Agenda item

The Leader considered the attached report which set out the progress made in developing a Design Framework for Integrated Health & Care in Haringey that seeks to ensure all adults in Haringey are able to live Healthy, Long and Fulfilling Lives. This had been developed by working with Public Health, Haringey CCG, and other key stakeholders.

The report described a framework between Public Health prevention opportunities and health and social care services that will help address the demand and budget challenges faced by the system now and in the future.

The Design Framework, at this point, was meant to provide a strategic point of reference in continuing to develop and inform a model of integrated health and care for the future with key stakeholders and partners.

It was designed to ensure a clear and consistent process and ‘framework’ to align the transformation and development of health and care services, reducing the risk of fragmentation and missed opportunities to use limited resources more effectively.

It also underpinned locally the work to develop the Haringey and Islington Wellbeing Partnership agreement, which provides the opportunity to shape and integrate services across a wider footprint.

The Assistant Director for social care put forward the representations of the Learning Disability Sub Group of the Adult Social Care Programme Oversight Group, strongly supported by the Dementia Sub – Group which expressed full support for the position which the Learning Disability Sub Group had taken.

The representation started by commenting on the timing of this report and whether there had been allowed enough time for meaningful consultation on the report, continuing with objection to the content of the proposals and the manner in which they felt they were being imposed.

Responding to the timing of proposals, the Assistant Director advised that that the council and partners had been working with stakeholders over 12 months and building on previous consultation on the Better Care Fund and Corporate Plan developments. The report, which was not a key decision, had been put forward to May in order to accompany the Health and Wellbeing Partnership agreement which was already on the Forward Plan for agreement as  a key decision in May.

The Assistant Director provided assurance that the approach outlined was not designed to be a single way of approaching transformation or service development, but a valuable point of reference to progress work and thinking.  It was not an end point but provided a strategic point of reference for working with partners to make best use of resources to improve outcomes.

The Assistant Director also highlighted that co-production and engagement with stakeholders was not a one off activity but part of an on- going conversation. The council and partners with stakeholders were committed to developing and improving this approach as part of the next step proposals.

The groups expressed concern about the applicability of the prevention pyramid to those whose conditions were not known by anyone to be preventable and in particular the future priority which will be given to services for those with dementia , autism and other learning difficulties who cannot be helped by re-ablement, recovery, or rehabilitation.

The group expressed that there was benefit from specific interventions such as cognitive and behavioural programmes for people with dementia and ‘positive behaviour support’ programmes for people with learning difficulties and challenging behaviour. But these programmes required skilled and experienced staff and premises in which they can work.

In response to these concerns, the Assistant Director emphasised that a prevention approach is part of the council’s strategy to manage and support those people who can be prevented from a deteriorating health and care situation. He outlined the joining up of analysis and services around different ‘at risk’ groups.

He explained that in developing the preventions pyramid, the value of understanding and mapping the council’s and health partners whole population approach to different health conditions and vulnerable groups of residents was regarded as an important next step. Those groups of people where this has been highlighted was important and included those with learning disabilities, mental health conditions, people who are becoming frail and those at risk of CVD and diabetes.

The Assistant Director reiterated that the council will work with partners and stakeholders, using the evidence of where we should be targeting effort to inform next steps.

The Learning Disability Sub Group of the Adult Social Care Programme Oversight Group expressed strong concerns about the potential neglect of specific social care needs. There was no breakdown of the different categories of Adults currently receiving social care and no costings of current provision for adults in these categories or indications of how they were likely to be affected by the current wave of closures of residential and day care facilities.

In response, the Assistant Director recognised that the design framework in its current form cannot reflect the diversity of experience or needs of all of the borough’s population, particularly those who need specialist services, due to overarching nature of the approach, so the report was recommending building on the strategic framework by exploring with service users, carers and other partners how it applies to different groups of vulnerable people.

It was also outlined that to support this, there was currently a joint review with users and carer representatives on whether the current arrangements for resident involvement provide the oversight and the opportunities for co – design required to deliver on the principle recommended in the Design Framework.

The Learning Disability Sub Group of the Adult Social Care Programme Oversight Group questioned the evidence and research that informed the thinking behind the Design Framework.

In response, the Assistant Director reiterated that the Design Framework proposed in the report provided a strategic point of reference for working across a rapidly changing landscape both as a council and with our partners. The research and evidence was reflective of that used by other local authorities nationally, however as work developed to refine the approach in different areas, more detailed research and evidence would inform this, such as the ‘Positive Behaviour Support’ approach highlighted by the group.

The design framework would therefore help shape and focus developments over time, for example to reflect the circumstances of those with more specific complex needs and their carers.

The Leader thanked the Assistant Director for his response to the representations and was clear that the Design Framework was the start of a process and the concerns by stakeholders would need to be worked through as part of the ongoing development of the Framework. The Leader noted that the Assistant Director was due to meet with the sub group on Thursday to start the process of taking forward and responding to concerns.

RESOLVED

To agree the approach set out Paragraph 6.9 and Appendix 1 and that the Design Framework be used as the strategic point of reference in continuing to develop the Council’s model of integrated health and care with key stakeholders and partners.

• To agree the next steps set out in Paragraph 6.10 in the application of the Design Framework. That is to:

·         Strengthen and align the Council and Haringey CCG  approach to co-design

·         Establish shared governance arrangements with Haringey CCG to address shared challenges & opportunities

·         Join-up analysis and services around different ‘at risk’ resident groups developing the Design Framework to reflect their specific circumstances e.g. those with Autism and Learning Disabilities and their carers.

Reasons for decision

Adult Social Care and Health partners in Haringey, Islington, North Central London, pan-London and Nationally are operating in a highly constrained environment, with demand projected to rise at a time when funding is under considerable pressure.

The changes that will determine the financial sustainability of local services and the quality of life for our residents requires action from a wide range of stakeholders, with  health and care services aiming at the same outcomes of prevention and early help to maximise independence and wellbeing . 

Residents and community groups have a central role in helping both develop and inform approaches, with all council services needing to have due regard for the way their policies and decisions can enhance, or hinder, the ability of our residents and communities to live healthy, long and fulfilling lives.

We need to address fundamental questions about how we use resources and deliver services differently with our partners and we need to continue to work on these challenges together. This agenda will only become more significant over the medium term and Haringey are playing a leading role in seeking innovative solutions as part of the Haringey & Islington Wellbeing Partnership and the NHS Sustainability and Transformation Plan across North Central London.

In that context, without a process and a framework to align the transformation and development of our health and care system, there is a risk of fragmentation and missed opportunities to use limited resources more effectively.

The Design Framework proposed in this report provides a strategic point of reference for working across this rapidly changing landscape both as a council and with our partners. It will need to develop over time, for example  to reflect the circumstances of those with more specific complex needs and their carers, but it represents a process that will help to keep our residents and those who use services at the centre of our decision-making.

Alternative options considered

Initial thinking focused on the role of adult social services in developing a target operating model.  However to continue with the design and development of adult social services without recognising the role of Public Health, Health and other key stakeholders, in shaping our work with partners within the Council, with local partners and across North Central London would risk fragmentation of health and care services and reduce the ability to coordinate resources for greatest impact across the local and wider system.

Secondly, developments to aim for a more fixed and detailed integrated target operating model across the whole health and social care system was also considered. However it’s lack of flexibility with partners, feedback from stakeholders and opportunities to evolve our thinking together in a time of dynamic change helped to steer thinking towards a ‘Design Framework’ approach. This embeds our commitment to working closely with stakeholders in Haringey (such as Haringey CCG), into Islington (as part of the Wellbeing Partnership) and across North Central London (through the Sustainability and Transformation Plan) to ensure our joint developments remain responsive and joined up as we move forward.