Modernising community care: an action plan

Modernising community care: an action plan

Chapter 4 Working together locally

Working together locally

"Integrated local partnerships are the way ahead. Joint vision, joint investment and shared responsibility are all vital."

4.1 The links have not been strong enough between strategic and resource decisions and decisions about people's needs. There need to be clear connections between high-level strategic and resource decisions at area level and local service delivery, with strong co-operation between agencies at both levels.

4.2 Combining health and social care in one organisation is one option. Health and social work are integrated in Northern Ireland. Since local government re-organisation in Scotland, social work and housing staff increasingly work in joint departments. And in Dumfries and Galloway, the Social Work Department and the Health Board share the same premises and public identity.

Working together locally

4.3 The lessons from this kind of integration are consistent. It can help people to work together but is not enough in itself to break down barriers. For this reason we are not suggesting a formal integration of local authority social work and housing with health services. Instead we aim to encourage joint planning and organising services at a more local level.

4.4 This should in turn develop the shared respect, understanding and trust we need for joint working and improved local services. No laws or national guidance can substitute for the local sense of value of working together successfully on joint agendas, joint investments and joint services.

4.5 Some local authorities and health boards are already starting to manage and deliver services on a locality basis. A locality should be a natural catchment area for community care. It may be:

a town or part of one;
a group of villages;
a district; or
a social work management, health or housing district, or a group of them.

4.6 'Designed to Care', for example, suggests that Local Health Care Co-operatives might serve populations of between 25,000 and 150,000. What is important is that the area served is large enough to be supported in community care terms. But this does not mean that it has to be self-sufficient in services. Most importantly, a locality's boundaries should not make administrative arrangements more complicated. They should use existing boundaries (for example social work catchment areas or GP practices).

4.7 Some of the present arrangements focus only on planning, but others deal with the needs of the local community and how to meet them.

Examples

Developing local planning and service delivery models (St Andrews, Caithness and Johnstone).
Developing resource centres shared by several agencies to serve one area (Angus).
Planned 'one stop shop' for social care, health care and housing (West Lothian).
Decentralising local authority management, including developing local plans (Fife and Angus).
Very sheltered housing, respite care and day care complex (Forres).

4.8 This local approach to community care can cover any one part or a large block of community care activity. The wider the scope, the better the results for the locality. We must consider the three key levels of:

planning;
organising services; and
delivering services.

Planning

4.9 Local plans should be consistent with a clear strategic vision for the 'area' and should influence that vision.

New local partnerships

4.10 New local partnerships may be necessary, not just between social work, health and housing agencies, but also with:

education, leisure and recreation;
independent community care providers; and
people using services locally.

These partnerships do not need to be the same as the formal structures in the present community care planning system. They should develop to reflect the needs of the area. It is most important to involve the people using the services and their carers.

4.11 The new structures in the NHS and the increased opportunities within primary care should make for closer local working between local authorities and Primary Care Trusts and, within them, the Local Health Care Co-operatives. We must seize the opportunity for greater co-ordination and co-operation across the social work, community health and primary care boundaries.

4.12 We must strengthen the relationship between professionals in the restructured NHS, and in local authorities and other organisations. For this reason we are:

encouraging those involved in co-operatives to recruit from a variety of backgrounds so as to provide a joint service; and
developing arrangements to support the new shape of the NHS which will encourage closer working links with stakeholders, including local authorities.

4.13 Local planning should achieve an agreed understanding of:

the locality's needs;
the period over which change will take place;
the investments needed from each agency; and
the responsibilities falling on partners.

4.14 Integrated local partnerships are the way ahead. This will mean individual agencies giving priority to the greater good of the locality. Joint vision, joint investment and shared responsibility are all vital if an area is to be well served.

4.15 We expect local partnerships to avoid unsuitable incentives and passing on their financial burdens (cost shunting). They should focus on using the locality's collective resources for the better based on:

a shared vision;
joint commissioning;
joint standards;
thinking based on users' and carers' needs; and
imaginative partnership funding (for example, local community care Trusts).

4.16 This more local approach offers considerable scope to work more effectively in partnership with people who use services, rather than doing things to them. The result should be communities which are more involved, helped and supported by community care.

Organising services

A 'tartan' of services

4.17 Organisational success depends on statutory organisations' roles and responsibilities being fully understood by them, their employees, their partners and those using their services. These organisations should identify where their functions begin and end. But, more importantly, they should also identify where they join with others to create a balanced 'tartan' of services for the areas.

4.18 Joint working must be based on strong understandings and effective systems. We cannot rely on individuals' strengths and commitment alone to achieve effective results. A structured approach, supported by joint training, will create a powerful platform for joint working.

Ways of improving current working practices

Create health, housing and social care trusts	pool all resources for community care in an area. integrate skills and services. reduce overheads and bureaucracy.

Agency staff to share premises	social workers in GP practices. one stop shops.

A single manager for community care services	from either health or social work. to manage all relevant staff and budgets.

Staff to move between agencies	from statutory to voluntary sector. from NHS Trusts to social work (assessment). between councils and boards (strategic issues).

General workers	social workers, nurses or occupational therapists as care managers. home care staff with a mix of personal care and nursing experience. hospital and community occupational therapists sharing caseloads.

Pooled or grouped budgets	covering capital and revenue (Trusts, co-ops). joint stores for equipment. joint services (for example, for dementia). matching capital and revenue funding.

Shared information systems	to collect and communicate information effectively. single assessment forms. shared assessment procedures for social work and housing. to protect confidentiality (for example, local information-sharing projects (LISP) supported by the NHS Information Directorate).

Joint training	to identify joint tasks. to carry out a training audit. to develop joint training agendas.

Many of these are already working successfully in some areas in Scotland.

Delivering services

4.19 Service delivery already tends to be focused on local areas. We want to build on this by encouraging an integrated, flexible 'tartan' of services, geared to the needs of each locality.

Quality services and real benefits

4.20 We expect high-quality services delivered efficiently and effectively. To focus on their locality, agencies should identify opportunities for task-sharing. This is particularly relevant for home care services (where health workers and social workers are often involved with the same person) and integrated specialist housing and care facilities. The aim is to trouble the user as little as possible while providing them with the maximum benefits. People are not usually concerned whether the care they receive is from health or social work staff. What matters is the quality of that care and the benefit to the user.

Some examples of effective service delivery which can be followed in localities are:
health and social care workers ordering home care services from one another in Stirling;
joint equipment stores in North Ayrshire;
users keeping their care plans at home for visiting professionals to see in Shetland;
integrated teams, especially where they also include housing, for people with mental health problems or learning disabilities, as in Inverclyde; and
nursing staff in the dementia teams in Aberdeenshire being able to use social work resources.

Making change happen

4.21 Local authorities, health boards and housing partners need to develop local frameworks for planning, organising and delivering services.

4.22 When preparing strategic plans, we must make clear the strategic vision for the area as a whole and its relevance to localities. Primary Care Trusts and Local Health Care Co-operatives must be in place by April 1999. And we must also develop the basis for a new local infrastructure and focus during the same period. We want every area to have effective local structures in place and working by March 2000.