A Brief Guide to Health and Social Care in Devon and Relevant Engagement 1 INTRODUCTION AND PURPOSE OF THIS GUIDE The UK health and social care system is large and complex. The system in Devon is particularly so because there are three local authorities in the geographical county, and their boundaries do not match those of the local NHS organisations. This guide aims to describe that situation to enable people who use health and social care services to understand which agencies do what, and where and how engagement is undertaken in the county. It is an attempt to accurately describe a system that is complicated, and should be used as starting point to show readers which organisation’s website they should visit for more detailed information. 2 Local authorities in Devon There are three local authorities in geographical Devon which have responsibility for social care. Devon County Council (DCC) This is an ‘upper tier’ authority with overall responsibility for social care in the county. District Councils There are 8 District Councils within the DCC area. These ‘lower tier’ authorities are responsible for housing, leisure, refuse collection etc. They are: - East Devon District Council - Exeter City Council - MiD Devon District Council - North Devon District Council - South Hams District Council - Teignbridge District Council - Torridge District Council - West Devon Borough Council 3 Plymouth Council and Torbay Council These are ‘unitary’ authorities, which means they are responsible for all local authority functions within their areas, both social care and housing etc. All local authorities are run by elected Councillors. 4 Social Care Most social care services are no longer provided by local authorities, but are instead commissioned from a wide range of independent providers. Most social care staff are therefore involved in assessing people’s needs and commissioning services. Social care (other than advice and information) is also subject to eligibility criteria and if you are eligible then you will have a financial assessment to determine whether you have to pay and, if so, how much. 5 The NHS in Devon The NHS is a national organisation. It is directly responsible to the Department of Health and to the Secretary of State for Health and Social Care, not to local elected councillors. NHS services are not subject to eligibility and assessment in the same way as social care. NHS services are divided into: - Primary care that takes place in community settings - Secondary care that takes place in hospitals NHS organisations are divided into commissioners and providers. NHS Commissioning organizations Commissioners check the needs of a population and then buy the required services from providers. In Devon there are two NHS Clinical Commissioning Groups: Northern, Eastern anD Western Devon Clinical Commissioning Group (NEW Devon CC) covers most of the DCC area and all the Plymouth Council area. South Devon and Torbay Clinical Commissioning Group (South Devon & Torbay CCG) covers part of the DCC area (Teignbridge, South Hams) and all of the Torbay Council area. 6 The two CCGs are working more and more closely together and plan to merge in the near future, but are still separate organisations. 7 NHS Provider Organizations Providers are responsible for the direct delivery of NHS services to patients. The Devon CCGs commission services from six major NHS providers in the county: The Royal Devon & Exeter NHS Foundation Trust Royal Devon & Exeter Hospital, and other services University Hospitals Plymouth NHS Trust Derriford Hospital Northern Devon Healthcare Trust North Devon District Hospital and Community Services Southern Devon Healthcare Trust Torbay Hospital and Community Services Devon Partnership NHS Trust Mental health and learning disability services in the Devon County Council and Torbay Council areas Livewell Trust Community services, mental health and learning disability services in Plymouth 8 Nationally-Commissioned Services While the CCGs have the ability to source some services themselves, other local services are commissioned nationally by NHS EnglanD: - Specialised and Highly Specialised services - Primary care at general practice level - Out-of-hours primary care for GP practices that have retained out-of-hours responsibility - All dental services and community pharmacy - Immunisation and national screening programmes - Prison and military health services. Health and social care integration Local authorities and NHS commissioners are working in partnership more and more often, and where possible they are identifying opportunities to merge, a process called integration. This means that some activities take place on a joint basis, such as the provision of community equipment. 9 Engagement, Consultation and Involvement in Devon The three local authorities and the NHS organisations in Devon have a general responsibility to ensure that the planning, commissioning and delivery of local services takes into account the experiences and views of patients, people who use social care and the wider public. National government guidance gives each of those organisations wide discretion in how they choose to engage their relevant populations and the principle embodied in that guidance is that the way in which citizens are engaged should be proportionate to the decisions they are asking for views on. In most instances the ways in which services are delivered are prescribed by legislation, treatment models or financial constraints so there is little room for public influence. However, when possible and relevant, all three local authorities work with local voluntary organisations to enable people who use services to give them their views via working groups, surveys, focus groups and forums on specific issues, up to and including participation in the tendering for contracts when possible. Every so often a significant public- facing decision (such as those made by DCC’s Cabinet or a local NHS Governing Body) on a major change will warrant formal consultation, either by the local authority or the NHS or jointly, in which case public engagement is more extensive. 10 Local Healthwatch As well as organising meetings and other means of hearing from people who use services, the three local authorities in Devon each have to commission an independent statutory consumer voice organization. Each local authority in the county has its own dedicated Healthwatch organisation: - Healthwatch Devon - Healthwatch Plymouth - Healthwatch Torbay Healthwatch gives the public the chance to comment on any local health or social care service. The views gathered by Healthwatch are fed back to their relevant local authority and NHS services, and also nationally via Healthwatch England. 11 DCC’s Engagement with Autistic People Autism Involvement Group (AIG) Devon County Council convenes the Autism Involvement Group to enable the local authority and relevant NHS colleagues to hold regular discussions with a small group of autistic people and their parents/carers. This is to enable those health and social care professionals to put issues before that group so that reflection on lived experiences can inform planning and practice. Autism Partnership BoarD (APB) The Autism Involvement Group sends a service user representative and a carer representative to the Devon Autism Partnership Board. This is a multi-agency board with members who are required to be at an influential level in their own organizations to ensure decisions made at that Board are not ignored. The Board is a means for Devon County Council to oversee its implementation of the Autism Strategy with relevant partner agencies. This strategy is a joint one with Torbay Council, which has its own Autism Partnership Board and Autism Involvement Group to hear the views of autistic people and carers who live in the Torbay area. Plymouth Council initially opted into the joint strategy, but has since decided to implement its own independent strategy instead. 12 Joint Engagement Forum (JEF) Devon County Council has also established a Joint Engagement Forum with Devon’s two NHS Clinical Commissioning Groups, to provide a quarterly overview of our local engagement activity and make links between projects and workstreams. As with all the other groups DCC runs – those for carers, people with learning disabilities, etc – the Autism Involvement Group sends a service user representative and a supporter to the JEF. The JEF also includes representatives from DCC’s Equality Reference Group, which is a corporate gathering from the voluntary sector able to represent the views and experiences of people with characteristics protected by the Equality Act (race, religion, sexual orientation, etc). 13 Other engagement forums As well as the above specific engagement for people with autism, members of the Autism Involvement Group can be asked to participate in other groups convened by DCC on wider social care issues, such as the recent disability employment campaign. Participants are selected on the basis of the relevance of their lived experience and the need for groups to contain diverse cross-sections of types of people, e.g. a group discussing a DCC social care assessment form would contain the different types of people who would have to use such a form, to help refine its accessibility to that audience. Because DCC is mainly a commissioning authority, we commission most of our local engagement activity and hold a contract with Living Options Devon as the lead agency in a partnership to provide DCC and the two NHS CCG’s with the Devon