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Report of the Joint Future Group

CHAPTER 5 NEW FINANCIAL, PLANNING AND SERVICE MANAGEMENT FRAMEWORKS

5.1 This chapter introduces structural changes to underpin the service and operational recommendations in previous chapters on both rebalancing care for older people and on joint working. Some will apply nationally, some locally, and some to both. These planning, financial and service management frameworks all have one thing in common: they will contribute in their own way to improving outcomes for people who use services.

National and Local Financial and Planning Frameworks

5.2 As suggested in the Introduction and in Chapter 3, the financial and planning systems for community care have not necessarily helped the balance of care. Planning locally is increasingly joined up but resourcing less so; and nationally, priorities may not be linked formally to the allocation of resources. National and local planning and financing must be more integrated. The Strategic Issues Working Group has been considering a number of options for changing the funding of local government. We wish to apply some of their thinking, but to a wider pool of resources, across community care. We advocate a new approach of a partnership between the Scottish Executive and local agencies, focusing on all the new resources for community care — both capital and revenue - across social work, the NHS (including relevant acute services) and social housing; and deciding in partnership what to target these resources on and what outcomes to expect. That approach will bring a much needed and clearer link between resources and priorities.

5.3 A further critical issue is to underpin the new arrangements with stability of funding. The Minister for Finance announced the introduction of 3 year budgeting in his statement on 20 September 2000, starting in 2001.

National Programme Planning Group

5.4 We envisage this agenda being taken forwarded by a National Programme Planning Group. That group’s role is not to develop policy. Rather, it will provide a strong lead and set targets for implementation of priorities that will ensure consistency and fairness across Scotland. The group will consist of key stakeholders including Ministers, elected and appointed members, senior managers and professionals from local authority, social work and housing departments, housing agencies and the NHS, and user representatives. It should:

• set development priorities and targets for local partners.
• monitor and assess local partnership agreements, and measure performance against such agreements.
• review financial arrangements at national and local level and ensure that they support integrated management of resources between partners. In particular, it should identify the relevant revenue and capital funding streams for acute and primary health care, residential and home based social care, and social housing; and advise on any reconfiguring to support the development of joint working and the achievement of priority service developments in community care.
• In a less formal way, we think it should also advise the Scottish Executive on ensuring that the legal and accountability arrangements for partners locally and nationally do not impede flexible partnership working, and on the extent to which national and local arrangements for performance measurement and management reflect and promote joint working. Lastly, it can disseminate good practice and reflect it in the development priorities and targets set.

5.5 We are very conscious that one alternative to our preferred approach would be more hypothecation of finance, and prescription of implementation mechanisms nationally. We clearly see that as second best. But to ensure that the Programme Planning Group can deliver, particularly on greater consistency across Scotland, it should have a degree of authority. It should, for example, be able to challenge local partnership agreements, and examine and advise on improving the existing financial, legal and performance frameworks for community care. Its precise ways of working can be developed more fully in the light of this report.

5.6 It may be asking too much to introduce these arrangements across the whole of community care. A staged approach seems appropriate. Services for older people take up the largest part of expenditure, offer considerable scope for changes of direction and are currently a priority. Early attention should therefore be directed to this care group, with others building on that progress.

Local Partnership Working

5.7 Moving from the national to a local perspective, Modernising Community Care proposed both more joint use of resources and more joint services locally. In their responses, agencies said they could do more within existing powers. There has been progress. Most people will be aware of the "Care Together" initiative in Perth and Kinross. And Glasgow has introduced joint management and joint resourcing of its learning disability services. The models are similar, as described briefly later.

5.8 These initiatives are very significant, but somewhat isolated. We know that some agencies still have doubts — at the margin at least — about their ability legally to have fully fledged pooled budgets. We also acknowledge the practical issues that creates. But like many of those at the seminars, we do not wish these doubts to get in the way of progress. We believe that a new lead is required, not just on bringing together agencies’ resources, but also on the management of services.

5.9 We are looking for an approach which reduces barriers, is practicable and deliverable, and provides better results for users. We believe jointly resourced and jointly managed community care services, either in the round or for each care group, achieves that. In future, that should be the norm. These arrangements give members the opportunity to take joint decisions on a bigger pool of resources, and opportunities to break down negative cultures, for mutual learning and, most importantly, to organise and deliver services in a more concerted way to the benefit of the person using the service.

5.10 To explain what we mean, joint resourcing is about the resources at agencies’ disposal — their staff, their buildings and their money, and how they use these resources jointly. As in other settings, we envisage relevant parts of health, social care and housing forming the nucleus of the local joint resource. The jointness is mainly in the use of these resources. As the models illustrate, decisions are taken by a joint body/single manager as appropriate. This approach is therefore not as advanced as pooled budgeting, but is more practicable at this point in time. And it is deliverable reasonably quickly. It is beginning to happen now. Pooled budgeting, in which resources are freely interchangeable in the pool and accountability joint may, however, be the Executive’s longer-term aim.

5.11 Joint resourcing and joint management of services go together. Joint management brings health, social and housing services, as appropriate, under a single manager — of either community care services in the round, or of individual care groups. The manager can come from either a health or social care background. At the outset social and health care services, together with relevant elements of housing, may be separate entities under a common manager, but over time we expect progress towards joint services, facilitated in part by the growing use of joint teams and generic workers. As indicated earlier, there are existing models of joint resourcing and joint service management.

Local Partnership Agreements

5.12 To consolidate this joint approach, we believe local agencies should draw up "local partnerships agreements". In due course, they will have regard to the lead and targets given by the National Programme Planning Group. The agreements will both inform communities about proposed service developments and allow scrutiny by the National Programme Planning Group. It is important to stress again that we do not see local partnership agreements as new policy statements, and thus a new layer of planning. Rather, they are action plans distilled from existing policy expressed in community plans, community care plans, HIPs and TIPs and housing plans. A local partnership agreement should include:

• the joint development priorities and targets for a 3 year period, covering the key community care client groups and carers, in the light of the lead from the National Programme Planning Group;
• developments in joint service management and joint resourcing proposed to support the stated development priorities and targets;
• the performance management framework to be used to monitor progress, evaluate impact, and guide corrective action if necessary. (This is likely to include local performance indicators, timetabled targets, user and carer feedback, service level pledges, etc. It should also include proposals for assessing outcomes.)
• the governance and accountability framework for the partnership agreement, straddling a number of local agencies. This could be a joint board, or joint programme commitments, or joint management arrangements with clear empowerment and reporting lines to parent agencies. (We would not wish to be prescriptive at the outset but the National Programme Planning Group will analyse proposals and ensure that robust frameworks for governance and accountability are in place.)

5.13 We envisage partnership agreements being updated annually in the light of performance, feedback and financial circumstances. They should be part of existing plans (eg community care, HIPs etc).

5.14 Local partnership agreements will therefore set out the arrangements for setting up joint resourcing and joint management of services across the board. But in concert with our thinking elsewhere in the report, we believe it is important to make an early start on services for older people, with full implementation from 2002. Local partners who believe they can move faster on either older people or any of the other groups are encouraged to do so.

5.15 To improve financial planning nationally and the financing and management of services locally, we therefore recommend:

The Scottish Executive should set up a programme planning and financial framework, beginning with services for older people in 2001.

Local authorities (that is social work and housing), health boards and NHS trusts, and Scottish Homes should draw up local partnership agreements, to include a clear programme for local joint resourcing and joint management of community care services collectively or for each care user group individually.

As a step towards that, and recognising current progress on the ground, every area should introduce joint resourcing and joint management of services for older people from April 2002, and in preparation for that introduce shadow arrangements in the course of 2001-02.

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