Contact: John Clifton, ext 7283

1 Introduction

1.1 The report to this Committee on 14 March 2003, set out for members the framework through which the department works in partnership with health organisations and other agencies to improve the health of the local population and tackle health inequalities. The report informed members of the department's early work through the care trust demonstrator site in the New Forest and its membership of the national integrated care network, as well as of developments to local services. This report advises members on the further achievements and forward plans of the department.

2 County-wide Partnerships

Partnerships are well established across the County for all care groups. Most developed partnership working is for mental health services with a totally integrated management structure and a £9 million partnership agreement. Learning disability services are delivered through a pooled budget with the seven Primary Care Trusts and a joint County Manager post. Current developments include:

Sensory Services

2.1 Following the Best Value review of sensory services, the department is to work in closer partnership with Health, both the primary and acute care sectors, to deliver its objectives and improve services to people with sight and/or hearing loss. The Director is meeting Health chief executives on 25^th September to discuss the review findings and seek improved partnership working. A stakeholders meeting is planned for 8 October.

Integrated Community Equipment Services (ICES)

2.2 The National Service Framework for older people http://www.doh.gov.uk/nsf/pdfs/nsfolderpeople.pdf identifies that demand for equipment is increasing as a result of the aging population, user expection and advances in technology and medical science. The government is requiring local community equipment services, that provide the majority of equipment that people need, be integrated and provide a gateway to other services. For example people who use wheelchairs may also need help with visual or hearing aids. The department is working with health, district councils and independent sector partners to provide a Hampshire with Portsmouth integrated equipment service by 2004.

Tackling Barriers to Joint Training

2.3 In partnership with the Department of Health Change Agent team, the local health authority and seven Primary Care Trusts (PCTs), the department is to address barriers to joint training for staff working in intermediate care services. A 2-year project funded by the department and Workforce Confederation will address the potentially 8 different policies and practices that underpin staff training. For example for `moving and handling' where there are significant health and safety implications for staff and service users and risks to the department and NHS. Benefits of an equitable approach across Hampshire include formal competency levels for staff e.g. NVQ, facilitating staff movement between partner organisations and localities, avoiding the need for retraining, maximisation of training resources, the potential to extend training to the voluntary and private sector, the development of Hampshire and Isle of Wight training networks across health and social care.

Guidance on Developing Partnerships

2.4 A consultancy team led by the County Treasurers department has produced guidance for managers involved in developing partnership arrangements. This guidance builds on the knowledge and experience of Social Services and provides a framework for tackling the financial, legal and governance matters to be addressed. The intention is that all departments involved in partnerships with external organisations will use the guide.

Children's Trust for Hampshire

2.5 Members will be aware that Hampshire has been selected to have one of the first Children's Trusts in the country. This will be a partnership formed by Social Services and Education with the seven Primary Care Trusts in Hampshire. The three-year pilot will co-ordinate and integrate child and adolescent mental health services (CAMHS) and work in partnership with children, their families and the independent sector to develop integrated services. Proposals for developing the Trust were presented to PCTs by the departments Partnership Managers who have worked to obtain agreement from all PCTs in Hampshire.

Nursing Care Investment Strategy

2.6 The report to the this Committee on the Nursing Care Investment Strategy dated 11 July 2003, sets out in greater detail progress made in the partnership with the health authority and PCT's to create an additional 500 nursing places across Hampshire by 2006, with 300 places becoming available by December 2004. Partnership Managers have recently worked to obtain agreement from all PCTs in Hampshire to the joint proposals and transfer of resources for the nursing home strategy.

Reimbursement Project and Delayed Transfers of Care

2.7 Elsewhere on the agenda for the Committee's meeting today is a report on the department's work to prepare for the introduction of legislation relating to delayed transfers of care. This requires councils to reimburse acute NHS Trusts where patient discharges from hospital are delayed for reasons that are attributed to a broad range of social care reasons as defined by the Department of Health. A pan County group has been established that includes representatives from each of the local acute NHS Trusts, the primary care trusts, strategic health authority and three neighbouring councils. This work is in addition to the continued efforts by the department to tackle delayed transfers of care for Hampshire's patients, some examples of which are included in this report on partnership working.

3 Partnerships with Primary Care Trusts and other agencies

Partnership working is the responsibility of all managers in the department with Partnership Managers and elected members continuing to spearhead strong relationships with PCTs. Appendix 1 lists the Primary Care Trusts, elected members and Partnership Managers. Partnership working with health is now embedded into the department's working culture with numerous projects designed to integrate management and services across all care groups and wider aspects of social care. Service developments are increasingly in partnership with a range of agencies, including district councils and the voluntary sector. One example of multi-agency working is the Healthy Living Programmes targeted on the most deprived wards in Hampshire.

3.1 In addition to developing the direct services set out in paragraph 4 to 11 below, an important feature of the departments partnership work involves sharing and pooling resources in their widest sense. This includes County Council policies and best practice, as well as the skills and facilities of support services. In this context the department's partnership work includes:

3.1.1 sharing good practice, for example Eastleigh and Test Valley South PCT is working with the department's Race Policy Adviser to adopt the equalities model piloted by Social Services; a Joint Complaints Protocol for North Hampshire that has been adopted by all Hampshire and the Isle of Wight acute and primary care trusts.

3.1.2 joint recruitment, for example through a recruitment fair in the New Forest where applicants were fast tracked to the appropriate organisation

3.1.3 joint problem solving such as that with Frimley NHS Trust to address the barriers to planning and delivery of services for older people

3.1.4 development of local protocols, for example for discharging homeless people from hospital in partnership with Fareham and Gosport PCT

3.1.5 consultation through stakeholder events such as that in the New Forest for commissioners and providers of services for people with physical disabilities

3.1.6 multi-agency service co-ordination such as that for supporting asylum seekers coming into Hampshire joint planning through local Partnership Boards with membership including PCTs, Social Services, district councils and the voluntary sector. Their role includes implementing national frameworks, overseeing health improvement planning, community based services initiatives and the use of small grants.

3.1.7 joint training for example home care staff in Eastleigh and Romsey are accessing NHS training facilities

3.1.8 sharing office facilities and equipment such as the developing plans for an integrated discharge team within North Hampshire Hospital Trust.

4 Blackwater Valley and Hart Primary Care Trust

4.1 Through the Partnership Managers role and membership of the executive committee, the department is closely involved in the current strategic issues for the PCT. These include commissioning and providing across the Surrey/Hampshire border, modernising primary care, the GP contract, implementing patient's choice, the development of a health centre for Aldershot and `Improved Working Lives' initiatives. Current work also includes development of local commissioning of `Supporting People', membership of the local strategic partnership and links with district councils, development of the Rushmoor Healthy Living project to Trust status.

4.2 The current social services/health joint work programme includes the development of services for older people to prevent admission and support hospital discharge for example the Rapid Response service, which inlcudes in-house home care, providing 15 places per week. A further example is the integrated intermediate care service, led by a joint senior manager, comprising five care workers and a dedicated senior practitioner.

4.3 Other priorities include the development of children's services and the PCT's contribution to the Children's Trust for child and adolescent mental health services, community based mental health services for older people and work with the NHS Trust acute hospital services to reform emergency care.

5 North Hampshire Primary Care Trust

5.1 The Partnership Manager is a joint appointment with the PCT, currently acting as Director of Provision and Primary Care and is a member of the PCT management team, the Professional and Executive Committee (PEC) and co-opted to the Trust Board. Hampshire County Council's strategic aims and the objectives and targets of the Social Services Department have informed and advised the planning and priorities of the PCT and the Local Delivery Plan.

5.2 Joint work, supported by the Change Agent Team expert advisors, focuses on preventing admission to hospital (particularly of older people and adults with chronic conditions), developing community intensive support services and a Rapid Response Service and working with the acute trust on emergency care pathways. The Social Care Access programme is being considered for the recruitment and retention of care managers. Work is in progress to implement the integrated discharge team and an integrated equipment service.

5.3 Further priorities include ensuring the work is progressing on the Health of Looked After Children; an integrated health and social care respite unit for children with disabilities; the launch of the Vulnerable People protocol and that the local systems and processes are in place for the Reimbursement legislation provisions mentioned elsewhere in this report.

5.4 The Partnership Manager also supports the LSP for two District Council areas, the Health and Housing Partnerships and the Community Safety Strategy.

6 Mid Hampshire Primary Care Trust

6.1 As well as a member of the PEC, the Partnership Manager attends all of the PCT Board meetings and is a member of the Modernisation Partnership Board and the Chief Executives Management Team. The Partnership Manager is also a member of various PCT groups, including those on Intermediate Care, the redevelopment of the Andover War Memorial Hospital, Continuing Care, and Needs Assessment in Primary Care. The latter has included meetings with the social services statisticians to ensure that social care needs form part of the overall assessment process.

6.2 Other joint developments include the Health Improvement and Social Inclusion Pooled Budget between the County Council, the PCT and Winchester City Council which has been quoted by the Government Office of the South East, and others, as an exemplar of joined up working (it is proposed to extend that scheme to that part of Test Valley covered by the PCT, i.e. Andover and its environs, in this financial year). Also of note is the development of jointly funded posts, based in the voluntary sector umbrella organisations in Winchester and Andover, to: improve joint working between the statutory and voluntary and community sectors; ensure the involvement of users and carers; facilitate delivery to the Hampshire Compact. This utilised an existing contract, previously solely funded by HCC, to increase capacity by the negotiation of additional funding from the PCT.

7 South East Hampshire

7.1 As can be seen from Appendix 1, there are two PCTs serving south east Hampshire - East Hampshire Primary Care Trust and Fareham and Gosport Primary Care Trust. These PCTs, in partnership with Portsmouth City PCT, manage contracts for Portsmouth Hospitals and for providing community services. There are two partnership managers covering the area with David Browning, on secondment from the Audit Commission until August 2003, working on partnerships in services for older people, in particular those which support hospital discharge and provide alternatives to hospital admission. Nicky Pendleton covers all other care groups and issues for East Hampshire and Fareham and Gosport PCTs, including representation of the County Council on the LIFT project board.

8 East Hampshire Primary Care Trust

8.1 East Hampshire PCT has a significant role as a service provider across southeast of Hampshire for older people and CAMHS as well as managing three community hospitals. The Partnership Manager is a member of the PEC and attends the Board for specific agenda items. The Partnership Manager is also a member of the Whole Systems Capacity Group established to increase health and social care capacity across SE Hampshire.

8.2 Current joint service developments include the primary care centres at Havant and Cowplain where integrated primary health and social care facilities are planned. The PCT is also building a large community hospital in Havant on the Oakpark site and the partnership manager has supported the PCT and community health council in the consultation process and proposals for the re-use of Emsworth hospital when it closes. This is part of the NHS LIFT (Local Improvement Finance Trust) initiative set out in more detail in the report to the Executive Member for Social Care of 15 November 2002.

8.3 Other service developments in partnership with the PCT include a multi-agency centre for children with disabilities and the provision of respite care for children with special needs.

9 Fareham and Gosport Primary Care Trust

9.1 Recent priorities for partnership working with this PCT has includes the implementation of the Commission for Health Improvement's action plan for Gosport War Memorial Hospital. The Partnership Manager is the County Councils representative on the PCT professional and executive committee (PEC) and is also a member of the joint Continuing Care Panel which has been set up recently to ensure health service consistency in applying the new criteria to all care groups. The partnership manager is a member of:

9.1.1 the Gosport Crime and Disorder partnership where recent developments have included development of the Haven Project to tackle persistent acquisitive offending to support drug use.

9.1.2 the Fareham and Gosport Housing Core Group contributing to strategies for homelessness and `Supporting People' The core group has also produced a multi agency policy to manage the discharge of homeless people from hospital, as part of the strategy to reduce hospital delays.

10 New Forest Primary Care Trust

10.1 The Partnership Manager for the New Forest is a joint appointment and also serves as Deputy Chief Executive of the PCT with responsibilities that include human resources and performance management. This combined and challenging role enables the Partnership Manager to work as part of the PCTs management team. This is a new post with a unique role and early work has focussed on induction and establishing networks.

10.2 Service developments in partnership with the PCT include co-ordination of the technicians service and Care and Repair schemes to support people discharged from hospital whose needs range from complex home improvement to simple repair work and a formal partnership agreement for the provision of mental health services with fully integrated services in place. This includes single line management within community mental health teams reporting to jointly appointed service managers.

10.3 In response to health service changes in the New Forest, locality teams have emerged as a way of ensuring older people can access services. These are `virtual teams' across health and social services. A review is planned to ensure local arrangements best meet needs and the performance objectives of both organisations.

10.4 Service developments for older people have focused on improving intensive support in the clients own home. This includes a joint Rapid Response service and Welcome Home from hospital scheme. Care management teams are now linked to GP surgeries and the Reception and Assessment Service has direct access for health professionals.

11 Eastleigh and Test Valley South Primary Care Trust

11.1 The Partnership Manager for the New Forest is also a joint appointment between the PCT and the department and serves as Deputy Chief Executive of the PCT. The partnership with the PCT is well advanced with joint commissioning priorities for older people, children and families, mental health services, learning disabilities and community safety set out in the Local Delivery Plan for 2003 - 2006. Specific service developments include two intermediate care teams based in Eastleigh and Romsey with successful bids for external funding that have enabled joint appointments at management level. The teams include an enhanced home care service that includes rehabilitation and gives the opportunity to home care staff to access training and development within the NHS services.

11.2 Planning for Older People - work is underway with the borough council to develop community based services following the closure of the Mount Hospital, Bishopstoke. Alongside this the department is also developing the role of care managers and social workers in the southern parish surgeries and two social workers are now specifically linked to the southern parish surgeries.

11.3 Children and Family Services - Eastleigh and Test Valley South PCT and New Forest PCT have jointly appointed a development manager and a Social Services team manager has been seconded to join the development team. A joint policy for looked after children services is in place and recruitment is now underway for a dedicated nurse for looked after children.

11.4 The department and the PCT are also working very closely on strengthening Eastleigh's mental health Local Implementation Team and the range of services offered.

11.5 Community Safety - Excellent partnership working has seen the development of joint posts, both domestic violence and drugs awareness workers. Current work is focusing on pooling resources to better support young people in school. joint appointments, for example to tackle community safety with Eastleigh and Test Valley South PCT

Recommendation

1 That the Committee note the progress in developing the partnership with Health.

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 of confidential information as defined in the Act.

NONE

Appendix 1