The North East Lincolnshire Care Trust Plus

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 Childrens Services into a
  Childrens 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

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 Childrens 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
Childrens Trust

• Every Child Matters Establishment of
  Childrens 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 Pooled fund 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 Trusts
  business at Board level)
• Partnership Undertakings
• - to operate in a manner that contributes to the
  delivery of each partners 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