Agenda item

This report, to be introduced by the Assistant Director, Adult Social Services, provides summary information to support a follow-up scrutiny discussion (following an all Members Learning and Development Session on 21^st September 2016) to contribute to the development of new ways of working, through an Integrated Target Operating Model that will; enable Adults in Haringey to live healthy, long and fulfilling lives by maximising their independence and support the future financial sustainability of health and care services in the borough.

Following discussion at a Members Learning and Development Session on 21 September, John Everson, Assistant Director of Adult Social Services, provided an update on developments concerning Haringey’s Integrated Target Operating Model (ITOM). The Panel was asked to note:

-       The significant funding and demand challenges facing Adult Social Services, Public Health and Health Services.

-       That the Council’s vision for adults in Haringey, and the guiding principles for service transformation (agreed by Cabinet on 16^th June 2015), placed an emphasis on values that promoted and maximized an individual’s independence, dignity, choice and control.

The Panel was informed that the Council’s approach, outlined by Priority 2 of the Corporate Plan, was based on a shift from institutional care towards community and home based solutions. 

Mr Everson explained that in order to deliver the Council’s vision of maximising independence and managing future demand pressures, whilst achieving financial sustainability, the Council had agreed a genuinely transformational approach between Adult Social Services, Public Health and Haringey CCG. 

In response to questions, the Panel was informed that the road-map for delivering a new sustainable model of health and care was set out in the ITOM. It was noted that as the model evolved it would support progressively greater integration between all services to deliver the significant change required.

Mr Everson advised, that in order to inform the development of the ITOM, work had been undertaken with service users, carers, staff and partners to ensure the Council was clear about its current service offer (the “As Is”), what people wanted for the future (the “I statements”), and how these may be delivered. It was noted that additional information, concerning service user, partner and carer engagement, had been provided as part of Appendix 1 to the report.

The Panel was informed objectives in Haringey’s Corporate Plan had a strong ‘whole population’ public health focus and would inform the future operating model. Dr de Gruchy, Director of Public Health, went on to provide information on the importance of prevention and various primary, secondary and tertiary prevention strategies. This included consideration of population, community and personal health issues. The Panel also considered the current service offer, outlined on a large process map, including entry and exit points for adult social care and the health and social care pathway.  

During the discussion, reference was made to the following:

-       The current budget position and the financial performance of Priority 2 Services (Adult Social Care, Commissioning and Public Health). It was agreed that further consideration needed to be given to these issues as part of the Panel’s planned Budget Monitoring session on 17 November. 

-       The importance of mental health services, day opportunities and the support provided by the Community Reablement Service.

-       The benefits and flexibility of using a Dynamic Purchasing System to streamline procurement for both suppliers and the Council. 

-       The schedule for developing the ITOM, as outlined in Appendix 1 to the report. 

-       Issue relating to the use of personal budgets and direct payments.

-       The Council’s Equality Duty and use of Equalities Impact Assessments in terms of assessing the impact of any new policies. In addition, the Panel suggested that a health assessment should be introduced, for all Haringey policies, in order to promote health gains for the local population, reduce health inequalities and to ensure new policies did not actively damage health.

-       The options that existed for the ITOM as a result of the council’s regeneration agenda, especially in Tottenham and Wood Green. The importance of collective decision making was highlighted.  

-       The importance of assessing value for money i.e. using the optimal use of resources to achieve intended ITOM outcomes. It was noted there were differences between “Economy” (spending less); “Efficiency” (spending well); and “Effectiveness” (spending wisely). 

-       The role of carers in terms of delivering a sustainable model of health and care across Haringey. It was noted that Carers Week, an annual campaign to raise awareness of caring, highlighted the challenges carers faced and the contribution they made to families and communities throughout the UK. However, the Panel agreed the importance of carers had not been reflected in the Haringey ITOM and that more needed to be done to ensure adequate support was provided to carers so that they could look after their loved ones. It was also recognised that carers were individuals with needs of their own and that this needed to be picked up in the development of the ITOM.    

-       The Sustainability and Transformation Plan for North Central London and what this might mean for the development of Haringey’s ITOM.

In addition, various issues, including those relating to governance, were discussed in relation to joint commissioning for Haringey CCG and the local authority, including plans for intermediate care, and the development of an accountable care partnership across Haringey and Islington.

Mr Everson concluded his presentation by explaining key steps for developing the ITOM. Based on the Council’s vision, understanding of the challenges, the “As Is” and “I Statements”, the Panel was informed that opportunities had been identified that would shape both new ways of working and the first phase of the Haringey ITOM. It was noted that the following opportunities (outlined in Appendix 1 of the report) had been identified for further development:

-       Integrated Commissioning

-       Develop Community Hubs

-       Information Integration

-       Re-Designed Service Model

-       Models of Care for People with LD

-       Integrated Out of Hospital Project

The Panel was assured that the comments and suggestions put forward by the Panel, and from the Member Learning and Development Session, would be taken on board before the projects (above) progressed to the scoping stage.

AGREED:

(a)  That the update on the Integrated Target Operating Model be noted.

(b) That the Chair of the Panel and Assistant Director, Adult Social Services meet, outside the meeting, to consider (formal and/or informal) options for scrutiny input before the scope and timeframes for each Business Critical Project are confirmed.