Our health, our care, our say

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• Our health, our care, our say
• Strengthening Commissioning
• Ronan Segrave, Project Manager
• Older People and Disability Division,
• Care Services Directorate, Department of Health

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Structure

• Vision
• Enabling well-being
• Access
• Support
• Care closer to home
• People in Control
• Making change happen

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Based on

• Independence, Well-being and Choice
• Your Health, your care, your say
• Links to other policies particularly Choosing
  Health

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People want

• Personalised services meeting individual needs
• Support for healthier, independent lives
• Promotion of well-being
• Better support for those with high level needs
• Services shifted to local communities

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• Emphasis on
• Prevention, public health and well-being
• Tackling inequalities
• More focussed support for people with long-term
  conditions
• More services provided outside of hospitals,
  closer to home

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What we will do (1)

• Help people to make choices and take control by
  understanding their own health and lifestyle
  better, with more support on prevention and
  promoting their independence
• Pilot new NHS Life Check starting with PCT
  spearhead areas help people at critical life
  stages assess their lifestyle risks and the right
  steps to take
• More emphasis on mental illness and support to
  deal with isolation and depression pilots for
  older people demonstrator sites for
  psychological therapies for people of working age
  
• Direct Payments new legislation to extend to
  currently excluded groups
• Individual Budgets pilot bringing together
  several income streams, giving people greater
  control over the type of support or care they
  want
• Improve information information prescription
  to help people maintain their own health and
  choose appropriate services when they need them
• Grasp the opportunities of the 2012 Olympics
  through a Fitter Britain

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What we will do (2)

• Offer people easy access to help when they need
  it, in a way that fits their lives
• New initiatives to support carers
• an information service/helpline for carers
• Establish in each council area short-term,
  home-based respite support for carers in crisis
• fund the creation of an Expert Carers Programme.
• Give patients a guarantee of registration onto a
  GP practice list in their locality
• Make it easier for people to get the information
  they need to choose a GP practice and know what
  health and local authority services are available
  in their area
• Provide incentives for GPs to work in areas that
  are under provided for at present this might
  include introducing new providers
• Improve access to GP practices more flexible
  opening hours easier to make appointments

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What we will do (3)

• Meet the whole of peoples needs and support
  their well-being and health, not just focusing on
  sickness or an immediate crisis
• Support self care treble investment in the
  Expert Patient Programme
• Strengthen role of a Director of Adult Social
  Services widen role of Director of Public
  Health more joint appointments
• Health and social care jointly responsible for
  understanding the needs of their communities and
  providing the right services to prevent ill
  health and support independent living
• Develop a common assessment framework to ensure
  less duplication across different agencies and
  allow people to self-assess where possible
• Establish end of life care networks, building on
  the pilots being undertaken with Marie Curie and
  other innovations

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What we will do (4)

• Provide care closer to where people live,
  provided these services are also safe and
  cost-effective
• A fundamental long term shift from hospitals to
  community facilities, and from institutional to
  home-based care.
• Pilot outpatient appointments for common
  conditions such as dermatology in the community
  (work with Royal Colleges to ensure the shift is
  based on best clinical practice)
• Encourage existing community service providers
  to take on more practitioners with a special
  interest
• A new generation of community hospitals to
  provide a wide array of non-urgent services in a
  community setting

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Strengthening Commissioning - System reforms

• Develop outcomes which apply to both NHS and
  social care, implemented through Local Area
  Agreements
• Regular strategic needs assessments to be
  udertaken jointly by the DASS and DPH enabling
  local services to plan ahead for the next 10 to
  15 years
• Align performance measures, assessments and
  inspection
• Align planning and budget frameworks between
  health and local authorities
• Strengthen local commissioning, shifting towards
  prevention and early support PCTs and LAs
  Practice based commissioning and Individual
  Budgets
• Unbundle the tariff
• Clarify roles of social enterprise, not for
  profit and independent sector providers

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Strengthening Commissioning stronger social
care markets

• National Commissioning Framework
• Recognition that in some areas, there are weak
  and fragile social care markets
• Lack of a long-term, co-ordinated, strategic
  procurement of services
• In some areas, lack of contestability
• Too many short-term contracts that hinder
  providers from making long-term investments
  required to raise quality
• Pressing need to deliver greater
  standardisation through procurement and
  contracting in order to reduce bureaucratic costs
  to both commissioners and providers
• Commitment to develop a procurement and best
  practice guidance to underpin key aspects of the
  commissioning framework.

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Conclusion

• Major strategic shift to meet future challenges
  peoples future needs (the way people live their
  lives demographic change), grasp new
  opportunities (new technologies)
• Implementation driven locally enabled nationally
• Chapter 9 high level implementation plan to 2008
• Now working on more detailed planning.

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• Individual Budgets
• Where we are

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Some background

• Policy Commitment to piloting individual budgets
• Improving the Life Chances of Disabled People
  (Strategy Unit, January 2005)
• Opportunity Age (Department for Work and
  Pensions, March 2005)
• Independence, Well-being and Choice (Department
  of Health, March 2005)
• 13 pilot authorities chosen
• Barnsley -Lincolnshire
• Barking Dagenham -Leicester
• Bath NE Somerset -Norfolk
• Coventry -Manchester
• Essex -West Sussex
• Gateshead _Kensington and Chelsea

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Why Individual Budgets?

• Putting people in control over the support they
  receive
• Tailoring support to an individuals needs not
  just what is available
• Building on the
  finding ways to
• best features of whilst overcome
  some of
• Direct payments the
  barriers

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What are individual budgets?
Inclusion of a range of funding streams and
benefits
Streamlined process for assessing need
Individual Budget
Different types of advocacy from different
providers
Transparent process for allocating resources
Individual works out content of support package,
with brokerage as necessary
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What is included?

• The pilot project will test the inclusion of a
  range of income streams
• Council provided social care services
• Supporting People
• Disabled Facilities Grants
• Integrated Community Equipment Services
• Independent Living Fund
• Access to Work
• and, along with older people, the pilots will
  support
• People with physical disabilities
• People with sensory impairments
• People with learning disabilities
• People with mental health needs
• Young people undergoing transition

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Current position

• Pilot sites are starting to come on stream
• West Sussex already begun pilot for older people
• Other pilot sites will begin before June 06
• Will run for about 2 years
• Evaluation
• Does the individual budgets approach deliver
  benefits for people who use services?
• Can it be delivered within existing resources?
• Implementation
• Pilots being delivered by the Care Services
  Improvement Partnership

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Recognise need to stimulate social care market..

• We are exploring ways in which we can support
  this that recognises value small providers can
  bring and enables new market entrants.
• Need to explore new ways of commissioning
  services such as partnership/agency/collaborative
  models and the use of Community Interest
  Companies
• Care brokerage
• Potential learning from other sectors/industries
• Focus on customer driven solutions

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Gershon concerns..

• DH established Care Services Efficiency Delivery
  Programme to support councils in achieving
  Gershon efficiency targets
• CSED taking an end to end approach not just
  looking at commissioning/procurement
• CSED now sits within CSIP and its work will
  support White Paper implementation
• While at least 50 of efficiencies must be cash
  releasing, quality improvements can count as
  efficiencies
• The focus is on better/smarter not simply
  more/faster