Minutes:
(1) Mark Lobban, Director of Strategic Commissioning, Kent County Council gave the Board a presentation leading to a workshop and table discussion on “Adult Social Care Transformation and Integrated Commissioning”.
(2) The presentation covered:
(a) Meeting the challenges through transformation to use more effectively the adult Social Care Budget (net) in 2011/12 of £352 million;
(b) The opportunities for more effective service delivery thorough “co-production”
(c) What a future model may look like;
(d) Taking transformation forward;
(i) April to June – to understand the business as a platform for transformation; understand how different parts of the business affect each other; identify spend that can be influenced, and spend that cannot
(ii) July to September – plan the work of the programme and allocate resources; develop and finalise a performance framework to monitor change; deliver plans for appropriate agreement; ensure programme management resources are in place
(iii) September 2012 – co-produce changes with stakeholders; re-design business processes to implement changes; develop clear role and responsibilities;
(iv) Develop tools to support people to make changes; and
(v) September 2012 – 2015 – Monitor people, processes and outcomes to check that expected benefits are realised; evaluate the effectiveness of the transformation programme.
(3) The Shadow Board noted the intentions for Countywide Integrated Commissioning including the interface and opportunity to add value between NHS Kent and Medway’s “Towards Sustainable Care for Kent and Medway” and Kent County Council’s “Adult Social Care Transformation Programme Blueprint and Preparation Plan”
(4) The presentation also covered the opportunity for Local Integrated commissioning e.g. creating a virtual joint commissioning team for Dover and Shepway which would work towards a joint commissioning strategy (local Health and Wellbeing Strategy and the production of a Joint Commissioning Plan for Kent). The strategy for Local Integrated Commissioning was to create a major shift from acute to community care:
(a) drive hard the efficiency of existing community services
(b) release money to invest in more community services
(c) reduce demand on acute services
(d) opportunity to invest further in community services
(e) not always about radical new services
(f) radical change is getting the whole system to work together
(g) integrated structures and pooled budgets may be a natural progression.
(5) The table discussions covered the following points:
The vision is to have a healthcare partnership to be proud of and therefore the aim is to create an environment for change. We should be making it easier for people to do the right thing.
The way people work is one of the biggest barriers for change. It is difficult to overcome the view that the safest place is in hospital or a care home. Community nurses, paramedics etc will be disciplined if they do not follow procedure. Issue is around professional decision making and risk levels.
Acute admissions should be seen as a failure to deal with long term conditions.
There needs to be joint targets, incentives and penalties across agencies. There should be penalties written into contracts.
The issue for the Health and Wellbeing Board is to consider how do
we create the environment of cultural shift? One of the enablers is
'information'. However Information Governance is a barrier. The
group felt that there are levers for change through the Health and
Wellbeing Strategy and this needs further exploration.
There needs to be a massive cultural shift to get more joint working between agencies. Building trust is key to this.
There are real opportunities to do things better and together e.g. should Adult Social Care be buying beds in the community, but not closing beds in hospital? Organisations often protect their own interests and have to balance the books - lurch from crisis to crisis.
The challenge is building relationships between organisations that traditionally have not had a huge amount of trust between them.
A sustainable care system means looking at this as a "system of care" and not health and social care.
Mark Lobban provided an invitation to find common ground in taking this forward. Everyone involved and taking responsibility. Treat each other as equals.
Actions:
There needs to be local strategies and plans for each area (Dover pilot used as an example)
Systems and information governance is a key issue. There needs to be an assessment of these issues and a paper to be presented at a future Board meeting.