Care England Regional Roundtables On Integration

Introduction

Care England hosted a series of roundtables throughout May, beginning on 17 May and concluding on 30 May. These roundtables sought to bring together social care providers and colleagues from integrated care systems (ICSs) and local authorities alike to reflect on the last year of the integration agenda.

Regionally, Care England wants to help further the dialogue between the independent sector and ICSs, and through these events and our other work, look to establish a common understanding of the local landscape from a range of perspectives with the ultimate ambition of taking forward the best practice to improve outcomes for services and those who draw on care and support.

Each page within this document reflects a thematic question raised in these roundtables, and the notes from each region have been mapped to highlight the differences and similarities across England. From this, Care England will use the discussion to inform our regional strategies with ICSs and allow for a more targeted approach to drive local success.

Care England has recently expanded its membership to include ICSs. This new branch of membership will foster dynamic relationships between care providers and their ICS leaders to improve the integration between health and social care and bring system partners together.

By becoming Care England members, ICSs will gain greater insight into understanding a care provider’s operational procedures, their day-to-day business and what fundamental policies must be implemented to overcome historic barriers that have prevented integration in the past. As the largest representative body for adult social care providers, Care England is best placed to ensure ICSs can connect and work collaboratively with the vast and dynamic care services that deliver invaluable support.

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Summary

To see a summary of each of the discussions across England, click on the image below to expand the notes.

 

 

North West

What is currently working well?

Local Authority and ICS Colleagues noted that they’ve looked to build on pre-existing, healthy relationships with providers. As a result, systems are ensuring that broad, balanced conversations are going on, leading to positive interactions between Integrated Care Partnerships (ICPs) and providers. Due to the integration agenda, new roles have been established, resulting in new local investment. Providers now have a stronger voice around the table and are not afraid to share their concerns when in discussions.

 

What Currently isn’t working well?

It was noted that the financial mechanisms regionally are not always there to support discussions. it takes time to identify appropriate contacts within the ICS. Provider communication and feedback loop has been lost over the years which leads to difficulty identifying what the priorities are for each area. Providers find themselves often talking separately to LAs and ICBs and struggle to get enough provisions to get appropriate care packages. There was confusion about the role and remit of provider collaboratives and how that will work in the system. There were further questions on how place work  for local providers, and how the system works with providers.

 

How do we accelerate success?

Systems highlighted that there are strategy meetings twice a week that looks at what needs addressing, where the problems are, and what can be done to prevent people from going into the hospital. Systems should try and bridge gaps and work with providers strategically on this. A lot of work going on at the moment is contingent on non-recurrent funding which makes it difficult to continue work. It was noted that measures that allow for longer-term planning are needed, intertwined with appropriate funding. Along with transparency, this would allow for shared priorities for the system and delegate properly to address those issues. With Care England’s market intelligence platform MINT, users have access to both historic and current fee/financial data within the sector, and benchmark this information to have full transparency with local funds.

 

 Midlands

What is currently working well?

Providers and Systems both noted that pooled budgets have had some success within the region, although there are risks present in terms of accountability for overspending. ICSs are focusing efforts over the course of this year to overcome their historic engagement challenges with smaller providers and the market as a whole.

 

What Currently isn’t working well?

The Integration agenda regionally is dominated by the NHS and the challenges it faces, including staffing, ambulance waits, etc. As a result, there is tension around the national focus of the NHS versus the local direction of LAs and providers. There is a regional disparity in terms of success with integration. There is difficulty in coordinating programmes and a lack of provider representation at a strategic level, leaving most areas unclear on how to engage.

 

How do we accelerate success?

Attendees noted that to truly focus on prevention there needs to be a focus on younger adults with a 30-40 year plan than considers a far wider number of factors contributing to overall health, including housing, sport, smoking, etc. It was also raised that the 1% of ICS budgets allocated towards prevention will not be enough, especially considering immediate challenges and wider pressure on budgets. Central Government putting restrictions on what LAs are able to spend the funding on is challenging. It was raised that there have been previous regional successes of initiatives to change public behaviour and no reason it can’t be done again at an integrated level. Care England can be a forum for collating regional best practices and sharing these amongst ICS, LA and provider colleagues.

 

South West

What is currently working well?

Certain areas within the South West region have provider organisations (either trade associations or providers themselves) sitting on the Integrated Care Partnerships (ICPs). Additionally, the use of integrated brokerage teams has developed far more effective discharge strategies. The use of technology was also noted as having positive outcomes in care settings regionally, having improved the well-being of individuals whilst also addressing capacity and backlog challenges.

 

What Currently isn’t working well?

There has been historic bad practice regarding D2A policies, that ‘‘any bed will do,’ and it was acknowledged that measures are needed to ensure that effective discharge supports both the healthcare and social care organisations involved to ensure better practice with bed placements. This will enable more effective strategies and reduce backlog pressures, and begin the journey for more personalised care. It was agreed that there needs to be greater cross-collaboration to develop and optimise capacity in social care settings.

 

How do we accelerate success?

There were calls from all colleagues on the importance of shared learning, particularly from other countries on what is/is not working well. ICS and local authority colleagues highlighted the importance of the social care workforce and the need for greater recruitment and retention campaigns to further drive capacity within health and care, with significant reference to the use of the voluntary sector and the role they play in supporting the ICS. As a national body, Care England has strong oversight and understanding as to what is working well in neighbouring countries and how elements of good practice can be transferred to England.

 

 

South East

What is currently working well?

ICSs have worked with Care Associations to look at career progression, pay, conditions, recruitment and retention challenges. The region has examples where systems have invested funding to build academies and establish joint pathways between roles in health and social care. One system shared an example of a community care hub, that focuses on both prevention and community provision, to use assets from both health and social care to help people live independently.

 

What Currently isn’t working well?

Systems recognised that they need to ensure that all providers, including SMEs, are involved at a strategic level within systems. ICSs agreed on the importance of outlining the benefit of engagement to the adult social care sector. Furthermore, systems need to have continued conversations in preparation for intense periods (such as Winter), so that all system partners are prepared.

 

How do we accelerate success?

Systems agreed that there should be more transparency to provide better integration between health and care. From this, ICSs can understand, and take appropriate action on some of the funding pressures, such as fee uplifts, where there can be better engagement on the issues being faced. Systems regionally need to have continued conversations ahead of Winter Preparations to identify what action is needed to effectively prepare. Care England has historically supported ICSs with Winter Resilience, informing leaders of the latest best practice, and useful information on policies to keep abreast when entering the Winter Period. Care England is committed to continuing this programme of work, and support systems build an effective discharge policy which properly utilizes the care sector’s strengths.

 

London

What is currently working well?

Systems highlighted that they have worked much more effectively with their partners than previously; North East London ICS have a care provider forum that feeds into the quality committee, a sub-committee of the ICB Board. Some ICBs noted that they are looking to have a care provider voice at system level, such as an executive lead.

 

What Currently isn’t working well?

Systems agreed that they need to ensure that these new institutions are providing allow for better visibility on how providers can engage, and what engagement is already available for providers. Providers expressed interest in engaging with systems in the region on workforce issues, specifically on shared training for the workforce between social care and the NHS. Systems and providers both understood the importance to ensure regional consistency regarding Non-AQP and wider fees, as the ICBs have offered different rates (with some providers noting that they have received different rates from the same system).

 

How do we accelerate success?

ICBs should move to a model that there is a consistent brokerage team to help providers operationally. ICBs noted that they hold public meetings, and encouraged providers and Care England to attend these sessions and propose questions. They can be a forum to share information and steer the direction of travel. It furthers the connection between the decision-makers and the care sector. Care England has consistently engaged in targeted work with ICSs to ascertain system-level commitment to resolve local issues which are impacting the care market. Our work on CHC and FNC with ICSs is just one example of this success.

 

East England

What is currently working well?

Systems across the region are conducting research, and beginning to develop longer contracts and more dynamic relationships with providers. Currently, the funding system between ICBs and Local authorities allows for integrated/joint commissioning and contracts which was favoured by attendees. As a result of this, ICSs across the region are in the early development of establishing Integrated transformation teams.

 

What Currently isn’t working well?

There needs to be a cultural shift to fully embrace the potential that these new systems have, rather than falling back to previous standards. Providers are currently reliant on current local authority arrangements, and utilising old connections from CCGs. ICSs need to move away from the transactional relationship and foster a new relationship dynamic which allows all stakeholders to be strategic long-term partners.

 

How do we accelerate success?

ICSs acknowledged that there must be an equal partnership with the care sector, and new dynamic relationships made to account for the sheer diversity of the sector. Conversations with the sector must be represented at the start of the formulation of initiatives. It was recognised that by keeping providers informed, the sector can be a long-term strategic partner within the ICS. The diversity of Care England’s membership, and the number of specialist groups we operate allows for full engagement with the whole sector on a variety of key subjects.

 

 

North East and Yorkshire

What is currently working well?

ICSs noted that there has culturally been more drive to properly integrate, allowing ICBs to have a more strategic approach. There are the beginnings of ICB workforce strategies for the care workforce, and increased conversations around development, with the ICB encouraging providers to look at certain areas based on LA/ICB plans and the existing market situation. Colleagues recognised the importance of utilising data collected via the Capacity Tracker to make informed decisions and unlock funding.

 

What Currently isn’t working well?

Regionally, providers continue to find engagement very challenging. Due to the integration agenda, new roles have been established, resulting in new local investment. As ICBs develop their frameworks without provider consultation, it can be difficult for a provider to navigate the various documents. There were challenges mentioned around the timescale when a patient goes to panel, which slows down the movement of a patient between services and into the community.

 

How do we accelerate success?

A lot of work going on at the moment is contingent on non-recurrent funding which makes it difficult for systems to plan and prioritise addressing certain pressures. There needs to be longer-term planning, intertwined with funding, and held to account with appropriate transparency. This would allow for shared priorities for the system and delegate appropriate resources to effectively address them. With our market intelligence platform MINT, users have access to both historic and current fee/financial data within the sector, and benchmark this information to have full transparency with local funds.