Social Care Reform Integration – where we are now and where are we going

1. Social Care ReformIntegration – where we are now and where are we going David Behan – Director General Social Care, Local Government and Care PartnershipsDepartment of Health March 2012

2. Where we are now?The Health and Social Care Bill Current reforms • NHS Commissioning Board new duties to promote integrated care • Health and wellbeing boards (H&WBs) will bring key stakeholders together • The Bill gives H&WBs a duty to encourage local commissioners to work together • H&WBs have to agree a Joint Strategic Needs Assessment and Joint Health and Wellbeing Strategy • H&WBs to consider partnership arrangements in the NHS Act (e.g. pooled budgets) • HealthWatch will provide a stronger voice for patients

3. Choice, competition and collaboration • Concerns integration will be prevented by competition • Listening Exercise/’Pause’ response was to introduce new safeguards • Monitor’s core duty is now clear that patient interests always come first • Monitor has new duties to support integration where it benefits patients Financial incentives to drive integration • SR made available considerable funding to back this up • £650m in 2011-12 to PCTs to transfer to councils for spending on social care services that also benefit health • £150m in 2011-12 to PCTs to invest in reablement services to support discharge

4. National Engagement Exercises • Took place between September and December 2011 • Future Forum on: • Education and training • Information • Integrated services • The NHS’s role in the public’s health • Caring for our future: Shared ambitions for care & support on: • Quality: improve quality of care and support workforce? • Personalisation: give people more choice & control over their care and support • Shaping local and responsive care services to people’s needs and choices • Prevention: support effective prevention & early intervention to keep people independent? • Integration : in partnership with Future Forum • The role of financial services: what role can sector play in supporting users, carers & families?

5. Future Forum • On 10th January the Future Forum submitted its second report to Government • Sets out to maximise pace and scale of integration within current reforms • The ‘headline’ recommendations are: • Integrate around the patient, not the system. • Make it easier for patients and carers to coordinate and navigate. • Information is a key enabler of integration. • You can only improve what you measure. • H&WBs must become the crucible of health and social care integration. • Clarify the rules on choice, competition and integration. • Freedom and flexibility to “get on and do”. • Allow the funding to follow the patient. • National level support for local leadership is essential.

6. The King’s Fund and Nuffield Trust – Integrated care for patients and populations • Setting a clear, ambitious and measurable goal to improve the experience of patients and service users - to be treated as a ‘must do’ priority • Offering guarantees to patients with complex needs - agreed care plan, a named case manager, access to telehealth and telecare, a personal health budget where appropriate • Integrated care must be delivered at scale and pace.

7. The King’s Fund and Nuffield Trust – Integrated care for patients and populations • The report cited Torbay as evidence that integration works - • A Department of Health Integrated Care Pilot. • Has improved care for older people, through five integrated health and social care teams, aligned with GP practices. • Has almost removed delayed transfers of care from the acute sector to the community, has greatly reduced the average number of daily occupied beds (from 750 in 1998/9 to 502 in 2009/10) and ensured below average emergency bed days for older people locally.

8. Health Select Committee Report on Social Care Focused heavily on Integration: • Misconception “typical” service user is a healthy adult with an episode of care • Older people - the “typical” users of services – 29% of population, but 50% of GP appointments and 70 per cent of all inpatient bed days • Older people and those with long term conditions experience fragmented services • Called for integration around older people with just a single local commissioner • Called for greater merging of Government funding streams • Repeated attempts to improve integration “The Committee welcomes Government support for this objective but is concerned that progress continues to be disappointing”

9. Where are we going? Further DH Policy Development Secretary of State’s written response to the Kings Fund and Nuffield Trust • Integrated care lies at the heart of the aims of the Health and Social Care Bill • Integration is about people, not structures • Bottom up approach – letting NHS CB, CCGs, HWBs, providers innovate and drive change • Integration is about health and social care working together to maximise independence and minimise dependence • The NHS Constitution will see patients’ rights evolve • White Paper on Care and Support in spring – will strengthen the framework to support integration

10. Next steps • The feedback from the future forum/’Caring for our future’ engagement is being used to understand the immediate and longer-term priorities for reform, and this will inform policy development and decisions. • The Department will continue to work with stakeholders to develop these policy recommendations to help us decide the approach to the Care and Support White Paper, and progress report on funding reform. • The Department has created a joint integration unit to progress this work • We will use the Care and Support White Paper to respond to the Health Select Committee report on Social Care • The Government has also committed to legislating at the earliest opportunity and our approach to law reform will take many of the recommendations of the Law Commission report as its foundation.