Putting People First:Joining Up Health and Social

Care

Jeff Jerome

The Individual Perspective

Most people want: – To stay healthy,active/involved– If get ill, want cure– If not cured, then limit damage/deterioration/reduce pain etc– Optimise functioning, keep as independent as possible– If have debilitating/deteriorating condition want high quality

care support, information– End of life care

Prevention, treatment, rehabilitation, care, support at different points, in different amounts

Spending by NHS and Loc Govt proportionally different

Personalisation: Common goals

• People increasingly expect to receive health and care services that are personalised – tailored to fit in with their lives and focused on keeping them well and independent: not just dealing with crisis situations’

• ‘Our Health our Care our Say’• ‘Putting People First’• D’Arzi

Putting People FirstA shared vision and commitment to the transformation of social care

• Central and local Government support• Recognises demographic challenges• NHS, Housing, Culture, Leisure, Adult Education,

Employment etc important to transformation of social care• Information, early intervention, & preventive services to

support independence and inclusion.• Individuals and their carers at the centre of planning and

delivery• Control through individual budgets• Commissioning of services which offer quality and ensure

individuals are treated with dignity

D’arzi• ….., we will explore the potential of personal budgets, to

give individual patients greater control over the services they receive….’

• ‘…..launch a national pilot programme in early 2009, supported by rigorous evaluation. This will enable the NHS and their local authority partners to test out a range of different models.’

• ‘Personal health budgets are likely to work for patients with fairly stable and predictable conditions, …… for example, some of those in receipt of continuing care or with long-term conditions.’

The New ‘Soc Care’ Approach• System in which everyone can use “their” £’s to

get care and support for themselves• Private payers, joined by publicly (Council) funded

personal/individual budget-holders• New RAS systems changes traditional

arrangements • Points means £s (local value for each point)• Try to maximise allocation of care funding• Efficiencies/minimise bureaucracy/incorporate

social capital and flexibility

New ModelAdvice and Information

Council FundedIndividual / Personal Budget

Self Funders

HELP TO BUILD A SUPPORT PLAN

HELP TO NAVIGATE MARKETPLACE AND SECURE SERVICES

ADVICE AND SUPPORT IF THINGS GO WRONG

QUALITY SERVICES DELIVERED DIRECTLY

Individual Direct LA held Service Fund OR Payment (£) OR budget

OWN RESOUCRES££

Assessments

Residents in Need

Choice and Control • £ doesn’t guarantee choice or control

– E.g. private use of care homes

• “Choice” needs a market, & information and support to choose

• “Control”– closely linked to dignity agenda – responsiveness of paid care staff/services– flexibility/changed contractual arrangements

• Risk, self-determination, self management and Protection• Multi-agency Adult Safeguarding system • “Would this be good enough for me and my family?” :

Commissioning: New direction• Care and support services: personal, sensitive to individual need

and maintain independence and dignity - more choice, louder voice

• Promoting health and well-being, investing now to reduce future ill health costs - better prevention, earlier intervention

• Services and interventions to achieve better health, across health and local government, promote inclusion and tackle health inequalities

• Better access to community services• Wider range of services -safe and effective– available in settings

closer to home, and integrated around individuals, not providers

• More support for people with long-term needs

Commissioning: Context

• Rising public expectations• Demographic/Demand Pressures:

– Over 85s to increase by 2.5% per year– 25% over 85s will develop dementia– One Third over 85s need constant care or supervision– 2% per year increase in people with learning disabilities– High inflationary pressure in sector– 8-9% pa increase in resource needed

• Challenging resource environment (workforce and financial)

• PBs/Self directed support

Commissioning Care and Support• Developing commissioning as a driver for change • Joint Strategic Needs Assessments• Partnerships between commissioners and communities;

interdependence of NHS, local govt and independent sector

• Understanding each other’s systems, and what each can offer the public – different ways of thinking and operating

• Re-designing care pathways, and procuring their delivery• Commissioning for outcomes• Increasing numbers of individual purchasers (public &

private)

Joint Commissioning: • Partnership : joining the two Commissioning Frameworks

• About individualised care pathways, supported by payment by results and practice based commissioning (including financial flexibilities) with agreed outcomes

• Best mix for patients of health/social care/3rd sector

• Improved access, choice (eg. choose and book), reducing health inequalities. promoting health by adding years to life and life to years

• Financial sustainability for NHS & Loc Govt, achieving NHS reconfiguration

• Transferring activity & its finance within care pathways= unbundling the tariff - the future of PbR

Re-aligning Money • Re-balancing investment between treatment, care and

the promotion of health and well-being• PBR / PBC and Personal Budgets to achieve flexible and

appropriate mix of health and LA resources• Growth in prevention, primary and community care with

resource shifts from acute care (5%)• Pathway investment• Commissioning Plans have clear strategy to develop

primary & community care, inc goals for shifting resources

Delivery• No assumptions re ‘in-house’, but

– different roles– Joined up teams/assessment/resource allocation ?– Support planning/brokerage/purchasing– Review/protection

• Opportunities for voluntary sector developments• Development of specialist services• Enabling/user-led services• Use of community resources/social capital

SDS Commissioning Issues?• Whole Community Approach• Council not major purchaser / procurer?• Role of individuals as purchaser and

commissioner• Is there a commissioning role?• Gap analysis• Market management role: ensuring availability

and choice? Bridging the gaps?

£+ High Wealth £ - Lower Wealth

Eligibility(FACS)Critical

Substantial

Moderate

Low

Adult Social Care – Current Commissioning

Common Governance Framework• Duty of cooperation• Health and wellbeing partnerships; LSPs• LAAs as key mechanism for integrated planning,

priority setting and delivery• Alignment of planning and budgetary cycles, &

performance assessment and accountability

What’s in the way ?• Whose responsibility ? • Two systems with different, cultures, agendas,

priorities, accountability systems• Challenge to distribution of

power,accountability,money• Silo-based structures, constantly renewing• Is the NHS part of the family of local services or

the local branch of NHS PLC?

Policy and Implementation Understanding/developing PBC and personal budgets interface• The wider social care role• Better Health, Fewer Hospitals

New services are shown to work and are valued by publicHospitals are there when required

• local financial incentives to encourage development of person-centred care.

• investment vehicle for delivering the vision e.g. pooled budgets – especially budgets with one lead commissioner

• Costed plans and timetables to re-deploy resources DASS budget decisions:

– Staff and associated processes – Pre-invested services– Free cash for individual budgets (de-commissioning)

So Joined Up approach means…..• A broad approach to commissioning wellbeing, not just about the health targets

• Locally driven within national frameworks and accountabilities

• Balance support, care, and treatment

• Must involve the transfer of (partic acute) health funding

• Moves us towards – Care closer to home– Personal budgets whenever possible

Information/Advice/

Guidance

SDS Operating Model

1st Contact/ Screening

Assessment

Reablement/

Further Assessment

Rapid Response

Assessment RAS

Support Planning

Brokerage

Care

& Support

Delivery

Review

Reassessment

Universalism Social care not universal Health ……? “Personalisation” requires more whole

picture/universal perspective for soc care– Clarify what is to be universally available– Clarify what is to be targeted– Clarify what is to be free/subsidised

Customer Engagement Models

Targeted help to individuals

Support to Communities

Infrastructure for Community development and self-help

Professional

gift relationship

Specialised interventions

Resource Intensive

Universal activities of daily living

Sustainability

Customer in control