integration of health and social care keith darragh – assistant director safeguarding, quality and...
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Integration of Health and Social Care
Keith Darragh – Assistant Director Safeguarding, Quality and Business Strategy
Salford - Context• Population 240,000
– Adults 180,000– Older people 34,000
• Health Services– Clinical Commissioning Group– Acute hospital – Salford Royal Foundation Trust– Community Health Services – Salford Royal Foundation Trust– Mental Health – Greater Manchester West Mental Health
Foundation Trust (Bolton, Salford, Trafford)
• Salford City Council – Adult Social Care
Busy Environment• Greater Manchester Devolution (regional)
• Integrated Care Programme for Older People (local)
• Integrated Care Organisation (local)
• Primary and Acute Care System - Vanguard status for Salford with the New Care Models team NHS England (national)
Integrated Care Programme2012 and ongoing
Partnership development Adult Social Care and Health• Adult Social Care – long and successful partnerships
with NHS Commissioner (CCG) and Providers (SRFT / GMW)
• Over 12 years of formal arrangements under Section 75 Partnership Agreements – first one for Learning Difficulties 2002
• Benefits – service alignment to manage demand / service quality, delivering joined up services
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Overview of Salford’s ICPContext• Four principal partners – co-terminus & high performing
• Commissioners: Salford CCG & Salford City Council• Providers: Salford Royal FT, GMW Mental Health FT &
City Council• Good relationships, alignment of effort & strategic intent• Shared vision – population health improvement by promoting
personal independence & community resilience• Potential to deliver more services in the community• High need population group requiring active case
management
High demand and rising
34,541 people aged 65+, 28% projected increase
1: 14 have dementia and over-represented in acute beds
Growth in limiting long-term illness
Disability-free life expectancy
2,130 falls related A&E attendancesGrowth in people living alone:
12,542 in 2011 to 15,998 in 2030
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Care Model for Older People (65+)
Multi Disciplinary Groups provide targeted support to people who
are most at risk and have a population focus on screening,
primary prevention and signposting to community support
Centre of Contact acts as an central health and social care hub,
supporting Multi Disciplinary Groups, helping people to navigate services and support mechanisms,
and coordinating telecare monitoring
Local community assets enable people to remain independent,
with greater confidence to manage their own care
Promoting independence to deliver:• Better Outcomes• Improved
Experience• Reduced Cost
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2 3
MULTI-DISCIPLINARY
GROUPS
COMMUNITY ASSETS
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2
3
CENTRE OF
CONTACT
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Supporting Systems• Population risk stratification &
integrated care standards• Measureable joint outcomes• Alliance Agreement• Gain / loss sharing
mechanism• £112m pooled budget• Service & financial plan 2014-
18• Academic Longitudinal
evaluation
Wellbeing Plan
Care Plan
Independence Plan
SupportedIndependence
Plan
Care Home standards
Home care and intermediate
care standards
GP standards
Carer support and disease
management
Able71%
Needs Some Help 17%
Needs More Help 9%
Needs A Lot Of Help 3%
City-widestandards
POPULATION RISK STRATIFICATION
Shared Care Plans Integrated Care Standards
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2020 Outcome Measures
• Emergency admissions and readmissions• 19.7% reduction in NEL admissions (from 315 to 253 per 1000 ppn) • Reduce readmissions from baseline • Cash-ability will be effected by a variety of factors• Permanent admissions to residential and nursing care
• 26% reduction in care home admissions (from 946 to 699 per 100,000 ppn)
• Savings directly cashable but need to be offset by cost of alternative care (especially increased domiciliary care)
• Quality of Life, Managing own Condition, Satisfaction• Maintain or improve position in upper quartile for global measures• Use of a variety of individual reported outcome measures
• Flu vaccine uptake for Older People• Increase flu uptake rate to 85% (from baseline of 77.2%)
• Proportion of Older People that are able to die at home• Increase to 50% (from baseline of 41%)
Integrated Care Programme for Older People• Four strategic partners (SCC, CCG, SRFT, GMW)
• £98m (14/15) of Health and Adult Social Care service for Older People £112m (15/16)
• Programme identified – – Common Demand issues from Older People population– Common service objectives
• Better outcomes• Improved experience for service users• Lower overall cost to health and social care
Integration – Alliance Partners
Salford City Council
GMWSRFT
Clinical Commissioning
Group
Integration scope / value of Council services
• Older People Services £34.8m– Social Work, O/ T and disability equipment £ 4.5m– Care services £28.3m
• Residential Care £18m• Home care £4.5m• Direct Payments £1.1m• Other services just under £5m
– Capital £ 1.8m
– Total Older People Services £34.8m
Integrated Care Programme for Older People• Business agreements needed to underpin strategic and
operational alignment and joint working
• Service and Financial Plan 2014 – 18
• Section 75 Agreement – 2014 – 18
• Alliance Agreement – Governance / Decision making
Decisions• Integrated Care Programme for Older People - Service and
Financial Plan (Incorporating the Better Care Fund) – value £98m annual service expenditure across Health and Social Care – set out the Commissioning intentions
• Health and Wellbeing Board 18th March 2014
• Approval of Service and Financial Plan / Better Care Fund
• Record of Decision – City Mayor 31st March 2014
• Approval of Section 75 pooled budget to create £98m commissioning fund
• Record of Decision – City Mayor 31st March 2014
Governance - Alliance Agreement
Structure of Agreement
• Section A - Objectives, Principles and Governance• The Governance is detailed further in terms of reference for 3
proposed Boards to govern the Alliance Partnership• Proposed Delegations scheme
• Section B - Pooled Budget and Commissioning• Section C - Collaboration and Care Co-ordination• Section D - Financial Risk and Benefit Sharing
Board Structure / Delegation Framework
• Covers decisions about service development, management and delivery through
– Alliance Board / Steering group comprising representation
from all 4 statutory partners
• Supported by a delegation framework
– Service change over £1m will be referred back to partner organisations (Mayoral Level within SCC Governance)
Proposed Board Governance
Alliance Board
Steering and Finance Group
Operational Board
Decisions over £1m – referred back to partner organisations
Scheme of Delegation
Up to £1m
Up to £100k or 10%
Up to £25k(Commissioning Assistant Director)
Level 1
Level 2
Level 3
Level 4
Level 5
Senior Commissioning Managers
Integrated Care Organisation2015 in development
Development steps
• Established Steering Group• Programme Management Office established• Finance Risk matrix established• Legal Risk matrix – being developed• Service due diligence – commencing
To do• Outline Business case• Full Business case• Contract and Financial close