Effective Partnership Project

1. Effective Partnership Project Ageing Well in Leicestershire Interim presentation of Findings Peer Review - February 2013 (Draft – Subject to further development)

2. “We have hundreds of beds and spend millions of pounds of putting people in the wrong places. The problem is that we don’t have enough right places.”

3. Context / Scope • We have an ageing population – the demand on services will become unaffordable • We need to shift resources to prevention and early intervention in order to reduce demand on high cost services and keep older people independent for longer • The Ageing Well Review, of which the Peer Review is a component, is designed to test and address: • how we work together and make decisions, • how we use and share information, and • how we can not just do things differently but do different things. • We need to make cashable savings now

4. The Review Team Sandra Whiles: Chief Executive, Blaby District Council (Team Leader) Ivan Browne: Consultant in Public Health, Leicester City Public Health Team Lucy Smith: Chair of Older Peoples Engagement Network (OPEN) Matthew Lugg: Director of Environment & Transport, Leicestershire County Council Cllr Stuart Wallace: Deputy Chairman of the Adult Social Care and Health Committee, Nottinghamshire County Council Wendy Fabbro: Strategic Director, People Group, Warwickshire County Council

5. Who did we engage Health Leicestershire Partnership Trust University Hospitals Leicestershire Clinical Commissioning Groups (CCG) Voluntary & Community Sector Rural Community Council Voluntary Action Leicestershire Leicestershire & Rutland Associate for Parish & Local Councils Communities in Partnership VISTA University for the 4th Age Age UK Local Authorities Leicestershire County Council (all departments) District Councils Older Peoples Champion Network Other Police Chamber of Commerce Department for Work & Pensions

6. Review Timetable Peer Review Aim (Feb-Mar): Make recommendations to inform, define, and improve the role, structure, governance, accountability, leadership & relationships Needs Analysis Aim (March onwards ): Prioritise a list of issues affecting older people and make recommendations for a sustainable approach to future service provision, informing the development of a joint strategy around Ageing in Leicestershire. Options Appraisal (Summer onwards): From the peer review and needs analysis, identity options for new governance and service/ support delivery which result in cashable savings and improved outcomes

7. Principle • We want this review to produce an environment which enables and empowers older people to take ownership of their own destiny. • To do this we need to: • Change the way we think about ageing well, • Enable people, • Empower communities, • Develop better insight to make better decisions about how and where things are done. • All of the above needs to contribute to the savings required by organisations across the place.

8. Change how we think • “This is going to require something transformational. Tinkering around the edges won’t be enough.” • We need to strike the right balance between providing the right services and positively supporting older people to remain independent • A whole system approach with clear leadership, clear ownership and clear accountability. Can this be achieved through a single strategy around ageing well and focussed governance arrangements? • Embed a more broadly defined and widely applied set of expectations and requirements for how providers work, and for how agencies and communities work together • “The First Contact scheme is a success and needs to be better used and developed via GP’s and other community offers”

9. Enable People • “Do we take people to services or services to people?” • Services need to be person led, not condition based • How do we ensure people are aware from an early age of the impact of their lifestyle choices to keep them healthy and happier for longer? How they live, where they live, and how they spend their money • Understanding, recognising, building and utilising the role of the Community and Voluntary Sector in supporting those individuals outside the Health and Social Care system

10. Empower Communities • “The idea that volunteering can take up the slack left by cuts is flawed” • Commissioning more support and services closer to communities; e.g. how viable are devolved commissioning units at a locality level? • How can we get the Voluntary Sector to overcome their competitive nervousness? • Enable independent thinking via effective communication and signposting mechanisms • How can we support communities to develop and deliver sustainable choices to support ageing well?

11. Better Insight, Better Decisions • “People tend to have bits of a jigsaw but no one appears to have the box with the picture on it.” • Unify public, private and voluntary sector information to manage services and support. Can we apply the JAG model to older people? (i.e., locally based case load management) • More regular and robust insight to inform service design and delivery • “We need to place a thousand pins against a map, rather than throw paint against a wall so that we can develop bespoke support rather than generic services.”

12. High level conclusions • We need to be clear where significant savings can be made through the re-design of services for Ageing. • We need to manage short term need whilst transforming to reduce long term demand through a preventative and earlier intervention approach. • We need to review the commissioner/ provider split across the partnership. • We need to improve current senior partnership structures (including Leicestershire Together). • We need a single accountable body for the ageing population because there can not be a single accountable organisation.

13. What Happens Next • Peer Review Team will develop a detailed report of findings • The report will inform the Needs Analysis stage of the Ageing Well review • Needs Analysis – March onwards • Recommendations developed based on combined findings of Peer Review and Needs Analysis– Summer Onwards • Further reports to Executive in Summer and Autumn

14. Need Analysis: Plan Understand needs & aspirations Prioritise outcomes Generate options

15. High Level Programme Plan

16. Proposed Programme Governance Overseen by independent chair Needs Analysis Reps from the following: Commissioners LCC A&C, Finance, Procurement Districts (with housing expertise) CCGs Public Health Providers UHL, LPT VCS (TBD) Users Representative Groups Options Generation Appraisal Reps from the following: Commissioners LCC A&C, Finance, Procurement Districts (housing expertise) Public Health CCGs Users OPEN plus others Select & Source Reps from the following: Commissioners LCC A&C, Finance, Procurement Districts (with housing expertise) Public Health CCGs Role: To ensure that the delivery models cohere with the processes previously undertaken. The group would consist of those partners who have contributed or have a stake in the delivery of the programme but have no commercial interest in any decision made. Role: To ensure that the options generated are robustly tested against the findings of the needs analysis (providers have to be excluded at this stage so as not to exclude themselves from future bidding processes). Role: To ensure needs analysis adequately represents a holistic view and arrives at agreed priorities