Contact: Yvonne Le Brun , ext 7790 or Carole Bennett, ext 7153

1. Summary

1.1 That the Executive Member:

_ Endorse the nomination of the Partnership Managers to the PCT executive committees for Blackwater Valley & Hart, East Hampshire and Fareham & Gosport.

Welcome the nomination of `link' elected members to attend PCT board meetings and of the joint appointments of additional Partnership Managers to work with PCTs.

2. Reason(s)

The Government's public services modernisation agenda expects local authorities to work in partnership with other organisations in order to deliver better services to local residents. There is a duty of partnership with the NHS.

The Social Services Department has established excellent links with local health organisations involving both its senior managers and elected members of the County Council. This report identifies progress in the partnership with Health and seeks endorsement of the nomination of newly appointed Partnership Managers to represent the County Council on the executive committees of Primary Care Trusts

3. Other options considered and rejected

3.1 Not applicable

4. Conflicts of Interest declared by the decision-maker or a Member or Officer consulted

4.1 Not applicable

5. Dispensation granted by the Standards Committee

5.1 Not applicable

6. Reason(s) for the matter being dealt with if urgent

6.1 Not applicable

Approved by: Date of decision:

Councillor Felicity Hindson

Contact: Yvonne Le Brun ext: 7790 or Carole Bennett ext: 7153

1 Introduction

1.1 The Government's public services modernisation agenda expects local authorities to work in partnership with other organisations in order to deliver better and seamless services to local residents. There is a duty to work in partnership with the NHS to improve the health of the local population and to tackle health inequalities. The reorganisation of the NHS has led to the creation of a strategic health authority for Hampshire and the Isle of Wight and seven Primary Care Trusts (PCTs) within Hampshire. PCTs are new organisations set up to implement the NHS reforms, commission and provide local health services.

1.2 Partnership working is a recognised responsibility of all managers in the department and Partnership Managers have been appointed to spearhead the planning of innovative and cross cutting services and enter into productive partnership arrangements with the NHS and other bodies. Partnership Managers represent the County Council on PCT Executive Committees and elected members have been nominated by Cabinet to attend PCT board meetings to participate in discussion about local health and social care matters.

1.3 Links at a strategic level have been maintained with the new health authority through the continuation of a strong and positive close working relationship with the Chief Executive who is the former head of the North & Mid Hampshire Health Authority and with whom the department has a very good history of joint working. The role of the new health authority is to oversee the delivery of improved performance of the local health economy for Hampshire and the Isle of Wight.

2 National Agenda

2.1 The NHS Plan sets out the Government's commitment to modernising health and social services and puts patients at the centre of the reforms. While such an approach is not new within social care it is recognition of the differences and different drivers between two organisations that both work to meet the care needs of the population. These differences are highlighted in the plan as a main reason why health and social care services are not delivering all that they might and why through partnership working and closer integration they will achieve more than the `sum of their parts'. This philosophy is driving major policy changes set out in legislation and in National Service Frameworks (NSFs) for older people and mental health although it is disappointing that the NSFs for Cancer, Coronary Heart Disease and Stroke do not recognise the preventative roles of local authorities, nor the role of Social Services in arranging and providing essential care components for many patients and their families.

2.2 National guidance and legislation on partnership working has enabled the creation of more formal partnerships through lead commissioning, integrated services, pooled budgets and the establishment of Care Trusts. More recently the government has announced its intention to develop Children's Trusts to integrate services for children. In addition it is creating Foundation Hospital Trusts to manage local hospitals, with membership of the Trust board being drawn from the local community.

2.3 To ensure public services work towards delivery of national agendas, the government has introduced performance management with the setting of objectives, targets and timescales that are monitored by national inspectors. As well as front line services, support services are also being modernised to support the delivery of care and the partnership agenda. For example information technology services are being developed to better share information across organisations and provide a tool for single assessment, personnel services are delivering joint training programmes and other staff development opportunities.

2.4 The department fully welcomes the recognition of the importance of social care to the health and well-being of the population and accepts the need for modernisation. It does however have some real concerns at the pressure large scale change places on existing good quality services, the stability of the external care market and pressure placed on partnership arrangements and relationships as resources are stretched to meet new development requirements and achieve national targets and standards. A real benefit of a performance culture is that it provides opportunities and greater freedoms for well performing councils. As a two star authority the department has demonstrated that it is meeting the challenge and is working towards the achievement of joint objectives and targets for health and social care.

2.5 The 2001/2002 Annual Review by the Social Services Inspectorate highlights a number of improvements made by the department and identified `positive partnership working with health, education, voluntary groups and other local authorities' as a key area of improvement.

3 New Forest Care Trust Demonstrator

3.1 The County Council is a lead partner in the Care Trust Demonstrator site in the New Forest that was established to learn more about the benefits of partnership arrangements for patients, service users and carers. The project looked at the range of options for forming partnerships including the comprehensive organisational change required to establish a Care Trust. The project, supported by the Department of Health, looked at partnership arrangements across the Country. National research has shown there to be a lack of real evidence on better outcomes for service users and that existing partnership initiatives should initially be recognised as learning opportunities to inform the future of partnership arrangements.

3.2 Locally, the Care Trust project outcomes include the development of principles and standards for partnership working to ensure `added value' for patients, services users and carers is at the core of joint working, a better understanding by other County Council departments of the implications and opportunities of partnership working with the NHS and a strengthening of the existing partnership in the New Forest. The project concluded that when agencies work together this would lead to better communication and problem solving which would lead to service improvements and better use of resources. It recommended that the establishment of a Care Trust at this point was not an appropriate or necessary next step to achieve better outcomes for local users of services and that the partner organisations should focus on integration of management and services where added value could be demonstrated and would reduce duplication of resources.

3.3 The County Council has confirmed its commitment to this approach and early work has included:

· Agreement to the joint appointment of a Partnership Manager and PCT Deputy Chief Executive

· A workshop for senior health and social services managers to agree the vision and future direction for the partnership

· Agreed priorities and action for older persons services in the New Forest

· Further work with other County Council departments on the financial and legal aspects of pooled budgets and service integration

4. Integrated Care Network

4.1 Building on our work in the New Forest, the department has become a founder member of this joint initiative of the Department of Health and National Primary and Care Trust Development Programme (NATPACT). The Integrated Care Network to be launched in January 2003, will provide an infrastructure of support to those wishing to progress integrated working between local authorities and the NHS. A website is being set up to facilitate communication and learning and the experiences of the network will inform the development of government policy.

5. The County Council's Care Trust Development Group

5.1 To support the work with New Forest partners, the department established an intra departmental development group to explore the risks and benefits to users of services, and to the County Council in the discharge of its duties, arising from the Care Trust model of joint working. Membership of the group comprised senior managers from the County Council departments that would be affected by the necessary changes. The group has more recently begun to explore the views of departments on other models of partnership permitted by the Health Act 1999, such as integrated services and management and will continue to be an essential mechanism in guiding the future of development of partnerships between the County Council and health organisations.

6. Strategic Partnerships with the Health Authority

6.1 A joint post was established in October 2001 to tackle the level of delayed transfers of care in acute hospitals in Hampshire. The agreed action plan is being addressed by NHS and Social Services through local Capacity and Modernisation Groups with key objectives to:

· Reduce the reliance upon in-patient and residential care services

· Streamline assessment and discharge processes and reviewing care pathways

· Create additional capacity

6.2 Major projects underway to increase capacity are:

· The creation of an additional 65 intermediate care places in the County Councils own residential care service and in independent sector homes from March 2003, with some extra places being made available before the end of the current financial year. The report presented to the Executive Member on 15 November 2002, sets out in detail the proposals to develop intermediate care services in Emsworth, Andover, Aldershot and Fleet and to under take feasibility studies in Lymington and Bishops Waltham. The enhanced services will care for people with dementia and physical frailty.

· Investment in nursing care capacity across Hampshire to provide an additional 500 places from 2004/2005. The County Council is currently undertaking a land feasibility survey, including some NHS sites, and the service will be operated by the County Council in partnership with the Primary Care Trusts. This initiative will provide more appropriate care for people waiting hospital discharge and will enable 190 acute and community hospitals to be released. A more detailed report will be presented to the Executive Member for Social Care in April/Mar 2003.

· A pilot study in partnership with district councils to create extra care housing, with opportunities anticipated in 2003 to bid for resources to enhance existing services to meet higher levels of need. A review of community support services is also underway in preparation

6.3 NHS LIFT (Local Improvement Finance Trust)

The NHS LIFT process has been introduced to stimulate investment in local primary and social care facilities and to ensure to delivery of NHS Plan targets for modernisation through capital development. The East Hants and Fareham and Gosport PCTs are the first in Hampshire to be awarded LIFT status, with the County Council as a partner, and is one of only 24 schemes nationally. Phase one includes the development primary care centres at Havant, Cowplain and Rowner where integrated primary health and social care facilities are planned. The report to the Executive Member on 15 November 2002, set out the developments in more detail and informs of the opportunity to become a participant in the Strategic Partnering Agreement giving the right to include future arrangements for social care within LIFT proposals.

6.4 Supporting People

The Supporting People program, which will be fully implemented in April 2003, offers vulnerable people the opportunity to improve their quality of life through greater independence. It promotes housing-related services which are cost effective and reliable, and which complement existing care services. Supporting People is a working partnership of local government, service users and support agencies. The County Council in partnership with the eleven district councils in Hampshire has established the `Hampshire Supporting People County Core Group' as the decision making and commissioning body. This group includes the Health Authority and a primary care trust representative from North Hampshire PCT in its membership.

6.5 Other ongoing work with the Health Authority includes the development of links to facilitate joint performance management and review and contributing to the development of the strategic level local delivery plan for Hampshire and the Isle of Wight

7. Partnerships with Primary Care Trusts

7.1 The creation of Partnership Manager posts and link elected members have enabled new and stronger relationships to be built with Primary Care Trusts. While still a relatively new relationship, early benefits include the bringing of the Local Authority perspective to PCTs. Partnership Managers and elected members are better able to facilitate communication and discussion especially of difficult issues such as budget pressures, a strengthened negotiating position for the County Council and greater responsiveness and agility in effecting change at a local level.

7.2 Mental Health Services

The department is working closely with Health to integrate the management and delivery of mental health services. Arrangements include the establishment of a strategic network with the health authority and Local Implementation Teams with PCTs to implement the National Service Framework. Partnerships with the local mental health trusts oversee the development of joint operational management of health and social care services and integration of locality based teams to provide mental health and substance misuse services.

7.3 Learning Disabilities

Since 2001 the department has taken the lead in the production of joint investment plans for services to adults with learning disabilities. The plan for Hampshire is based on the work of local strategic learning disability groups that had long and successful histories of partnership working across health and social services, including good collaboration between the Social Services Departments of the County Council and the Cities of Portsmouth and Southampton. In March, 2001, the Government launched the White Paper - "Valuing People" - a strategy for learning disability services for the 21^st century. In response the department has led the establishment of a partnership board to deliver the objectives set out in the new strategy. An update to the joint investment plan, responding to the new strategy is one of the first targets for the new partnership boards to deliver.

7.4 Physical Disabilities

Priority areas of partnership work include integration of occupational therapy services and the development of integrated community equipment services (ICES)

7.5 Older People

The project described in paragraph 4 was set up in response to the need to tackle delayed transfers of care from acute hospitals that primarily affect older people, in particular those aged over 75 years. This national and local priority is driving the development of services for older people and is underpinned by a national service framework aimed at integrating health and social care. Local partnerships with PCTs are developing intermediate and interim care services to provide additional capacity in the community to prevent inappropriate hospital admission and support early discharge. Innovative service developments currently being led by Partnership Managers include `Millennium Homes' an initiative which used information technology to support people living in their own homes.

7.6 Children & Families

Social services departments have lead responsibility for children's services planning and are required to develop robust systems for partnership working with relevant agencies to improve life chances for children. There is a concern that too many children fail to achieve their full potential and face involvement in crime, poor health, early unwanted pregnancies, substance misuse and underachievement in education. A national service framework is due to be published shortly and will include standards for care including integrated child and adolescent mental health services. The department welcomes the recognition that local authorities are best placed to lead on children's services. Prioritisation of children's services within the NHS presents a real opportunity for the County Council to build on its partnership with PCTs to ensure an integrated approach across Hampshire. Developing and potential areas for partnership working include children with disabilities, Children's Fund and the Teenage Pregnancy Strategy.

7.7 Support Services

Partnership arrangements include opportunities for closer working and sharing skills and experience of support services such as personnel and training and IT in which the County Council has gained external recognition for its high quality services. Benefits include IT integration to support faster transfer of information between organisations, better use of client information and single assessment, client access to information about services and records. Workforce development partnerships are already providing for job shadowing at senior management level and a number of training events are now held jointly with health organisations. Future opportunities include career development through integrated management and tackling recruitment and retention of staff from the health and social care sector to minimise competing for the same people.

8. Health Overview and Scrutiny

8.1 The County Council has established a Health Review Committee that will include district council elected members and is currently consulting on arrangements for the scrutiny of health services provided to its residents. The Council wants to work in partnership with local health organisations and district councils to ensure reviews focus on matters of local concern. The Council wishes to undertake a first programme of reviews under the theme of `The Health of our Children'. Early responses have been positive regarding the framework and supportive of the choice of children's services as the initial area of review. The consultation document has been sent to partnership organisations and can accessed via the County Councils website at

www.hants.gov.uk/chexecs/healthconsultation

9. Enhanced Partnership Manager arrangements and Elected Member Links with Primary Care Trusts

9.1 The post of Partnership Manager was established as part of the department's remodelled management structure in recognition of the need to build upon and better co-ordinate the considerable joint health and social care arrangements in place across the County. The main role of Partnership Managers is to lead the planning of innovative and cross cutting services and enter into productive partnership arrangements with the NHS and other bodies.

9.2 Early feedback from Primary Care Trusts was that they welcomed this initiative by the department, but viewed the potential for joint working was such that each of the seven PCT required its own designated Partnership Manager. PCTs also confirmed they would welcome closer links with elected members of the County Council. In November 2001, the Cabinet delegated The Leader to nominate elected members to attend PCT board meetings and endorsed the recommendation of the Social Services Committee that Partnership Managers should represent the Council on the PCT executive committees.

9.3 Local authorities with social care responsibilities have a place of right on the executive committees (PECs) of PCTs that must be filled by a senior manager of the local Social Services Department. This requirement has been built upon and extended by the department and its health partners through the appointment of Partnership Managers for each PCT. Negotiation with health partners has confirmed joint funding and other arrangements leading to the establishment of the additional Partnership Manager posts.

9.4 The department believes the appointment of elected members and Partnership Managers to work closely with PCTs is a considerable joint local achievement and commends the initiative to the Executive Member. New Partnership Manager appointments are complete with the exception of the New Forest and the Executive Member for Social Care is asked to endorse the nomination of the managers named below to PCT executive committees.

* The County Manager for Health and Social Care Planning is undertaking this role pending the appointment of the joint Deputy PCT Chief Executive/Partnership Manager for the New Forest.

Recommendation

That the Executive Member for Social Care:

1. Endorse the nomination of the Partnership Managers to the PCT executive committees for Blackwater Valley & Hart, East Hampshire and Fareham & Gosport as set out in paragraph 9.4.

2. Welcome the nomination of `link' elected members to attend PCT board meetings and of the joint appointments of additional Partnership Managers to work with PCTs.

Section 100 D - Local Government Act 1972 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list excludes:

1. Published works

2. Documents which disclose exempt or confidential information as defined in the Act

NONE