ARE THERE ANY LESSONS FOR US FROM A ‘CARE TRUST

PLUS’?‘Making Partnerships Work in Health & Local

Government’

Peter MeltonPEC Chair, North East Lincolnshire Care Trust Plus

14 February 2008

AIMS OF THE CARE TRUST PLUS

• Create and develop a formal key strategic partnership between the Local Authority and Local NHS

• Drawing on respective strengths in order to deliver improved and accelerated outcomes

• Adopting a holistic and integrated approach for those residents with the most complex needs

• A Children’s Trust for whole population

THE KEY ASPECTS OF THE CARE TRUST PLUS

• Transfer Adult Social Care Commissioning responsibilities and budget from LA to NHS

• Transfer Social Care Provision (LD, Adult Care, Intermediate Care, Mental Health) from LA to NHS

• Transfer Public Health Directorate and responsibilities from NHS to LA

• Transfer NHS community child services from NHS to LA which leads the Children’s Trust

DRIVING PRINCIPLES OF THE CARE TRUST PLUS

• Align Accountability with Responsibility• Deliver integrated services and decision making• Deliver holistic services and decision making• Bringing services and decision making as close to

the patient, user, carer or citizen as possible• Balancing the rights and responsibilities of the

individual and wider community

STRATEGIC EXAMPLES OF HEALTH AND SOCIAL CARE IMPROVEMENT

• Integrated review of home care services aligned to commissioning group plans

• Re-commissioning GP OOH services to form an integrated health and social care provider

• Re-aligning of health and social care teams to the four commissioning groups to support SAP and MDT working

• Aligning PBC and Social Care budgets to support joint planning at individual and population level

• Open Door• Open Mind, The Willows, Tukes• Joint Strategy and investment in LD

OPERATIONAL EXAMPLES OF HEALTH AND SOCIAL CARE IMPROVEMENTS

• Monthly MDT case planning meetings• Monthly commissioning group meetings• Reduced emergency hospital admission rate• Reduced residential care home admissions• Commissioning group plans around elderly,

mental health, children and health improvement

EXAMPLES OF IMPROVEMENT HEALTH AND TACKLING INEQUALITIES

• Established a LA portfolio holder for Healthier Communities• Formulated jointly owned health inequalities action plan• Health inequalities adopted as a top 6 LA priority• LA investment in alcohol and tobacco control, reducing

harm in the workplace• Health Impact Housing Strategy• Re-fresh teenage pregnancy strategy• Sports and active recreation strategy• LEGI• Social Marketing to reduce delayed cancer presentations• Neighbourhood renewal areas, housing, police aligned to

commissioning groups

EXMAPLES OF IMPROVEMENTS IN CHILD SERVICES

• Moving towards a health and well being model of care

• Shifting focus of delivery from practice to community and children’s centres

• Common IT solution• Early support programme• Changing role of Health Visitors and School

Nurses• LAPs and children’s centres aligned to

commissioning groups

ADDED VALUE OF CARE TRUST PLUS APPROACH

• Management cost savings• Accelerates resolution of interface restraints to

delivery• Positive cultural change• Constructive tension and challenge• Accelerated delivery of LAA• Greater workforce opportunities and satisfaction• Redressing ‘democratic deficit’

CARE TRUST PLUS – THE FUTURE

• Expanding health and social care provider teams to include secondary care, third sector and private

• Commissioning group plans expanded to become ‘Mini LSPs’ leading to ‘Mini LAAs’

• More individual commissioning• Key local private businesses becoming more

active partners of community leadership• Parents agreeing joint annual well being plans

with the Care Trust Plus for each child

ENABLERS TO THE CARE TRUST PLUS

• Geography• Co-terminosity• Leadership• Strategic Fit• Clinical Engagement & PBC• Robust Legal Framework• Performance Agreements• Governance• Financial Parity• FeSC

ISSUES IN ESTABLISHING A CARE TRUST PLUS

• Scepticism / Trust• Risk aversion• Change fatigue• Change management capacity• Timing• Practical barriers• Perceived loss of control• Untested

CONCLUSIONS

• Initial local and external evaluation positive• Created boost to joint strategic directions• Brings complimentary skills• Creates a more robust system to balance the

rights and responsibilities between individual and community

• Redresses the balance between ‘looking out’ and ‘looking up’

• Creating ‘empowered communities’• ?Transferable• Questions: peter.melton@nelctp.nhs.uk