Agenda item

To consider a report of the Director of Adult Social Services providing an overview of the principal integration initiatives currently underway between Leeds City Council, Adult Social Services and colleagues form the NHS family of organisations in the City

(report attached)

The Board considered the first of a series of four reports relating to the integration of health and social care services

Members considered a report of the Director of Adult Social Services providing an overview of the principal integration initiatives currently underway between Leeds City Council (predominantly through Adult Social Services) and colleagues from the NHS family of organisations within the city.  Appended to the report was a document from The King’s Fund relating to integrated care for patients and populations

Attending for this item were:

• Dennis Holmes (Deputy Director) – Leeds City Council, Adult Social Services
• Matt Ward (Associate Director of Commissioning) – NHS Airedale, Bradford and Leeds

Dennis Holmes outlined the background to proposed integration and stressed this was something which was being considered by Local Authorities and NHS Trusts throughout the country.  It was highlighted that work in this area was seeking to address two fundamental issues, namely:

• Improving patient/service user experience – reducing duplication and providing seamless interactions with a number of different health and social care professionals
• Making better use of public money – through more integrated working arrangements, making better and more efficient use of available resources

It was emphasised that alongside the desire for better patient care and experiences, the current financial circumstances being faced by a number of public organisations had been a significant driver, leading to greater focus on public funding and how this could be made to work better for patients and reduce duplication

Whilst there were different levels of integration, one of the key challenges for Elected Members would be around governance issues and how Councillors could exercise their democratic role in this area, with the importance of this being stressed as a key to success

Over recent years, it was reported that, on a national level, significant challenges around funding streams and governance arrangements had led to a general stagnation around health and social care integration

Members commented on the report, with the main issues discussed being:

• Terms and conditions of employment, given that the Council and NHS operate different pay and grading structures and how potential tensions this could cause would be addressed

It was reported that one of the biggest impediments of structural integration was the different working structures in the two organisations, with the view that full integration was possibly undesirable, particularly as this stage, as the focus of the service would be on staffing issues.  Therefore, it was proposed to bring staff into the integrated structure while maintaining continued employment with their current employer.  Arrangements would be maintained until further consideration could be given to if and how, full integration could take place

It was also reported that both organisations had strong Trade Union representation and that there was a commitment to maintaining working conditions

• How the success of integration would be measured

In response it was stated that success would be measured in different ways.  In terms of Adult Social Care, there was an acceptance that integration would lead to less time being spent in hospital by older people through the provision of a better health and social care system

Concerns were raised that the measurements of success related to older patients but there were no details of how younger patients with long term health conditions would benefit from integration

Officers responded that initially older people were the priority in terms of service integration, as they represented the biggest group of service users accessing these services

• The need to ensure that the correct levels of support were in place when tackling early discharges to avoid readmission

It was outlined that further work would be required to ensure that health professionals considering early discharge would have knowledge of the services which would be provided to the patient in terms of aftercare to better inform that decision

• The approach towards joint commissioning, in addition to integrated service delivery

It was outlined that there was a greater commitment to viewing public money as a single source, rather than in terms of Council funding and NHS Leeds funding.  As such, regular meetings between the financial directors of both organisations were taking place

• The relationship between local arrangements and national policy, including the Health Bill which was currently progressing through Parliament

It was reported that the local proposals around service integration were considered to be appropriate from both a patient care and experience perspective and from an organisational perspective, regardless of the proposals contained in the current Health and Social Care Bill

RESOLVED -  a) To note the report and associated information provided at the meeting

  b) To welcome the ambition and commitment demonstrated at the meeting while recognising the significance of the likely challenges ahead

  c) To maintain an overview of progress of the developments in general and any specific matters that may arise in the future