Management Forum July 8th 2013 Health and Social Care Integration

1. Management Forum July 8th 2013 Health and Social Care Integration

2. Walsall Social Care and Inclusion – going forward John Bolton Interim Executive Director

3. Feedback from last Forum Over 80% of those completing the evaluation form said that: • the event overall was either good or very good • the opportunity to understand our progress to date in terms of promoting self directed support was good • the opportunity to consider medium term financial plan was good

4. Feedback from last forum But almost a third of you completing the evaluation form were unclear what outcomes there would be for … • yourself • your service • our Directorate … and very few of you completed the evaluation form, so please remember to do so at the end of today’s event

5. General Feedback • Good to have opportunity to share/challenge perceptions/views • Would have been good to have had information on what the Directorate was working on • Would have been useful to hear from the ADs about current developments and initiatives in their services • Want senior managers to join the tables!

6. How could the event have been more effective? You said … give us more notice of these events We did … publish the date of the November event You said … give us more information in advance We did … send today’s programme and slides out earlier You said … presentations don’t take enough account of the role and understanding of workers in partner organisations We did … make sure there are presentations today which address the roles of colleagues in DWMHT and JCU

7. How could the event have been more effective? You said … give us an opportunity to put forward questions to the Director and ADs We did … include this in today’s event, though we expect you to come up with solutions too! You said … let us put forward topics for future Forums We did … arrange for a suggestions wall today, so please make sure to use it for your ideas on items for November’s event

8. Last Meeting….. We looked at the agenda going forward – emphasis on getting prevention right in the operating model and getting personal budgets right. Fresh challenges of the money – we considered all of your suggestions and have started to work them up into solid proposals (I read every sheet personally) – some of them are about improving and changing our practice – e.g. Building our preventive services – others are really difficult political decisions – e.g. Charging or redundancies Now we will focus on reducing admissions to residential care – through better intermediate care; better care pathways for dementia and reprovision for younger adults

9. Diagnostic and Early Intervention Phase Intermediate Care Services – residential and community (reablement) Hospital discharge requiring support Preventive Services Community Alarms Equipment – telecare, Aids to daily living – Independent Living Centre Community Social Workers Neighbourhood Community Officers Sensory Impairment Services Housing Related Support Services Community and Voluntary Sector - Carers Health - falls prevention Employment Assessment for longer term care Inquiry to Adult Social care Divert to Community/ Voluntary sector Information and Advice Safeguarding assessment

10. Assessment and Long Term Interventions Outcomes delivered through - Direct Payment with DP Support Services/ PAs / Community/ Family support Resources Allocation And Support Planning With a Focus on Outcomes = Personal Budgets Review Assessment for longer term support Managed Accounts – outcomes delivered by access to services – Domiciliary Care / Day /Residential/ Shared Lives/ What are the interventions that will help this person become more independent? – Reprovision programme – Living well with Dementia – Expert Patient for a long-term condition – Prepare for employment

11. Four key priorities going forward • Building the operating model – get preventive services to deliver • Build on the personal budgets – get both Direct Payments and Managed Accounts working for everyone • Work collaboratively with partners – noticeably Health • Start being prepared for the possible financial challenges ahead.

12. Relationship between Strategic Commissioning and the Operational Commissioning role of Access, Assessment and Care Management Andy Rust – Head of Commissioning Suzanne Joyner – Head of Community Care

13. Strategic Commissioning • Whole Health and Social Care System • Need Supply Demand Analysis • Market Shaping • Menu of Services • Improving Quality • Regulation • Service Specification • Contract Management / Accreditation • Contract Monitoring / Holding to Account • Safeguarding • Clinical Improvement

14. Operational Commissioning • Individual Case Management • Whole Family • Person Centred • Personalisation • Social Workers/Occupational Therapists/Reablement • Safeguarding

15. Relationship Between Strategic and Operational Commissioning • How do we effectively capture collective intelligence about gaps in the market from individual/operational case management and communicate to strategic commissioners? • How do we effectively communicate new market options to case managers / individual service users? • How do we use feedback captured during review and reassessment processes on quality issues in the market so that we can take those issues up with the market? • How do we relate strategic commissioning concerns to individual case management?

16. Mental Health ServicesPartnershipsCommissioningSocial Work

17. The Partnership with the Mental Health TrustPeter Davis Head of ServiceWalsall Social Care & Inclusion

18. Context • A single organisation delivering services to children, adults and older people in a seamless way • Need to integrate organisations with different governance arrangements, organisational structures, funding and cultures • Sense that Mental Health was “bolted” onto the local agenda • No holistic consideration of wider care pathway, especially for older adults

19. Local Benefits • Change to silo working • Senior managers have a greater understanding of how each organisation works • Development of a formal joint approach to planning and strategic management; via Partnership Operation Group (POG) and Partnership Board • Middle managers become more involved in changes • Better front line integration and senior managers working together

20. Service User benefits • Greater uptake and offer of Personal Budgets with wider choice of alternatives to residential care • Prompt and consistent decision making via panel arrangements • Increased involvement of the third sector

21. The future benefits • Understand gaps in community based provision and commission accordingly • Improve engagement with service users and carers with consistent consultation and communications mechanisms • Give people control and choice over their care and support packages • Develop a shared outcome focussed evidence base for treatment and support services • Plan and manage the impact of decreasing resources • Develop metrics around the quality of Section 75 arrangements • Improve the range of community based preventative services • Understand the needs of the Section 75 workforce • Develop strategic partnerships with statutory, commercial and voluntary sector agencies

22. Mental Health CommissioningIn Walsall Marcus Law Commissioning Development Manager

23. Summary of commissioners’ role • Budget management and ensuring VfM • Market development • Promote independence, prevention and early intervention • Reinvestment in appropriate services • Contractual and performance management

24. Mental Health Vision • Whole population mental health & wellbeing • Early interventions • Intensive support • Time limited targeted interventions • Recovery focus • Supported discharge • Signposting • Above fits with the Councils Operating Model

25. Mental Health

26. Adult Mental Health • Key achievements to date • Personal budgets – rolled out successfully • Developed Supported living schemes • Developed S117 policy which has enabled discharge for over 100 MH users from S117 aftercare – removes them from MH services. As well as moving others responsibility to other LA’s and PCT’s. • Closure of poor provision in day services, residential and nursing care sector • Brought service users back from out of area placements • New prevention services such as Rethink community model, Big White Wall and Kooth. • New specialist hospital and rehab provision built in Walsall for detained and complex users • New PICU service built in collaboration with Black Country commissioners – High quality, local and short stays • Assertive review panel – stepped down care and support for many individuals enabling them to return to community without support or move to supported living or extra care schemes • Payment By Results data – model worked on with SHA colleagues to establish key reports from MHMDS through partnership working with DWMHT • Enabling greater independence, shorter stays in care, offering a wider menu of services and achieving savings by implementing above

27. Adult Mental Health • Achievements to date cont’d: • New specialist hospital and rehab provision built in Walsall for detained and complex users • New PICU service built in collaboration with Black Country commissioners – High quality, local and short stays • Assertive review panel – stepped down care and support for many individuals enabling them to return to community without support or move to supported living or extra care schemes • Improved review practice by DWMHT staff by implementing assertive review process • Pathway improved -Reduced length of stays in hospital, rehab, nursing and community packages. • Wider range of services now available and more appropriate selection based on need and preference • Payment By Results data – model worked on with SHA colleagues to establish key reports from MHMDS through partnership working with DWMHT • Review of psychiatric liaison services • Enabling greater independence, offering a wider menu of services and achieving savings by implementing above

28. Efficiencies achieved 2010/11 - 2012/13 NB - Year 2011/12 and 2012/13 refers to additional savings to that of 2010/11 and not recurring savings from previous years

29. Adult Mental Health Future services and redesign work • Continuing redesign of secondary mental health services (MH Trust) • Create a wellbeing and recovery service hub: Create new preventative services with closer links to the community, GP’s creating improved pathway for users Enhance existing recovery college provision • Ongoing work on NHS Payment By Results (PBR) in MH – build new tariffs/contracts for services based on cluster activity in the future along with outcome based monitoring • Redesign of existing crisis and respite provision • Strive to achieve ‘cultural shift’ in all providers to promote recovery and independence that is both effective and efficient

30. Adult Mental Health • The team • Commissioning Engagement Manager across Dudley and Walsall (Walsall Team Manager) • Anet Baker • CAMHs commissioner • Alicia Wood • Adult commissioners • Marcus Law & Mark Williams • Older Adults Programme Manager Lead • Michael Hurt

31. The role of the social worker in the Mental Health Trust Santokh Dulai – Walsall Council Hassan Omar -DWMHP

32. The Ten Essential Shared Capabilities: A Framework for the Whole of the Mental Health Workforce (National Institute for Mental Health in England andSainsbury Centre for Mental Health – 2004) • Professional groups expected to retain their distinctive roles though the demand for change is increasing • Professionals to focus on shared elements of good practice • Much of this has been historically associated with social work

33. Shared capabilities for Mental Health practitioners • Working in Partnership. • Respecting Diversity. • Practising Ethically. • Challenging Inequality. • Promoting Recovery. • Identifying People's Needs and Strengths. • Providing Service User Centred Care. • Making a Difference. • Promoting Safety and Positive Risk Taking • Personal Development and Learning

34. What do we bring to the integrated model? • The social model of mental illness v medical (symptoms) • Context / normalisation • Prevention rather then cure • Instil hope • Recovery and empowerment • Promote dignity • Human worth • Social justice • Principles and social perspectives of the recovery model

35. Table Exercise What should my service be doing to further integrate with Health?

36. Table Exercise Current issues and challenges? Solutions? How can EDMT support you? Sharing success and good practice

37. Evaluation

38. Management Forum July 8th 2013 Health and Social Care Integration