NHS Education for Scotland. Board Paper Summary NES/11/98. October Title of Paper. Health and Social Care Integration and Partnership

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1 NES Item 8e October 2011 NES/11/98 (Enclosure) NHS Education for Scotland Board Paper Summary 1. Title of Paper Health and Social Care Integration and Partnership 2. Author(s) of Paper Bob Parry, Associate Director: Nursing and Midwifery, NMAHP 3. Purpose of Paper The aim of this paper is to update the NES Board on recent developments regarding the Health and Social Care Integration agenda and to discuss NES contribution and direction of travel. 4. Key Issues The recent Scottish Government publications Priorities for Reform in Response to the Christie Commission have highlighted the progressive integration of health and social care. Emerging messages for an integrated health and social care service include national agreed outcomes, joint commissioning is seen to be crucial with one person accountable for operations delivered using a few models determined locally. The potential of a reformed CHP model to deliver change with revised governance are being discussed has is the requirement for wholesale culture change to the system. 5. Educational Implications The underlying assumption is that a workforce that learns together works together and that shared common goals and values will produce better outcomes for individuals and communities. NES/SSSC are already working together through the plethora of policy directives supporting education and training of the health and social care workforce with both organisations keen to do more. 6. Financial Implications The NES Business Group through Operational Planning 2012 / 13 will be requested to financially support NES work in delivering on the Scottish Governments health and social care integration agenda. This requested shift in budget is in line with territorial 1

2 NHS Boards requirement to significantly shift budgets to support the reshaping of care services. 7. Which NES Strategic Objectives(s) does this align to? In respect to the alignment with the NES strategic themes and objectives the following are addressed: Strategic Themes Education to create an excellent workforce Improving quality Reshaping the NHS workforce Developing innovative educational infrastructure Strategic Objectives We will deliver consistent evidence-based excellence in education for improved care We will continue to build co-ordinated joint working and engagement with our partners We will develop our support for workforce redesign We will support education in partnership that maximises shared knowledge and understanding We will develop flexible, connected and responsive educational infrastructure which covers people, technology and educational content 8. Impact on the Quality Ambitions Currently all the health and social care workstreams address the three quality ambitions in the NHS Healthcare Quality Strategy. 9. Key Risks and Proposals to Mitigate the Risks Risk Lack of strategic support for health and social care partnership working may give rise to reputational damage Dysfunctional partnership working Plans to mitigate Joint strategic leadership demonstrated by all parties Opportunities to promote joint partnership working at all times Engagement with health and social care workforce Agreed joint plans which clearly detail areas of responsibilities Equality of partnership Communication strategy Valuing each others unique contribution 2

3 10. Equality and Diversity Impact Assessment Please select one of the boxes Impact Assessment is not required at this stage because: Equality and Diversity Impact Assessment has been planned (briefly summarise your arrangements for undertaking the EQIA): Rapid Impact Assessment completed* Full Impact Assessment completed* Impact assessments for individual work streams have been completed as appropriate. 11. Communications Plan A revised communications plan is currently being developed between NES and SSSC and NES and IRISS. The Head of Communications is involved in developing the revised plan Yes No 12. Recommendation(s) for Decision The Board is invited to: 1. Note and discuss the content of this paper 2. Consider further engagement with social services colleagues to support health and social care integration and partnership. 3. Endorse the proposed recommendations for Operational Planning 2012 /13 NES October 2011 BP 3

4 Health and Social Care Integration and Partnership 1. Introduction The aim of this paper is to provide the NHS Education for Scotland (NES) Board with an update on the integration / partnership landscape of the health and social care agenda. An overview of the current Scottish Government direction of travel is presented which provides the Board with an opportunity to discuss NES contribution to partnership and integration and in addition endorse the actions contained within the recommendations. The paper is presented five sections which are: 1 Introduction 2 Background and Policy Context 3 Key Workstreams NES/SSSC 4 Outcomes and Challenges for Partnership Working 5 Recommendations 2. Background and policy context A paper presented to the NES Board in March 2011 Strategic Joint Working between NHS Education for Scotland (NES) and the Scottish Social Services Council detailed an update on joint working between NES and SSSC. The workstreams centre around the current major policy initiatives including: Reshaping Care for Older People A Programme for Change , Scotland s National Dementia Strategy 2010, Caring Together: The Carers Strategy for Scotland and the Early Years Framework. Within the health and social care agenda the NES / SSSC partnership is well recognised and acknowledged by Scottish Government and is cited in the Scottish Governments Renewing Scotland s Public Services Priorities for Reform in Response to the Christie Commission (September 2011). The partnership continues to strengthen whilst maintaining recognition of each others unique contribution of professional boundaries, skills and values. 2.1 Policy Context The Christie Review and the Scottish Government Response The Commission on the Future Delivery of Public Services (The Christie Review: June 2011) clearly documented that public service providers must be required to work much more closely in partnership to integrate service provision and thus improve the outcomes they achieve. The future configuration of public services in the wake of the Christie Review is currently unravelling with the publication of the Renewing Scotland s Public Services Priorities for Reform in Response to the Christie Commission (September 2011) which details the four pillars of the Governments response:- (i) (ii) a decisive shift towards prevention greater integration of public services at a local level driven by better partnerships, collaboration and effective local delivery 4

5 (iii) (iv) greater investment in the people who deliver services through enhanced workforce development and effective leadership and a sharp focus on improving performance, through greater transparency, innovation and use of digital technology. Within the four pillars priorities for parliament have been identified and those that will have impact on health and social care partnership for NES in particular; (i) Preventative new legislation that supports councils, the health service and government to deliver early years services and to see early years education as an essential part of the learning journey and ensure the Getting it Right for Every Child (GIRFEC) approach is developed nationwide (ii) Integrated Local Services includes supporting Community Planning Partnerships and Single Outcome Agreements, new Change Fund for NHS Boards and local authorities to invest in partnership to redesign services, new approaches to services, closer joint working between GP s, Pharmacists and other Community Services and legal duty to work together and place the child at the centre of service delivery (iii) Workforce and Leadership NES and SSSC are cited as driving workforce and leadership development across the whole of the social services workforce, in particular through the work of the SSSC and through supporting collaborative approaches to workforce development between all of the key delivery agents NES, SSSC, employer bodies, employers and education and training bodies and (iv) Improving Performance continuation of Scotland Performs and the reduction of running and management costs. Within this paper the Government commits to enhancing the capability of the workforce and will continue to invest in workforce engagement and development and to support leadership collaborations across public service organisations. Growing mutual understanding and shared purpose breaks down barriers between organisations and frees the frontline to respond directly to the needs of individual service users Review of Community Health Partnership The Review of Community Health Partnerships (Audit Scotland June 2011) identified that partnership working for health and social care is challenging and requires strong, shared leadership by both NHS Boards and Councils. Differences in organisational cultures, planning and performance and financial management are barriers that need to be overcome. CHPs governance and accountability arrangements are complex and not always clear. It was further identified that joint workforce planning for health and social care staff is limited. The number and skill mix of health and social care staff required are likely to change in the future in response to planned service changes. Currently NHS Boards and Councils have their own separate workforce plans. Within Renewing Scotland s Public Services Priorities for Reform in Response to the Christie Commission (September 2011 p13) states we will look to leaders of Community Planning Partnerships across Scotland to disrespect boundaries between public services and focus on achievement of shared outcomes and cross-sectoral workforce development strategies The Healthcare Quality Strategy and Delivering Quality in Primary Care National Action Plan for Delivery in Primary Care The Healthcare Quality Strategy for NHSScotland (2010), and Better Health, Better Care (2007) emphasise the need for care to be safe, patient-centred and effective in 5

6 every intervention, every time and these policy documents acknowledge the NHS workforce as pivotal to achievement of these aspirations and challenges. In addition, the current economic environment and future forecasts highlight the need to deliver best value across the whole workforce. The Delivering Quality in Primary Care National Action Plan emphasised the central role of Primary care in developing the NHS Healthcare Quality Strategy and detailed 11 actions and the NES Board Paper Delivering Quality in Primary Care (DQPC) The SGHD National Action Plan and the NES Educational Support provided an overview of NES educational activities relating to Primary Care. Inevitably these policies will impact upon integrated services across health and social care as the demands will require respective workforces to ensure they are prepared to function and migrate across boundaries Integration of Health and Social Care A number of meetings over recent weeks have been convened by Graeme Dickson, Director of Integration and Service Development, Scottish Government to contribute to the development of the Scottish Government policy framework to progress the integration of health and social care. The meetings have focused on a range of issues including integration, outcomes, and governance arrangements. Emphasis was placed on consistency of approach across the country with someone being clearly accountable for delivering agreed outcomes. NES has participated in discussions at these events. Key themes and issues emerging from the events included: the importance of national agreed outcomes: the need for clearer accountability; only a couple of models of service delivery are required to promote joint commissioning plans; learning from the use of the Integrated Resource Framework ; issues of changing culture; and the reform of CHP s. 3. Key Workstreams NES / SSSC The major policy initiatives currently being addressed are those related to: Reshaping Care for Older People A Programme for Change ; Dementia Strategy 2010; Carers and Young Carers Strategy and the Early Years Framework. These were described in detail in the NES Board paper Strategic Joint Working between NES and SSSC March 2011 and separate NES Board reports on these are being prepared for presentation in due course. Many support the key features highlighted in addressing integration and partnership issues including leadership development through Action Learning sets for managers of CHP s. It is important to acknowledge that much of the current health and social care education is aimed at developing the entire workforce and not just professional groups. The Remote and Rural Healthcare Educational Alliance (RRHEAL), on behalf of NES, is leading work to support service improvement, integration and workforce redesign across the remote and rural education landscape The Delivering for Remote and Rural Healthcare Implementation Group (RRIG) Action Plan 2008 describes the development of a new Generic (Health and Social Care) Support Worker role as an essential component for the required stratified workforce. The plan also outlines the objective for RRHEAL to develop an appropriate education programme to support the development of this role. In addition, Since 2008, the Social Services MKN has been instrumental in developing and implementing the national knowledge management strategy Sharing Knowledge, Improving Practice, Changing Lives (NES and IRISS, 2010) and in delivering Social 6

7 Services Knowledge Scotland (SSKS as a national gateway to knowledge for the sector. This strategy ends in March 2012, so a new strategy and action plan is currently being developed in order to take effect from April 2012 onwards Dr Murray Lough, NES Research Lead and Helen Albutt; NES Research Governance Lead recently met with Professor Alison Petch, Director of IRISS to discuss potential research collaborations between NHS and social care. Discussions included joint working in three distinct but complementary areas; an empirical study relating to workforce development and learning environments in practice settings, syntheses of evidence covering health and social services and sharing resources on research education. 4. Outcomes and Challenges for Partnership Working In supporting the health and social care integration and partnership agenda NES has worked predominately with the Scottish Social Services Council (SSSC) and the Institute for Research and Innovation in Social Services (IRISS) through established Memorandums of Understanding. The collaborative work has been underpinned by the NES / SSSC Strategy Group cojointly Chaired by Dr Lindsay Burley, (Chair NES) and Garry Coutts, Convenor SSSC. The outcomes of the partnership include; Strategic coordination of educational and learning systems that support the integration agenda Effective and efficient use of resources in addressing the workforces shared educational and learning needs Improved outcomes for those who use health and social care services A number of key commentaries have identified the challenge for partnership / integrated working. The Scottish Government Social Research (2010) Financial Integration Across Health and Social Care: Evidence Review identified that health and social care systems are subject to continuous reform, as policy makers seek to improve efficiency in the financing and delivery of services and to enhance the quality of care. The Integrated Resource Framework (IRF) developed by Scottish Government, NHS Scotland and Convention of Scottish Local Authorities (COSLA) to help facilitate greater integration of services and realign resources to improve patient outcomes. The report identified the Critical success factors for a clear, joined up vision: The goals driving integration need to be made explicit to all those involved in providing the service. Recognition of different perspectives on key issues such as risk, financial constraints and accountability is vital if the partnership is to flourish. The Association of Directors of Social Work (ADSW) recently commissioned Professor Alison Petch, Director of IRISS to undertake An Evidence Base for the Delivery of Adult Services (August 2011). The report concluded the need to ensure the most effective configuration for the delivery of adult health and social care is imperative given the current financial and demographic challenges. There is a range of terms used in the discussion of partnership working and potential models of integration between health and social care and the concept of a continuum of partnership working extending from relative autonomy to structural integration. Consideration of the evidence for partnership working highlights the need to adopt a more nuanced approach, namely what sort of partnership can produce what kinds of outcomes for which groups of people who use services when and how. There is a strong body of evidence demonstrating that 7

8 structural integration between health and social care does not deliver the effective service improvement that had been anticipated. Differences in culture and in values and differential in power tend to distort any blueprint and to undermine and projected model. NHS Confederation and the Association of Directors of Adult Social Services (ADASS) in England in 2010 presented A Typology for degrees of health and social care integration (Figure 1 below) Structural Integration Formation of a single integrated legal entity (care trust) or a combined service (health and social care department System wide commitment, shared vision and integration across most strategic and commissioning functions, senior and middletier joint appointments formal legal backing but separate legal entities remain. Enhanced partnership Joint appointment Key joint appointments and the teams collaborate but are not integrated / combined. Reasonable level of formal commitment to joint working, coordination around some areas of strategy and / or commissioning depending on circumstances Coordination Relative Autonomy Local authority and NHS meet statutory requirements for formal partnership working, but most coordination largely informal Figure1: Typology for degrees of health and social care integration (NHS Confederation and ADSS 2010) (adapted) Figure 1 provides a framework which could support future NES and its partnership work with social services and the table below provides further evidence of the degree of current NES health and social care partnerships particularly with SSSC. Whilst this paper is not proposing structural integration since this is a matter for others but further work can be undertaken to Enhance Partnership working. Good relationships, commitment and joint strategy and vision will go some way to enhance the partnership working. 8

9 Degree of Health and Social Care Integration Relative Autonomy Co-ordination Joint Appointment Enhanced Partnership Structural Integration Current Evidence of NES (Health) and Social Service Integration Evidenced in the range and number of joint actions for NHS and local authorities Memorandums of Understanding are in place between NES and SSSC and IRISS In delivering Scotlands National Dementia Strategy (2010) workforce development plan Joint Appointment Project Leads have been appointed. NES / SSSC Strategy Group overseeing joint activity and plans. Core functions of NES and other social services e.g. SSSC* are statutorily different. *The Scottish Social Services Council (SSSC) is responsible for registering people who work in social services and regulating their education and training. SSSC role is to raise standards of practice, strengthen and support the workforce and increase the protection of people who use services with a vision of a competent, confident workforce, capable of delivering high quality services that has the confidence of the public, those who use services and their carers. Putting service users and carers at the centre of everything they: set up registers of key groups of social service staff publish Codes of Practice for all social service workers and their employers regulate the training and education of the workforce promote education and training undertake the functions of the sector skills council; Skills for Care and Development, this includes workforce planning and development. 5. Recommendations The NES Board are invited to (i) (ii) discuss the content of this paper consider further engagement with its social service partners e.g. SSSC to support the Health and Social Care Integration agenda which may include:- 9

10 (a) NES Board and the SSSC Council** members undertaking a developmental day to focus on health and social care partnership agenda to develop further commitment and to develop a shared vision. **The membership of the SSSC Council reflects a wide range of interests in the field of social care, including service users, carers, those involved in service delivery, professional bodies and those delivering education and training for the social service workforce. The Council Members work together to achieve the corporate vision of the Scottish Social Services Council which has overall responsibility for oversight of the work of the SSSC and in particular for ensuring that the interface between the SSSC s work in registration and regulation and development of the capability and capacity of the workforce is identified and managed to ensure that the SSSC works in a coherent and effective manner. (b) discussions of how a shared governance structure is developed in order to meet health and social care integration agenda. (iii) support Operational Planning 2012 /13 proposals that reflect joint planning between health and social care partners. This will require the necessary realignment of resources to ensure support for the social care sector in line with the Scottish Government health and social care integration agenda. 10