GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD

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1 7a GREATER MANCHESTER HEALTH AND SOCIAL CARE PARTNERSHIP STRATEGIC PARTNERSHIP BOARD Date: 30 June 2016 Subject: Adult Social Care Report of: Lord Peter Smith, AGMA Portfolio Holder Health and Wellbeing Steven Pleasant, AGMA Lead Chief Executive, Health and Wellbeing PURPOSE OF REPORT: This paper provides the Strategic Partnership Board with an update on work to transform Adult Social Care across Greater Manchester RECOMMENDATIONS: The Strategic Partnership Board is asked to: 1. Note the contents of the paper and appendix; 2. Support the findings and next steps. CONTACT OFFICERS: Tim Griffiths

2 1. INTRODUCTION 1.1 This paper provides the Strategic Partnership Board with an update on work to transform Adult Social Care across Greater Manchester. 2. BACKGROUND 2.1 In April 2016 AGMA Wider Leadership Team commissioned a review of adult social care across Greater Manchester. The overall aims are to radically improve the population health, through improving and reforming community based responses, whilst streamlining and standardising acute and support services and addressing the financial deficit across the whole system. 2.2 In follow up the GM Director of Adult Social Services (GMDASS) (in conjunction with a range of partners and key stakeholders) identified eight key lines of enquiry that offer the greatest improvement opportunities: 1. Moving to an asset based model to maximise independence and resilience. 2. Investing in prevention to reduce the need for acute and long-term treatment. 3. Redefining the deal with citizens to enable people to organise their own care whilst ensuing assessments are common and trusted across GM. 4. Designing a new model of care at home. 5. Re-commissioning a fit for purpose residential and nursing marker. 6. Supporting Carers. 7. Transforming and stabilising the social care workforce. 8. Transforming services for people with learning disabilities. 2.3 These eight priorities now form the core of our transformation ambitions for adult social care across GM. Further detail is found at section four, and in the appended slide pack. 3. PROCESS 3.1 Adult social care forms a key part of GM health and care economy, and has a significant contribution to make in ensuring that the health and social care economy in GM is financially and clinically sustainable by Adult Social Care provides a key component part of both our integrated care and commissioning arrangements.

3 3.2 Both the GM DASS and AGMA have agreed a narrative that describes how a transformed adult social care offer is critical to the improved health and wellbeing of people with a range of complex needs, their carers and communities in general. 3.3 The high level case for change has been agreed following an initial scoping exercise across each of the key lines of enquiry (KLOE), and the GMDASS group will be responsible for leading each of the areas identified. 3.4 Further detail of the eight KLOE s is set out at section KEY FINDINGS 4.1 As part of the review process the high level case for change was established for each of the priority areas identified at 2.2. These are set out below and provide a rationale for adopting eight pillars of transformation. 4.2 Move to an asset based approach Need to strengthen community resilience and design ways to connect people to local neighbourhood networks 4.3 Investing in prevention and early intervention Need for a consistent approach to primary, secondary and tertiary prevention across GM, underpinned by shared information and a common approach to predictive modelling of risk and need Need to improve co-ordination of early intervention to prevent the need for acute services whilst improving health outcomes There is a significant opportunity to commission better reablement and "discharge to assess" service. 4.4 Contact, eligibility and referral Opportunity to develop a common approach to dealing with those people who contact adult social care in need of support and care, that enables more choices and promotes independence. 4.5 Support for people at home Recognised that the current model of support at home is broken. There is an estimated 73 million of expenditure per annum across GM into a unsustainable model of care that delivers inadequate responses utilising a workforce that is increasingly difficult to recruit and retain Support at home needs to be part of the core health and social care offer available to all people of all ages with complex needs. 4.6 Support for carers Opportunity to address the need to offer support to carers through local neighbourhood networks underpinned by a GM approach to offering

4 information, advice, advocacy and personal budgets that allows carers to continue caring. 4.7 Fit for purpose residential and nursing homes Nursing homes are becoming increasingly difficult to staff and quality, price and availability vary significantly across GM There is an opportunity to manage a GM market, investing in new models of care homes (more closely aligned with the NHS). 4.8 Transform learning disability services Young people (specifically those with LD and MH issues) have difficulty transitioning into adult hood and in fulfilling their potential. In particular there are challenges in accessing high quality opportunities to ongoing education and employment opportunities; and a new partnership approach with employers and service providers. 4.9 Workforce development High turnover, rising cost base, and lack of sufficient professional and career development opportunities, all hamper the development of a skilled and stable workforce This needs to be addressed to ensure the workforce is supported to develop, and to ensure that care becomes a career choice, that provides routes into employment and career pathways for resident in and across GM Devolution provides GM with a significant opportunity to create such employment and career pathways through our transformation programmes at local and GM level. Our new models of care, particularly those delivered through our locality care organisations, will require a different type of worker that can meet the need of the service user regardless of whether care is funded through NHS monies or Adult Social Care monies Information Management Technology Key to the successful transformation of Adult Social Care is a recognition that, as with all transformation and improvement programmes, the opportunity presented by IMT needs to be exploited At the GM level the GM Strategic Plan made specific commitments to using information and technology to: Understand resident needs, and develop services more efficiently and effectively Ensure people to have greater access, ownership and responsibility over their own data Share data and information across organisations on a daily basis to support integrated multi-agency case management Use technology to support self-management

5 GM Date Connect and DataWell both provide Adult Social Care with significant opportunities, and devolution has provided GM with a platform upon which national funding streams can be accessed to support the IMT requirement we know will be required as we transform our offer. 5. NEXT STEPS 5.1 As part of the review, a series of next steps were identified: Undertake further analysis on the needs of current and future cohorts and model the CBA against each priority response to support the business cases. Secure capacity to support the programme including the appointment of an interim Executive Director, permanent appointment of Assistant Director and additional analytical support. Establish an overarching quality assurance and performance framework to support a standardised approach across GM, locating Adult Social Care within the wider Taking Charge framework. 6. RECOMMENDATIONS 6.1 The Strategic Partnership Board are asked to: 1. Note the contents of the paper and appendix; 2. Support the findings and next steps.

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7 Adult Social Care Radical Reform at Scale and Pace June 2016

8 Executive Summary AGMA commissioned in April a fundamental review of adult social care across Greater Manchester. This forms an integral part of realising the vision set out in 'Taking Charge' to achieve a radical upgrade in population health through investment in community based services, standardising acute health care and streamlining support services. Progress Using a co- production approach engaging stakeholders across health and care in Greater Manchester the following eight business areas have been reviewed identifying key issues and improvement opportunities: Moving to an asset based based model that draws on the whole range of personal, family and community resources to maximise independence and resilience; Investing in primary, secondary and tertiary prevention to reduce the need for acute interventions and long term treatment; Redefining the deal with the citizens so that contacts with services become self service and enable people to organise their own care and support, and ensure that assessments are common, trusted and portable across Greater Manchester; Designing and commissioning a new model of care at home in partnership with service users, providers and investors; Focusing residential and nursing care on those who can really benefit from it and creating centres of excellence in care that maximise independence and reduce the call for hospital admission; Supporting Carers by creating a Greater Manchester offer to provide consistent advice and support to local and condition based career organisations and integrating all funding and support to Carers; Working with employers, educational institutions and professional organisations to strengthen the recruitment, retention, skills and stability of the social care workforce; Transforming services for people with learning disabilities to provide access to inclusive local services for people with complex needs. 2

9 Executive Summary.Priorities Create a Greater Manchester model of asset based practice to enable all boroughs and localities to support independence resilience and self management; Redesign and decommission care at home that reduces urgent care and builds community health and care capacity; Commission a new model of residential and nursing care linked to new models of NHS care for people with complex needs, including continuing health care; Jointly commission hospital admission and discharge for people at high risk of hospital admission. Next steps Establish a programme to deliver the priorities at scale and pace Appoint a Director to lead and guide the programme Commission priorities Agree programme funding 3

10 Vision 4

11 The new narrative We will deliver improved outcomes for Adults who need care and support across GM by: Supporting more asset based interventions to promote resilience, confidence and wellbeing in families and local communities Developing a transparent way of shifting funding around the system Managing the hospital discharge process and continuing health care through social care Reducing the demand on the urgent care system by 5% through a fundamental shift in homecare and residential and nursing home models Supporting individuals with long term conditions in the community to better manage their health in a way that suits them, reducing demand for elective hospital services by 15% and helping these individuals to experience 30% fewer unplanned admissions supporting the ambition to reduce acute capacity by 20%; Enabling 25,000 people with severe and enduring mental illness to benefit from proactive, effective, community based care that prevents their mental health deteriorating and reduces their involvement with urgent services by 30% Delivering cashable savings of 10% through diversion of current customers into existing community solutions, the significant upscaling of technology and further expansion of the own front door model of supported living. Creating a Greater Manchester intelligence lead performance management and quality assurance system Upskilling of entry levels jobs and shift of current low pay, zero hour culture within care work to one of nourishing and rewarding employment, reducing in work benefit ask and developing pipeline of future health and social care professionals. 5

12 Adult Social Care in GM Taking Charge Adult social care is critical to the health and wellbeing of people with complex range of often intense needs, their carers and families and our communities more generally. It is critical to the sustainability of the NHS and our care integration agenda in Greater Manchester. However, securing a better care and health system isn t just about health integration. National policy framework - the Government s objectives are to enhance adults quality of life, delay and reduce the need for care, ensure positive care experiences, and safeguard adults from harm. Greater Manchester policy objectives: The integration of health and social care provision across Greater Manchester (GM) is a fundamental component of the growth and reform strategy. GM health and social care system can support GM s priority of reducing worklessness, supporting people back into employment and providing growth through innovation. System reform is a pre-requisite to addressing the fundamental challenge of ensuring that the health and social care system becomes financially sustainable over time. GM ambition is to achieve a pathway to independence for all: Start Well - Children with special needs are prepared for an independent life, supported to make choices and plan for adulthood from birth. Live Well - People with complex needs can live in their own homes, be with their family and friends, are able to work with the right support, can join in everyday life and are valued for their contribution to society Age Well - Older people maintain choice and freedom to live the life they choose, stay in good homes, are supported by family, friends and their local community, and special services to maintain their health and well being come to them and work together to ensure a good quality of life and a dignified death 2

13 Adult Social Care in GM Taking Charge The what Taking charge strategy identifies: 1. Radical upgrade in population health prevention 2. Transforming community based care & support 3. Standardising acute & specialist care 4. Standardising clinical support and back office services The how Adult social care is an integral part of achieving these Changes through: 1.Empowering individuals and families through better community support and information 2.Radical changes to care at home and asset based approaches 3.Recommissioning residential, nursing and continuing health care 4.Common intelligence led performance management and data sharing 5.Consistent support for carers and a better skilled workforce 5. Enabling better care Review of the Taking Charge priorities and development of specific ASC programme principles and ambition Evaluation of locality plans ASC Director and AD agreement on priorities ASC leads to drive forward to KLOEs Development of business cases H&SC Strategy Case for Change Agreeing priorities Evaluation of performance data Development of eight scoping document to identify the key issues and KLOEs Identify GM, Cluster and Locality opportunities 7

14 Case for Change Asset Based Approach Need to improve outcomes for Greater Manchester Residents by strengthening community resilience and connecting people to neighbourhood networks Need to equip staff for different approach and role that maximises community and family contributions and maintains choice and independence Opportunity to empower individuals and families through digital services a GM Google for care and support Prevention and early intervention Need for consistent approach to primary, secondary and tertiary prevention across Greater Manchester underpinned by shared information and a common approach to predictive modelling of risk and needs Need for better co-ordination across Boroughs of early intervention to prevent hospitalisation and poorer health outcomes Opportunity to commission better re-ablement and discharge to assess services Contact, Eligibility and Referral Need for a common definition of a contact between the Council and a citizen needing care and support and opportunity to create a new deal for citizens that enables more choice, control and independence and reduces the cost of unneccesary referrals and assessments Assessments are not trusted across Greater Manchester and portable between authorities opportunity to improve outcomes and reduce costs by making all assessments trusted and transportable Support for people at home Current model is broken unsupportable costs, weak market, difficulty retaining and recruiting staff. Opportunity to stop existing re-procurements and adopt a radical co-design approach with service users and providers to develop a sustainable model that meets wider range of needs Better home support is the key to earlier more effective intervention and should be part of the core health care offer linked to primary and community health and available to all ages and all people with complex needs 8

15 Case for Change (continued) Support for Carers Carers provide six times the support funded by the state and have new statutory entitlements under the Care Act 2014.Most carers are themselves old and often experience economic hardship, isolation and health issues Opportunity for a more o-ordinated and carer led approach to supporting carers through local neighbourhood networks and support organisations underpinned by Greater Manchester wide approach to information, advice, advocacy and personal budgets Fit for purpose residential and nursing homes Quality, price and availability vary widely across the different boroughs in Greater Manchester and Boroughs compete for access to the best value care homes Nursing homes are increasingly hard to staff and quality is at risk. Opportunity to manage a Greater Manchester market investing in new models of care home, closer aligned with the NHS, better staffed and with economic models that benefit commissioners and the local economy Transform learning disability services Greater Manchester makes high use of in patient beds and high cost residential facilities. Half of people with learning disabilities are over the age of 65.Need for new local models of care that promote inclusion for older people and people with complex needs People graduating from children s services have high expectation but access to employment is poor across Greater Manchester and needs a new partnership approach with employers and services. Workforce development High turnover, rising wage costs and lack of sufficient training and career progression all hamper the development of a skilled and stable workforce. Need to address these challenges in collaboration with employers at a Greater Manchester level through combined training, IT and digital support, cross service career development and investment in local training and development capability. 9

16 Design Principles 10

17 Priorities By: Rethink how people are support to live at home independently Redefining the contract between councils and their local citizens Radically improving how hospitals admit and discharge patients with complex and long term conditions Jointly commissioning continuing health care across GM Ensuring the estimated 73m spend on homecare provides VfM Developing a strategic vision with our providers Developing and upskilling a joint care workforce across the GM 11

18 GM Opportunity New Money New Money System Transformation Learning and Development 12

19 Pyramid of change GM Joint commissioning Better admissions to hospital & discharge The right specialist support Better help for people at home New deal with citizen Deepening commissioning arrangements and stimulating new models of early intervention, prevention and provision Discharge to assess, not asses to discharge Social care to manage the hospital discharge process and continuing health care Making every contact count Provides speedy access to specialist care Recommisisoning contracts Google GM for adults. Individuals take more responsibility for their own care and families and communities are supported to help those individuals to be as independent as possible Citizens will have a duty to contribute as well as a right to receive support 13

20 Update on progress and Next Steps Progress: An independent analysis of current outcomes and spend to help provide collective understanding of data and intelligence has been competed and being evaluated by the DAS group. Understanding where are the variations across the system and how can we learn from one another Agreement about priority key lines of enquiry for ASC where working differently has a potential benefit of either efficiency with reduction in cost, improved quality of intervention, or increased effectiveness of outcomes for either the short or long term 8 Scoping documents has been produced by the DASs and identify the key KLOEs, opportunities and quick wins Steering groups are being established to drive the changes forward with stakeholder workshops being organised Agreed transformation fund investment of 300k to support this programme. Full day workshop on the 2 nd June to discuss the opportunities to redesign services for adults across GM and to understand, interdependencies, the commonalities in locality plans and a discussion on linking applications for transformation funding 14

21 Next Steps Priority programme summary one pagers to be produced Define a single social care offer across Greater Manchester Understand the different population cohorts and their needs now and in the future Compare and contrast best practice across the Greater Manchester system Model the financial challenge and capital requirement Work with providers to understand and manage the market across Greater Manchester Cost benefit analysis to be completed across GM by Metro Dynamics Appointment of an ASC programme Director Align this work with opportunities that are emerging from other areas of devolution work and identify where current work programmes can or should be extended. Prove the case that social care sits at the heart of the transformation and public service reform journey Set up programme governance, timetable, metrics and reporting Development of business cases on the agreed KLOEs and priorities 15