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The North East Lincolnshire Care Trust Plus

The North East Lincolnshire Care Trust Plus. CSIP Workshop The Pavilions, Harrogate 10 th October 2007 Julie Ogley Executive Director Community Care. OUR CONTEXT – NORTH EAST LINCOLNSHIRE. Unitary Authority Co-terminus PCT Effective partnership working

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The North East Lincolnshire Care Trust Plus

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  1. The North East Lincolnshire Care Trust Plus CSIP Workshop The Pavilions, Harrogate 10th October 2007 Julie Ogley Executive Director Community Care

  2. OUR CONTEXT – NORTH EAST LINCOLNSHIRE • Unitary Authority • Co-terminus PCT • Effective partnership working • Widening health gap and significant neighbourhood deprivation • Council and PCT in financial balance

  3. The ambition to deliver: • Fully integrated approaches to commissioning at individual, community and strategic levels • Fully integrated working both in direct contact with service users and patients and in the back office functions • New forms of governance • An integrated public health and well-being function in the Council that will enable different approaches to be taken to address the health inequalities and health improvement issues for our population • The integration of Children’s Services into a Children’s Trust that fully meets the expectations of Every Child Matters and goes beyond • Step change

  4. Timeline • July 2005 - “Ensuring a Patient-Led NHS” report • December 05 – March 06 - Strategic Health Authority consultation on options for Northern Lincolnshire • June 2006 - Initial application to establish a Care Trust Plus • July 2006 -3 month Public Consultation on the proposal • September 2006 – select committee convened • Appraisal process • February 2007 – agreement for joint Executive Director of Public Health • Formal staff consultations commenced • March 2007 – final application submitted • June 2007- Ministerial approval for Care Trust Plus • September 2007 – Implementation!

  5. The Three Elements of the Care Trust Plus The ‘Care Trust’ – commissioning and provision of adult health and social care services in a new and integrated way • From 1st September 2007 • 677 staff (519 wte) transfer to the Care Trust Plus • £54.3m budget transfers to the Care Trust Plus • Director of Adult Social Services (DASS) function retained by the Council • Service Level Agreements £3.3m The ‘Plus’ – the transfer and integration of the public health function from the PCT to the Council to facilitate influence on the wider determinants of health and well-being • From 1st October 2007 • 65 staff (56 wte) seconded to Council • £2.03m budget transfers to the Council • Joint Executive Director of Public Health already in post A ‘Children’s Trust’ – to fulfil the requirements of Every Child Matters and hosted by the Council • From 1st April 2008 • 117 staff (88.15 wte) second/transfer to the Council • From 1st April 2009 • £22.03m budget transfers to the Council

  6. Integrated Health and Social Care • An integrated approach to commissioning at the individual level linking Practice Based Commissioning with the personalised approaches being developed by the Local Authority through Direct Payments and individualised budgets • Professional leadership at Practice, locality and strategic levels • Wider opportunities for collaboration • A jointly developed, shaped and managed market

  7. COMBINED ASSESSMENT FRAMEWORK E-Access Customer Access Points GP Practice Community Facilities Direct Access 40k population based generic assessment teams Geographical or GP population Low Level Services (Befriending/Cognitive Therapy / Sexual Health etc) Immediate / Necessary Enduring Health Promotion / Social Inclusion End of Life Provision

  8. The Plus Element • Key driver – health inequalities in North East Lincolnshire • Lead member for Healthy Communities • Legal agreement to deliver health improvement and health inequalities responsibilities • Legal agreement for accountability and performance management • Transfer public health funding and functions to Local Authority • Health improvement responsibilities of the Local Strategic Partnership

  9. Children’s Trust • “Every Child Matters” – Establishment of Children’s Trust • Arrangements for integrated working comprising joint planning and commissioning - Integrated processes - Integrated front line delivery - Transparent accountabilities - Involvement of children, young people and families in decision making

  10. Success Criteria • Impact of service user/carer involvement • Reduced health inequalities • Workforce – recruitment / retention • Infrastructure – fit for purpose • Health and social care targets delivered • Effective sharing of information ‘an organisation that delivers’

  11. Benefits to Citizens • Strengthen democratic accountability – ownership • Effective commissioning close to the local population it serves • Strengthen community leadership to promote wellbeing and regeneration • Improve ‘quality of life’ issues that affect all citizens • Enable citizens to self determine their wellbeing and choice of care

  12. The Partnership Agreement • Finance • Performance • Governance

  13. Purpose of the Partnership Agreement • Section 75 of the National Health Service Act 2006 • A legally binding agreement is necessary to: • Manage the Partnership • Ensure that delegated responsibilities are fulfilled • Establish proper and effective financial arrangements • Establish the governance arrangements

  14. How long will the Agreement last? • In force until terminated by - 12 months notice - Early termination - Material breach - Fundamental change in law

  15. Main Provisions • Delegations • The Strategic Agreement - Sets out the strategic direction of the Care Trust Plus as agreed between the partners - A 3 year plan, reviewed annually - Must be referred to Cabinet and Care Trust Board for approval • Performance Framework - The mechanism that enables the Council and the Care Trust Plus to performance manage the delivery of the responsibilities it has delegated • Value for Money reviews and co-operation • Establishment of the Pooledfund for revenue expenditure in respect of prescribed functions

  16. Governance • The Care Trust Board • 3 Council members are appointed with full corporate responsibilities (i.e. they will participate in all aspects of the Care Trust’s business at Board level) • Partnership Undertakings: - to operate in a manner that contributes to the delivery of each partner’s strategic objectives and corporate priorities - to consult with each other about decisions or actions that may significantly affect the operations of each partner • Protocol on Reserved Matters (Key Decisions) • Accountability for delegated responsibilities

  17. Financial Risks and Controls • Over commitment / overspending by the Care Trust • Over commitment / overspending by the Council • Service Level Agreement • Residual Costs • V A T • Pensions • Medium Term Financial Plan – budget setting • Monitoring and reporting requirements • Statutory responsibilities

  18. What have we learnt? • It can be done • Be creative • Focus on the needs of the population

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