Integration of Health and Care Transformation Programme
Councillor Christine Jones, Cabinet Member for Adult Social Care, said:
“The people of Wirral told us that they want improved and more fully integrated services in relation to health and care.
They want to tell their story once; they want one number to call and to receive a properly co-ordinated response to their care and support needs.
To this end we are bringing together community nurses, community matrons, social workers and therapists in four areas clustered around GP practices to work as one service to support people in their local communities.
The aim is to deliver the right care, in the right place, at the right time, in order to ensure that our residents are able to be as independent as possible but get access to important health and care services when they need them”.
Councillor Phil Davies informed that Paddy Cleary Wirral UNISON’s Branch Secretary had asked if he could address the Cabinet on this item of business and he had given him permission.
Mr Cleary thanked the Cabinet for allowing him to speak on behalf of the members of Wirral UNISON. He made clear that it was because of the Government’s austerity measures that public services were under constant attack. The reduction in grant funding meant that UNISON would become solely reliant on the income it could generate and the subscriptions paid. However, Mr Cleary was concerned because he perceived that the Council had not communicated or consulted with UNISON on the reports the Cabinet were considering at the meeting.
Mr Cleary informed that prior to receiving this Cabinet agenda UNISON had a workable relationship with the Council’s leadership through challenging times and some resolutions had been agreed and difficult decisions had been made. UNISON had been promised that it would be consulted on alternative delivery models and future provision of services. Mr Cleary was disappointed that this now did not seem to be the case with items on the agenda for this meeting. He was disappointed that a political party that the union was affiliated to had not provided UNISON with the same opportunities it had provided to consultants and other outside agencies whose ultimate agenda was not in the best interests of UNISON members and did not put Wirral residents first. Mr Cleary informed that he found it insulting that consultants could address the Labour Group and share information whilst UNISON was prevented from doing so. He also found it insulting that managers, staff and Trade Unions were not involved in scrutiny groups.
Mr Cleary reported that UNISON was not opposed to the concept of integration but it was concerned about the terms and conditions that its members were actual transferring across to the Trust on. He informed that time and again, the union had battled to defend the terms and conditions of its members. His view was that the labour council should honour these terms that had been negotiated and fought for.
Mr Cleary also informed that UNISON was pleased that its members were transferring to the Trust would remain members of the Merseyside Pension Fund but it did have concerns about a two tiered workforce and the problems associated with that. This could create division between colleagues. The union also had major concerns about future pay rises for its members. Staff had suffered a real time pay cut since 2010, due to the Government, of up to 15% and it was vital that union members remained part of the national negotiating framework for all future pay rises. He considered that this should form part of the contract and, as the leadership was aware, UNISON had continually asked for an ethical element to be attached to any contract the Council entered into, that protected the terms and conditions of staff.
It was noted that he protection of social care professionals and ethos, integrity of the social care model and framework still gave UNISON cause for concern. UNISON had concerns about how staff would be professionally regulated, protected, valued and also represented going forward. It still believed that future meaningful consultation needed to take place on these issues and Mr Cleary requested a delay in the implementation date until satisfactory resolutions were found.
Councillor Chris Jones then introduced the report which followed an earlier Cabinet report to the meeting on 16 January 2017 (Minute No. 85 refers.). It covered two elements of health and care integration. The two elements were; the direct delivery of social care statutory assessment and support functions and the planning, funding and commissioning arrangements for health and care.
Members noted that the Cabinet’s approval was being sought for the commissioning of specific delegated functions through the formation of an integrated health and social care assessment and support planning service for older people and adults. In addition, in relation to commissioning, permission was sought to progress the development of a single commissioning organisation with the CCG. It was also sought for the commissioning of a due diligence exercise to fully understand the potential benefits and risks of pooling resources with the NHS.
The Cabinet noted that Social Care Services played an important role in enabling vulnerable people to maintain independence and keep well in Wirral. The cost of adult social care was, however, significant and it did not operate in isolation. The inter-dependency between health and care systems had become increasingly clear over recent years. Nationally, Councils were being faced with increasing demand on Social Care Services which presented as a challenge to meet within the available resources. Local Authorities and NHS providers were increasingly working to integrate Social Care and Health Services locally to provide both sustainability and a better experience for people who used those services.
The key proposal was to integrate the statutory frontline assessment and support planning processes in order to contribute to meeting the challenges of growth and demand, and provide an improved service for local residents. The integrated front line service would deliver the assessment and support planning function for older people and adults on behalf of the Council under a contractual arrangement. The proposal was that this service would be provided by the NHS Wirral Community Foundation Trust (WCFT) who provided community health services in Wirral. This would involve the transfer of social care staff to the NHS in order to provide joined up seamless health and social care delivery services for older people and adults. A separate proposal for an all age disability, and all age mental health integrated service was planned for 2018.
In addition, the further proposal was to create an integrated commissioner for health and care on Wirral. This would enable services to be commissioned through a single organisation fulfilling the statutory health and care functions of the Council and the Clinical Commissioning Group (CCG). It would also enable strategic outcomes to be effectively delivered through a single planning framework and structure. This single commissioner initiative would enable the health and care system to use Wirral’s resources together to jointly create a sustainable health and care system. Commissioning would provide system leadership and a focus on outcomes for people alongside the accountable care delivery arrangements that were emerging for Wirral.
The report also set out key aspects of the integration programme which was focussed on improving outcomes for residents with the aim of delivering the right care in the right place at the right time.
The Cabinet noted the Key Strategic Outcomes to be delivered through this initiative which were as follows:
Wirral Plan Pledge 1: Older People Live Well
The integrated teams would provide timely local responses and personalised care, supporting people to live as independently as possible, avoiding unnecessary admissions to hospital or to care homes.
Services would be commissioned across health and care to get the best outcomes for people within available resources.
Wirral Plan Pledge 6: People with disabilities live independently
The majority of people with disabilities would be supported by the Integrated Care Co-ordination Teams, with a later project to develop an Integrated All Age Disability and All Age Mental Health Service.
Wirral Plan Pledge 16: Wirral Residents live healthier lives
Services would be commissioned on a whole system basis ensuring that there was a clear link between the 2020 partnership pledges and the Healthy Wirral Programme. The Integrated Care Co-ordination Teams would continue to develop pathways and working arrangements in line with the key strategic objectives of the above programmes.
Councillor Chris Jones informed that care services were very important, the cost of adult social care was significant and the Government was under funding social care across the board. She also informed that this was one of the biggest projects the Council was under taking. Councillor Jones told Mr Cleary that she was disappointed about his comments and that the Council was doing all that it could in respect of staff pensions.
Councillor Jones thanked Council and Clinical Commissioning Group Officers for the work they had carried out to get to this point and informed that she would not be recommending a delay because it was vital that the full transfer of the relevant staff to the employment of WCFT, under TUPE arrangements was carried out on 1 June 2017.
Councillor Ann McLachlan informed that the report was in the first phase of a plan to bring budgets and staff from the Council and the WCFT together to deliver the services. She also informed that the transfer of staff and integrated service for Older People did not achieve any additional budget savings directly. Some reductions had already been applied to this area - £500k in 2016-17. In addition there was an outstanding balance of savings of £700k which was anticipated in 2017-18.
Councillor McLachlan also informed that the second phase would include the full business case being presented to the Cabinet at its meeting in September 2017. Updates would be reported to the Transformation Board. All risks would be considered and mitigated to ensure the aims of the integrated commissioning hub were achievable.
Councillor McLachlan reported that the integration project had been designed to ensure that the new delivery model ensured that people received the Right Care in the Right Place at the Right Time. It aimed to reduce the growth burden to the Council’s net revenue funding based on more joined up working, managing demand and reducing the cost of care. The Council would retain robust accountability and governance arrangements through a formal contractual relationship with the WCFT. Performance would be closely monitored to ensure contract compliance and delivery of outcomes.
Councillor McLachlan informed that the project had been delayed from 1 April 2017 to 1 June 2017 so that staff pension arrangements and terms and conditions of employment could be scrutinised. The NHS Pension Scheme was not as good as the Merseyside Pension Scheme and staff would TUPE over on their current terms and conditions. The Council had principles around fairness but it was unable to guarantee what would happen in the future. It could not dictate to other organisations but it was doing its level best to ensure job protections into the future.
Councillor Phil Davies informed that he was surprised that UNISON did not feel properly engaged with this project. There were financial benefits associated with it and he asked the Cabinet to note paragraph 3.1 of the report as follows as there were benefits to integrated care, it was addressing a key issue that would improve the service:
‘Delivering the Right Care in the Right Place at the Right Time: Services can be developed more effectively to meet the needs of local residents. With social care and health staff working within one organisation it is possible to streamline assessment processes, reduce duplication of multiple professional involvements, and develop a single point of access and single social care and health support planning. This first tranche of fully integrated provision covers non specialist aspects of social care provision delivered within community teams primarily for older vulnerable people.’
Integrated Care Teams
(1) the delegation of relevant assessment and support planning functions to WCFT under contract be approved;
(2) the full transfer of the relevant staff to the employment of WCFT, under TUPE arrangements with a transfer date of 1st June 2017 be approved;
(3) the associated s75v agreement, and contract value be approved;
(4) the arrangements for pensions be approved;
(5) the arrangements for corporate and back office support as detailed within the contract and specification be approved;
(6) the Cabinet Member for Adult Social Care, supported as necessary by the Director of Health and Care, the Head of Legal Services and the Head of Financial Services, be authorised to agree any final outstanding contractual matters.
Single Integrated Commissioner for Wirral
(7) the further development of a single integrated health and care commissioning organisation for Wirral to undertake statutory health and care commissioning functions of the CCG and the Local Authority be supported;
(8) a due diligence exercise be undertaken to explore in more detail the relative benefits and risks of fully pooling LA social care and CCG healthcare funding; and
(9) a further report in relation to pooled funds (post due diligence) be presented to the Cabinet at its meeting in September 2017.
- Integration of Health and Social Care Report FINAL, item 111. PDF 192 KB
- Appendix 2 - Integration Health and Care Overview Scrutiny Report, item 111. PDF 174 KB
- Appendix 4 - Integration Health and Care Partnership Governance Chart, item 111. PDF 64 KB
- Appendix 6 - Integration Health and Care Operating Model, item 111. PDF 444 KB
- Appendix 8 - Integration Health and Care List of Service Level Agreements, item 111. PDF 194 KB