Health and Social Care Draft Integration Scheme

Consultation BriefingJan/Feb 2015

Aims of briefing

1. Background and rationale

2. What is in the Draft Integration Scheme

3. Explain what can be influenced

4. Lay out high-level timeline and next steps.

Illustration of need for integration

c. 300 people currently unable to

leave hospital

Levels of personal independence

Unit Cost

Step Down

Reablement Operations cancelled

Risk of Hospital Acquired Infection

Slower recovery

Residential care

Care at home

Self care

Community Health

GP’s

District Nurses

Limited capacityProcess delaysReactive rather than responsive

Background

Policy announced by the Minister 2011

Consultation Spring/Summer 2012

Act comes into force April 2014

Regs and Orders enacted. Guidance still emerging in Dec 14

Community Health Partnership (CHP) subsumed by integration April 2015

Draft Integration Schemes for Consultation

Final Integration Schemes submitted 31 March 2015

SG expected response – end June 15

SG expected response – end June 15

IJB created before 31/1/16

Integration Planning PrinciplesDeliver services to improve wellbeing of service users in a way:

• integrated from point of view of recipient;

• takes account of different needs/characteristics of people and in

different areas;

• respects rights and dignity;

• takes account of views of service users their community and local

practitioners;

• is planned and led locally engaged with local

practitioners/clinicians;

• better anticipates need; and

• makes the best use of facilities people and resources.

Draft Scheme

What does it include...

Not all elements can be influenced. The Summary explains why.

• Aims and Outcomes• Choice of Integration Model• IJB governance

arrangements• NHS and Social Care

functions delegated to the IJB

• Support to prepare the Strategic Plan

• Local operational delivery• How performance will be

provided• Clinical and Care

Governance *

• Operational Role of the Chief Officer

• Workforce Development• Financial Management and

Processes• Participation and

Engagement• Information Sharing and data

handling • Complaints• Claims• Risk Management• Dispute Resolution

What the integration scheme covers:

IntegrationJoint

Board (IJB)

IntegrationJoint

Board (IJB)

Delegatefunctions

&money

New authority created by Government.NHS & CEC appoint voting Board members.

Has all powers and duties to make decisions within the scope of the delegated functions and budget.

We must delegate specific functions and can delegate others

The IJB does not employ any staff or own any assets. It appoints the Chief Officer (CO), who may be seconded from either NHS or CEC.

The CO will have a duel role, to instruct NHS & CEC to deliver and resource functions, and deliver operationally in line with these instructions.

The Model - Integration Joint Board (IJB)

The IJB is wholly responsible for planning health and social care for the local population.

IntegrationJointBoard

IntegrationJointBoard

ServiceDelivery

ServiceDelivery

Model A - Integration Joint Board (IJB)

The IJB creates and approves a 3 year Strategic Plan (incl.a resource plan). The IJB must consult NHS & CEC on the plan. Note, the published plan can then only be changed if BOTH parties agree to step in. This has finance associated with it.

The IJB receives ALL it’s funding from NHS & CEC, and therefore NHS & CEC continue to carry the financial risk.

IJB is accountable for the delivery of outcomes and principles and overseeing the delivery of functions

NHS functions that will be delegated

Hospital services (includesassociated services – e.g. AHPs)

• A&E• general medicine • geriatric medicine• rehabilitation medicine • respiratory medicine• psychiatry of learning disability• palliative care• hospital services provided by GPs• mental health services provided in a

hospital with exception of forensic mental health services

• Services relating to an addiction or dependence on any substance.

Community Health Services

• District Nursing• Services relating to an addiction or

dependence on any substance.• Services provided by AHPs• Public dental service• Primary medical services (GP)*• General dental services*• Ophthalmic services*• Pharmaceutical services*• Out-of-Hours primary medical services• Community geriatric medicine• Palliative care• Mental health services• Continence services• Kidney dialysis• Services to promote public health

Social Care functions that will be delegated

• Residential Care –Older People• Extra Care Housing and Sheltered Housing (Housing Support

provided)• Intermediate Care • Supported Housing-Learning Disability• Rehabilitation-Mental Health• Day Services and Local Area Coordination-LD; Older People; Mental

Health• Care at home services and Reablement –All client groups• Rapid Response• Telecare• Respite services-all client groups• Quality assurance and Contracts• Assessment and Care Management-incl. OT services• Specialist Services-Sensory Impairment, Drugs and Alcohol.Not delegating Criminal Justice or Childrens’ services*

IJB budget

Current BudgetCEC Social Care £203MNHS Community £295MNHS ‘acute’ – est £90M

How will this be done?

Next Steps to integration

Strategic Plan

• Co-produced – Statutory list of those to engage• Detailed strategic needs assessment• Local plan element and local planning• Directs service change• Integrates service planning across health and adult

social care• Instruction to Council and NHS Lothian flow• Directs the IJB resources • Will become an ongoing process.

Principles for localities

• People/family- centred services• Empower managers, staff and local people to engage in

the provision of services for the local area• Create environment for local collaboration and

innovation• Create environment to foster community asset-based

responses• Tackle ‘demand- failure’ (revolving door)• Support the balance between reducing costs but meeting

people’s needs in the best way possible• 4 common areas creates partnership approach across

public sector

31 March 2015

2 February 2015

4 November 20149 October 2014

7 August 2014

23 July 2014

TodayAnalysis of benefits of each model option

Approval of model selection

Negotiation of key terms ofIntegration Scheme

Approval of draft Integration Scheme

3 month consultation of Integration Scheme

Approval of changes resulting from consultation

31 March 2016

SG review of proposed scheme

30 June 2015

31 July 2015

1 November 2015

1 December 2015

Implement new governance model & approve draft Strategic Plan

3 month consultation of Strategic Plan

Revise and approve Strategic Plan

Implementation of Strategic Plan including any organisational changes to delivery

Critical Path

Focus

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How to Comment

• Papers available:– Council Papers online for corporate Policy and Strategy

Committee on 20/1/15– Council’s Consultation Hub

https://consultationhub.edinburgh.gov.uk/hsc/draft-integration-scheme-consultation/consult_view