joint

decisions).• Understanding how budgets, risks and benefits are

shared.• Understanding what integrated commissioning means

for providers.• Involvement of service users and members of the public

through Healthwatch Sheffield.

What’s next?

Question and Answer slot

• End of August 2013: Publish report about this meeting.• September 2013: Hear about bid to be a pioneer.• October-December: Whether or not we are selected to

be a pioneer, create plan for integration.• December 2013: Formal discussion at Health and

Wellbeing Board.• Now: creation of an ‘Integration Advisory Group’ – to

register your interest in being part of it email healthandwellbeingboard@sheffield.gov.uk by 30th August 2013 and say why you’d like to be involved.

Round table discussions• Talk about what each of the four groups below

need to change to make integration work:– Commissioners in Sheffield City Council and

NHS Sheffield Clinical Commissioning Group.– Providers/suppliers.– National policy/central government.– Service users.

• Talk about what some of the risks and benefits of greater integration are, and for whom.