VSNW Conference October 2014

Better Care and Integration

Sue Lightup – Strategic Director, Salford City Council and Chair of ADASS NW

The Better Care Fund

• A Mechanism to move money round the system – NHS and Social Care, largely from acute care into community and social care

• Recognises the interdependencies of the whole system• Responsibility of the Health and Wellbeing Board• To achieve integrated health and social care, better

outcomes and performance related• There are 7 national conditions, including a 3.5%

reduction in admissions, 7 day a week working

Better Care fund – the story so far!

• Joined up discussions• First submission – draft/early version March 14• Formal submission signed off by HWBB - April 14• Consternation – June 14• New conditions set out -July 14• All plans to be resubmitted – Sept 14• Followed by national assessment, moderation, categorisation and

staggered implementation dependent on the category assigned

• Process - Process – Process! And Painful.

What’s the point – the theory and the practice• Creating better outcomes with much less resources• Reforming Health and Social Care – locally, regionally

and nationally• Increasing personalisation and co-production• A sustainable system? • Shifting emphasis from deficit to assets base• An extended pathway of support including community

resilience• A clear sense of place

Moving on

• Strong and Effective Leadership across the whole system – individually and in HWBB’s

• Innovation• Letting go• New relationships• Much harder if you aren’t co-terminus or your hospital

hasn’t agreed, if you are in financial deficit, or special measures

• Outcomes has to be the key driver

Financial Benefits of close relationships to Salford residents• Prior to 2010 – risk pooling in joint budget reduced likelihood

of overspending – 10 years more stability than many others

• Handover of historic £6m to LD funding in 2009

• A variety of section 75 agreements

• Formal agreement to NHS funding transfer– 2011/12– 2012/13– 2013/14– Plus one off not recurrent support from PCT– Transfer of PH - £19m one of highest levels in GM– Alliance agreement in 2014

What’s been agreed to date• PSR across GM involving the re shaping of hospital

provision, primary care and council/social care.• History of strong partnership working in section 75 a

arrangements. Covers more than many other councils • Section 236 transfers in the last few years from NHS • Better Care fund and integration approach as part of an

Alliance between the Council, the CCG, Salford Royal and GMW Mental Health trust

• To achieve better outcomes for Sally Ford, an improved experience for her, and a reduction in demand, therefore cost.

Relationship with the Voluntary Sector• Interdependent • Complex• Yet rich in depth and tone• Flexible enough?• Encouraging enough?• Honest about what can be achieved?• Competitive for limited resources but still able to

challenge• Independendence

Place: Greater Manchester Health and Social Care system • 2.6 million people

• 10 local authorities • 1 Combined

Authority• 12 CCGs• 8 acute trusts with

10 A&E departments (including 3 Teaching Trusts)

• 4 NHS Trusts in the FT pipeline

• 1 specialist cancer trust

• 4 Mental Health Trusts

• 1 ambulance trust

• £6bn health & social care spend