Social Care and Inclusion

Managers Forum 15th June, 2015 Moving Forward

Warm Welcome

Evaluation

www.walsall.gov.uk

25th Feb – better outcomes at lower cost

47 attended - 25 evaluation forms completed 53% (form now anonymous); Nov was 61%

88% of attendees perceived the event to be either good or very good.

8% said fair; none ‘poor’, none ‘excellent’

Thought provoking, interesting, realistic, Valuable, clear, challenging, timely

Uninspiring, confusing, nothing new

State of the Nation – Keith Skerman

www.walsall.gov.uk

June 2015 update

Council leadership SC&I leadership Budgets 15/16 and beyond Performance Improvement projects Integration

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Council Leadership

CMT changes Cabinet changes Corporate plan SC&I leadership changes Work with other Directorates

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Budget 15/16 and beyond

15/16 issues: £3.5m savings +£1.5m CF+ £1m price = £6m Care packages & commissioning Staffing & efficiency Review/redesign in-house services

16/17 issues: £5.8m savings+ £1m price + CSR? = £6.8+m Demand management & prevention Consolidate commissioning + care

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Performance

Productivity and sickness issues Target to review min of 85% of users Target to reach min 95% personal budgets Reduce waiting lists to max 5 days Maintain standards of safeguarding & DoLS Work towards outcome based support plans

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Improvement Projects

MOSAIC – go live 31.8.15 DEST & performance Making Safeguarding Personal In-house service reviews Complex needs review programme SEND & preparing for adulthood Experts by experience

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Integration

BCF, JCU & local joint working with NHS Walsall aims & objectives Integration of commissioning – Council, CCG Integration of delivery – ambitious plans Governance/ decisions Frontline co-location & focus

Market Shaping, Commissioning Intentions, Joint Commissioning – Andy Rust

www.walsall.gov.uk

The Care Act and Commissioning

Market shaping and commissioning• Commissioning focused on outcomes and promoting wellbeing• Promoting choice to drive quality and sustainability• Importance of workforce development and pay

Managing provider failure• Local authorities’ responsibilities to meet needs in cases of provider

failure. Emphasis on contingency planning and early warning. Regulations set out when there is a “business failure” to trigger local authority duty.

• New CQC oversight regime of financial health of “difficult to replace” providers. Regulations set out criteria for which providers are in regime.

www.walsall.gov.uk

Market Management

• Market Position Statements setting out commissioning intentions• Older People• Complex Conditions • Mental Health

• JCU supports regular forums for local providers (i.e. SLHS forum, R&N forum, Prevention forum, Disability Services Forum) and disseminates information, guidance and advice about the Care Act.

• JCU has also developed a Contract Management Framework to assist in detecting, preventing and managing Provider failure. Contracts awarded by the JCU are monitored using three specific monitoring processes based around tiered inspection of providers to a level proportionate to funding and risk, whilst evidencing the achievement of outcomes for Walsall citizens.

• JCU and CCG Quality Improvement Programme manages quality in the regulated social care market in partnership with CQC with active suspension and restrictions programme and Service Improvement Plans i.e. Residential Home Quality Monitoring Tool and Nursing Home Quality Monitoring Tool

www.walsall.gov.uk

Market Shaping

New Framework Contract for Care Homes:• Older People – Standard Fee Levels• Adults Complex Needs – Individual placements by negotiation – mini

auctions

New Framework Contract for Community Based Services:• Older People – 3 suppliers in each of 6 Zones• ACN - accredited suppliers for call off• Rapid Response, Reablement, Bereavement• Supported Housing• Joint with Children’s Services

Framework for Direct Payment Support Organisations

www.walsall.gov.uk

Medium Term Financial Plan

Directorate Savings Targets• 2015/16 £3.269m savings plus carry forward

overspend from 2014/15 = £5.8m• 2016/17 £5.878m• Efficiency Delivery Plan to reduce spend in

commissioning budgets – fewer residential placements and less community based care

• Review in-house learning disability services

www.walsall.gov.uk

Older People – care act prevention

• Information and Advice• Independent Financial Advice• Independent Advocacy• Care Accounts• Joint Work with Public Health

Integration of Community Services / Better Care Fund

Redesign of Community Health Services for Care Closer to Home• Locality Structure aligned to Primary Care• Risk Stratification – Case Management• Single Point of Access• Rapid Response• Support to Care Homes

www.walsall.gov.uk

Older people continued ..

Hospital:• Frailty Pathway• Ward and Board Rounds• Expected Date of Discharge• Multi-disciplinary Discharge Planning• Week-end / 7 day working• Redesign Therapy Services Better Care Fund Integration:• Community Health/Social Care/Primary Care/Mental Health• Locality based multi-disciplinary teams; joint asst and care mgt • Reablement Services/ Intermediate Care/Transitional Care Pathways• Assistive Technology• Dementia Care and Support / Older People Mental Health

www.walsall.gov.uk

OPMH and Dementia

Main Commissioning Intentions 2015/17: Intensive support team (crisis) 7 days Community teams to 7 days & aligned to locality teams Improved activity in Care Homes (equipment via ILC) Service to support care homes with dementia and EoL Primary Care Co-ordinators for single point of access OPMH acute hospital liaison team to 7 day working Review / Improve Memory Assessment Service Personal Assistants – Dementia to work with people from diagnosis

for support, information & signposting Continue Dementia Friendly Communities Programme Procurement for dementia cafés and Dementia Support

www.walsall.gov.uk

Adults Complex Needs

There is a need to ensure that services are promoting people’s well-being and they are supported to be as independent as possible.

Support Plans to focus on outcomes and be innovative in the way needs are addressed.

People should be supported to access mainstream services as an alternative to specialised provision wherever possible.

There needs to be significant changes in clinical pathways that support people who are unwell to receive care and support within their local community preventing the need for admission to hospital and for prolonged lengths of stay.

A renewed emphasis on reablement and enablement models that continue to break the culture of dependency and promote better integration across all public services.

www.walsall.gov.uk

Adults Complex Needs

Main Commissioning Intentions:• Reduce care home placements and care packages via Efficiency

Delivery Plan reinforced by changes to Council/CCG framework contracts

• Changes in Clinical Practice in BCPFT to reduce hospital admissions / LoS and support community living – Clinical Treatment Reviews

• Changes to in-house services for employment support and daytime activity

• Changes to transition arrangements• Independent Advocacy• Autism• Market shaping housing for community living

www.walsall.gov.uk

Mental Health Services

Main Commissioning Intentions:• Improve mental health well being and parity of esteem• Continue redesign of adult mental health service in DWMHT• Review Section 12 Aftercare processes• Re-commission acute rehabilitation / recovery pathway• Relocate mental health recovery college from Broadway North• Maternal Mental Health Support Services• Interaction of alcohol / mental health freq hospital attendance• Continue Crisis Car • Mental Health Concordat• Greater access to Psychiatric Liaison and Counselling Services• Personalisation / Personal Budgets • Review S75 Partnership Agreement between Council - DWMHT• Review Psychiatric Support to urgent care – i.e. in A&E• Increase development of early interventions and CAMHs

www.walsall.gov.uk

Changes to Joint Commissioning

Main features of changes:• Review of JCU has resulted in revised arrangements• “A process of integrated commissioning at strategic level” - reinforce

matrix working - less emphasis upon a Unit• Alignment of children’s, adults and public health commissioning in

the Council• New management structure in the CCG• Finance, Legal, Procurement, HR etc Teams working more jointly

between Council and CCG• Revised arrangements for Health and Well Being Board and Joint

Commissioning Committee• Revised Legal S75 Agreements for Commissioning• Joint Accountability Frameworks

Comfort Break

Energiser

 Partnership working with DWMHPT

Hassan Omar / Andy Rust

www.walsall.gov.uk

Independent Review

Conducted by National Development Team for Inclusion from September 2014 to end January 2015.

The purpose of the independent review was to establish whether the local mental health system in Dudley and Walsall is fit to support the outcomes people with mental health problems in both areas want.

The work focused on: leadership, commissioning, partnerships, workforce and organisational development, information and advice, prevention and early intervention, person centered systems and approaches, fair access and equality, support for managing personal budgets and support for carers.

www.walsall.gov.uk

Review – Headline ConclusionsThere are some excellent areas of good practice that can be built upon.

Areas for Development: All staff need regular and professional supervision and a supportive

environment in which to develop Access to mental health services needs to be simplified More community based prevention and recovery services are needed Clearer outcome measures should be agreed for everyone using mental

health services A mechanism for engagement and co-production (a shared approach) must be

built to inform change and service re-design as well as provide feedback A broader range of community based mental health provision is required The process for applying for funding via panel should be clearer and more

effective Personal Health Budgets / Individual Service Funds to be explored further Change should focus on culture and practice, rather than processes and

documentation

www.walsall.gov.uk

Changing Requirements

Impact of changes to mental health legislation and individual legal case rulings is creating more demand for specialised skills relating to Mental Capacity Act, Deprivation of Liberty, best interest assessment, knowledge of legal landscape, Care Act, C&F Act, etc

This creates a need to review current skill mix and make up of mental health social care

This in turn raises a question of how and where best to provide the right skill mix from

Leads to need to review the Section 75 Partnership Agreement

www.walsall.gov.uk

Review S75 Partnership Agreement

S75 Partnership Agreement between Walsall Council and Dudley Walsall Mental Health Trust for delivery of integrated health and social care mental health services

Agreement from 2013/14 to 2015/16 Clear processes for management and resolution of human

resource issues, complaint handling, information technology and information governance, financial reporting and performance.

Partnership Operations Group Options Appraisal Conclude in time to establish arrangements from April 16

Leadership and ManagementWorkforce Development

www.walsall.gov.uk

Reflecting on Management Survey, October 2014

42% of respondents said they would benefit from guidance in better understanding their leadership role

77% of respondents said they were not inspired by leaders in the Directorate

30% of respondents did not agree that their learning and development needs are being met

47% of respondents said they had not received any form of management training or development in the last 2 years

A strong case has therefore been made for a social care centric leadership course

www.walsall.gov.uk

New Leadership Programme

Developed, materials currently being finalised Good support from corporate and childrens colleagues Pilot to commence in September, 2015 For operational/front line managers in first instance (up to 12 initially) The programme will be referenced against the National Skills

Academy for Social Care Leadership Qualities Framework Structured around 4 modules:

Myself as Leader,

The People side of Leadership,

Steering not Rowing

Person Centred Outcomes ‘Homework’/research in between modules Final project presentation

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By the end of the programme delegates will.....

Understand their leadership role within the context of social care

Have developed their skills, knowledge and confidence in providing effective leadership

Use positive leadership behaviours to maintain high quality services and drive improvement

Largely delivered by Workforce Development but with support from current leaders/managers – could you support delivery?

Resilience Activity Heads up – Keith Skerman

 

Q and A