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

1

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