The Care Together Programme a local authority perspective on integration
Ben Jay
Assistant Director (Finance)
Tameside MBC
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content
• the Care Together Programme
• Background issues
• Reflections and learning
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THE CARE TOGETHER PROGRAMME
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Care Together - Why
We are a discrete community serving a population of c250, 000 citizens •Some strong social networks•Long history of good partnership working.•Poor but improving health outcomes but still significant health and social care needs.Healthy life expectancy at birth is currently 57.4 years for males in Tameside and 56.6 years for females in Tameside. This is significantly lower than the England averages. Circulatory diseases including heart disease are the commonest cause of early death and rates are 55% higher than the national averagePremature death through lung cancer is 54% higher than the national averageHigh levels of social isolation in some of our communitiesWe are living with the consequences of tobacco being one of our biggest industries in 1950s and 60sForecast deficit of £74m by 2018/2019 if we do not act now
A Radically Different Way of Delivering Care
All parties recognise that “doing nothing” is not an option It is widely acknowledged that a radical and forward thinking IC care model is
the optimal solution bringing social, primary, community and hospital services together for:
A focus on wellness Supporting people to manage their own health and make healthy choices Proactive care and properly resourced general practice Care organised and delivered around people in their own home and
communities A range of hospital services available locally only for the most acutely ill,
working in partnership with neighbouring hospitals
TGHHospital Provider
Hospital Provider
Hospital Provider
Hospital Provider
Community
Primary
Social Care
WellbeingVertical Integration – services delivered at locality level
Horizontal Integration – Healthier Together in respect of a number of specialties
Care Together - How: Commissioner preferred (ICO) model
Following our option appraisal work commissioners have agreed a fully Integrated Care approach and organisation is the preferred model for Tameside & Glossop citizens:
Designing a new model of care
Proactive & Preventative Care
Women’s & Children’s
Integrated Urgent Care
Elective CareAcute
Specification
Gt. Manchester Conurbation
Patient Flows
Service Specification based on Care Design Groups
Estates IM&T Workforce & Education
Comms & Engagement Transport Joint
Intelligence
Enabling Workstreams
Issues to considerGovernanceLeadershipLegislationCultureBehavioursList basedGeneral Practice
Finance & Contracting
FINANCIAL AND GOVERNANCE ISSUES
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Governance for the Pooled Budget
Commissioning Executive(Providing Strategic Oversight)
Governing Body Executive Cabinet
Joint Finance Management Team
CCG Internal Gov.
Process
TMBC Internal Gov.
Process
= Decision making powers
= Recommendation Only
= Limited Delegated Authority
Key:
MBCCCG
CTP
Financial content of the pool
• Ongoing budgets for admitted services/service clusters
• Risk pool (to manage unforeseen costs)• Investment pool (One-off budgets to support
service redesign)– Capital investment (eg ICT)– Revenue investment (eg workforce change, double
running of acute/community services for a limited period)
• Pooled funds hosted by Tameside MBC
The Outline Business Cases (OBCs)
Phase 1
▪ Community, Home & Hospital Enhanced Care Team (CHHECT)
▪ Specialist LTC – Respiratory
▪ Musculoskeletal
▪ Dementia
▪ Ophthalmology
Phase 2
Phase 3 Phase 4
▪ Stroke & Neuro Rehabilitation
▪ All Age Learning Disability
▪ Palliative Support Service
▪ Local Community Care Team
▪ Wellness Offer
▪ Sexual Health
▪ Substance Misuse
▪ Cancer
▪ Carers
▪ Health Improvement
▪ Telehealth & Telecare
▪ Specialist Accommodation
▪ Children
▪ Specialist LTC – Cardiology
▪ Joint Equipment Service
▪ All Age Mental Health
▪ General Surgery
▪ Diagnostics
▪ Safeguarding
▪ Admission Avoidance: Minors
Implications…
Work stream 2014/15 Budget Recurrent Future Budget % Change Expected Savings
CHHECT – total 85,642,518 65,227,774 -23.8% -20,414,744
Dementia 8,183,791 7,689,658 -6.0% -494,133
Respiratory 8,978,911 8,049,625 -10.3% -929,286
MSK 27,036,051 24,120,465 -10.8% -2,915,586
Ophthalmology 7,460,528 6,925,398 -7.2% -535,130
Total Phase 1 137,301,799 112,012,920 -18.4% -25,288,879
All Age Learning Disability 25,651,711 23,545,633 -8.2% -2,106,078
Palliative Support Service 1,354,716 1,354,716 0.0% 0
Stroke & Neuro Rehab 3,404,946 3,169,166 -6.9% -235,780
Local Community Care Team 19,806,010 16,240,928 -18.0% -3,565,082
Total Phase 2 50,217,383 44,310,443 -11.8% -5,906,940
Total Phases 1 & 2 187,519,182 156,323,363 -16.6% -31,195,819
Audit, assurance, quality, data
• Proposals already being discussed with external auditors– Development of approach to single pool that will satisfy
both assurance regimes (Monitor/TDA AND LA)
• Jointly commissioned activities will require clear performance framework and regular reporting
Entering and exiting the pool
• To gain entry to the pool– Business case and financial plan; commissioner
agreement; identified lead commissioner; case for change
• Rolling position agreed in both budget processes• To exit the pool
– Unmanageable over spending (demand pressure) and/or Inadequate clinical or care standards
– Recommendation of CFOs and the Joint Finance Management Team to the Commissioning Executive
– Exit strategy; goes down well with auditors…
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REFLECTIONS/LEARNING
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Reflections and Learning
• Partnership; Communication & Myth-busting– council attitudes; NHS attitudes; partnership behaviours
• Hosting with the council; common concerns• Governance; HFMA guidance and its application• Working with watchdogs• Devolution
– Not a take-over; an unparalleled opportunity.– Governance heavy. Of necessity.
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