Devolution and Integration General Meeting – 15th October 2015 Background • Devolution and integration are amongst the Government’s flagship policies • Ministerial Taskforce is considering ambition for integration and ways to implement e.g. BCF, Vanguards, pooling of budgets and metrics • More powers devolved to Scotland and Wales • Greater Manchester and beyond - 38 bids were received by the deadline of 4th September • There is speculation that only a handful of applications will be announced with the SR 2 Challenges • Ambivalence about local political control • Delegation, rather than devolution • How much funding will be available? SR 25th November. • Timescales or behaviours mean that systems change does not involve the individuals and communities it intends to serve • Integration becomes an end in itself rather than a means to an end. 3 Challenges • Social model is subjugated to the medical model, that social care becomes ancillary health care and that social work reverts to case management • The role that LAs can and do play in whole system leadership across health and social care - strengthen Health and Wellbeing Boards, with more funding routed via them • A clean settlement for social care, not dependent on transfer from NHS 4 Opportunities • Devolution could front increased local democratic oversight of health and care • It may enable some local shaping of models - flexibility of design • Can help to make changes that are necessary but difficult if overseen centrally. • It could help to enable local areas to influence national policy to provide levers for change 5 Ministerial Integration Implementation Taskforce • Includes Jeremy Hunt, Oliver Letwin, Greg Clark, Alistair Burt • Aim - Monitor and drive delivery, as well as consider the options for future health and social care integration policy • Some of the key issues discussed have been the future of the BCF, workforce and the integration scorecard • Ray James represents ADASS on the Taskforce 6 Scorecard • On 1 July, the Secretary of State for Health announced a new set of unified metrics for the integration of health and social care • All areas should be baselined and benchmarked nationally by December 2015 • Harold Bodmer sits on the Department of Health’s Integration Scorecard Task and Finish Group 7 Draft Scorecard metrics • Currently there are six metrics proposed around outputs, technology and patients’ experiences. – Technological enabler - Do all health and social care organisations have read/write access on care records – Technological enabler 2: Do you share data to drive the coordinated allocation of resources through risk stratification? – Output 1: Total bed days for unplanned admissions of ambulatory care sensitive conditions per 100,000 population – Output 2: Proportion of 65+ who were still at home 91 days after discharge from hospital into reablement and rehabilitation – Patient Experience 1: Proportion of people with both PHB and social care personal budgets who have been able to link the two. – Patient Experience. 2: New survey question focused on experience of integrated care 8 Future of BCF • The Government has announced that BCF will continue beyond April 2016 - unclear how long the financial settlement will be for • Planning guidance will not be published until after the spending review • Early clarification of aims, processes and timelines will help local partners to plan beyond 2016 • Transformation fund - to support the service transformation needed to make the integration of social care and health a reality 9 Vanguards/New Care Models • Organise services that focus on the needs of citizens and look to dismantle the traditional boundaries as to where, when and how care is delivered • 29 areas were selected to pilot new models for localised healthcare in March 2015 • 23rd July, NHS England launched eight new Vanguards relating to urgent and emergency care • 25th September, a further 13 hospital Vanguards were announced which allows some of the best-known and best-run hospitals in Britain, to extend their geographical reach • Currently a lack of detailed national evaluation 10 Priorities in shaping integration and devolution • We want to see a system that is protected, aligned, and re-designed • DVP - ensure that new social and health care delivery models prioritise the need for: – Personalised services which are more joined-up around the individual – Good information and advice to enable us to look after ourselves – Building supportive relationships – Maintain independence • Money to ensure sustainability, capacity and quality - including living wage and workforce 11 Some questions to consider • Comments on: – Devolution – BCF and proposed Scorecard – Vanguards/new care models • What experience do people have of issues that need to be addressed nationally (challenges or opportunities)? • What national activity would support directors and senior colleagues? 12.