1.
(i)
Purpose of the Strategic Agreement
This Strategic Agreement is a requirement of the Partnership Agreement between North East Lincolnshire Council and North East Lincolnshire Care Trust Plus. The Agreement covers two main elements: The „Care Trust‟ responsibility for the commissioning and provision of adult health and social care services in a new and integrated way; The „Plus‟ elements which relate principally to the transfer and integration of the public health function to the Council to better influence the wider determinants of health and well-being.
(ii)
The Agreement is a mechanism by which the Council and the Care Trust Plus will: agree annual objectives for the coming year; set out broad longer term objectives within a three year rolling programme; agree the respective resource commitments to enable delivery of the objectives; agree monitoring arrangements for the respective objectives of the two organisations, namely for the delivery of social care by the Care Trust Plus as delegated by the Council and conversely the delivery by the Council of the “Plus elements” of the original Legal Agreement; set out anticipated major changes in policy, new strategies proposed and describe any issues that are defined as “reserved matters” in the Legal Agreement.
(iii)
The Strategic Agreement will be jointly prepared (usually) not later than 31 st December each year and finally agreed by the Care Trust Plus Board and the Cabinet of the Council not later than 31st March each year. The Agreement would normally be reviewed in May when final confirmation of social care targets is received but this will not take place in 2008/9.
2.
(i)
Framework of Policies and Strategies
The partnership between the Council and the Care Trust Plus already benefits from a range of current, jointly agreed strategies for the improved health and well being of the population jointly served. The strategies covering the two main area outlined above are: “Choosing Life”: A Strategic Plan for the Older People of North East Lincolnshire: 2006-09. This strategy identifies the six areas of greatest importance to older people following consultation, reviews current action in these areas and sets out future intentions. “Changing Lives in Partnership”: A Strategic Plan for People with Learning Disabilities in North East Lincolnshire 2007-2010. This strategy is designed to enable people with learning disabilities to live as full and valued members of our North East Lincolnshire community.
“Getting There”: An Interim Strategy for People with Physical Disabilities in North East Lincolnshire 2007-2009. This strategy adopts a social model of disability and seeks to improve the range of community and health services available for people with disabilities.
“Promoting Independent Living In North East Lincolnshire” Direct Payments Strategy 2007-9. This strategy was developed in recognition of the important role Direct Payments plays in promoting the independence of people of all ages with disabilities. The strategy is designed to make direct payments a much more widely available care option for people. “Meeting Carers’ Needs in North East Lincolnshire Strategy” 2007-09. This strategy sets out how local public services collectively will seek to support that 10% of the population of North East Lincolnshire who are regularly providing unpaid care to relatives friends and neighbours. The main elements of the strategy are Information, Support and Care. “The Annual Report of the Director of Public Health 2007” by the Director of Public Health in North East Lincolnshire reviews the major public health issues in North East Lincolnshire, actions taken to address these and recommends future action for 2008/09; “Progressing with Pride”: North East Lincolnshire Council‟s Corporate Plan 2007-2010. Priority 4 in particular (Adults, Health and Well Being) is directly relevant to the Council and Care Trust Plus‟ ambitions to improve the care and support for adults in North East Lincolnshire, whilst other priorities in the Corporate Plan are directly relevant to the wider determinants of good health and well being. “Local Area Agreement 2: Better lives – Stronger Communities”: LAA 2 sets out the cross cutting priorities for North East Lincolnshire. It focuses on future opportunities for our community and how our local partnership can help people achieve their aspirations. The consultation undertaken resulted in the identification of 10 priorities for the LAA2. Throughout the process the following factors have emerged to underpin LAA2 and these have been translated into an ambition to: o create the conditions to sustain more and better jobs in the area and enable local people to access these by addressing barriers to participation and raising skill levels; o Raising the aspirations of our family units and promoting the opportunities that will be made available, encouraging people to make positive life choices; o Narrow the gap in terms of social inequality, whether the cause is health, educational attainment, age, disability, ethnicity or any other factor.
3.
(i)
Strategic and Policy Context
There remain a number of well-documented, longstanding pressures on adult social care. The pressures are in some ways the product of success, in so far as they arise from people living longer lives and rising expectations of public services. The pressures can be summarised very broadly as follows: Increasing numbers of older people, many with complex needs towards the later stages of their lives; Rising expectations as to the quality and convenience of service provided; Increasing numbers of disabled young people, some with very complex needs, transferring to adult services and requiring care that affords them as normalised a life as possible; Greater life expectancy in all adult user groups; Rising prices for social care, which is a very labour intensive activity, at a time of prolonged economic growth and full employment.
(ii)
The Local Authority Circular (LAC (DH) (2008) 1) “Transforming Social Care” was issued on 17th January, 2008. It is a radical response to some of the pressures described above. The central thrust is the government‟s personalisation agenda, which requires a radical shift in power and control from care managers and service providers to individual service users. The government is providing a grant amounting to £1.7m over three years to North East Lincolnshire Care Trust Plus to help transform social care delivery. These funds are intended to deliver transformational change to the whole system, rather than as service development funds or as an explicit strategy to respond to the longstanding financial pressures facing Councils with Adult Social Service Responsibility (CASSRs). The total investment from the SCRG across England is over half a billion pounds over three years. The government has now responded to concerted pressure to address the generally agreed shortfall in funding for adult social care. In May 2008, the government launched consultation leading to a Green Paper in 2009 on funding for adult community care. The key issue will be what proportion of the cost of funding future care for individuals is borne by the state and what proportion by individuals and families themselves. Whatever solution is finally reached, the Government obviously insists on affordability as one of the three explicit criteria and this almost certainly rules out a Scottish type solution with a bigger proportion of costs funded via central taxation. If delivered to time, this should be a key factor in terms of next year‟s budget. These pressures described in 3(i) above have led to a great many Councils with Adult Social Service Responsibility (CASSR) restricting access to services in an attempt to balance their books at a time when government policy has exhorted CASSRs to greater levels of preventative services. This practice has caused alarm in government. The response has been the announcement of a review by CSCI of social care eligibility criteria, which is the main mechanism for restricting access to care services. Again, the outcome of that review may be a major factor in planning for 2009/10.
(iii)
(iv)
(v)
(vi)
The Darzi Review is likely to recommend the development of community based services to support enhanced access, such as Poly Clinics. Care Management and social care services generally will need to respond to this reshaping of health care provision. If Professor Darzi‟s initial enthusiasm for personal budgets for social care is carried through into his final report, plans for personal budgets in social care will need to be flexible enough to incorporate some elements of health care. The publication of this review is very likely to require a response from the CTP this year. “Our Health Our Care Our Say” preceded the Darzi review and provided a common agenda for health and social care. It had four main objectives which are still relevant and are likely to be further developed by the Darzi review: Health and social care services will provide better prevention services with earlier intervention; High priority to be given to convenient access to social and primary care services that people can choose and influence. More work to tackle inequalities and improve access to community services; More support for people with long-term needs.
(vii)
(viii) Transforming Social Care requires CASSRs and Care Trusts to respond to carers as full partners. It contained little detail as to exactly what was required. There is to be a Prime Ministerial announcement on carers in Spring 2008 and this may alter policy in respect of carers. (x) The Safeguarding of Vulnerable Adults is emerging as an increasingly important national priority. This has been a long standing responsibility of CASSRs and their partners. Priority is increasing as a result of concerns at the effectiveness of some safeguarding arrangements, as well as recognition that safeguarding needs to be extremely reliable so that it can deal with the potential risks associated with some of the Transforming Social Care agenda. Performance monitoring by CSCI is already reflecting this increasing priority and the Care Trust Plus and Council will need to continue existing work to further improve our safeguarding arrangements. A national dementia strategy will be published in the Autumn of 2008. Again, this may require adjustments to existing strategies.
(x)
4.
(i)
Further Strategies that Need to be Developed
It is not possible at this stage to predict precisely what the government reviews described above will require in terms of revision of our existing strategies and policies or when these are likely to impact. Transforming Social Care certainly requires a radical overhaul of the system for accessing care and for its delivery. At a minimal level, these changes will require us to replace “Promoting Independent Living” with a “Personalisation Strategy”. This can be developed from our implementation plan for Transforming Social Care. Given the emphasis on public engagement and the development of our community governance model, full involvement in the design and specification of any new system is required.
(ii)
The Green Paper on funding care and the review of eligibility criteria certainly have the potential to fundamentally alter the citizen‟s relationship with the “state”, both local and national, in respect of who contributes what to the cost of care and what rights citizens have in respect of help from the “state”. It may well be that we will need to consult on these issues locally before deciding on implementation. It is not anticipated that there will be any further strategies beyond the above developed in 2008/9. Whilst work will need to begin in 2008/9, their completion and implementation is likely to fall in 2009/10.
(iii)
5.
(i)
Review of Previous Year’s Progress
As this is the first strategic agreement between the Council and the Care Trust Plus, this version contains no review. Next year‟s agreement will contain an overview of progress on the previous year‟s objectives.
6.
(i)
Adult Health and Social Care Services: Objectives and Targets 2008/9
Directorate of Care
Brief Description Lead Director Objective Deadline ( final deadline ) March 2009 Interim Milestones Other Comments/ Source
High Level Objective Name Integrated Intermediate Care Services
Respond to Implications for In House Service of Integration of Intermediate Care
Director of Care
Re: Respond to Commissioning Implications for of Home Care- In House Service of Re Commissioning Home Care
Director of Care
March 2009
Improved Carers‟ Services
Carers to have access to an expanded range of
Director of Care
March 2009 (unless indicated
Implementation of new rotas within CST Implementation of Homecare Management System Ensure effective completion of building work at the Beacon Implementation of new roles within CST Transfer of CST night sitting service and Stratford House to independent sector Implementation of emergency care scheme; Use carers
Targets within LAA2 and NI135
services, advice and information to enable them to retain their independence health and well being.
as ongoing)
Improvement and integration of Occupational Therapy
Availability of appropriate and timely occupational therapy services through one point of access
Director of Care
March 2009
Learning Disability Service “Changing Lives in Partnership” A Strategy for Social Inclusion Learning Disability Service – Towards Improved Care Management
To identify the resources required to deliver „Changing Lives in Partnership‟
Director of Care
March 2009
grant to deliver priorities in Carers‟ strategy (ongoing) New contract for the delivery of carers services Develop proposal for respite Deliver on the requirements of Transforming Community Equipment services Develop self assessment and direct access to low level services Meet requirements of waiting times performance targets Agree SLA for the provision of OT service for children To secure the additional resources required to deliver the strategy in full.
NI132 NI133
Source: “Changing Lives in Partnership”
Improve the functionality of the Community Learning Disability Team and develop it as the „hub‟ of the service
Director of Care
March 2009
Community Learning Disability Team reviewed and implementation in progress. Preparatory work in progress for the implementation
“Changing Lives in Partnership” “Valuing People Now”
Learning Disability Service – Improving Health and Wellbeing
Improve access to health services and health inequalities for people with LD including people with complex needs
Director of Care
Nov 2008
of Individualised Budgets Care Management processes to be reviewed and refined including the embedding of Person Centred Planning Cromwell Road Resource Centre development commenced – building work to be completed. Four Health and Wellbeing Coordinator Posts to be recruited. Enhanced GP practices to be „signed up‟ – 11 already part of the programme Health Action Plans and Hospital Passports to be available for all people with a Learning Disability Joint working with Mental Health Services to include responses for people with ASD Additional staff appointed in respect of
“Changing Lives in Partnership” “Valuing People Now”
May 2008
Ongoing
March 2009
Ongoing
October 2008
November 2008
psychology services, speech and language therapy and physiotherapy Oct The development of an Intensive Support Team – to be fully staffed by Nov 08 New learning disability strategic housing sub group formed and operational. Farnhurst reprovision enables final closure of Farnhurst by March 2010
Learning Disability Service – A Suitable Place to Live
Extend and Director of improve the Care range of accommodation options for people with a learning disability
June 2008
Changing Lives in Partnership Valuing People Now
Ongoing
New performance indicator N145
Ongoing
Learning Disability Service – Fulfilling Lives
Further develop the range of employment, vocational, educational and leisure opportunities for people with a learning disability
Director of Care
Ongoing
June 2008
The development of short breaks/respite options; including a generic adult placement scheme. Changing To increase Lives in the number of people with LD Partnership in voluntary and paid employment Valuing People Now Community and Leisure Coordinator New post performance established to indicator N146 support the development of LAA 2 target a diverse
Ongoing
range of opportunities – to be in post by May 2008 Develop JOBS 4 All as a social enterprise by Oct 2008 A training group is being developed to ensure a coordinated strategic approach to training needs Review current working practice Explore opportunities for integration with care management in commissioning groups Undertake a training needs assessment Work with the workforce development team to develop suitable training programmes Identify suitable accommodatio n within the hospital for the integrated team Develop the Team Structure Develop team Performance Indicators Transfer DPCB Clerks to Council
Learning Disability Service – A Workforce fit for purpose
Further develop the workforce to meet the demands of a modernised service
Director of Care
June 2008
Changing Lives in Partnership
Review the current work levels of Community Matrons
Review the current work levels of Community Matrons and provide them with the appropriate skills to undertake the clinical specialist role
Director of Care
September 2008
Integration of Liaison District Nurses into Hospital Social Work Team
Integrate the Hospital Discharge and Hospital Social Work teams
Director of Care
July 2008
March 2009
Integration of the Care Support
Redeploy and develop elements of the
Director of Care
Assessment & Commissioning Business Plan
Service into other support sections
Care Support Service (Advice Officers, Purchasing Assistants, Reviewing Assistants and Disabled Care Badge Clerks) to improve service.
Improve the Numbers supported by Physical Disability Services
Implement findings of review of physical disability services.
Director of Care
March 2009
Customer 2007-10 Access Points Transfer Purchasing Assistants to Business Support Unit Create Residential Reviewing Team within Business Support to carry out reviews in residential and nursing homes and to tie into nursing reviews Review function and position of Advice/intake team through Care Services Efficiency Development (CSED) Programme Produce action plan from Disability Review; Visit successful authorities to review what they record Improve Stroke and Respite Services; Improve engagement of people with disabilities; Improve transport and accessibility to public buildings; Improve access to culture, sport and leisure activities; Review the
Work with external partners to develop extra care housing options
Extra Care Housing incorporates supported Housing and Home Care
Director of Care
March 2009 (Bids)
Safeguarding Adults
Assist the newly formed Safeguarding Adults Board to implement improvements in practice
Director of Ongoing Care/Director of Mental Health
contracts of providers of Day Services To work with Havelok in their bid to the Housing Corporation To submit a bid for the DoH bidding round for 2008 To work with retirement village developers to develop extra care elements Develop the Safeguarding Adults Board; Develop the Safeguarding Operational Group; Raise Awareness generally, including public awareness Provide opportunities for Service User involvement in the development of safeguarding strategies and practice Embed Safeguarding Adults‟ principles and practice within all stakeholder groups; Increase the number of staff trained to respond to allegations of abuse; Forward plan for the implementation
Assessment & Care Management Service Improvement Plan 20072010
Assessment & Care Management Service Improvement Plan 20072010
Review level of charges for community care services.
Review contribution of charges for services to overall objectives for social care.
Director of Care
December 2008
of the Independent Safeguarding Authority – Vetting and Barring scheme; Effectively implement the Mental Health Act – Deprivation of Liberty Safeguards Contribute to the Review of „No Secrets‟ and effectively implement the recommendati ons following the review; Review and relaunch of Policy & Procedures; Improve recording of statistical data. Benchmark level of charges against comparators; Agree with Council charges for 2009/10.
(ii.)
Mental Health Directorate
Brief Description Lead Director Objective Deadline ( final deadline ) October 2008 Interim Milestones Other Comments
High Level Objective Name
Assist in operational re provision of ASW roster
The ASW rota is a statutory requirement of the council, but is increasingly provided by seconded mental health staff. As the
Director of Mental Health
Design of service and exploration of options Jan – Mar 2008; Consultation with staff Mar 2008;
Improve User/Carer involvement in MH services
Emergency Duty Team is recommended to disband we will assist in the creation of 24 hour cover emanating from mental health service personnel, seconded back for this function. Ensure Director service of Mental User/carer Health involvement in all design, training and management initiatives.
Testing recruitment availability Mar/April 2008; Transfers of any staff not in MH services Summer 2008.
March 2009
Seminars and debates with voluntary sector and service user bodies to explore further cooperation and potential shapes for future work.
(iii.)
Social Care Commissioning
Brief Description Lead Director Objective Deadline ( final deadline ) March 2009 Interim Milestones Other Comments
High Level Objective Name
Integrate social Ensure care adequate commissioning. coordination and integration of commissioning at all levels in the CTP and wider network: Social care commissioning; Strategic commissioning; Activity of Commissioning Groups. Development Develop a of Effective and range of high Efficient range quality of home care responsive services home care services with new roles for CTP home
Director of Commissioning.
Director of Commissioning and Business Support Unit
Start: April 2008: Completion: Sept 2009
Recommission ing of externally provided services ensuring coverage of
care service and transfer of long term care to independent sector providers. Integrated Intermediate Care Services Development of integrated re-ablement/ intermediate care services. Director of Commissioning March 2009
all geographic al areas and service user groups. Review all tier 2 services Agreed referral routes, care pathways and service access across stakeholder s Expansion of Start Generic job description for front line community staff Relates to new performance indicator: N125
(iv.)
Implementing Transforming Care
Brief Description Lead Director Objective Interim Deadline Milestones ( final deadline ) Approach on Estimate Personal demand for Budgets PBs finalised by Expedite March 2009. our PB Pilot. Strengthen Link to PB Networks nationally and seek involvemen t in the developme nt agencies. Specify PB support arrangeme nts. Re-tender for support – with or Other Comments “Transforming Social Care”
High Level Objective Name Personal Budgets (PBs)
Everyone eligible for statutory support should have a personal budget, a clear allocation of resources, with many more people taking all or part of this budget as a direct payment.
Director of Care
Revise Care Management Model
Changed Care Management Model, with revised structure and jobs.
Director of Care
Planning Complete by March 2009
Refine Social Care Elements of Commissioning Strategy
Develop more explicit objectives based on JSNA and evaluation of the NEL market for care.
Director of October Care/Director 2008; of Commissioning October 2008;
without DP support and selffunder support. Roll-out PBs in social care from 4/2009. Need to quantify pace of transition to PBs and estimate the workload implication s of this change. Re-write of care manageme nt and related procedures . Re-shape care manageme nt service. Develop a programme to shift to a more general application of Person centred Planning across Adult Services Develop more precise market development objectives; Determine how innovation can be be supported; Determine how effective
“Transforming Social Care”
“Transforming Social Care”
March 2009;
March 2009
incentives for better quality can be created;
Universal joined up information giving
Currently we have a mixture of paper publications and websites for social care. There are links from some websites to other sites. Informationgiving is not well connected between the various agencies involved. We need to co-ordinate the provision of information so that all a person needs is available from one source but via a range of channels and in an acceptable, understandable format. Integration and Develop an prevention integrated approach across local government, the NHS and others that can mobilise resources across the whole system with a shift away from intervention in crisis to a more
Develop a strategy to improve skills levels in the care sector. Director of Specification Decide target Care/Director for an audiences; of integrated Agree scope Commissioning service to be of information developed to be provided; by March Specify 2009. Service; Determine Procurement strategy.
“Transforming Social Care”
Director of Care/Director of Commissioning
March 2009 for Integrated Intermediate Care and Single Assessment Process.
See integration “Transforming initiatives in 5 Social Care” (i.), namely Intermediate Care; Integration of care management Teams with Commissioning Groups; Integration of Discharge Liaison and
preventative model Carers as Partners Involve family members as care partners, with training to enable carers to develop skills and confidence Director of Care Timescale dependent on timing and content of PM‟s statement.
Hospital Social Work. In Spring 2008, “Transforming there will be an Social Care” announcement from the PM on improved support to Carers. We should work on existing actions (see 4 (i.) above) pending this announcement
(v.)
Infrastructure
Brief Description Lead Director Objective Interim Deadline Milestones ( final deadline ) September Agree 2008 project manageme nt arrangeme nts Develop implementa tion plan. Other Comments/Source “Transforming Social Care”
High Level Objective Name
Personalisation “Transforming Agenda Social Care/ the Social Care Reform Grant and the awaited Social Care Green paper outline the modernisation agenda for social care. This requires such fundamental changes in care delivery that it will need managing through dedicated project management arrangements Ensure pattern Levels of of resource investment in allocation major service supports areas need to strategic be priorities for benchmarked social care. with others and checked
Director of Care
Deputy Chief Executive and Director of Finance.
September Thorough 2008 Analysis of resource allocation pattern; Identify change priorities for to
Integrated health and social care clinical information
against CTP priorities and strategic commitments. Development Director of and Informatics deployment of „fit for purpose‟ health and social care electronic record solutions
inform 2009/10 budget setting process. May 08 Baseline review/ Scoping project
August 08
Develop bid for CfH Phase 2 Health & Social care integration early adopter programme
7.
Adult Health and Social Care Services: Objectives Years 2 and 3 (4/2009-3/2011)
Directorate of Care
Brief Description Lead Director Objective Deadline ( final deadline ) Initially March 2010 Interim Milestones Other Comments/ Source
(i.)
High Level Objective Name Integration of Care Management Teams into Commissioning Groups
Care Management Teams for older people aligned to the Commissioning Groups. Develop integrated Health and Social Care teams.
Director of Care
Improved Carers‟ Services
Carers to have access to an expanded range of services, advice and information to enable them to retain their independence health and well being. Assist the newly formed Safeguarding Adults Board to
Director of Care
Grant ongoing
Centre 2009/10
Yarborough & Clee (Pathfinder) Lead Team integration pilot Lincs2Care, GrImm, HOPE focus on identified integration projects September 2009 Yarborough & Clee move into PCC, all teams co-located. Identify management structures for Social care and future roles for CSM and AD Identify professional leads/ accountability for Social Care Use carers grant to deliver priorities in Carers‟ strategy Development of Carers Centre
Safeguarding Adults
Director of Care
Ongoing
Develop the Safeguarding Adults Board Develop the
Assessment & Care Management Service
implement improvements in practice
Learning Disability Service – Improving Health and Wellbeing
Improve access to health services and health inequalities for people with LD including people with complex needs
Director of Care
Ongoing from 2008 start
Safeguarding Operational Group Improve recording of statistical data Review and relaunch of Policy & Procedures Increase numbers trained Raise Awareness generally, including public awareness Provide opportunities for Service User involvement in the development of Safeguarding strategies and practice Embed Safeguarding Adults‟ principles and practice within all stakeholder groups. Enhanced GP practices to be „signed up‟. Joint working with Mental Health Services to include responses for people with ASD
Improvement Plan 20072010
Learning Disability Service – A Suitable Place to Live
Extend and Director improve the of Care range of accommodation options for people with a learning disability
March 2010
Farnhurst reprovision enables final closure of Farnhurst. The development of short breaks/respite options; including a generic adult placement scheme.
Learning Disability Service – Fulfilling Lives
Further develop the range of employment, vocational, educational and leisure opportunities for people with a learning disability
Director of Care
Ongoing to March 2011
To increase the number of people with LD in voluntary and paid employment Develop “JOBS 4 All” as a social enterprise by Oct 2008
Ongoing to March 2011
(ii.)
Mental Health Directorate
Brief Description Lead Director Objective Deadline ( final deadline ) March 2010 Interim Milestones Other Comments
High Level Objective Name Increase Work and training opportunities for people with MH problems
Tukes now run core contracts and have more agreed with new site, but need to further expand choices in training and employment. Supports for external employment also need enhancing further.
Kevin Bond
6 employment advisors by 2010. All contracts in mental health provision to be scrutinised and made available to Tukes where viable by end of re provison programme in 2010 Further Tukes expansions in both contracts to other bodies and types of training and employment on offer 2010
(iii.)
Social Care Commissioning
Brief Description Lead Director Objective Deadline ( final deadline ) Interim Milestones Recommissioning of externally provided services ensuring coverage of all geographical areas and service user groups Other Comments
High Level Objective Name
Development of Effective and Efficient range of home care services
Develop a range of high quality responsive home care services.
Director of Start: April Commissioning 2008: Completion: Sept 2009
(iv.)
Implementing Transforming Care
Brief Description Lead Director Objective Deadline ( final deadline ) March 2010 Interim Milestones Other Comments
High Level Objective Name Personal Budgets (PBs)
Everyone eligible for statutory support should have a personal budget, a clear allocation of resources, with many more people taking all or part of this budget as a direct payment. Revise Care Changed Care Management Management Model Model, with revised structure and jobs. Refine Social Develop more Care Elements explicit of objectives Commissioning based on Strategy JSNA and evaluation of the NEL market for
Director of Care
Approach on Personal Budgets fully implemented For all user groups.
Director of Care
Implementation Revised model by March of care 2010. management implemented across all user groups. Director of March 2010 Implement Care/Director objectives in of Commissioning Commissioning Strategy to address quality and shortfall issues.
Universal joined up information giving
care. Currently we have a mixture of paper publications and websites for social care. There are links from some websites to other sites. Informationgiving is not well connected between the various agencies involved. We need to co-ordinate the provision of information so that all a person needs is available from one source but via a range of channels and in an acceptable, understandable format.
Director of March 2010 Care/Director of Commissioning
Implement agreed procurement strategy for a Joined up Information Service
(vi.)
Infrastructure
Brief Description Lead Director Objective Deadline ( final deadline ) April 09 Interim Milestones Other Comments
High Level Objective Name Integrated health and social care clinical information
Development and deployment of „fit for purpose‟ health and social care electronic record solutions
Director of Care
Develop of system integration strategy as part of the CfH Phase 2 Health & Social care integration early adopter programme
April 10
Deployment of integrated solution
8. The “Plus” Elements of the Agreement: Objectives and Targets
Introduction to the Plus Section (i) The priority areas for Public Health intervention within Council services need to take cognisance of the priorities in the Local Area Agreement. In Year One1 these are: Strategic Housing– chosen because there are has not been a significant Public Health input in the past and the likelihood of a major impact is high. The specific areas of contribution will concern health impact of the Housing Strategy and housing developments, homelessness and overcrowding. It has been agreed that a Health Impact Assessment will be carried out on the East Marsh Housing Renewal work; Teenage Pregnancy– chosen because this is a major priority for North East Lincolnshire and considerable additional emphasis is required. The specific areas of contribution will be related to Children and Young People Plan targets and identifying vulnerable populations which can be targeted; Tobacco Control including Smokefree legislation– chosen because this is an important public health issue where considerable joint working is underway and the opportunity exists to develop excellence. The specific areas of contribution will be to lead the work on the priority, implement the Tobacco Control Strategy, and deliver the Local Area Agreement stretch target on smoking quits; Sports Development - chosen because this is an important public health issue where considerable joint working is underway and the opportunity exists to develop excellence. The specific areas of contribution will be to jointly develop the Sports and Active Recreation Strategy and to increase participation; Local Enterprise Growth Initiative– chosen because this is a new initiative where Public Health advice could be a significant contribution to success. The specific areas of contribution will be to review the Regeneration Strategy from a public health perspective by carrying out an Health Impact Assessment of the existing Strategy and involvement with the Economic Development and Enterprise thematic partnership of the LSP and the LEGI steering group; Developing and implementing the Associate Health Trainer role especially within the Council (Year 1 and 2). The specific objectives behave been agreed. In Year 2, priorities will be: Fuel Poverty Alcohol Misuse Environmental Health Healthy Schools
(ii)
1
Year One is until March 2009 and Year Two is until March 2010.
(iii)
In addition, the Council recognises that it will be the lead agency for health improvement and will need to oversee the continuation of existing health improvement priorities which have until now been lead by the former PCT. These include: delivery of stop smoking services and targets development and implementation of the Health Trainers programme leading the implementation of the obesity strategy early adoption of Health Direct establishing a Tobacco Control Alliance coordinating screening programmes delivering the Specialist Health Promotion programmes
(iv.)
“Plus” Objectives: 2008/9
Objective Deadline ( final deadline ) Increase the Director March number of of Public 2009 clients Health supported and signposted and increase the numbers of Associate Health Trainers Integrated Director March Employability of Public 2009 programme Health delivered by public sector organisations coordinated by Public Health Brief Description Lead Director Interim Milestones Other Comments
High Level Objective Name Expand the Health Trainer programme. to
Train 100 additional Associate Health Trainers Deliver 1000 people helped in NEL 100 referrals to SSSS or quits supported
Set up overall Employability schemes within NEL Council and NELCTP, coordinating with Acute NHS Trust Scheme Write and Publish Annual Public Health Report
Statutory requirement
Director January of Public 2009 Health
Introduction and Conclusion Health Improvement & Inequalities Diabetes Equity Audit Adolescent Lifestyle Survey OPNA Health Protection Edit and publish Disseminate Monitor progress on previous APHR
Complete Older Peoples Health and Social Needs and Inequalities Assessment
Complete Physical Disability Health and Social Needs and Inequalities Assessment Publish Joint Strategic Needs Assessment Achieve Breast Screening Target
Comprehensive report to allow the development of an revised Older Peoples Strategy and commissioning plans Comprehensive report to allow the development of a revised Strategy and commissioning plans Jointly DCS DASS
Director June 2008 of Public Health
recommendations Report produced. Presentations. Commissioning changes planned.
Director of Public Health
March 2009
Protocol produced. Ethics and RG approval. Study Complete. Report produced Presentations. Commissioning changes planned.
with Director and of Public Health Director of Public Health
December 2008
March 2008
Achieve Cervical Cancer Screening Target
Director of Public Health
March 2008
Achieve Immunisation Targets Achieve Chlamydia Screening Target Achieve Colon Cancer Screening Target
Director of Public Health Director of Public Health
March 2008 March 2008
Director of Public Health
March 2009
Annual Report. Develop Static Screening site in Grimsby. Support Tendering Exercise. Plan implementation of Cancer Reform Strategy. Expansions to programme. Annual Report. Review District Policy. Plan implementation of Cancer Reform Strategy requirements. Annual Report. Introduce HPV Vaccine. Expand service to achieve coverage target. Review policies and protocols. Annual Report. Work with provider to achieve coverage target.
Achieve Antenatal Screening Target
Director of Public Health
March 2009
Achieve Breast Feeding Target Commission Weight Management Services Develop and Implement Action Plan on Childhood Obesity Achieve Vital Signs Indicator for Suicide Implement Alcohol Education programme Achieve smoking quits target
Director of Public Health Director of Public Health Director of Public Health
March 2009
Plan implementation of Cancer Reform Strategy requirements. Annual Report. Implement new Downes tests. Work with providers to achieve coverage targets. Work with NLaG & partners to achieve target. Tendering Exercise.
May 2008
March 2009
Director of Public Health Director of Public Health
March 2009
March 2009
Director of Public Health
March 2009
Maintain and Develop Emergency Planning system.
Director of Public Health
Ongoing
Suicide Audit. Mental Health Promotion programme. Recruit Programme Coordinator. Agree objectives with stakeholders. Achieve Smoking in Pregnancy quit target. Appoint Tobacco Control Alliance Coordinator Co-ordinate the review and maintenance of the Major Incident Response Plan. Ensure that the requirements of HC Core Standard 24 are met. Ensure that the relevant DoH and SHA guidance on Emergency Planning is implemented and maintained.
Environmental Policy and Green Transport Plan in NELCTP Local assessment of NICE Guidance
Director of Public Health
Sept 2008
Develop a revised approach to Business Continuity Management in conjunction with P&SI Directorate and HEPS. Implement the revised national guidance and revised local Pandemic Influenza Plan. Produce EP Work Plan for 2008-09 to include a programme of briefing, training and exercising for the CTP. Continue to develop the CTP EP Co-ordinating Group as a means of embedding EP across the CTP and engaging all directorates with their responsibilities. Continue to input to multi agency working across the LRF. Maintain input to COMAH exercises. Review the location and equipping of the CTP Major Incident Command Centre and resilience arrangements. Review and revise.
Director of Public Health
March 2009
Local reports on each TAG Local implementation
arrangements for NICE PH Guidance.
(v.)
“Plus” Objectives: Years 2 and 3 (4/2009 to 3/2011)
Objective Deadline ( final deadline ) JSNA will Director of March 2010 need annual Public and March updating but Health 2011 will gradually be extended to cover all the requirements Undertake 2 Director of March 2010 major Public and March assessments Health 2011 each year Brief Description Lead Director Interim Milestones Other Comments
High Level Objective Name Repeat and extend the Joint Strategic Needs Assessment
Continue Health and Social Needs and Inequalities Assessment Programme Continue to implement and extend new Public Health Programmes particularly relating to Darzi Continue to deliver the existing Public Health programmes and associated targets Deliver Year 2 of the Statement of Intent Identify and deliver Year 3 of the Statement of Intent Write and Publish an Annual
Agreement on assessment topics each year
Director of March 2011 Public Health
Director of March 2011 Public Health
Director of Public Health Director of Public Health
March 2010
March 2011
Agree exact Public Health Contribution for each area of work Identify areas of work. Agree exact Public Health Contribution for each area of work
Director of Public Health
March 2010 and March 2011
Public Health Report each year
8.
(i)
Performance Monitoring
Monitoring of performance against the respective elements of the agreement will be undertaken in the quarterly review meeting as described in the Partnership Agreement. The agenda will include exceptions against the plan (and subsequently 3 year strategic agreement), performance issues, finance and any other exceptional issues. In the same meeting this will be undertaken for adult social care (CTP to LA) and public health (LA to CTP). The meeting will also pick up LAA 1 and 2 and any other cross partnership issues, such as older people. Officer attendance at the reviews has been agreed for the two organisations, with chair of the Local Authority element of the meeting being held by the Executive Director of Corporate Services of the Local Authority and chair of the CTP element being held by the Director of Performance and Service Improvement at the CTP. Care Trust Plus accountability to North East Lincolnshire Council for Adult Social Care Performance The agreed reporting framework covers those of the mandatory 198 National Indicators which are relevant to social care performance and agreed local indicators. Local indicators will be put forward by the CTP in discussion with DASS but will be the original PAF indicators (with a few agreed exceptions). Trajectories for the above targets will be set by the CTP. These were provided to the local authority by the end of March 2008 to feed in to the Corporate Plan and April Cabinet. The CTP will report directly to the Local Authority on those elements of the 198 National Indicators and locally agreed indicators that are relevant to social care. Local Indicators and 198 National Indicators will be input data directly in to Business Objects. From 2009/10, there will be an even greater emphasis on value for money as a result of the CTP being in a position to exploit the efficiencies inherent in the structure and from the transformation initiatives. Value for money will therefore constitute a growing component of the monitoring agenda.
(ii)
(iii)
North East Lincolnshire Council accountability to the Care Trust Plus for the Plus Elements This will include those elements of the 198 National Indicators which are relevant to the Plus functions and any agreed local indicators. Relevant targets within the NI dataset will have trajectories developed and input on to Business Objects by the Local Authority. The Local authority have established a meeting to agree the local indicators, trajectories for these and the relevant NI targets and reporting processes with Public Health. The local authority
will then need to provide the CTP with the agreed targets and trajectories. This will be incorporated in to the CTP performance reporting processes. Processes for agreement, reporting and monitoring targets within LAA-1 and LAA-2 are already well established. Following finalisation in June, LAA -2 will continue to be reported through agreed existing processes with the LSP. Any exceptional issues will be raised at the performance meeting as described above. It was felt helpful to revisit the process for ensuring wider engagement, including member engagement and non executive engagement and agreed that the second of the quarterly meetings (September 2008) would include a wider range of stakeholders including executives, members and nonexecutives. This would be a round table discussions with a strategic focus aimed to precede and support the budgetary and planning processes later in the year. This would include all the delegated functions.
9.
(i)
Resources
Payment to the Care Trust Plus from the Council The Council agrees to pay to the Care Trust Plus from its general resources a net sum of in 2008/9: £42,780m. This is for the purposes of delivering adult social care services and agreed developments. This amount includes sums for the following adjustments to the 2007/8 base budget for 2008/9: The budget was inflated by 2.5%; All income is assumed to be inflated by 3%. All the grants being re-routed through RSG and Area Based Grants are treated as committed expenditure, and those grants in RSG become part of the CTP base budget. The new Social Care Reform Grant is to be managed by the CTP, with advice from the DASS. Growth committed by the local authority in previous years is added to the base budget i.e. increase to care home fees by 2% above inflation (505K) and extra funding for preventative services (520K). The local authority committed the planned CTP efficiency gains (£170K net) plus a global sum of £500k to cover all other pressures within Adult Services The local authority agreed to continue their commitment to fund the capital costs of Farnhurst re-provision and remodelling of the Beacons, and agreed to fund non recurrent revenue costs due to the resulting temporary/partial closure of the Beacons (£84k) There was an agreement between the Council and the Care Trust Plus to review funding mid-year for two specific pressures: o Funding for quality premiums for home, residential and nursing home care; o Costs of packages for young people in transition to adult care.
(ii)
(iii)
It is expected that the Care Trust Plus will manage other pressures from within the amounts set out above whilst improving performance and quality. These pressures are: COST (£000) 180 55 245 40 388 416 300 200
UNAVOIDABLE COSTS Emergency Duty Team Funding Shortfall Approved Social Worker Dispute Resolution Supporting People Grant Loss Income shortfall Learning Disability Transitions UNFUNDED REQUIREMENTS Learning Disability Strategy Increased Home Care Quality Scheme
Mechanisms for dealing with over and under-spends are set out in the Legal Agreement. (iv) Payment to the Council from the Care Trust Plus The Care Trust Plus agrees to pay the Council a net sum of: £3.273 millions for the delivery of the Plus elements of this Agreement.
11.
(i)
Charges
For 2008/9, the Council and the Care Trust Plus agreed to increase fees for individual care services by 3%, which is the assumption that the Council makes each year for increases in all charges for services across the Council. The level of charges for care services is a reserved matter under the Partnership Agreement and any variation on the above increase, ie by the 3% uplift, would be subject to consideration by a specially appointed committee as set out in the Partnership Agreement. Charges for individual community care services have been increased by 3% and for 2008/9 are as follows: Home Care £5.25 per hour Day Care Centres £2.10 per day Transport £1.05 per return journey Laundry £4.75 per week Meals in the Home £2.75 each Meals in a centre £2.35 The ceiling on charges for community care packages has been retained at £100 per week for 2008/9.
(ii)
(iii)
Capital limits on charges for residential and nursing home care follow government guidance and for 2008/9 are: People with capital and/or Savings exceeding £22,250 will pay the full cost of their accommodation/care;
People with capital and/or savings of between £13,500 and £22,000 will make a contribution on a sliding scale.
12.
(i)
Anticipated Decisions on Reserved Matters
Background: Definition of Reserved Matters The Council's Constitution defines “key decisions”. Key decisions require a formal Cabinet decision. These are decisions that are likely to have a significant financial impact and/or significantly impact on 2 or more wards in the Borough (Key Decisions). The reason for defining Key Decisions is to ensure proper compliance by the Council with statutory obligations in respect of public access to information. For the purposes of the Legal Agreement: (i) Key Council Decisions that my have a significant impact on the Care Trust, and Care Trust Decisions that may have a significant impact on the Council are both referred to as Reserved Matters. Reserved Matters are categorised as below.
(ii)
(ii)
Reserved matters for 2008/9: The approval and adoption (by each of the Partners) of corporate and strategic plans and policies affecting the delivery of adult social care, health, public health and children's services. Reserved Matters for 2008/9: Care Trust Plus Initiatives: Development of a Personalisation Strategy in response to Transforming Care; Likely government requirement to review eligibility criteria for adult social care; Responses to: o Carers Announcement; o Dementia Strategy; o Darzi Review.
Council Initiatives: Healthier Communities Strategy; Children and Young People‟s Plan; Teenage Pregnancy Strategy and Investment Plan; Review of Choosing Life (Older People‟s Strategy); Healthy Communities Strategy; Tobacco Control Strategy; Choosing Health Implementation Plans i.e. Obesity Strategy;
(b)
Housing Strategies, to include Private Sector Housing Renewal Strategy, Affordable Warmth Strategy, Homeless strategy ; Supporting Housing Strategy (Supporting People); Joint Strategic Needs Assessment; Health Inequalities Action Plan; Partnership Plan (Community Safety Strategy); Revised Regeneration Strategy; Economic Development Strategy; Leisure Provision Review; Children Centre Action Plan; Building Schools for the Future Plans.
Decisions (by each of the Partners) to procure goods, works and services under the auspices of European Procurement rules and/or a non- EU competitive exercise, where owing to the value, term or political sensitivity of the proposed contract, it is considered reasonably necessary to refer the matter to the Cabinet and/or the Care Trust Board, as appropriate. Reserved Matters for 2008/9: Relevant Care Trust Plus Procurement: None Relevant Council Procurement: None
(c)
Decisions which are likely to have a significant financial impact and/or significantly impact on 2 or more wards in the Borough. Reserved Matters for 2008/9: Care Trust Plus Initiatives:
Re Commissioning of Home Care; Scheme to promote Improved Quality in commissioned residential care; Further Developments of the Commissioning Strategy; Development of Information Giving; Charges for Community Care Services.
Council Initiatives: None