White Paper Simon Pearce Head of Community Care Services March - - PowerPoint PPT Presentation

White Paper

Simon Pearce Head of Community Care Services March 2006

White Paper Introduction 1.

In January 2006 the Government published it’s white paper on Health and Social care titled:

Our health, our care, our say:

A new direction for community services It is paper, which covers both Social Care and Health Services

White Paper Introduction 2.

If the White Paper has a big idea it about shifting the emphasis of care from being based in Hospitals to be more centered on the community. Secondly, services need to be focused on individuals and those individuals should have choice. The Government undertook a major consultation exercise over the summer, seeking peoples views on the future of both Health and Social Care. The White Paper says 14,000 people were involved in these consultations.

White Paper Introduction 3.

The White Paper has four main goals.

• 1. “…better prevention services with earlier

intervention…”

• 2. “..more choice and a louder voice..”
• 3. “..do more on tackling inequalities and improving

access to community services.”

• 4. “..more support for people with long term needs…”

The above quotes are in bold type in the White Paper.

What is the white Paper for ?

It pulls together a policy direction for both the NHS and Social Care, although much in it is not new and for the NHS there are other policy initiatives.. Along with the Wanless review of social care budgets, Sir Michael Lyons review of Local Government and the pensions review, it is part of a strong health and social care input into the government’s comprehensive spending review in 2007. The White Paper will set the direction for health and social policy for the remainder of this Government.

What is the white Paper for ? Cont’d

It seems unlikely to be followed by legislation. Although there will be further statutory guidance. Both Local Authorities and the NHS will be performance managed on their delivery of the White Paper. It seeks to draw together the different strands of policy. It gives a strategic context to the delivery of the remainder of the 10 year NHS plan , launched in July 2000.

Social Care implications 1

Revised guidance for the Director of Adult Social Services (DASS) This is due in April 2006. the White Paper says the DASS will play crucial role in supporting transition between children’s and adults services. It seems likely that the DASS will also have a strengthened coordination role, ensuring health, social care, housing and transport work together.

Social Care implications 2

The White Paper announces that there will be a new appointment to the Department of Health Board focusing

• n social care. This post has now been advertised.

This is an increased role for social care in the national leadership of the NHS and should help to keep the social care profile at the forefront of policy.

Social Care implications 3

Direct Payments: The White Paper says the Government will both extend the scope of Direct Payments and launch a national campaign to promote them. The Government wants to see much faster growth of Direct Payments. Local Authorities will be expected to set challenging targets for the growth of Direct Payments.

Social Care implications 4

Individual budgets: This was an idea launched in the Green Paper Independence, Choice and Well-being last year. A range of funding can be drawn into an individual budget; social care funding, community equipment, Access to work, disabled facilities grant and supporting People funding. Local Authorities will effectively “hold “ this account, which the service user can draw down. There are major implications for many aspects of social services: assessment as well as provision.

Social Care implications 5

Individual budgets… continued. There are now 12 pilots across the country for Individual budgets. These will be evaluated with a possible national implementation of the scheme by 2009/10. When the Government consulted on these personalisation issues last year there were concerns expressed about managing risk, so the Government has announced that it will seek “..to develop national approach to risk management in social care….over the coming year.”

Wider Implications for the Council

The White Paper has implications for other Council Departments: The prevention agenda and basing more care in the community will engage councils in helping to: Promote healthy living – through diet and exercise. Coordinate transport policies to facilitate access to services. Develop new housing options for older and disabled people. Promote partnerships with health and the voluntary sector. To play the lead role in coordinating Local Area Agreements, LAA’s.

NHS Implications 1

There are a wide range of implications for the NHS in the White Paper, but it is not the exclusive policy vehicle for the forthcoming changes in the NHS. There has been the announcement on commissioning a patient led NHS in the summer of 2005 and a range of other policy initiatives, such as choosing Health. The White Paper picks up many of these themes, but there are other policy initiatives in the NHS, such as payment by results, PBR and practice based commissioning PBC.

NHS Implications 2

Practice Based Commissioning: One of the major changes to the NHS is the development of Practice based commissioning. This will see responsibility for commissioning services shift to GP’s. This is seen as a way offering more choice, better value and shifting services closer to where people live. There is separate, extensive guidance on Practice Based commissioning (PBC).

NHS Implications 3

Practice Based Commissioning…..plus PBC is only one of range of measures within the NHS, which pre- date the white Paper, which seeks to incentivise the NHS, or introduce quasi-market mechanisms. These major changes underpin the White Paper and seek to create a more responsive and efficient NHS, which puts the patient at the centre of care. There is a growing literature, which examines the potential impact of these changes. Some of this is on the Community Care Intranet.

NHS Implications 4

NHS Life Checks: The White Paper announced that these would be

• created. It will come in two parts ; a self assessment and

some expert advice. They will be available on-line. They will be developed by

• 2007. They will be voluntary.

Development ill take place first in areas where there is the worst general health. The Life checks will seek to integrate with wider local strategies.

NHS Implications 5

Mental Health: The Government will seek improve public understanding of Mental Health Issues. Two Demonstration sites for psychological therapies will be chosen with a view establish an evidence base for the effectiveness of these services for people with moderate to severe mental illness, to enable working age adults to remain, or return to work. More on-line solutions to health problems will possibly be explored by the extension of computerised cognitive behaviour therapy CCBT, although the Government is awaiting NICE (National Institute

• f Clinical Excellence) approval.

NHS Implications 6

Community Hospitals: Part of the aim to deliver care closer to home has led to a re-think about the future of Community Hospitals. The NHS is strongly encouraged to look sympathetically and creatively on the future use of Community Hospitals. Tackling areas of persistent deficit. The White Paper says that areas where the NHS money consistently is in the red will have external help in developing models of “service reconfiguration” to ensure stable finances. These have been reported in the Press as turnaround teams.

Joint NHS and Social Care Implications 1

It known that there was some debate whether to have one White Paper covering social care and health, or to have two white papers,

• ne for each. In the end the Government came down on the side of

having one white Paper. The Government continues to see further integration of health and Social Care in the future. However, how this will happen is less clear than it was a few years ago when it was anticipated by many, that social and primary care would merge. The desire for better integration and coordination remains, but there are few new mechanism to do this. Possibly Local Area Agreements and an expectation that the NHS and Local Authorities develop more joint teams.

Joint NHS and Social Care Implications 2

Budget and Planning cycles together by 2007: The different budget and planning cycles of Local Government and the NHS have been a barrier to integration for a long time. This will be a major undertaking the White Paper says: “Therefore, working across departments, the Government will align the planning and budgeting cycle for the NHS with the timetable for local government planning and budget setting, making a start in 2007/08.”

Joint NHS and Social Care Implications 3

Budget and Planning cycles together by 2007..cont’d What this means is as yet unclear. To fully harmonise the budget and planning is likely to take longer than 2007/08. With practice based commissioning becoming increasingly important joint planning between Local Authorities and PCT’s will be more complex. There are a host of other differences between NHS and LA finance systems : different end of year practices, different powers in relation to VAT etc, it is not clear whether these two will be brought together.

Joint NHS and Social Care Implications 4

Joint Teams: “By 2008 we expect all PCT’s and local authorities to have established joint health and social care managed networks and /or teams to support those people with long-term conditions who have the most complex needs.” The white paper is very clear in the drive for the development of these teams or networks. In this area RBK has already made excellent progress, with the joint Health and Social Care Teams for Older People and joint teams in Mental health.

Joint NHS and Social Care Implications 5

Joint Teams… cont’d: There remain some challenges though. We still have work to do for adults under 65. Will the current PCT changes due to financial difficulties and Practice Based commissioning support the development of the integrated model? There is a question whether the new quasi-market mechanisms in the NHS will support the development of integrated models of care with Local Authorities.

Joint NHS and Social Care Implications 6

Strengthened role of DPH – Director of Public Health. The white Paper plans a enhanced role for directors of Public Health and encourages, but des not require, joint PCT/LA appointments. Improved information In 2006 the Department of health will review information for both health and social care. This will lead to a pilot site, LA and PCT providing joint integrated information.

Joint NHS and Social Care Implications 7

End of life care networks (hopefully joint) The white Paper is explicit here, announcing the establishment of end of life care networks. There is a recognition that agencies need to work together better, to improve care and support for carers. There is a recognition that more people want to chose to die at home. There will be investment in rapid response palliative care services.

Joint NHS and Social Care Implications 8

Health Care Commission and CSCI The government has already announced plans to merge these two regulatory bodies. The white Paper doesn’t give any more detail on this. By 2008 the two performance management systems will be synchronised. Both bodies will place a greater emphasis in ensuring that there is stronger commissioning.

Commitment Key milestones 1

NHS ‘Life Check’ • Develop on-line self-assessment –2006/07 Pilot NHS ‘Life Check’ in spearhead PCTs – 2007/08 Announcement on national demonstration sites for psychological therapies for mental health • During 2006 Director of Adult Social Services (DASS) new guidance issued to local authorities • April 2006: Align budget cycles between health and local government • 2007/08 New QOF measures for health and well-being incorporated • 20008/09 PCTs to take action on poor provision • With immediate effect PCTs invited to participate in national procurements • Summer 2006

Commitment Key milestones 2

Guaranteed acceptance on an open list and streamlined registration rules • Begin in 2007/08 Changes to ‘closed list’ rules • Effects from 2007/08 Obligation on PCTs to provide detailed information on hours and services as well as new services • Available in 2007/08 Review of PMS funding arrangements • Report in early 2007 New Expanding Practice Allowance • To be considered during 2006/07 PCTs offering more responsive opening hours• 2007/08 Extend scope of direct payments • As parliamentary time allows Roll-out of individual budget pilots • Impact immediate – 2006/07

Commitment Key milestones 3

National bowel screening programme • End 2006 Development of an urgent care strategy • End 2006 Improving choice and continuity in maternity services • In place by 2009 End of campus provision for people with learning disabilities • By 2010 End-of-life care networks • In place by 2009 Information prescription for all with long-term or social care needs • By 2008 Establish an information service/helpline for carers (or delegate to a voluntary organisation) • By 2007/08

Commitment Key milestones 4

Short-term home-based respite support for carers in place full implementation by 2007/08 • Begin implementation in 2006, Personal Health and Social Care Plans for those with both social care needs and a long-term condition • In place by 2008 Joint networks and/or teams for management of health and social care needs between PCTs and local authorities • Establish by 2008 Demonstration project to reduce A&E admissions on 1 million patients • Project commences in 2006 • Share findings in 2008 Demonstration sites in six specialties to (time of study define appropriate models of care 12 months)• 2006/07

Commitment Key milestones 5

PCT local delivery plans not approved unless a clear strategy for shifting care is a major component • Protocol in place by 2008 Establish an expert group on preventative health spending • End 2006 Details on timing and tender process for new generation

• f community hospitals • Summer 2006

PCTs demonstrate they have followed proper processes

• n future of community hospitals • With immediate effect

Commitment Key milestones 6

New turnaround teams for service reconfiguration with focus on tackling causes for local imbalances • Begin in 2006 Un-bundle tariff • From 2007/08 Extend to community setting • 2007/08 Best practice tariff • As early as possible Review of surveys to determine how to make them more effective in the future • Autumn 2006 National commissioning framework • First part in summer 2006, subsequent parts later in 2006 Develop ‘local triggers’ relating to public satisfaction and service quality by autumn 2006 • Consult in spring 2006, guidance by autumn 2006

Commitment Key milestones 7

Establish social enterprise fund to provide support for third-sector suppliers wishing to enter the market • Establish from April 2007 Review of Public and Patient Involvement • By 2006 Revised commissioning assessment of PCTs and local authorities • During 2006 Comprehensive single complaints system • By 2009 Synchronise joint performance management systems• By 2008 Review provision of health and social care information • End 2006 Information pilots – to determine how best to join up health and social care information • Pilots to begin in 2006 Develop and pilot new practitioners with special interest roles• 2007/08