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www.walsall.gov.uk
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
www.walsall.gov.uk
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
www.walsall.gov.uk
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!
www.walsall.gov.uk
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
www.walsall.gov.uk
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
www.walsall.gov.uk
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
www.walsall.gov.uk
Inquiry to Adult Social care
Hospital discharge requiring support
Intermediate Care Services – residential and community (reablement)
Preventive ServicesCommunity AlarmsEquipment – telecare, Aids to daily living – Independent Living CentreCommunity Social WorkersNeighbourhood Community OfficersSensory Impairment ServicesHousing Related Support ServicesCommunity and Voluntary Sector - CarersHealth - falls preventionEmployment
Assessment for longer term care
Safeguarding assessment
Divert to Community/ Voluntary sector Information and Advice
Diagnostic and Early Intervention Phase
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Assessment for longer term support
Resources AllocationAnd Support PlanningWith a Focus on Outcomes = Personal Budgets
Outcomes delivered through - Direct Payment with DP Support Services/ PAs / Community/ Family support
Managed Accounts – outcomes delivered by access to services –Domiciliary Care / Day /Residential/ Shared Lives/
Assessment and Long Term Interventions
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
Review
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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.
Walsall CCG
Relationship between Strategic Commissioning and the Operational Commissioning role of Access, Assessment
and Care Management
Andy Rust – Head of CommissioningSuzanne Joyner – Head of Community Care
Walsall CCG
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
Walsall CCG
Operational Commissioning
• Individual Case Management
• Whole Family
• Person Centred
• Personalisation
• Social Workers/Occupational Therapists/Reablement
• Safeguarding
Walsall CCG
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?
The Partnership with the Mental Health Trust
Peter Davis Head of Service
Walsall Social Care & Inclusion
www.walsall.gov.uk
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
www.walsall.gov.uk
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
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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
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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
• Budget management and ensuring VfM
• Market development
• Promote independence, prevention and early intervention
• Reinvestment in appropriate services
• Contractual and performance management
Summary of commissioners’ role
• 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
Mental Health Vision
Mental Health
32643268.12; 82%
7375024.87; 18%
Forecasted Expenditure split between NHS and LA (£) 2013/14
NHSLA
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
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
Efficiencies achieved 2010/11 - 2012/13
2010/11 2011/12 2012/13Cumulative on year
savingsOrganisation Part year
effectFull year effect
Part year effect
Full year effect
Part year effect
Full year effect
Full year effect
£ £ £ £ £ £ £
SC+I 70,994 121,382 126,139 361,712 52,205 97,702 580,796
NHS 347,551 537,730 279,186 608,069 171,600 213,200 1,358,999
Total 418,545 659,112 405,105 964,061 405,105 964,061 1,939,794
NB - Year 2011/12 and 2012/13 refers to additional savings to that of 2010/11 and not recurring savings from previous years
Adult Mental Health
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 usersEnhance 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
Future services and redesign work
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
The role of the social worker
in the Mental Health Trust
Santokh Dulai – Walsall CouncilHassan Omar -DWMHP
www.walsall.gov.uk
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
www.walsall.gov.uk
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
www.walsall.gov.uk
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
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Table Exercise
What should my service be doing to further integrate with Health?
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Table Exercise
Current issues and challenges?Solutions?How can EDMT support you?
Sharing success and good practice