PAPER C

 

SOCIAL SERVICES, HOUSING AND BENEFITS SELECT COMMITTEE – 8 JULY 2003

 

HEALTH AND SOCIAL CARE AGENDA

 

REPORT OF THE STRATEGIC DIRECTOR OF SOCIAL SERVICES AND HOUSING

 

REASON FOR SELECT COMMITTEE CONSIDERATION

 

The agenda for the integration of health and social care services on the Island has gained pace with the arrival of new faces and the “Healthfit” agenda.  In an attempt to encapsulate what all this means and give a clear sense of direction, relevant officers with the support of the Portfolio Holder have met in the preceding 3 months. A key consequence is the ‘Statement of Intent’ which has obtained endorsement by this Council and, at the time of writing, is anticipated to be endorsed by respective Boards of the Primary Care Trust and the Acute Trust (Appendix 1). 

 

ACTION REQUIRED BY THE SELECT COMMITTEE

 

To Debate & Make Recommendations

 

BACKGROUND

 

As one might imagine there is a considerable degree of previous work and detail which lies behind the Statement of Intent. At practice level a number of examples exist of good joint working, notably in the field of learning disability, mental health and occupational therapy. More recently the Primary Care Trust and this Directorate have an agreed Joint Commissioning Structure and a ‘first’ for the Island – a formal pooled budget for Free Nursing Care. Whilst this is not an exhaustive list it reveals a desire for closer working across professional and organisational boundaries. Relationships are good and this is the first element to get right when considering how better to work more closely together or, share resources.

 

The Statement itself encapsulates a wide array of services, some of which are far more developed than others.  Furthermore, it is easier to understand where the future lies for some areas of activity whilst others remain unclear.  Here, one might usefully draw a distinction between the future journey of Children’s Services, Adult Services and those, titled ‘Business Support’ including contracting, IT and administrative services.  Each has a different set of relationships, national drivers, local influences and refers to vulnerable people with different needs. 

 

It is hardly surprising therefore that any blueprint for change should be sufficiently sophisticated to reflect these differences.  To put it another way one size will not fit all. 

 

Recently the Council released a press statement concerning ‘healthfit’ that is the subject of related papers on this Committee’s agenda today. This raises a question about how many health and social care organisations can and should be sustained on the Island.  It adds a different but related dimension to those described above which are primarily concentrated on care groups, such as children, older people, learning disabled and so forth. 

 

This agenda cannot be avoided.  The question lies in how best we can shape it to suit the Island’s needs both now and into the future.  Notwithstanding this there are down sides to be considered and discussed openly so that the partnerships to follow are entered into with our eyes wide open. 

 

A number of issues for the Council are detailed below as examples:

 

·         By merging budgets with health colleagues or between education and social services we will be fettering members discretion in that their ability to move money around to service policy changes will be constrained.

·         Governance arrangements between stakeholders will need a lot of working through.

·         Merging areas of activity with health colleagues introduces risk attached to their budget deficit.

·         Organisational change of this nature can prove disruptive to managers, staff and day-to-day services (ref. The Climbie enquiry)

 

Of course, the intended benefits, not least to the people who need and use public services must outweigh any limitations. A number of potential benefits have been identified and indeed realised through joint working both on the Island and elsewhere:

 

  1. Management and service delivery are more cohesive and congruent
  2. The organisation of service is easier for users and carers to understand
  3. Specialist expertise is easier to retain
  4. There is a more co-ordinated approach to professional and practice development with improved skill-mix
  5. Economies of scale exist
  6. A recognised ‘voice’ develops for key groups of people with needs
  7. Improved communication and reduced bureaucracy occurs
  8. Reduced opportunities exist for ‘hidden’ cross subsidies

 

RELEVANT PLANS, POLICIES, STRATEGIES AND PERFORMANCE INDICATORS

 

There are a myriad set of national and local policies and strategies which reflect the need for closer working and integration of services. More can be anticipated. Of considerable note is the change in emphasis for both the Audit Commission and OFSTED in assessing the performance of Council’s and Council services which in the future will be more heavily weighted on the partnership agenda reflected here.

 

CONSULTATION PROCESS

 

Consultation levels reflect the various stages of development in each particular area on the Island. It is noteworthy that under the Health Act 1999 ,consultation is a prerequisite with staff and users of a particular service before formal integration  under a ‘Section 31 agreement’ can take place. 

 

FINANCIAL, LEGAL, CRIME AND DISORDER IMPLICATIONS

 

There are significant financial and legal implications and these are, in part described above.

 

APPENDICES ATTACHED

 

Statement of Intent.

 

BACKGROUND PAPERS USED IN THE PREPARATION OF THIS REPORT

 

Contact Point : Glen Garrod, 01983-520600 ext 2225 email: [email protected]

 

 

GLEN GARROD

Strategic Director of Social Services and Housing