John DixonExecutive Director Adults and Children

ADPH Conference21st May 2010

How does partnership working between Health and Local Government

Benefit my Role?

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The Big Themes 2010

Personalisation Families Recession Workforce Integration/Integrated working

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Personalisation Personal Budgets 200,000

Personal Health Budgets Starting out

Key PPF Milestone Areas for April 2010:– Effective Partnerships with People using Services etc.– Self-Directed Support and Personal Budgets– Prevention and Cost-effective Services– Information and Advice– Local Commissioning

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Recession

20% reductions in Local Authority Budgets 20bn in NHS Pace of reductions? Total Place – Cross party interest Reshaping of public sector :

takeover/merger or integrated working? Tories promise to winnow out ‘bureaucrats’:

SHAs/PCT’s/Field Forces/Regulators etc.

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West SussexIntegration: Joint Adults and Children’s Department Integrated working: PCT and Council

£200m pooled budgets/joint commissioning. Plans for £800mSeconded PCT Executive Director –

Joint CommissioningJoint DPH and Commissioning Posts

Personalisation: Personal Budgets from 1700 in Sept. 2009 to 2600 in March 2010

Personal Health Budgets based on PbC : Carers, CHC, Children with Disabilities

Families: Whole life disability service being developed.

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Integration : The Policy“To make our vision for the future of care and support a reality… we need

more joined up working between health, housing and social care services and between care and benefits services”

Care & Support Green Paper

“We need to reform adult social care services, improve integration with health and make services more preventive in nature… we will greatly increase the integration of services by doing more to shape them around patients and to ensure that the boundaries between organisations do not fragment care”

NHS From Good to Great

“At the heart of this is transforming patient pathways, leading to the integration of services and in some cases, the integration of organisations”

NHS Operating Framework

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Integration : Top Facilitating Factors

Friendly relationships Leadership Commitment from the top Joint strategy Joint vision Coterminosity Additional funding Patient and user focus Front-line staff commitment

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Integration : Top hindrances

Performance regimes Financial pressures Organisational complexity Changing leadership Financial complexity Culture Data and I.T. National policies Local history

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So…………. None of the top 6 factors which help are mainly

national But the top 2 and 3 of the 5 factors which hinder are

national Only 20% of the factors which help are national

issues So the centre can probably do more harm than good

– it can limit local ambition and progress but can probably do little to create and stimulate joint working

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Effective Joint Commissioning

• All about patient/care pathways• Best mix for patients of health/social

care/Third Sector input• From self-care to tertiary care• Choice and control – from professionals to

users/patients• Transferring activity and finance within care

pathways - the ‘5% plus’ test• Joining the two commissioning frameworks• Achieving:

– user satisfaction– clinical outcomes– reconfiguration– financial sustainability

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Familiar Problems, New SolutionsFamiliar problems Old solutions New solutions

Working with users and carers •Formal consultation on plans•Nominal representation on planning groups

•User-led services

Managing budget pressures •Holding vacancies•Gate-keeping panels•Slippage savings•Central control

•Long-term strategic perspective•Aligned operational and financial management•Reliable delegated systems

Workforce pressures •Agency staff•Acting up/cover arrangements•Posts left vacant•Unmanaged workload

•Workforce strategy •Improving skill mix•Integrated teams•Better forecasting information

Modernising social services •Innovative projects•Focus on process/procedures•Reinvesting in old services•Incremental change

•Mainstream change via Best ValueCommissioning ethos•Defining critical success factors•Evidence-based

Getting the best from partnerships

•Joint planning forums•Spending ring-fenced monies•Sharing information about intentions

•Pooled budgets•Joint commissioning•Integrated frontline teams•Joint management