W E L C O M E

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W E L C O M E
Who are we? What do we know? What are we going
to explore together?
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A strong organisation is clear in its vision,
in touch with its customers and has a lively
proactive feel at all levels. It uses its
resources well, is modern in outlook and knows
the value of working with others to achieve
shared goals
Sir David Henshaw Chair, North West Strategic
Health Authority
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About Knowsley
Resident population of 150,200 Practice
Population of 155, 800 8th Most deprived
district in England 33 square miles in area
70 rural/green belt land Demographic 22
population lt16 6.1 population gt 75 Older
People largest single group of service users of
Health Social Care Social Services Budget
13.972 Million Adults,
16.2 Million, Older People,
13.5 Million
Childrens. PCT Budget 235
Million Pooled Budget for Service Provision
Older People 4 Million
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About Knowsley

• Staffing
• Knowsley Council 8000 (over 50 resident in the
  Borough)
• Knowsley Primary Care Trust 1200 (50 resident
  in the Borough)
• Borders
• The City of Liverpool Council, Liverpool PCT,
• Sefton Metropolitan Borough Council Sefton PCT,
  
• Halton Unitary Authority Halton PCT,
• St. Helens Metropolitan Borough Council St.
  Helens PCT
• Benchmark Authorities
• City of Salford, Unitary Borough of Halton,
  Metropolitan Borough of
• Oldham, Middlesbrough Council, Sandwell Council,
  Bromley Council

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About Knowsley
Co-terminus Local Authority Primary Care
Trust Part of two Local Health Economies, Three
PBC Groups Acute Trusts St Helens Knowsley
Hospitals, University Hospital Aintree, The
Royal Liverpool Broadgreen University
Hospitals Southport Ormskirk Hospitals Tertiary
Specialist Trusts Mersey Care NHS Trust 5
Boroughs Partnership NHS Trust Liverpool Womens
Hospital Royal Liverpool Childrens
Hospital Clatterbridge Centre for Oncology North
West Ambulance Service NHS Trust Walton Centre
for Neurology and Neuro-surgery
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What Promotes Integration?

• Contextual Factors
• Cultural and Professional Factors
• Organisational Factors

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Contextual Factors Policy enablers

• Our Health, Our Care, Our Say (DoH)
• Transforming Emergency Care (DoH)
• Ten High Impact Changes (DoH)
• ALL National Service Frameworks (DoH)
• Commissioning a Patient Led NHS (DoH)
• Sure Start for Later Life (ODPM)
• NHS Improvement Plan (DoH)
• Choosing Health (DoH)
• Every Child Matters (DoH)
• Taking Healthcare to the Patient (DoH)
• Fair Access to Care Guidance Policy (DoH)
• Integrated Services Improvement Programme
• Care Services Improvement Programme

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Contextual Factors

• Managing local service change against a backdrop
  of national and regional change
• Council Re-structure PCT Fitness for Purpose
• Co-terminus
• Removing resource and financial boundaries
• Workforce planning and development

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Influencing Cultural Factors

• Strong, visionary leadership
• Overcoming a lack of understanding of-
• -Existing job roles and future development
• -The purpose of integration
• Developing trust and respect among professionals
• Joint development and team building
• Creating a shared culture that all professions
  can work with
• Supervision that underpins a performance
  framework

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Organisational Factors

• Agreed joint priorities
• Integrated business planning
• Integrated business performance framework
• Re-aligning roles and responsibilities to meet
  joint business objectives
• Integrated information systems, referral systems,
  record keeping
• Joint working, co-location and integration

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What are we doing in Knowsley?
Were integrating using Go Integral Go
Integral is the name the Council and the Primary
Care Trust have given to the process of bringing
together, and integrating services across
Knowsley. Go Integral is not a project, it is
a programme of change. Go Integral is
radically altering the way services are planned,
structured, commissioned, managed, provided and
delivered.
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Is it about merging into one organisation ?
We will remain TWO SEPARATE organisations joined
by a partnership agreement under Section 31 of
the Health Act, 1999
This is not a merger or a takeover. However, it
is a PARTNERSHIP arrangement that will improve
how we commission, manage and deliver services
across Health Social Care and the Wider
Council.
What do you think the benefits of this are?
What do you think the challenges of this are?
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Current Scope of Go Integral

• Social Work Assessment Services
• In House Social Care Provider Services
• Allied Health Professionals
• Community Nursing Health Visiting
• Managers at all levels
• Trainers and Educators
• Commissioning Teams
• Modernisation Team
• The whole range of Support Services.

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Current Interfaces Go Integral

• Primary Care
• Secondary Care
• Tertiary Care
• Childrens Young Peoples Services
• Wider Council Services
• Ambulance Services
• UC24 (OOH Provider)
• Voluntary Not for Profit sectors
• Independent sector
• Other NHS Trusts

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Why bother?
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Why are we bothering?
We want to create sustainable change and
sustainable services for the future. It will
enable further efficiencies and deliver
increased business benefits. Ultimately, the
changes we make will enable us to continue to
deliver Excellent services to the people of
Knowsley.
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Whats it all about?
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Go Integral is about
Valuing People and the contribution they make
to life in the Borough Moving away from
reactive support Continuing to build on
existing services whilst commissioning, creating
and developing new preventative
services Enabling and empowering people to
take responsibility for their lives
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Go Integral is about
Continuing to reducing, minimise or eliminate
risk Increasing support for informal
Carers Increasing use of new assistive
technologies to enable people to maintain their
independence Becoming neighbourhood based, with
local delivery and accountability of services.
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Neighbourhood Cluster Teams
North Kirkby Neighbourhood Cluster
South Kirkby Neighbourhood Cluster

• We will establish Neighbourhood Cluster Teams.
• These are termed Cluster Neighbourhoods as KMBC
  are aligning to Neighbourhoods and these may be
  smaller than those proposed for Go Integral.
• These will benefit from
• New Buildings (LIFT) utilise current Council
  premises for co-location/integration.
• Shared Services (IT, Phones)

North Huyton Neighbourhood Cluster
Prescot, Whiston Cronton Neighbourhood Cluster
South Huyton Neighbourhood Cluster
Halewood Neighbourhood Cluster
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Its also about liberating staff talents

• Our staff are key and our greatest asset
• Skills, experience and understanding
• Using the staff we have in different ways
• Developing different and/or new roles for staff
• Training and developing staff, extending roles
• Blurring the boundaries, whilst maintaining
  professional specialism
• Redeployment of staff to identified areas of
  need

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How are we doing this in Knowsley?
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Commitment to Staff

• Both the Council and the PCT have Investors in
  People Accreditation
• PCT have Improving Working Lives Practice Plus
  (IWLPP)
• The IWLPP standards are being used as a benchmark
  across Social Services
• A Health and Social Care Workforce Development
  Group
• Development Portfolio for all Health and Social
  Care staff

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Our Commitment to staff

• Integration of the Social Services Training Team
  PCT Learning and Development Team
• Re launched as Health and Social Care Workforce
  Development
• Co location was the catalyst for more integrated
  working
• Conducted a comprehensive Training Needs Analysis
  across both organisations
• Unique integrated Health and Social Care Learning
  and Development Plan
• Developed a Health and Social Care Training
  prospectus that contains-
• - Wider opportunities for joint
  learning
• - New development opportunities to
  meet national and local service needs

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Development of Staff

• The Care Sector has moved towards a system based
  more on
• developing the competencies required to perform
  in a role and
• less on professional groups. Key areas include-
  
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• Mandatory and Essential Training
• Health Promotion
• Long Term Conditions
• Leadership and Management Development
• Joint development opportunities across Health and
  Social Care based on roles and responsibilities
• Professional Specific Development
• Qualifications
• - vocational
• - professional

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Mandatory and Essential Training

• Concerned with the health and welfare of staff
  and/or service users and
• underpins the management of risk
• Mandatory and Essential Training Matrix across
  Health Social Care
• Childrens Safeguarding Training Route
• Multi-disciplinary workshops include-
• - infection control
• - personal safety
• - basic first aid

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Health Promotion

• Renewed focus on well being and better prevention
  services and
• earlier interventions ( DoH 2006, Our Health, Our
  Care, Our Say)
• Menu of multi-disciplinary programmes include-
• - using a behavioural approach to support
  clients to make
• health related lifestyle changes
• - healthy lifestyles
• - working with groups

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Long Term Conditions

• Support for people with long term conditions to
  self-manage their
• needs more effectively
• A series of workshops have been developed to
  increase the
• knowledge of health and social care staff who
  support people
• with long term conditions and to recognise early
  warning signs.
• These include
• - Understanding heart disease
• - Understanding heart failure
• - Understanding diabetes
• - Understanding chronic obstructive pulmonary
  disease

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Leadership and Management Development

• Enhanced leadership and management capability is
  pivotal to
• the success of this programme of change
• Multi-layered approach-
• - HR capability for line managers
• - Joint Core Management programme
• - NVQ Level 4 Management
• - Higher education opportunities

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Joint Development Opportunities

• Health and Social Care staff have welcomed and
  benefited from
• the provision of multi-disciplinary learning
  which are wide
• ranging-
• Court Report Writing
• Tissue Viability to prevent Pressure Sores
• Understanding the effects of Substance Misuse
• Safeguarding Adults

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Professional Specific Development/Qualifications

• There is a recognition and commitment to the
  support for the
• continual development of professional competence.
  
• Post Qualifying Awards (Social Work)
• Post Qualification Framework (Clinical)
• Support Services development (e.g Finance)

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Qualifications

• An extensive range of NVQs and general
  qualifications have
• been offered to both administrative and frontline
  support staff to
• enhance competence and facilitate service
  delivery.
• Essential Skills
• Computer Skills (beginners to advanced)
• Customer Care
• NVQs at levels 2 to 4
• - Health and Social Care
• - Diagnostic and Therapeutic
• - Administration

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The benefits of Go Integral
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The benefits for service users, their carers and
families
A single point of contact for all Community NHS
and Borough Council Services
Clarity about who does what and for whom they do
it When it should be done and what service users
and carers can expect as an end result of the
support provided.
Single Assessment is already greatly reducing
duplication in information given by service
users, their carers or families. eSAP will
continue to support and improve information
sharing.
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The benefits for service users, their carers and
families
All of our staff promote and focus on supporting
people to
Remain independent and retain life
skills Enable access to and increase the uptake
of Direct Payments to aid independence and
promote autonomy Avoid attending the Emergency
Department by understanding how to manage their
health or disability in better ways Supporting
unpaid carers and being pro-active to prevent
carer breakdown.
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The benefits for our staff
IWL Practice Plus, Joint Team Briefing and Staff
Magazine
Be working together, in the same buildings, in
local neighbourhoods
Improve communication between staff and
through this bring about an improvement in the
quality of service.
Joint Management Policies, Integrated Practice
Policies/Protocols
Improved job opportunities and career development
Improved job satisfaction
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The benefits for our staff

• Shared objectives to business planning and
  appraisal processes
• have led to a clearer focus on priority
  activities
• Collaborative working across traditional
  boundaries has
• facilitated the
• Sharing of good practice and innovation
• Sharing and acquisition of additional skills
• Development of competence
• Improved education, training and development
  pathways
• Streamlining of processes and reduction in
  duplication

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The benefits for Knowsley Social Services and
Knowsley Primary Care Trust
Use the limited amount of resources available to
us in a much more effective way. Our management
structure will be unified and simplified.
Improve the management of our physical
resources across the Borough. Workforce fit for
purpose jointly educated trained, equipped
with the skills needed to work in new ways and
new job roles. Improve our performance against
standards set locally and nationally. Plan for
and continue to provide Excellent services across
the Borough.
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Examples of integrated achievement

• Community equipment 98.9 delivered in 7 days
• Delayed transfers of care reduced from 4.9 to
  0.7
• Unplanned visits to Hospital reduced by 88.45
  across the
• Borough by our multi-professional Case Managers
• Number of people currently
• identified for case management 1300
• Home Care support always available on
• the day of discharge or Assessment
• Targets achieved for Flu Vaccinations across
  Knowsley
• Dramatically increased Diabetic Retinopathy
  Screening

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Examples of integrated achievement

• 30 people per month prevented from hospital
• admission by our Rapid Response Team
• 46.6 reduction in the number of falls by
  Integrated Falls and Well
• Being Service and Healthy Communities
  Collaborative
• 5 reduction in admissions to residential and
  nursing home care
• One of 19 Local Authorities selected from 144 to
  successfully obtain
• the Partnership for Older People (POPPs) moneys
  to
• develop proactive, preventative services
• Go Integral was awarded second place in the
• Primary Care Innovation category at the HSJ
  Awards 2005
• Commended Finalist at the MJ Awards 2006 for
  Effective Top Team Leadership Older Peoples
  Services

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Examples of Integrated Achievement

• Achieved 3 star Social Services Status for 3rd
  Year
• Achieved Excellent Council status for 3rd year
• Retained 2 stars at PCT for 2nd year
• Awarded Excellent rating for Home Care Services
  by the Commission for Social Care Inspection
  (Csci) for 3rd year
• Knowsley has strategic lead for Older People
  across
• Cheshire Merseyside footprint of NW SHA.
• Standard for Resilience Planning set by Knowsley
• Health Social Care Services response and plans

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Examples of Integrated Achievement

• Contributed and shaped National Strategy for
  Tele-care and Tele-Health with DoH and A Sure
  Start to Later Life with ODPM
• Contributed to and shaped National Strategy for
• non nursing case managers with DoH
• Successfully selected for the Large Scale
• Changing Workforce Collaborative with DoH
• Part of the NHS National Workforce Project on
• Maximising Staff Engagement

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Its all about
Engaging with and including local
communities Engaging with and including our
staff and partners Reforming and streamlining
our management structure Integrating our staff
into new teams in local neighbourhoods, in shared
buildings with integrated resources
Further developing and educating our workforce
Ultimately delivering services that provide best
value, Excellence , promote independence, are
proactive and preventative.
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Time for questions