Integration, cooperation and partnerships

Care Act 2014

Outline of content

Introduction What the Act says and the duties that fall to local authorities The duty to promote greater integration The duty to cooperate Integration, cooperation and partnerships in practice Working together: examples Summary

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Integration, cooperation and partnerships are not new concepts

NHS Reorganisation Act 1973

The New NHS: Modern, Dependable 1997

Health Act 1999

Independence Wellbeing and Choice 2005

National Health Service Act 2006

Health and Social Care Act 2012

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Why integration, cooperation and partnerships?

Improves the service user experience

Eliminates duplication

Streamlines care pathways

Early intervention and prevention

Improves safeguarding

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What do we mean by integration, cooperation and partnerships?

Integration: The combined set of methods, processes and models that seek to bring about improved coordination of care

Cooperation: Public organisations working in partnership to ensure a focus on the care and support and health and health-related needs of their local population

Partnership: A joint working arrangement where the partners: are otherwise independent bodies; agree to co-operate to achieve a common goal; create a new organisational structure or process to achieve this goal; plan and implement a joint programme; share information, risks and rewards

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What does the Act say?

Sections 3, 6, 7 and 43 of the Act require that:

3. “A local authority must exercise its functions under this Part with a view to ensuring the integration of care and support provision with health provision and health-related provision”

6. “A local authority must co-operate with each of its relevant partners, and each relevant partner must co-operate with the authority, in the exercise of their functions relating to adults and carers”

7. “Local authorities and their partners must co-operate where this is needed in the case of specific individuals who have care and support needs”

43. “Each local authority must establish a Safeguarding Adults Board (SAB) for its area... The way in which a SAB must seek to achieve its objective is by co-ordinating and ensuring the effectiveness of what each of its members does.”

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What is the vision?

“The vision is for integrated care and support that is person-centred, tailored to the needs and preferences of those needing care and support, carers and families.”

Care and Support Statutory Guidance October 2014

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Under what circumstances?

This duty applies where the local authority considers that the integration of services will: “promote the wellbeing of adults with care and support needs or of

carers in its area;” “contribute to the prevention or delay of the development by adults

in its area of needs for care and support or the development by carers in its area of needs for support, or;”

“improve the quality of care and support for adults, and of support for carers, provided in its area (including the outcomes that are achieved from such provision).”

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Other legislation

The Health and Social Care Act 2012 (Sections 13N and 14Z1) also states that the NHS also has a duty to promote and secure integrated care where it will improve the quality of services, and reduce inequalities in accessing services or improve outcomes.

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The five aims of cooperation

1. Promoting wellbeing

2. Improving the quality of care (including the outcomes from such provision)

3. Smoothing the transition from children’s to adults’ services

4. Ensuring agencies work effectively together to safeguard adults at risk of abuse or neglect

5. Reviewing and learning lessons from cases where adults have experienced abuse or neglect

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With whom should local authorities cooperate?

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Cooperation

Local authorities

District Councils

Other authorities

Health

CCGs

Hospital trusts

NHS England

DWP

Police

Prisons and probation

Others

Cooperation in specific cases

The general principle is one of cooperation in the day to day delivery of care

But there might be a need for cooperation, in the case of individuals, which goes beyond the general requirement

If specific cooperation is requested, either from the local authority or by the local authority, the partner organisation must respond unless it is incompatible with their own functions and duties

A person or agency must comply with a request for information from a Safeguarding Adults Board under certain conditions regarding issues involving a safeguarding case

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Integration, cooperation and partnership in practice

Partnership, cooperation and integration need to be key components of a local authority’s strategic approach. This may be with a range of organisations (including other local authority functions, public sector organisations and the independent and private sector) and occur in a number of ways:

Planning and commissioning Assessment and information Care delivery Quality assurance

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Working with health services

Integration and cooperation must be delivered in the context of improving care and support, in line with the duty to promote wellbeing, prevent or delay the development of needs and improve the quality of care

There is a reciprocal duty placed on the NHS, specifically any NHS body within the authority’s area including Clinical Commissioning Groups, hospital trusts and NHS England

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The boundaries of co-operation

Local authorities have a duty to meet eligible needs for care and support

Local authorities have a duty to make enquiries in cases of abuse But there are restrictions on what they can provide in terms of health

care, for example: Nursing care provided by registered nurses NHS Continuing Healthcare funded care

All partners need to be clear about their own responsibilities, and how they fit together

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Discharge of hospital patients with care and support needs: Delayed Transfers of Care (DTOC)

A key area for local authorities and the NHS to consider working together

Provisions are made within the Act to reflect current care and support landscape for people who have both health and social care needs

The NHS can seek reimbursement from Local Authorities for a DTOC. This is intended to act as an incentive to improve joint working

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Working with housing

Suitable living accommodation is a key ingredient in promoting physical and emotional health and wellbeing

Housing can also prevent or delay care needs from arising; as well as support existing needs

Local authorities must provide information and advice on care and support and this must include housing services

Local authorities are not expected to provide all housing services but should “make effective use” of other statutory, voluntary and private resources

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Working with employment, training and education services

The wellbeing principle includes participation in work, training and education and as such local authorities must consider this as part of their care and support functions

Local authorities must: Consider the links between care and support, employment and

welfare when planning and commissioning Ensure good quality information and advice including eligibility for

benefits, disability benefits and employment support Consider education, training and support when working with

individuals

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Working together: examples of integration, cooperation and partnerships

Strategic planning by building better commissioning arrangements or joint commissioning teams

Commissioning integrated services, or jointly commissioning specific services such as advice and advocacy services

Assessments, information and advice such as integrated health, care and housing assessments

Delivery or provision of care via integrated community teams, or working with housing providers to ensure that adaptations support independence, reablement or recovery

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Strategic planning

Joint Strategic Needs Assessment (JSNA) Joint Health and Wellbeing Strategies and commissioning strategies Local Development Frameworks Joint commissioning teams Joint governance structures Pooled budgets Development of combined approaches to the market through joint

market position statements

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Commissioning across agencies

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Separate - independently and without co-ordination

Parallel – with reference to other agencies

Joint – in partnership by separate agencies

Combined – through a singleorganisation or partnership

Agencies have separate approaches and do not liaise e.g. the financial impact of services and policies on other agencies is not considered

Agencies liaise over commissioning activities e.g. separate cost, benchmarking and market intelligence shared by agencies

Agencies work jointly on commissioning activities e.g. a jointly researched and produced market position statement

Single, combined functions or arrangements e.g. a single, integrated commissioning function

Integrating assessment and information

Joint information and advice service - based around the needs of the end user rather than around individual services or structures

Integrated assessment processes “Care co-ordinators” Integrating assessment and care planning for carers

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Integrating service delivery

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Care and repair

Assistive technology

District nursing

Occupational therapy

Home Care

Community alarm

service

Physiotherapy

Reablement

The need to integrate provision to help keep people within the community

Summary

The Care Act ensures that people should experience provision that works well together and where each participant know what the others are doing and why

The responsibility goes wider than just integration and cooperation with health services but to other services that provide care and support

The duty to cooperate is not just one way, and involves both a general requirement to cooperate as well as a specific requirement in the case of individuals

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