North East Lincolnshire’s integration story began 10 years ago.
The Care Trust Plus (CTP) was established in 2007, a then-ground-breaking move that brought health and social care much closer together.
Key features included the delegation of adult social care commissioning and the full adult social care budget to the CTP, the reciprocal delegation of public health and health visiting responsibilities to the council , and the establishment of a pooled fund to foster integration and the efficient use of a significant suite of combined resources. This was all under the auspices of a Section 75 NHS Act agreement. The strength of this partnership and the manner in which it has developed over the last 10 years is, in and of itself, unique.
Fast forward five years and the passing of the Health and Social Care Act 2012 and the advent of clinical commissioning groups was seen as a further opportunity in North East Lincolnshire, primarily to strengthen the relationship across the clinical and democratic leadership spectrum. The CCG was delegated full adult social care commissioning responsibility, with the statutory director of adult social services role retained by the council. In short, the journey that we started in 2007 continued. With a degree of creativity, a partnership board was formed, sitting under the CCG governing body, thus enabling elected members to be appointed and engaged in key partnership business alongside clinical leaders and non-executive directors.
In the provider space, three separate organisations emerged, in social enterprise form, covering community services (Care Plus Group), mental health services (Navigo) and of particular note, Focus, responsible for adult social work and initially trialled as a social work practice pilot. So, in terms of the commissioning and provision of health and social care and the local authority/NHS interface, a unique set of arrangements crystallised. We were, apparently, ahead of the game.
Now fast forward another a few years to the present. Local government and the NHS are in the midst of a hugely complex and challenging period of change. Sustainability and transformation partnerships and the Five Year Forward View are challenging health commissioners and providers to think about the sustainability, quality and fitness of services in the context of increasing demand, immense financial challenge, heightened expectation and significant technological advancements.
Over the last three or four years, North East Lincolnshire Council has shifted firmly into the strategic commissioning and enabling space, seeing the importance of place-based economic growth as the key to unlocking the potential of communities, raising aspiration, closing the health inequality gap and fostering independence. We’ve also centred a lot of our thinking and practice on prevention and early help, with the integration of teams and services across a multi-agency landscape, recently recognised by Ofsted in relation to children’s services.
Cutting to the chase, both the council and the CCG are ‘in the business’ of wellbeing. It makes eminent sense for us to focus, together, on the wider determinants of health: a decent job, a decent home, a decent education etc. Against this backdrop our council/CCG ‘union’ model was conceived; the two largest strategic commissioners operating even more closely together, moving towards a single leadership team across both organisations and overseen by a union board comprising an equal number of elected members and clinical leaders. The appointment of a joint chief executive (me), given our 10-year journey, was the next natural step.
So what? With senior leadership and organisational capacity at a premium, why wouldn’t we seek to further combine our resources and fully assess how best to play to our individual and collective strengths for local benefit? Pooling resource and capacity at the leadership level fosters more inclusive and informed decision-making across both organisations; the union board will shape a strategic direction that lends itself to developing a ‘cradle to grave’ commissioning model. It means that, in the STP context, we can and should make the strong case for a place- based model of health and social care that’s led by local democratic and clinical leaders, best placed to take local decisions impacting on outcomes for local people, but pragmatic about what services needs to be commissioned on a wider geographic footprint.
Our approach to the STP debate, the challenges currently faced by the local acute foundation trust and the development of an accountable care partnership by the aforementioned providers all ask the same fundamental question of us: how best do we meet the needs of an ageing population where demand is not diminishing, the health inequality gap is not closing quickly enough and where there are still too many families on the wrong side of the poverty line?
An important part of the answer has to be that we bring the two biggest commissioners together to focus on economy, community and wellbeing for the benefit of place; major on prevention and early help; and take better informed decisions about the use of our combined resources. But we’re not complacent about the challenges we face.
The key ones for me are:
- National NHS policy drivers not always chiming with the ‘place’ message or, at the very least, lost in translation
- Culture: the NHS and local government, despite 10 years together in North East Lincolnshire, still often speak a different language so the organisational development focus will be paramount
- People: it’s the quality of the personal relationships that’s been instrumental in getting us to this point and enabled us to withstand some significant challenges; the retention, development and best use of individual skill and capacity will be key from this point
- Governance: keep it as simple as possible (says the former lawyer!) so that elected members and GPs are included, informed, assured and leading
We’re doing a few things a bit differently here in North East Lincolnshire, but, I believe, for all the right reasons.
Rob Walsh, chief executive, North East Lincolnshire Council and CCG