Agenda item

To scrutinise progress on joint commissioning and integrated care.

Tim Miller, Joint Assistant Director for Vulnerable Adults & Children at Haringey Council & Haringey CCG and Paul Allen, Head of Integrated Commissioning (Integrated Care & Frailty) at Haringey CCG, presented slides to the Panel on joint commissioning and integrated care. The key points covered were:

• The Better Care Fund Plan funds three main elements of a “community-based system:

o   A community-based approach to commissioning and asset building.

o   Multi-agency anticipatory care solutions to manage people who could benefit from a coordinated approach.

o   Crisis and Recovery Pathways.

• A community-based approach to commissioning which is about mobilising all assets within a community to support individuals at an earlier stage with their health and care needs. This requires information, advice and guidance targeted at the right individuals and community navigation (such as Local Area Coordinators) and social prescribing to connect people to community solutions.
• The multi-agency anticipatory care solutions bring together professionals to discuss social and medical needs of people. Examples of this include:

o   Haringey Coordination & Prevention Team – this includes nurses, therapists, pharmacists, social care workers and community navigators which manage cases of people with complex needs.

o   Multi-disciplinary team (MDT) Tele-conferences for older people – these focus on individuals with multiple A&E or hospital admissions and enable the coordination of a care plan.

o   Frailty Care Closer to Home – this focuses on individuals with less complex needs but moderate frailty issues who may need community navigation or a comprehensive geriatric assessment.

• Crisis and Recovery Pathways refers to services that help people to recover their health and independence after an illness/crisis or to avoid a crisis/hospital episode. Examples include:

o   Nurse-led Rapid Response to help people avoid hospitalisation

o   Single Point of Access that triages people into the right solution

o   Home-based reablement to help recover daily living tasks

o   Bed-based rehabilitation to help people with more complex needs

• The jointly provided and commissioned care services for adults with severe mental health conditions or learning disabilities comprise of three main elements:

o   Care teams – such as Haringey Learning Disability Partnership and Mental Health Locality Teams which include doctors, nurses, therapists, social workers and some third sector staff working together as an integrated team to provide individuals with the care and support that they need.

o   Personalised assessment and planning – the team works together with individuals to develop a care plan and some people may have the right to a personal budget to meet any eligible care needs.

o   Care funding – community and preventative services are jointly commissioned by the Council and the CCG. Individual care packages are also jointly funded by the Council and the CCG.

Tim Miller and Paul Allen then responded to questions from the Panel:

• Asked how ‘crisis’ is defined, Paul Allen said that medically this is when an individual’s biophysical-social model of health has suddenly dropped to a low level. The rapid response service visits people in their homes in crisis situations which may be able to stabilise someone and prevent the need for them to go to A&E.
• On the monitoring of performance, there are service specifications for the services that have been described and these include performance metrics which are routinely collected by the service and are monitored as part of the contract management process. There is an evaluation of services funded by the Better Care Fund at the end of each year with course correction measures taken if required. The integrated nature of this doesn’t lessen the oversight but can help to avoid individuals from falling through the gaps of services. Asked whether these figures could be provided to the Panel at a future date, this would be possible but there is a large amount of complex data so it may be necessary to select one or two specific areas to examine.
• Asked about seasonal pressures in winter and summer, the NHS has recently moved away from describing ‘winter pressures’ and now refers to ‘system resilience’ as there is increased recognition that there can be pressures at other times of the year such as respiratory conditions in August caused by heat for example. The Better Care Fund Plan identifies a number of areas where investment for system resilience needs to be considered all year round.
• Asked about the statistic quoted in paragraph 6.1.2 of the report that 78% of over-65s were at home for 91 days after hospital discharge (as opposed to returning to hospital or being admitted to a care home), Paul Allen confirmed that this is the figure for Haringey and is slightly lower than the national average but that the precise figures could be provided in writing to the Panel (ACTION).
• The Community Navigator Network referred to in paragraph 6.4.1 of the report will be launched in January 2020.
• On the various services referred to in paragraph 5.2.2 of the report, the joint commissioning arrangements had been agreed by the Cabinet and the CCG’s governing body. They are each separate but they are all covered by the agreement. Though the Better Care Fund Plan has a different funding stream it runs through the same process. Charlotte Pomery, AD for Commissioning, added that this is a partnership agreement set out under Section 75 of the National Health Service Act 2006. Tim Miller and Paul Allen’s managerial roles are both joint appointments and Cllrs James and Brabazon both sit on the Joint Finance and Performance Partnership Board which has significant delegated responsibility.
• The Integrated Brokerage Team referred to in paragraph 6.3.3 of the report secures providers for the care and support that social workers or nurses have determined is required by an individual as part of their support plan. The team is led by the Council but has some CCG staff as part of the integrated arrangements. Asked whether demand for this could drop as a consequence of personal budgets, Tim Miller said that the brokers are busy and that there is no shortage of work. The team also includes the financial assessments team and the direct payment support team so the range of type of care packages is covered. The use of funds is audited so the direct payment support team has oversight on overspending or underspending patterns in personal budgets which may indicate that an individual requires advice or support. John Everson, AD for Adult Social Services, added that there is a schedule of reviews for individuals, who should receive one at least every 12 months, but that if information was received via a different route that an additional conversation was required then this would happen. Asked about the staff carrying out the assessments, John Everson said that there are reviewing officers working alongside social workers. These reviewing officers may not necessarily have a formal social work qualification but come from a variety of backgrounds and have the right skills and abilities to understand and manage care and support needs.

Cllr Connor thanked Tim Miller and Paul Allen for their presentation and said that there would be a follow-up conversation soon on the next stage of the Panel’s scrutiny over joint funding.