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Consultation on the Integration of services between Staffordshire County Council and the proposed Staffordshire and Stoke on Trent

Partnership NHS Trust

Evaluation Report

Consultation DocumentA joint consultation between NHS North Staffordshire, NHS Stoke on Trent, South Staffordshire PCT and Staffordshire and Stoke on Trent Partnership NHS Trust

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Please contact Staffordshire County Council Communications Team on

T:01785 276804 or Email: communications@staffordshire.gov.uk

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Contents Page

Introduction 4

Background 4

•NationalContext 4

•Consultation 4

•ProposedOptions 5

•ProposedBenefits 5

•Methodology 5

•ConsultationPeriod 6

•ConsultationApproach 6

•EngagementActivity 7

•SummaryofResponses 8

Question Feedback 9 - 22

Summary of Key Themes 23 - 25

Conclusion 26

Frequently Asked Questions 27 - 41

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IntroductionStaffordshireCountyCouncil(SCC)inpartnershipwithNHSNorthStaffordshire;NHSStokeonTrentandSouthStaffordshirePrimaryCareTrust(PCT)haveundertakenaconsultationunderaSection75agreementontheintegrationofservicesbetweenSCCandtheproposedStaffordshireandStokeonTrentPartnershipNHSTrust(nowestablished).Theconsultationperiodranbetween9thMayand20thJune2011.

Thisdocumentprovidesasummaryofthefeedbackreceivedandincludestheidentificationofkeythemesandoutcomesfromtheconsultation.

BackgroundNational Context:

InordertoimprovehealthandwellbeingoutcomesforresidentstheCoalitionGovernmenthasencouragedhealthandsocialcareservicestoworktogetherwithexamplesrangingfromjointandcloserworkingarrangementstofullyintegratingservicesunderthemanagementofoneorganisation.Nationalpolicyaimsincludemaximisingpeople’squalityoflife,independenceandcontrol;promotingintegratedcareandtheself–managementofserviceusers.

Atalocallevelanumberofissueshavebeenidentifiedwhichsupportthenationalpictureincludingthecurrentmazeofhealthandsocialcareserviceswhichpeoplefindconfusing and the increasing health and social care needs of an aging population which willimpactondemandfortheseservices.Theaimsofthepartnershiparetodeliverbothsocialcareandhealthservicesinsuchawayastoimprovehowwellpatientsandpubliccanaccesstherequiredsupportandhowquicklytheservicerespondstotheirneeds.

Consultation:

TheconsultationsetsoutthevisionforStaffordshireCountyCouncilandthethreeStaffordshirePCTsforthefutureofsomeAdultSocialCareservices.ThecostofAdultSocialCareservicesiscurrentlycirca£150m.Theservicesinvolvedinthisconsultationinclude:

•Enablementservices(rehabilitation)

•Communitysupportservices(careinyourownhome)

•On-goingHealthandSocialCareSupport(assessmentandmanagementofyourcareandsupport)

•EquipmentServices(toassistdailylivingtasks)

•BrightonHouse(rehabilitationcentre)

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ServicesexcludedinthisconsultationincludeLearningDisabilities;MentalHealth(forpeopleunder65asthisisalreadyintegrated)andSubstanceMisuseservices,whichwillremainwithinthecountycouncil,althoughsomestaffworkinthelatterwillmovetothePartnershipTrust.

Proposed Options:

Theconsultationhassoughtviewsonthefollowingproposals:

•Integratedservices:ThenewTrustandthecountycouncilwillputtheirmoneytogethertoprovideintegratedcommunityhealthandadultsocialcareservices(detailedonpage4)inamorefocussedand‘integrated’way.

•Closerjointworking:Thereisacommitment,sharedvisionandaimsacrossservices,butseparationattheexecutivelevelwithoperationalbudgetsdealtwithindependently.

•Stayingasweare:Therearelocalagreementstomakeservicesbetterbutlimitedstrategyforjointworkinginthefuture.Atanoperationallevelsomejointworkingexistsbuttheseservices arestillseparatelymanaged.

Proposed Benefits:

The benefits that are expected to be realised from the proposals include:•Servicesbasedonpeople/carersandthecommunity’sneeds.

•Co-ordinatedaccesstoservices.

•Moreeffectiveservicestomanageincreasingdemand.

•Alessconfusingrangeofservicesandpeopletointeractwithwhenindividualsareattheirmostvulnerable.

•Oneapproachtoassessmentplusearlyresponsetodecision-makingandcareplanning.

Methodology

Thethree(asatMay2011)PCTsinStaffordshire(i.e.NorthStaffordshirePCT,SouthStaffordshirePCT,andStokeonTrentPCT)havealreadyundertakenanengagementexerciseduringOctoberandNovember2010withtheviewtoseekingfeedbackontheiramalgamationintotheproposedStaffordshireandStokeonTrentPartnershipNHSTrust.InadditiontothisAdultSocialCarehasbeenconsultingwithkeystakeholdersthroughSocialCareandHealthScrutinycommitteesandTradeUnionsasakeypartoftheprocess.

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Thisphaseoftheconsultationhasbuiltonthisworkasacontinuationofconversationswithcommunitiesandotherkeystakeholdersandisbasedon:

•Providingtheopportunityforpatients,serviceusersandresidentstohavetheirsay,onwhethersomeAdultSocialCareservicesandHealthservicesshouldbeintegrated.

•Takingeveryopportunitytoexplainwhytheproposedchangesaredesirable.

Theconsultationprogrammewassupportedbyproactivecommunicationsexplainingallthedifferentwaysthatpeoplecanhavetheirsay,howandwhenthedecisionwillbemadeandwhatthenextphasesofimplementationwillbe(ifapproved)anditslikelyimpact.

Theproactivesupportingcommunicationfocussedoninvestingtimewithkeyopinionformers(stakeholderssuchasGPs,PatientCouncil,stakeholderpanels/forum,Councilmembers,tradeunionsandthemedia)toexplainwhyweareundertakingtheconsultation.

Consultation Period:

Theengagementcommencedweekbeginning9thMayandendedon20thJune2011.

Theconsultationquestionsaresetoutbelow:

•Whatdoyouthinkofourproposedchanges?

•Howdoyouthinktheseproposalsmayimpactonyouand/oryourfamily?

•Howdoyouthinktheseproposalsmayimpactonyourorganisation,thepeopleyoucareforandtheservicesthatyoumightprovidetothem?

•Whatwouldyoulikeustoconsiderinthedevelopmentofajointapproachtodeliveringcaretolocalpeople?

•Pleaseletusknowothercommentsyouhaveonourproposals?

Consultation Approach

Aspecificconsultationplanwasdevelopedwithkeystakeholders.

Proactivedirectcommunicationswereundertakenwhichareoutlinedoverleaf.However,togainarichseamofqualitativeinformationinresponsetotheconsultationquestions,itwasfeltthattherewassignificantbenefitinusingpartnerstakeholderstoreachabroadertargetaudience.Thesepartnershaverelationshipsalreadyestablishedaswellasregularlymethodsofcommunications.Partnersalsohaveawiderreachtoindividualsi.e.carersviaTheCarerAssociations;ethnicminoritygroupsviaRacialEqualityCouncil;patientnetworkviaLINks.

Informationwassharedwithourpartnerstakeholderswhointurnsupportedtheconsultationbycontactingtheirstakeholders(communitygroupsandorganisations).

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135keystakeholdersweremadeawareoftheconsultationviaelectronicmeansandincluded:

•District&BoroughCouncils

•Voluntarysectorgroups

•Emergencyservices

•StaffordshireandStokeonTrentConsortiumofInfrastructureOrganisations(SCIO)andStaffordshireandStokeonTrentLocalInformationNetworks(LINk)

•OverviewandScrutinyCommittees,MP’s,StrategicHealthAuthorities

•GeneralPractitioners

•Unionrepresentatives

Engagement Activity

Inordertoreachallsectionsofthecommunitytheconsultationhasbeenpromotedthroughmanycommunicationactivities.Withinthoseactivitiesweencouragedresponsesinavarietyofways,bypost,byemail,on-lineand,face-to-face.

•Consultationwithexistingnetworks–PatientParticipationGroups,PatientCouncilandE-Panel

•Threepubliceventswereheldattracting102people

•Promotiononwebsites:SouthStaffordshirePCT,NHSNorthStaffordshire,NHSStoke-on-Trent,StaffordshireCountyCouncil,SCIOandLINks(NorthandSouth)

•Articlesine-newslettersproducedbySCIOandLINKs(NorthandSouth)

•Hardcopydistributionofconsultationdocumentto45equalitygroupstoensureourapproach was inclusive

•Hardcopydistributionofconsultationdocumenttoalllibraries,socialservicesareaoffices,collegesandleisurecentres

•InternalcommunicationchannelstoreachstaffinSouthStaffordshirePCT,NHSNorthStaffordshire,NHSStoke-on-TrentandStaffordshireCountyCouncil

•Awarenessraisingthroughstakeholderboards

•Advertsin8keynewspapersacrossStaffordshireandStoke-on-Trent

•EmaildistributiontoGPConsortiachairs

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Summary of Responses

Ourmethodologywasaqualitativeratherthanquantitativeapproachtoreachourtargetaudience;thereforeitmakesitdifficulttoaccuratelyoutlinethenumberofindividualsandgroupsthatweregiventheopportunitytorespondtotheconsultation.However,ifwelookatjustoneofour135keystakeholdersthatwecommunicateddirectlywiththatpromotedtheconsultatione.g.StaffordshireLINk,theirreachwastoanaudienceof2,000stakeholders.

Thetablebelowshowsthetotalnumberofindividualswhoattendedthecountywideconsultationevents;thetotalnumberofindividualorganisationswhichwererepresentedandengagedattheevents;thetotalnumberofcompletedon-linequestionnairesandthetotalnumberofresponsesreceivedfromformalgroupsandorganisations.

Source No.ofResponsesPubliceventtotalattendees 102Individualorganisationsrepresented/engagedatpublicevents 26Completedon-lineresponses 25Formalgroup/organisationresponses 15

Formalgroups/organisationswhorespondedincluded:SouthStaffordshireLocalMedicalCommittee;SouthStaffordshireLocalPharmaceuticalCommittee;StaffordshireHealthScrutinyCommittee;NewcastleBoroughCouncil’sHealthScrutinySub-Committee;UttoxeterLabourParty;DenstoneParishCouncil;EastStaffordshireBoroughCouncil;SouthStaffordshireNeurologicalAlliance;NewcastleUnderLyme50+Forum;StaffordandRuralHomes;EngAGE50+Forum;LifeworksStaffordshire;StokeonTrentLINk;HomeInsteadSeniorCare.

Theformalgroups’responsesrepresentagreaternumberofindividualstakeholders,however,aswecannotaccuratelyquantifythenumberofpeoplerepresentedinthisreport,thenumbershownisbasedonlyonthewholegroupororganisationcollectiveresponse.

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Question FeedbackFivespecificquestionswereaskedinrelationtotheconsultation(pleaserefertoparagraph2,page3).Thekeythemespertainingtoeachquestionaresummarisedbelow.

Consultation Question 1:

What do you think of our proposed changes?

Theme 1: Support

Overallthereisageneralfeelingofsupportfortheintegrationofservicesproposals,forexample:

•���“I�think�it�is�good�to�consider�how�we�can�work�together�in�a�more�joined�up�way�and�that�the�customers’�needs�should�be�put�first”

•��“I�agree�with�your�proposals�and�look�forward�to�seeing�them�in�action”

•�“Integrated�working�is�the�way�forward”

•��“We�welcome�the�opportunities�for�more�cooperation�between�health�and�social�care”�

•��“We�would�like�to�say�that�we�feel�optimistic�about�the�forthcoming�integration�and�the�opportunity�it�presents.�We�believe�that�in�sharing�skills,�knowledge�and�expertise�our�service�users�will�ultimately�benefit�from�a�much�improved�experience�of�a�seamless�service”�

Itisnotedhoweverthat“inprinciplethechangeslookpositive”andthattheyare“agoodideaintheory”butthereissometrepidationthattheproposalscanactuallybedeliveredandwhetherornottheycanworkinpracticei.e.“Bringinghealthandsocialcaretogether,ifitworks,shouldmakeaccesstoservicesmuchquickerandsimpler.”

Theme�2:�Working�together

‘Workingtogether’isconsideredakeysuccessfactoroftheproposals,forexample:

•��“The�proposed�changes�appear�to�make�sense�providing�all�the�separate�organisations�and�teams�make�the�effort�to�work�together”�

•��“Further�consideration�must�be�taken�into�account�on�how�the�different�agencies�will�work�together”�

Inrelationtothis,concernshavebeenraisedthatthesynergiesclaimed“willnotmaterialiseaspeopleservedbythetwoorganisationsarenotthesame”andthat“moreintegrationofhealthandsocialcarecanonlybeagoodthing,butimportanttorecognise

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thatskillsaredifferentandshouldbeutilised”.Thecurrentdifferencesinworkpracticesandpoliciesshouldnotbeunderestimated.

Theme 3: Cultural differences

Closelylinkedtotheabovecommentsareconcernsabouttheculturaldifferencesbetweenthetwoorganisations,forexample:

•�“A�key�issue�will�be�the�change�in�culture�for�social�care�staff”

•��“There�are�currently�two�different�cultures�and�they�will�struggle�to�inter-relate”

•��“The�difficulty�of�achieving�cultural�change�as�four�organisations�come�together�should�not�be�underestimated”�

•��“I�am�concerned�that�social�care�culture�will�dissipate�in�mental�health�as�NHS�preference�to�medical�solutions”�

Theme 4: Funding and commissioning

Fundingandcommissioningthe“servicesneeded”isbroadlyconsideredasakeysuccessfactori.e.“Ifgivensufficientfundingtomakethiswork,itwillbeofgreatbenefit”andthe“testwillbeifGPCommissionerswillputtheirhandsintheirpockets”.

Relatedconcernsreceivedinclude:

•���“How�the�new�trust�will�ensure�that�whoever�determines�the�package�of�care�for�an�individual�patient�has�the�‘budgetary�clout’�to�make�sure�that�care�package�is�actually�delivered”�

•��“Unsound�to�believe�that�commissioning�another�agency�to�commission services via assessment and care management will�lead�to�a�loss�of�control�and�will�potentially�undermine�commissioning�strategies”�

•��“There�needs�to�be�a�change�in�attitude�throughout�both�services,�at a time of cutbacks is the extra resource required to imbed these changes�in�attitude�available”�

•��“Will�it�be�possible�with�the�resources�available�to�provide�a�single�easy�to�understand�gateway�to�services.�The�preferred�solution�integration�(which�I�support)�addresses�the�current�confusion.�It�will�not�be�simple,�or�cheap,�to�establish�such�a�gateway”

Additionalquestionshavebeenreceivedseekingclarityon“howmuchitisallgoingtocostandsave?”,“howareservicesgoingtobefunded?”and“willservicesbecomemoreintegratedorlimitedasorganisationscompeteforfunding?”

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Theme 5: Vulnerable (Learning disabilities/mental health/ substance�misuse)

Someconcernsaroundtheexclusionofservicesforpeoplewithlearningdisabilitiesandmentalhealthproblemsfromthechangeshavebeenreceivedincluding:

•��“I�do�believe�that�the�learning�disability�and�mental�health�services�should�have�been�included�in�the�formation�of�the�new�trust”�

•��“Without�strong�links�to�substance�misuse�and�mental�health�there�is�still�an�issue�with�how�those�services�will�engage�and�provide�a�coherent�approach�to�support�for�the�most�vulnerable”�

•��“The�plans�have�the�potential�to�undermine�progress�with�regards�to�safeguarding�vulnerable�adults�and�abuse”�

•��“For�people�with�learning�difficulties�and�those�people�with�mental�health�services�unfortunately�it�will�be�a�post�code�lottery�as�to�what�services�they�receive”

•��“We�would�wish�to�see�the�new�Trust�develop�a�strong�relationship�with�mental�health�service�providers�to�make�sure�that�people’s�physical�and�mental�wellbeing�are�considered�together”�

ClarificationwasalsosoughtwithregardstothePartnershipTrust’srolewithpeoplewithdementia.

Theme 6: Children and Young People

Anumberofconcernshavebeenraisedthattheproposalsaretoonarrowanddonotincorporatechildrenandyoungpeopleforexample:

•��“A�golden�opportunity�is�also�being�missed�to�include�children’s�services�which�would�have�ensured�a�smooth�transition�for�children�once�they�reach�18�years”�

•��“Working�with�children�and�young�people�I�worry�that�families�will�not�embrace�the�system�without�good�plain�English�explanations”

Therearefurtherqueriesabouthowtheneworganisationwilllinkwithchildren’sservices.

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Theme 7: Duplication

Thereisabroadopinionthat“integrationneedstoreduceduplication,waste,excessiveadministration,costandaplethoraofpremiseswhilstdeliveringabetter,moreresponsivecustomerdrivenservice”.Supportingcommentsinclude:

•��“I�agree�that�services�can�be�delivered�in�a�more�efficient�way�by pooling NHS and social care resources and that this can also improve�services�to�people”�

•���“There�is�currently�far�too�much�repetition�and�going�round�in�circles�trying�to�find�the�right�person�to�help�at�the�right�time”�

Theme 8: Governance and accountability

Anumberofconcernshavebeenraisedaroundgovernanceandaccountabilityforexample:

•��“I�am�in�favour�of�closer�integration�between�social�care�and�health,�but�do�not�think�this�NHS�Trust�is�the�way�forward�as�the�County�Council�has�100%�democratic�accountability�whereas�the�trust�has�none”�

•���“A�joint�approach�to�care�delivery�would�be�welcomed�however,�there�must be clear lines of accountability for the people receiving the care”�

•��“The�integration�of�these�services�is�necessary�however�the�integration needs to be full and transparent in order that there are clear�lines�of�responsibility�and�accountability”

Thereisageneralconsensusthatgettingthe“governanceandaccountabilityrightwillbekeyandoncethisisachievedthentherestwillfollow”.

Other Concerns

Anumberofbroadconcernshavebeenraised,whichinclude“concernsthattheStaffordshireviewismovingforwardwhenthenationalviewistotakestock”andthat“thereisn’tenoughdetailabouthowitwillworkinreality”,thattheplans“lackanyevidencebase”andthat“theproposalslacksubstance”.Thereareviewsalsothattheplansare“tooambitious”and“stillnottransparentenough”.

Consultation Question 2

Keythemesidentifiedfromquestiontwo,whichhavenotbeenaccountedforinquestiononearesummarisedbelow:

How do you think these proposals may impact on you / or your family?

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Theme 9: Support

Thereisageneralviewthattheproposalswillhaveapositiveimpactforexample:

•��“As�a�social�care�manager�I�am�happy�to�work�in�a�multi-disciplinary�way”

•�“Hopefully�it�will�speed�up�the�process�when�I�need�help”

•��“That�the�bewildering�array�and�complexity�of�both�health�and�social�care�services�will�become�clearer,�better�meeting�our�needs�both�now�and�in�the�future”

•��“It�is�hoped�that�the�present�arbitrary�time�scales�for�care�therapies�will�be�removed�and�be�replaced�by�those�related�to�actual�individual�need”�

Theme 10: Accessibility

Thereisbroadagreementthatiftheproposalsareimplementedsuccessfullythen“itwillbemucheasierandquickertoaccesstherightservices”forexample;“ifthereisonesinglepointofaccessforinitialenquiriesandthenanominatedkeyworkerthiscouldsmooththejourneythroughwhatiscurrentlyacomplicatedsystem”.

However,specificconcernsregardingaccesshavebeenraisedandinclude:

•��“There�may�be�a�discrepancy�in�access�to�services�because�Stoke��on�Trent�won’t�be�offering�the�same�services�as�Staffordshire.”�

•��“Members�are�concerned�about�the�delivery�of�care�however�the�complexity of accessing that care does not seem to have been addressed.”

Theme�11:�Key�workers

Thereissignificantsupportforthekeyworkerrole,butitwasraisedthatthereneedstobeenough“keyworkersinplacestraightawayfortheproposalstowork”.Keyworkerswereseenas“essential”,keytothesuccessofthisinitiativeandwillneedtohavethenecessary“training,authorityandkudos”todeliver.Considerationforthejobtitleshouldalsobetakenintoaccounttoreflectseniorityoftherole.Questionswereraisedaroundthedurationofinvolvementwiththekeyworkers,howthekeyworkerwouldcopewithincreasedcaseloadsandwhatwouldhappenifthekeyworkerhadtotakesickleave,forexample:

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•��“The�key�worker�is�a�great�idea,�but�who�will�they�be,�where�will�they�be�based�and�what�will�happen�if�they�are�absent?”

Additionallyrespondentssoughtclarityon:

•�“Who�gets�a�key�worker�and�at�what�stage�do�they�get�one?”

•�“How�many�patients�will�a�key�worker�have?”

•�“Will�the�key�worker�be�expert�in�all�areas�to�decide�what�is�needed?”�

Theme 12: Voluntary sector

Someconcernswereraisedastowhatexpectationsthereareforthethirdsectorandhowvoluntaryserviceswillbeinvolvedattheendofpathwaydelivery,forexample:

•��“The�third�sector�is�critical�to�help�with�referrals,�but�struggling�with�funding. There are therefore implications if people are being sign-posted�to�third�sector�agencies”

•��“I�am�concerned�as�to�what�expectations�there�are�for�voluntary/third�sector organisations that are inadequately funded at the present and may�become�main�providers”�

•��“As�funding�to�third�sector�is�being�reduced�by�government�and�local�authorities,�how�will�they�cope�with�any�increase�in�demand�for�their�services?”

Other Concerns

Anumberofbroadconcernshavebeenraisedconcerning“securityofemployment”,apotential“reductioninservices”,“longerwaitingtimesforservices”and“poorerqualityservices”.Concernwasalsoexpressedaround“thetimescalesofimplementationandhowlongitwilltakebeforeanyimpactisfelt”andconcernthatthisisacostcuttingmeasurei.e.“theargumentsforfutureintegrationsoundpersuasivehowevertheover-ridingconcernwouldbethatthismaybeacost-cuttingmeasureleadingtoapoorqualitysecondclassservicewhichcouldpotentiallyincreasethevulnerabilityofthe65+”.

Consultation Question 3

Keythemesidentifiedfromquestionthree,whichhavenotbeenaccountedforinquestiononeandtwoaresummarisedbelow:

How do you think these proposals may impact on your organisation, the people you care for and the services that you might provide to them?

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Theme 13: Support

Thereareanumberofcommentsthatendorsetheproposalsandinclude:

•�“In�theory�it�makes�sense�and�could�break�down�barriers”�

•��“It�should�make�it�simpler,�as�a�domiciliary�care�provider�we�currently�deal�with�PCT�and�social�services�completely�separately�even�though�clients�may�have�very�similar�needs”

•��“I�am�in�the�field�of�domestic�abuse,�a�greater�emphasis�on�joint�working�would�be�helpful”

•��“Once�the�teething�problems�have�been�smoothed�out,�people�who�use�the�service�should�get�better�value�for�money”�

•��“The�new�proposals�would�in�theory�allow�for�more�joined�up�approach�and�sharing�of�information�would�assist�to�prevent�duplication�of�action�taken,�it�would�improve�communication�and�provide�positive�outcomes�for�the�customer”�

Theme 14: Financial risk

Ithasbeenraisedbyarepresentativeformalgroupthatthekeyproblemfacedwillbe‘resources’andaconcernthatthereisnoevidenceofanyfinancialmodellingtosupporttheproposalsthatamalgamationwillprovideefficiency.Thegroupcommentsthat“moststructuralreformsendupcostingmorenotless”andthereforequery“whythiswillbeanydifferent”.Thegroupcommentsthatthetwoorganisationshaveworkedtogetherforyears,but“havecompletelyfailedtodelivertheirobjectives”becauseintheirview“theydonotchangetheiroperationalgoals”.Thesamegroupalsoraiseconcernsaboutrapidresponsefromsocialservicesinacutecrises;team-workingand“wouldpreferbothorganisationstosortoutbasicoperationalissuesbeforetheywouldgivethemagreementtofurtherstructuralchange”.Furtherquestionshavebeenraisedfromotherrespondentsonhowthenewtrustwillmanagefinancialriski.e.“lackofresourceisnotadefence”.Otherrelatedcommentsinclude:

•��“We�have�concerns�about�the�financial�management�of�an�integrated�Adult�Care�Service.��What�safeguards�would�be�in�place�to�prevent�what�was�previously�local�authority�funds�from�being�‘siphoned�off’�into�other�aspects�of�health�care?”

•��“How�can�the�whole�system�work�without�the�participation�of�Stoke�on�Trent�City�Council:�would�there�not�be�the�risk�of�the�County�Council�funds�subsidising�health�provision�in�the�City?��What�is�the�likely�impact�on�council�tax�of�these�changes?”

•��“We�would�welcome�reassurance�on�how�the�jobs,�pay�and�conditions�of�current�County�Council�employees�who�are�moved�into�the�new�Trust�will�be�protected.��Who�will�have�the�say�on�salary�levels,�conditions�of�working�and�performance�management?”

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Theme 15: Cross border provision

Feedbackhasbeenreceivedabout“thelackofinformationoncrossborderprovision”andconcernsaboutadministrativeboundariesandtheallocationofGPs,forexample:

•��“The�split�in�services�across�boundaries�may�cause�problems.�Stoke�may�say�one�thing,�Staffordshire�another”�

•��“There�will�be�no�cohesion�for�organisations�that�provide�services�across�the�whole�of�the�Staffordshire�area”�

•��“We�have�big�boundary�issues�in�that�they�are�inconsistent�and�these�need�to�be�remedied�to�provide�a�more�seamless�service”

•��“Delivery�of�services�goes�wider�than�Staffordshire�as�we�border�a�number�of�other�counties�and�have�clients�who�may�live�in�Staffordshire�but�are�registered�to�a�GP�outside�of�your�borders�which�creates�a�headache�when�developing�joined�up�care”�

•��“Local�GPs�have�patients�who�are�non�Staffordshire�residents�and�hence�will�get�their�social�care�needs�met�by�other�authorities.�Equally�Staffordshire�residents�may�have�GPs�who�are�‘out�of�county’�and�yet�they�will�be�eligible�for�social�care�from�the�Partnership�Trust”.�

Crossboundaryarrangementsneedtobeclear.

Other concerns

Additionalconcernsrecordedrangefromwhyadultprotectionisbeingretainedbythecountycouncil,cutstostaff,toincreasedtensionbetweenprofessionalsand“anerosionofprofessionalidentity”.Otherconcernsraisedstatedthattheproposals“couldadverselyaffectthelocalauthority’sabilitytomeetitsstatutoryfunctions”andresultin“apostcodelotteryastowhatservicespeoplewillreceive”.Afurtherissuehighlightedthat“thereisnotenoughunderstandingofhowthecountycouncilchargesforcare”andassociatedriskstothebudgetinrespectoftwelveweekenablementchargesandthereafter.

Consultation Question 4

Keythemesidentifiedfromquestionfour,whichhavenotbeenaccountedforinquestionone,twoandthreearesummarisedbelow:

What would you like us to consider in the development of a joint approach to delivering care to local people?

Theme 16: Support

Agenerallybalancedresponsetothisquestionwithspecificresponseshighlightingtheimportanceof:

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•��“Maintaining�and�promoting�pride�in�the�social�care�profession,�which�is�key�to�maintaining�morale�and�developing�the�focus�on�personalised�services”

•��“A�vision�for�service�delivery�across�Staffordshire�that�can�be�translated into a service that is fit for purpose and that through independent audit is able to demonstrate efficacy of service delivery and�quality�outcomes�for�service�users”

•��“Genuine�integration�and�partnerships�with�all�sectors�who�have�a contribution to make in decision making and implementation of realistic�and�affordable�service�provision”

Theme 17: Communication

Ensuringthatcommunicationchannelsarerobust(acrossorganisationsandtoserviceusers)isconsideredakeyrequirement,forexample:

•��“Everything�always�works�well�on�paper,�communication�is�a�real�issue�and�will�need�to�be�addressed�and�improved�in�the�new�organisation”

•��“The�principle�is�perfect�but�to�me�the�real�issue�is�around�communication”

•�“Effective�communication�is�key”�

•��“The�importance�of�good�communications�with�professionals,�the�third�sector�and�first�sector”

•��“Need�to�ensure�that�information�is�provided�in�alternative�formats�and�must�be�accessible”�

•�“Improved�information�and�communication�with�service�users”�

•��“Best�use�of�technology�to�provide�rapid,�reliable�information�/�the�need�for�up�to�date,�clear,�written�information�to�be�given�to�those�being�discharged�from�hospital”�

•��“That�it�is�essential�to�communicate�effectively�what�is�happening�to�people�using�services�and�their�carers”�

Theme 18: Personalisation and individual need

Thereisabroadviewthat“personalisationiskey”withawelcomingforthechangesthatwouldimprove“integration”,“careforindividuals”andonlyhavingtohave“oneassessment”.“Theproposalsare“customerfocussed”withaneedtofocus“ontheindividual”and“personcentredcare”,forexample:

•�“Care�needs�to�be�more�structured�and�individualised”

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•��“These�proposals�have�merit�in�managing�a�complex�issue,�delivery�of care depends on the individual understanding the services available�but�the�services�delivered�should�appear�seamless”��

•��A�person�focussed�approach�needs�to�be�adopted�to�help�people�“achieve�their�potential�and�beyond”

Acautionarycommentreceivednotedthat“Integrationofservicesmaybeanecessaryfirststep,butresponsivenesstowhathelpapatientsaysshewantsiscrucialtothequalityofcare”.

Theme 19: Integration of IT and the sharing of information

IntegratedITisconsideredakeydeterminantinthesuccessoftheproposalsasistheneedtoshareinformationandtheneedforaccuratebaselinedataforexample:

•�“Computer�systems�that�speak�to�one�another”�

•��“All�agencies�need�to�be�involved�in�every�decision�made�and�accurate,�effective�sharing�of�information”�

•��“Would�like�to�see�some�reference�to�housing�options�and�sharing�of�information�with�housing�professionals�relating�to�their�customers”�

•��“Would�like�to�see�an�integrated�sharing�system�in�place”�

Insupportofthis“organisationsseemtobegoodatholdingontopeopleandnotsharinginformation,weallneedtoworkharderandbemoreopentojointworking”and“Whilstweexpectsomeaspectsofinformationsharingtoimprovewithasingleorganisation,thisstillremainsaconsiderablebarriertointegratedcarewhenworkingwithotherorganisations”.

Theme 20: Service user involvement

The“involvementofserviceusersand/orcarersinthedevelopmentoftheservices”isconsideredimportantforexample:

•�“In�developing�the�proposals,�ask�the�people�who�use�the�service”�

•��“Meaningful�service�user�involvement�in�the�future�development�and�delivery�of�services”�

•��“Ensuring�the�new�organisation�develops�a�“customer�centred�culture”

•��“Delivery�should�be�measured�by�the�customers�who�should�be�encouraged to give constant constructive criticism and suggestions for�improvement”�

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Furtherqueriesreceivedseekclarityonthe‘engagementmodel’forthenewtrustandwhatprocesseswillbeputinplacetoprovidefeedback.“PPIneedstoincludearelationshipwithlocalrepresentativesincludingcouncillorswhomayraiseissuesonbehalfofpeopleusingservices”and“itmustdemonstratefromthebeginningacultureofbeingopenaboutandlearningfromfeedback”.

Other concerns

Somedirectconcernsreceivedwhichareopposedtotheproposalsinclude:

•��“The�social�model�of�working�is�meant�to�run�alongside�the�medical�model�with�each�complimenting�the�other.�The�way�that�you�are�proposing�will�cause�a�clash�and�will�not�be�in�the�best�interest�of�patients�or�service�users”�

•��“I�do�not�believe�that�a�merger�of�local�authority�assessment�and�care�management�services�with�NHS�provider�services�will�be a positive step. I believe that there are other more obvious partnerships that should be established e.g. joint learning disability teams�that�incorporate�learning�disability�clinicians�with�specialist�social�workers,�older�people’s�mental�health�teams�etc”

Analternativeoptionproposedincluded“theprovisionofamenuofcarepackageswhicharecostedtoanaveragedailyrate;andtheoptionforanelderlypersonforwhomacarepackagehasbeendeterminedtotakeadailyfinancialallowanceinstead”.

Consultation Question 5

Keythemesidentifiedfromquestionfive,whichhavenotbeenaccountedforinquestionone,two,threeandfouraresummarisedbelow:

Please let us know other comments you have on our proposals?

Theme 21: Support

Generalsupportfortheproposalsisevidencedthroughthefollowingstatements:

•�“Proposals�positive�as�long�as�they�avoid�duplication”�

•�“Proposals�positive�but�needs�to�deliver”

•�“Some�scepticism�around�delivery�but�model�is�good”�

•�“Move�on�from�silo�mentality”�

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•�“Should�have�been�done�20�years�ago”�

•��“Lines�of�communication�between�health�and�social�care�will�be�better”,�“if�the�key�worker�works�it�will�be�great”�

•�“Good�vision”

•�“The�vision�is�laudable�and�the�initial�objectives�realistic”�

•��“The�idea�of�a�‘hub’�approach�to�care�is�a�good�one.�For�too�long�care�has�been�disjointed�but�an�inclusive�formula�will�need�to�be�found�in�order�to�engage�all�stakeholders”

Additionalcommentsreceivedoutsideofthestructuredresponseformwhichfurthersupport the proposals include:

•��“We�agree�with�the�comments�about�improving�access�and�about�having�clear�pathways�on�options�and�services�available”�

•�“The�option�of�staying�as�we�are�is�not�really�an�option”�

•��“We�welcome�the�opportunities�for�more�cooperation�between�health�and�social�care”�

•��“There�are�huge�opportunities�for�efficiencies�by�working�more�closely�with�borough�councils”

•��“Service�integration�between�the�NHS�and�the�County�Council�is�welcome,�but�changing�the�structure�is�the�easy�bit”

�•�“The�parish�council�is�in�general�support�of�the�proposals”

•��“We�agree�that�a�single�organisation�with�an�integrated�management�structure is most likely to support the integration of health and social care�community�services”�

•��“We�think�that�this�should�provide�for�greater�commitment�to�shared�objectives�and,�with�the�right�governance�structure,�clear�accountability”�

•��“We�do�concur�that�a�single�organisation�should�be�better�placed�to�develop�a�clear�framework�for�spending�decisions”

Theme�22:�Staffing�of�the�new�organisation

Feedbackhasbeenreceivedinrelationtotheimportanceof“workforcedevelopmenttoensurethatthoseatthepointyendareskilled,willingandable!”Furthercommentsinclude:

•��“It�must�be�directed�by�carefully�selected,�trained�and�experienced�

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managers�who�are�proven�inspirational�leaders�of�people�dedicated�to�change�and�innovation”

•��“People�with�a�flexible�approach,�capable�of�thinking�and�acting�outside the box to deliver real customer care should be recruited and rewarded”�

•��“Back�office�functions�often�have�little�consideration,�what�does�support�look�like�in�the�new�organisation�from�an�HR,�finance�and�performance�perspective”�

•��“Quick�decision�making�is�key,�staffing�culture�needs�to�embrace�this”�

FurtherquerieshavebeenreceivedastohowtheBoardwillbeconstructed.

Theme 23: National changes

Nationalchangeshavebeenhighlightedasaspecificissuewithconcernsthattheproposalsarebeingdrivenforwardatatimewhenthe“outcomeofdiscussionsonthefutureoftheNHSnationallyisbynomeansclear”.Aspecificrequestbyaformalgroupurges“forthemomentthatorganisationsdonotprogressbeyondthestageofcloserjointworking,andonlygiveconsiderationtofullyintegratedserviceswhentheNHSreformshaveatleastreachedtheWhitePaperstage,andtheirimpactandconsequencescanbebetterassessed”.Arelatedcommentdrawsourattentiontothefollowing:

•��“This�proposal�is�for�a�huge�change�programme�at�a�time�of�so�much�other�change.��We�have�heard�much�about�the�opportunities�that�this�represents�but�less�about�the�risks�and�how�these�might�be�mitigated”

Theme 24: Locally based provision

Feedbackwasalsoreceivedontheimportanceofretaininglocalisationofservices,forexample:

•��“We�would�wish�there�to�be�guarantees�that�following�the�merger�of�the�trusts,�and�any�integration�of�Adult�Social�Care,�there�would�continue�to�be�locally�based�provision.�Even�if�this�is�the�case,�we�are�concerned about the lack of local accountability for local services when�they�are�taken�out�of�County�Council�control�and�placed�in�the�hands�of�a�large�county-wide�NHS�Trust”�

•��“Breaking�down�the�organisation�so�that�a�local�service�i.e.�friendly�and�relevant�to�the�community”

•��“The�need�to�have�localised�centres�with�professional�and�trained�staff�who�can�support�adults�and�children�with�needs�and�the�wider�population�with�wellbeing�and�health�advice”

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Other concerns

Concernsraisedinthisquestionarebroadinscopeandrangefrom;“theproposalsareanti-competitiveandbycreatingasingleprovidertherewillbelesschoiceforcommissionersandserviceusers”,pressuresonstaff,(particularlysocialworkers)theroleofthekeyworkerandtheirabilitytomanagecaseloads,diversityisnotcateredfor,“useofagencyworkersisanissue–weneedthesamepeopletocare”and“wemustensurethatthenewtrustisnotanadditionalcostandadministrativesetup”.

Otherconsiderationsreceivedwithinthefeedbackinclude:

•��“We�believe�the�huge�benefits�offered�through�improved�working�with�borough�councils�has�been�completely�overlooked”

•��“The�involvement�of�community�pharmacies�at�both�strategic�and�operational�level�will�be�essential�to�ensure�that�the�goals�of�this�integration�are�realised”

•��“It�appears�that�there�is�a�lack�of�information�or�understanding�regarding roles and remits and a lack of emphasis relating to the essential�work�of�OT’s�and�OTA’s”

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Key Theme Key considerations

Support Overall there is a general feeling of support for the •proposals.

Some trepidation that the proposals can actually be •delivered and whether or not they can work in practice.

Working together ‘Working together’ is considered a key success factor of the •proposals.

Concerns have been raised that the synergies claimed will •not materialise as people served by the two organisations are not the same.

Cultural differences Concerns about the cultural differences between the two •organisations if they come together.

A key issue raised will be the change in culture for social •care staff particularly.

Funding and commissioning Funding and commissioning the • ‘services needed’ is broadly considered as a key success factor.

Clarity sought on how the services are going to be •funded and whether the services become more integrated or limited as organisations compete for funding.

Vulnerable Some concerns around the exclusion of services for people •with learning disabilities and mental health problems.

Issues with how these services will engage and provide a •coherent approach to support for the most vulnerable.

Summary of Key ThemesThetablebelowrepresentsasummaryofthekeythemesidentified

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Children and young people A number of concerns raised that the proposals are too •narrow and do not incorporate children and young people.

Further queries about how the new organisation will link •with children’s services.

Duplication There is a broad opinion that integration needs to reduce •duplication whilst delivering a better, more responsive customer driven service.

Accountability Broad view that the integration of services is necessary •however the integration needs to be full and transparent in order that there are clear lines of responsibility and accountability.

Accessibility There is broad agreement that if the proposals are •implemented successfully then it will be much easier and quicker to access the right services.

Concerns around discrepancy in access to services •because Stoke on Trent won’t be offering the same services as Staffordshire.

Key workers Significant support for the key worker role, but it was raised •that there needs to be enough key workers in place straight away for the proposals to work.

Clarity sought on how many patients a key worker will have •and eligibility of patients to be assigned a key worker.

Voluntary sector Some concerns were raised as to what expectations there •are for the third sector (specifically in relation to funding cuts) and how voluntary services will be involved at the end of pathway delivery.

Financial risk Concerns about the financial management of an integrated •Adult Care Service and questions around how the new trust will manage financial risk and safeguard funds.

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Cross border provision Concerns about the lack of information on cross border •provision , administrative boundaries and the allocation of GPs. Cross boundary arrangements need to be clear.

Communication Ensuring that communication channels are robust across •organisations and to service users is considered a key requirement.

Communication is a real issue and will need to be addressed •and improved in the new organisation.

Personalisation There is a broad view that personalisation will be key and a •welcome for the changes that will improve integration, care for individuals and only having to have one assessment.

Integration of IT / sharing information

Integrated IT is considered a key determinant in the success •of the proposals as is the need to share information and the need for accurate base line data.

Service user involvement The involvement of service users and / or carers in the •development of the services is considered important.

Queries received seek clarity on the ‘engagement model’ •for the new trust and what processes will be put in place to provide feedback.

Staffing of the new organisation

The importance of workforce development and direction by •carefully selected, trained and experienced managers who are dedicated to change and innovation.

National changes Concern that proposals are being driven forward at a time •when the outcome of discussions on the future of the NHS nationally is not clear.

Locally based provision Concern about the lack of local accountability for local •services when they are taken out of County Council control.

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ConclusionThewiderangingresponsestotheengagementhavebeencarefullyconsidered.Itisclearthatthereisoverallsupportforthe‘integrationofservices’optionbetweenStaffordshireCountyCouncilandtheproposedStaffordshireandStokeonTrentPartnershipTrust.Theconsultationhashighlightedthefollowingkeysuccessfactors:

•Organisationsandteamsworkingtogether

•Fundingandcommissioningthe‘servicesneeded’

•Integrationneedstobefullandtransparentwithclearlinesofresponsibilityandaccountability

•Integrationneedstoreduceduplicationwhilstdeliveringcustomerdrivenservice

•Ensuringaccesstotherightservices

•Conceptofthekeyworkerandgettingtheroleright

•Managingfinancialriskandsafeguardingfunds

•Ensuringthatcommunicationchannelsarerobustacrossorganisations

•Amovetowardspersonalisationand‘oneassessment’

•IntegrationofITandsharinginformation

•Theinvolvementofserviceusersand/orcarersinthedevelopmentoftheservices

•Workforcedevelopmentandhavingthebeststafftodeliver

•Retaininglocalisationofservices

However,despiteoverallsupportfortheintegratedapproach,manyareasofconcernhavebeenidentifiedandwillrequirefurtherconsideration,including:

•Cantheproposalsworkinpractice?

•Culturaldifferencesbetweenthetwoorganisations.

•Howtheservicesaregoingtobefundedandwhethertheservicesbecomemoreintegratedorlimitedasorganisationscompeteforfunding.

•Exclusionofservicesforpeoplewithlearningdisabilities,substancemisuseandmentalhealthproblems.

•Thestatusofchildrenandyoungpeopleservices.

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•Governanceandaccountabilityissues

•DiscrepancyinaccesstoservicesinStokeonTrentandStaffordshire

•Coreresponsibilitiesofthekeyworkerandcaseload

•Expectationsofthevoluntarysector

•Howthenewtrustwillmanagefinancialriskandsafeguardfunds

•Clarityaroundcross-boundaryarrangements

•Theimportanceofcommunication

FormoredetailedFrequentlyAskedQuestionsseebelow.

Frequently Asked Questions These have been prepared in response to the key questions that arose during the consultation process.

Working�together/culture�

Q. We are concerned that the synergies claimed will not materialise as people served by the two organisations are not the same?

A.ThereissignificantcrossoverofthepeopleinStaffordshirethathealthandsocialcareservicessupport.Thisisevidentinservicesthatrehabilitatepeople(intermediatecare,reablement)andinserviceswhichsupportpeoplewithlongtermconditions.Thereisacommoncaseloadbetweensocialworkers,occupationaltherapistanddistrictnursesforexample.OneoftheaimsoftheneworganisationistohaveabetteroverviewofallthepeopleinStaffordshirewhouseourservicesandtomeettheirhealthandsocialcareneedsmoreholisticallyasopposedtonow,wheretheyareseparate.

Q. How will the cultural approach be addressed?

A.TheBoardofthenewStaffordshireandStokeonTrentNHSPartnershipTrusthas developed a vision and approach to how care and support will be delivered in StaffordshireandStokeonTrent,whichitshareswiththecountycouncil.Thispresentsacommonapproachtothemodelofcare,whichistosupportpeoplewhentheyaremostinneed,rehabilitatingpeoplewhoareillorincrisis,offeringsupporttomanagelongtermconditionssothatpeoplegrowintheirconfidenceofhowtomanagetheircare.

ThePartnershipTrustwillhaveadetailedorganisationaldevelopmentprogrammethatwillengagestaffandpartnersinthismodelofcareandthephilosophy,skillsandbehaviourstodeliverit.Theaimistobreakdownboundariesbetweenprofessionalsandofferserviceswhichareseamlessandeffectiveforthebenefitoftheindividual.

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Funding and commissioning

Q. How much is it all going to cost and save? What extra costs will be involved?

A.Allofthenationalpilotworkonjoiningupservicesacrosshealthandsocialcarehavedemonstratedbenefitsandacknowledgedshorttermcostsofbringingteamstogether.OneofthedriversforintegrationistoprovideamuchbetterserviceforthepeopleofStaffordshire.Withamajorprojectlikethisanextensiveamountofworkhasbeenunderwaytoidentifyallthebenefitsthattheintegrationcouldbring.Afullbusinesscaseisbeingfinalisedwhichwillsettheseoutinfullanddetailallthecostsandthesavingsfortheintegrationofhealthandsocialcare.ThiswillgotothePartnershipTrust’sboardandthecountycouncil’sCabinetforconsiderationlaterthisyear.Theywillmakethefinaldecisionaroundthenextstepsatthesemeetings.Whileitwillundoubtedlycostmoneytosetupthenewinfrastructureintheshortterm,ourviewisthatinthelongterm,thisapproachwillbringmanybenefits,notonlyinsavingthetaxpayermoneybutalsobyprovidingamuchbetterserviceforStaffordshire’sresidents.

Q. How are services going to be funded and will this then impact on the services that can/will be offered?

A.TheaimisthatStaffordshireandStokeonTrentPartnershipNHSTrustandStaffordshireCountyCouncil’sAdultSocialCareservicesbringtogethertheirresourcesandprovideintegratedserviceswhereappropriate.Nationallyhealthorganisationsarerequiredtomakeefficiencieswhichreducetheirbudgetby4%.Thiscouldbedonebyreducinganyduplication,inefficiencyandwastethroughhavingoneorganisationchargedwithprovidingintegratedhealthandsocialcareservices.

FundingiscurrentlyprovidedbyStaffordshireCountyCouncilforAdultSocialCareservicesandfromhealthcommissionersforcommunityhealthservices.AllofthecommissionershavebeeninvolvedintheplanstoestablishthePartnershipTrust.Thereisnoreasontoassumethatanyofthesefundingstreamswillchange.

Q. Will services become more integrated or limited as organisations compete for funding?

A.Serviceswillbecomemoreintegratedbetweenhealthandsocialcareratherthanmorelimited.Webelievethatbybeingmoreefficientwecanattractmorefundswhichwillmaintainandimproveservicesanddeliverefficienciesacrossthewholesystemincludingacute(hospital)care.

Q. How does commissioning work in the new organisation - are they the commissioners of services or are the county council? Who then procures those services?

A.Commissioningwillremainasitisnow(subjecttoanynationalchangesinlegislation)–withPCTCluster,clinicalcommissioningconsortia(groupsofGPs)andcountycouncilcommissioningwhichsitoutsideofthedeliveryofservices.Procurementismainlyundertakenbycommissioners.

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Q. What safeguards would be in place to prevent what was previously local authority funds from being ‘siphoned off’ into other aspects of health care?

TherewillberobustarrangementsbetweenthePartnershipTrustandthecountycounciltoensureeffectiveandqualityservicedelivery.Thecountycouncilstillremainsprimarilyresponsiblefordeliveryofservices,butservicedeliverywillbedelegatedtothePartnershipTrust.ThesearrangementswillmakeuppartofthelegalagreementbetweenthePartnershipTrustandthecountycouncil.Indeed,allofthecommissionerswillreceiveregularreportsontheperformanceandfinancialspendofthePartnershipTrust.ThisputsqualityattheheartofservicesandshowstransparencyaroundfundingsothatitisspentintherightwaytomeetagreedoutcomesforthepeopleofStaffordshire.

Q. How will you ensure that whoever determines the package of care for an individual patient has the budgetary clout to make sure that the care package is actually delivered?

A.Thenewarrangementswillbeseekingtomakefrontlinestaffandmanagersmoreaccountablefortheirbudgetsandformakingthedecisiononthecareandsupportdeliveredtomeettheneedsofpatientsandserviceusers.Experiencetellsusthatthisreducesdelays,ensuresmoneyisspentmoreeffectivelyandempowersstafftomaketherightdecisionswiththepersonreceivingtheservice.

Q. How will you tackle the relationship with acute care: at a strategic level, ensuring that there’s adequate funding for basics like hip and cataract operations which can have a huge impact on the capacity to live independently; and, in terms of individuals, helping them to assert their needs?

A.Undoubtedlythisisachallengewhichallcommissionersface.CommissioningforacutecarewithinStaffordshire,asnationally,isundertakenbytheclinicalcommissioninggroups.ThePartnershipTrustwillhelptheclinicalcommissioninggroupsunderstanddemand,needs,servicesandgapstoensurethattherightlevelofservicesareprovidedwithinthecommunity.

Vulnerable

Q. There is no mention as to whether additional services are going to be included in the future. Are learning disabilities, mental health and substance misuse to remain with the county council for the time being – when are they programmed to move?

ItisanticipatedthatLearningDisabilityServiceswillbecomeanindependentservicedevelopedanddeliveredwithserviceusers.Specialistmentalhealthservicesareprovidedbytwohealthtrustsalready.Thesubstancemisuseiscurrentlybeingredesignedtoenablepeopletoaccessservicesandtreatmentquicker.

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Q. How will people with disabilities be assessed on their medical issues and not on social care?

A.Medicalassessmentswillbeundertakenastheyarecurrently.Therearenoplanstochangethis.

Q. Evidence that mental health and physical health need to be linked – why is this not happening?

A.TherearedifferentserviceprovidersinStaffordshireandStokeonTrentanditisunlikelythatallserviceswilleverbeprovidedbyjustoneorganisation.Thesuccessofjoiningupanysupportwhereitisprovidedbydifferentserviceprovidersistousethekeyworker(themaincoordinatorofcare)toensurejoinedupandeffectivesupportplansaredelivered,andtostoppeople‘fallingbetween’organisations.

Q. What will happen to those with sensory needs as well as other issues e.g. mental health, substance misuse etc. Who decides the primary need?

A.Sensoryservicesarepartoftheproposedpartnershiparrangements.Theprofessionalwhocarriesouttheassessmentwillagreetheprimaryneed.Thekeyprofessionalwhoworkswiththecustomer/patientthencoordinatesthecareandsupportinawaythatmaximisesthedifferentskillsrequiredtosupportsomeonewithmultipleneedsandreduceanyproblemsduringthehandoverbetweendifferentorganisations.Manystafffromdifferentserviceswillcoordinatethecarewhichisthekeytoitbeingsuccessfulandapositiveexperienceforpatientsandserviceusers.

Q. Why is the county council taking away adult protection and imposing changes prior to us becoming a Trust? Will the Trust be micro managed by Stafford?

A.ThecountycouncilisnottakingawayadultprotectionfromthePartnershipTrust.MostinvestigationswillinfactcontinuetobeledbytheTrust.

ThecountycouncilisbringingtogetheraMulti-AgencySafeguardingHub[MASH]whichaimstobringtogethercurrentcontact,referral,informationandintelligencegatheringandinitialinvestigationfunctionsforsafeguardingandcommunitysafetyfromStaffordshirePolice,StaffordshireCountyCouncil,StokeonTrentCityCouncil,StaffordshireandStokeonTrentNHSorganisations,theProbationService,StaffordshireFireandRescueandallotheragenciesengagedinsafeguardingfromanonstatutoryandthirdsectorbasis.Thiswillcoverissuessuchaschildren’ssafeguarding,adultsafeguarding,domesticviolence,hatecrime,andchildsexualexploitation.

TheworkoftheHubwillensuretheneedsoftheindividualarefullyunderstoodandwillencourageinnovationwhichiscentraltothedevelopmentoftheMASHandwillworkwithinthecontextofawholefamilyapproach.Theywillundertakeinterventionswhichareproportionateandbasedontheassessedriskposedbytheallegedharmorabuse.

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Bysharinginformationandimprovingcommunicationsinamultiagencyenvironmentandwithinagreedprotocols,theaimistoimproveourapproachestoprotectingthemostvulnerablepeopleinStaffordshireandStokeonTrent.

Throughearlyidentificationofbothriskandharm,itwillallowforearlierandwellinformedinterventionstopreventfurtherescalationofharm/risk.

Finally,underpinningthismultiagencyapproachisthelearningopportunitiesfororganisationsengagedinsafeguardingandthedevelopmentofpreventativesafeguardingstrategies.

ThiswillsavetheTrusttime,introduceconsistencyandincreasethequalityofthestrategydiscussionsgettingtheinvestigationsofftoamoreeffectivestartandpositiveoutcomes.

ItisalsoimportanttonotethattheMulti-AgencySafeguardingHubisnotbeingsetupbecauseoftheformationofthePartnershipTrust.Thedriverbehindtheconceptnationallyandregionallywasthattherehadbeenaconsistentthemeinseriouschildren’sandadults’casereviewswherekeyinformationhadnotbeensharedbetweenagenciesinatimelyandcoherentway.ThiswaspickedupstronglybyLordLaminginhisreviewofchildprotectionpracticesfollowingthetragicdeathofVictoriaClimbé.InStaffordshireandStokeonTrent,wewanttoimproveourapproachtoprotectingthemostvulnerableandbelievebybringingtogethertherelevantstaffwewillbebetterplacedtodothisanddemonstrateourcommitmentacrossallpartnerstoimprovetheprevention,detectionandresponsestovulnerablepeople.

Dementia

Q. How will the Partnership Trust support the increasing number of people with dementia, the rumour that is circulating is that the Trust ‘will not do dementia’ is this true?

A.Dementiaisincreasingasthepopulationgetsolderandliveslonger.MostpeoplewithdementiawhorequireservicesandsupportwillreceivethisfromthePartnershipTrust.Additionallythough(andnotinsteadof)peoplewhoareadvancedintheirdementiaandneedmorespecialistinputwillalsobeabletoaccessspecialistmentalhealthservices,whichmaybedeliveredfromotherorganisations.

Children and young people

Q. No mention of children’s health and social care and why this is not included. Are you able to provide details of what will happen regarding children’s services?

A.Children’sserviceswithinthecountycouncilhaveworkedupaseriesofoptionstolookattheviabilityofaformalpartnershiparrangement.Noformaldecisionhasbeenmadeasyet,althoughservicesarebeingjoineduplocallyandoperationallythroughtheFamiliesFirstdevelopment.

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Duplication

Q. How will you reduce duplication whilst delivering a better, more responsive customer driven service?

A.Mostduplicationhappenswithinservicedeliverywherecustomers/patientsexperienceanumberofprofessionalsworkingwiththem,whereassessmentsareundertakenbydifferentorganisations,andsometimesresourcestosupportthemoverlap.InthePartnershipTrust,thereisauniqueopportunityforhealthandsocialcareresourcestobetargetedinthemostappropriateways.Atypicalexampleinthefuturemaybeadistrictnurseinstallinglongtermequipmentforapersonwhichhelpstomakethemmoreindependent.Atthispresenttime,thiswouldnecessitatetwoseparateprofessionalsandtwoseparateassessmentsandinevitablythisleadstodelayandcost.

Accountability

Q. What will be the governance and accountability of the new Partnership Trust?

A.ThePartnershipTrustisastatutoryNHSbodywithaBoardmadeupofnon-executiveandexecutivedirectorsandachiefexecutive.TheTrustisaccountabletoitsmembership,totheNHSataregionalandnationallevelandtotheCareQualityCommission.WhenthePartnershipTrustgainsFoundationTruststatusitisalsoaccountabletoMonitor–theindependentregulatorofNHSFoundationTrusts.

Q. How will you ensure that the integration will be full and transparent in order that there are clear lines of responsibility and accountability?

A.Theaimistocreatesingleteams(ofhealthandsocialcareprofessionals)whoareaccountablethroughthelinemanagementofthePartnershipTrust.TheperformanceoftheseteamswillbemanagedthroughacontractwiththecountycouncilandthePCTCluster/ClinicalCommissioningGroups.Teamswillhaveplansoutliningtheirobjectives,whotheyreporttoandexplainhowworkisdelegated.Theywillalsooutlinetheindividual’saccountabilityanddecisionmakingremits.TheemployingorganisationisanNHSTrustsostaffwillhaveaccountabilitytotheBoardandareregularlymonitoredbothindividuallyandonateambasis.Wholeservicesarealsomonitoredondeliveringhighqualitycosteffectiveservices.

Accessibility

Q. How will you ensure that there is no discrepancy in access to services as Stoke on Trent won’t be offering the same services as Staffordshire?

Servicesarenotcurrentlydeliveredandaccessedallinthesamewayandtheywillnotbeinthefuture.Thevariationsarebasedonunderstandingandmeetinglocalneedsandcommissioners’viewswhichareinformedbythoseneeds.Itisalsobasedonthebestwaytoorganisetheskillsofstaffandtheirspecialisms,locally.However,outcomesaremeasuredacrossallservices,irrespectiveofthewayinwhichservicesaredelivered.

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Key�worker�role

Q. What is a ‘key worker’? Roles and responsibilities need to be defined. Asking a lot from one person?

A.AKeyworkerwillbeappointedtoworkwitheveryonewhoseneedsarecomplexenoughtoneedlongtermsupportandconsiderablecoordinationbetweendifferentprofessionalsand/ordifferentagencies.Thisdoesnotmeanthatthekeyworkercarriesoutallthefunctionsrequiredtokeepthatpersonindependentandsafe.Itisarolethatensures people have one person to relate to and who can coordinate all their services andarrangethespecialistprofessionalassessmentandsupporttheyneed.

Q. At what stage does a person get a key worker – does everyone get one?

A.No,onlypeoplewhoneedlongtermsupportfromarangeofdifferentservicesandprofessionals.Peoplewhoneedsimpleservicesthatremainthesamefromonereviewtothenext,haveanamedmemberofstafftheycantelephone,meetandreferqueriesto.

Q. Where will the key worker come from? Is it going to be practical? How many patients will the key worker have?

A.Peopletellusthatiftheyneedsupporttheywanttodealwithonepersonwhomtheycancontacteasilywhentheyneedtoandwhocanhelpthemnavigatethecomplexpathwaysthroughhealthandsocialcare.KeyworkingisthereforeafundamentalelementinthenewPartnershipTrust.Peoplewhoneedsupportorcarewillbeabletocontactonenamedperson,theirkeyworker,atallthestagesintheirjourneythroughthehealthandsocialcaresystem.

Intheory,anysocialcareorhealthprofessionalcouldtakeontheroleofkeyworkerifassessmentanddiscussionswiththeirlinemanagerindicatestheyarethemostappropriatepersontotakeonthisrole.Someoftheareasthatkeyworkerswilltakealeadon are to:

•Ensurethatthepeopletheyworkwithknowhowtocontactthemdirectly.

•SupportpeopletoarrangethesupportandcaretheyneedthroughhelpingthemdeveloptheirPersonalSupportPlans/HealthPlans.

•Provideorarrangeappropriatesupporttohelppeoplefindsolutionstotheirownproblemsasfaraspossible.

•Actascoordinatorofservicesprovidedacrossmorethanoneagencywhereanindividualhasarangeofcomplexneedswhicharebeingmetthroughavarietyofsupporte.g.dementia.

•Ensurecarersreceivetheappropriatesupporttocarryonprovidinghelp.

•EnsureregularreviewsarecarriedouttoensureHealth/SupportPlansremainappropriate,uptodateandcosteffective.

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Noteveryonewhocontactsuswillneedakeyworkerbutmanagerswillallocateaprofessionaltoactinthiscapacitywhereindividualsituationsareeithermorecomplexorrequirecoordinationbetweenagencies.Partofdevelopingthekeyworkermodelistogainstaffviewsontherealisticlevelofcasesthatcanbemanagedbyoneperson.

Q. What will be the duration of involvement with the key worker?

A.Keyworkerswillhaveactiveandinactivecasesatanyonetime.Thelengthoftimewillbedeterminedbytheindividual’sneeds.

Q. Who will they be; how many will there be and where based, what happens if absent or sick?

A.Asabovetheycanbeanyprofessionalwithinthehealthandsocialcaresystem.Iftheyarenotavailableforashortorlongerperiodoftime,itistheroleoftheteamleadertoreallocatetheircasestobecoveredforthattime.

Q. How will they acquire knowledge – what training will be provided and how much will this cost?

A.Mostoftheknowledgetheyrequirewillbepartoftheirexistingcompetenciesandskills.Peoplewillreceiveadviceandguidanceonhowtocarryouttheirkeyworkingfunctionsandgainawarenessofthereportingandsystemsmanagementissues.Ifanyadditionalclinical/professionaltrainingisrequiredtocarryouttheirrole,thiswillbeidentifiedaspartoftheirindividualtraininganddevelopmentplan.

Q. Clarity around who is doing the assessments and how these will be done?

A.LocalAuthoritieshaveastatutorydutytoassesseveryonewho“appearstobeinneedofcommunitycare”–iesocialcare.ThisdutyisdelegatedtotheTrustaspartofthepartnershipagreement.Initiallytherefore,socialworkersandsocialcareassessorswillcontinuetocarryoutthisfunctionastheyalwayshavedone.Inthefuture,asweworkoutexactlyhowtheteamswillintegrate,thestaffmemberorotherNHSorsocialcareprofessionalwhoseemsthemostappropriatewillcarryoutgenericcommunitycareassessments.

Specialistassessmentsmayalsotakeplace.Thesewillcontinuetobecarriedoutbythoseprofessionalswhohavetheskillstorecogniseandaddresstheparticularspecialistneede.g.occupationaltherapist,physiotherapist,socialworkersandnursingstaff.

Q. What will happen to those users who fall outside the circa 10,000 priority users that are your initial target?

Q. How will you identify the 10,000 people? What will happen to the next level down?

A.Themodelofcareisbasedonaconceptknowasmanagedcare.Thisisbasedon

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riskstratification(measuringtheriskofhealthproblemsandsubsequentneedtousehealthservices)ofagivenpopulationandproactiveandcoordinatedinterventiontohelppeopletomaintaintheirhealthstatusandwellbeingasfaraspossible.

The10,000figurereferstohighriskpatients(between1%and5%ofthepopulation)wherewewouldexpecttoundertakecasemanagement.Thisisbasedonapersonalcareplanwithclearselfmanagementandtriggersforinterventions.TherearethreeorfournationallyrecognisedassessmentNHShealthtoolkitswhichprofessionalscanworkthroughwithapatient/customertoidentifythosewhoareatthemostrisk,wheretheywillneedmorecomplexcare.

Forthesepeople,carewillbemanagedbymulti-disciplinaryteamswithprofessionalsworkingmoreflexiblyacrossboundaries.Aswemoveforward,eachpatientorclientwhohasmorecomplexneedwillhaveakeyworkerwhocanbefromanyprofessionalbackgroundbutwhowilltakealeadroleinensuringcoordinationandcommunication.

Othersresidentswillcontinuetoreceiveservicesastheydonowandpeoplewhoneedsimpleservicesthatremainthesamefromonereviewtothenextwillcontinuetohaveanamedmemberofstafftheytelephone,visitorreferanyissuesto.

Q. Key workers will have the authority to access different teams and services to get the most appropriate responses for the patient/service user – won’t there be some disagreement between disciplines as to what is best for the patient/service user?

A.Wewillusemulti-disciplinaryforums(mixtureofdifferentstaffandskills)todiscussthebestoutcomesforapatient/customerandwilluseourprofessionalstogivethebestadvicetoresolveanydifferencesinviewpoint.Keyworkersco-ordinateallthecareandensureitmeetstheperson’sneeds.Theycannothavespecialistknowledgeinallhealthandsocialcarefields;itisthereforeuptoeachkeyworkertotakeadvicefromthespecialistsinvolved.Itisimportanttostatethatthecustomer’s/patient’sviewsinformthefinaldecision.

Q. Will key workers be for health or social services?

A.Keyworkerswillbeforboth.

Voluntary sector

Q. What expectations are there for the third sector (specifically in relation to funding cuts) and how will voluntary services be involved at the end of pathway delivery?

A.WeareindiscussionswiththevoluntarysectortodesignhowtheymightbestfitwithintheservicedeliveryofthenewPartnershipTrustforexampleinrelationtocreatingnetworksofsupportforolderpeople.Oncewehavedevelopedthecareplansforthemostcomplexpatients/customers,wewillalsohaveanindicationofwherethevoluntarysectormaybesttargetitsresources.

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Financial risk

Q. How will the new trust manage financial risk and safeguard funds?

A.AllNHSTrustsarerequiredtohaveafinancialriskstrategyandarefullyaccountableforspendingpublicmoney.

Q. High Court ruling that county councils cannot run out of money means that assessed, eligible need must be met by the provider. Lack of resource is not a defence. How will the Trust manage this and other financial risk?

A.Itiscorrectthatlackofresourceisnotanexcusefornotsupportingindividualswhohaveassessedneeds.ThecountycouncilandthenewPartnershipTrusthavelongtermfinancialmodelswhichtakeaccountoftheirlikelyfundingpositions,theincreaseinfundingpressures(e.g.thegrowingnumbersofolderpeoplewhowillrequireservices)andwhereefficienciescanbemade.Theseplansaremonitoredagainstrealspendingtoensurethatanysignificantvariationsareunderstoodandcanbeplannedfor.Inaddition,theDepartmentofHealthundertakesanassuranceprocesstoascertainthefinancialsustainabilityofthePartnershipTrustintheimmediateandlongerterm.

Cross border provision

Q. There is a lack of information on cross border provision, administrative boundaries and the allocation of GPs. Can this be clarified?

A.Healthandsocialcareboundariesaredifferentnowandthiswillcontinuetobethecase.HealthisbasedonGPpopulations,andsocialcareonwhereapersonordinarilylives.ItissomethingthatweareawareofandthePartnershipTrustwillworkwithneighbouringorganisationstominimiseanyproblemsthatcrossborderissueshighlight,especiallyaroundaccessingsupportandresources.

Q. Why did Stoke on Trent City Council decline? Will residents of SOT be able to access the services provided by the new Trust? What is being done to bring SOT CC services into this?

A.StokeonTrentCityCouncilhavenotdeclinedtoworkwiththenewPartnershipTrust.TheyremainveryengagedwiththedevelopmentsandwillseektocreatelocaldeliveryteamsthatareverysimilartotheonesinthenewPartnershipTrust.StaffordshireCountyCouncilhasbeendiscussingthepotentialtousethePartnershipTrusttodeliverjointservicesforalongtimeandisthereforefurtheradvancedintheirplanningtoachievethis.

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Q. How can the whole system work without the participation of Stoke on Trent City Council: would there not be the risk of the county council funds subsidising health provision in Stoke? What is the likely impact on council tax of these changes?

A.Asperthequestionandanswerabove,StokeonTrentCityCouncilisactivelyinvolvedintheplanningoflocaldeliveryandwillworktowardsmirroringthatintheirarea.EachorganisationthatisworkingwiththePartnershipTrustisbringingsomefundingwithitwhichisattachedtoandaccountabletothelocalpopulationneedsofeacharea.Thiswillnotchangeinthenewarrangementsandcounciltaxwillbeunaffected.

Q. There seems to be much exclusion i.e. the Shropshire and South Staffordshire Healthcare Trust is not part of the new arrangements, and they are designated to take over two hospitals?

A.TherearedifferentserviceprovidersinStaffordshireandStokeonTrentanditisunlikelythatallserviceswilleverbeprovidedbyjustoneorganisation.Thesuccessofjoiningupanysupportwhereitisprovidedbydifferentserviceprovidersistousethekeyworker(themaincoordinatorofcare)toensurejoinedupandeffectivesupportplansaredelivered,andtostoppeoplefallingbetweenorganisations.

ThetwohospitalsreferredtoarepresumedtobethosethathavetransferredtoQueensHospital,Burton-upon-Trent,whichareSamuelJohnsonHospital,LichfieldandSirRobertPeelHospital,Tamworth.

Q. There is no information around cross border provision, e.g. if you live in South Derbyshire you may be referred to Queens how will you then get the ongoing support and provision?

A.Providerswillliaiseacrossboundariesastheydonow.

Communication

Q. What assurances can you put in place that communication channels will be robust across organisations?

A.GoodcommunicationsisapriorityforthePartnershipTrustandweareputtinginplacemorewaysofsupportingstafftoensurethatitiseasiertocommunicatethroughouttheorganisationsatalllevelsi.e.Seniormanagementteam,linemanagersandteams.ThiswillincludejoiningtogetherITsystems,settingupteammeetingsandstaffbriefings,newslettersandothercommunicationsmethods.

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Integration of IT/sharing information

Q. Integrated IT is considered a key determinant in the success of the proposals as is the need to share information and the need for accurate base line data. Where has the baseline data been collated from to substantiate changes?

A.StaffordshireCountyCouncilandthePCTshavebeenhavingdiscussionsonsharedITlinksforseveralyearsandforthescaleoftheintegration,thesharingofinformationisessential.Wewilllooktohaveacommonclinicalrecordinplaceasquicklyaspossible,probablybuildingontheseparatehealthandsocialcareITsystems.Theaimofasinglecomputersystem,whilstideal,isunrealisticintheshorttermasnationallywithinthemarketplacethesystemsdonotexist.

Therearerobustinformationsharingprotocolsinexistenceinotherpartsofthecountry,andthesehavebeendiscussedoverthelastyearinStaffordshire.WebelievethisisanissuethatcanbequicklyresolvedandonethatisapriorityforthenewPartnershipTrust.

Baselinedatahasbeentakenfromthecurrentorganisations’performancesystemsandfrompilotswithintegratedteamsacrossthecounty.

Service user involvement

Q. Can you please provide clarity on the ‘engagement model’ for the new Trust and what processes will be put in place to provide feedback?

A.ApatientandpublicinvolvementstakeholdereventwasheldinApril2011tospecificallydiscusshowthenewStaffordshireandStokeonTrentPartnershipNHSTrustwillengage,involveandconsultwithitsserviceusersandlocalcommunities.Oneofthekeyrecommendationsfromtheeventwasfortheestablishmentofacounty-widerepresentativemembershipscheme,whichiscurrentlybeingdevelopedandwillsupporttheneworganisation’smovetowardsFoundationTruststatus.MembersofthepublicwillbeabletoelectPublicGovernorstoprovideastrongervoiceforthecommunitywithintheorganisation.Wewillensurethatprocessesareinplacetoprovidefeedbacktoserviceusers/public/patientsandthatfeedbackiseffectivelycheckedandmonitored.Themodelwillbepartofawiderstructurethatincludesarangeofwaystodeliverpublicandpatientinvolvement,usingexpertiseandskillsthatarealreadyprovidedacrossthecounty.

Staffing�of�the�new�organisation

Q. What does support look like in the new organisations from an HR, finance and performance perspective?

A.Eachofthefourorganisationshasworkedthroughwhatresourcesandstafftheywilltransferintothenewarrangements.Insomecasesthisisamoneytransfer,inothersitisstaffwhoworkinthatfunction.AllsupportserviceshavebeenscopedandastructureundertheBoardlevelhasbeenpublished.

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Q. How will the Board be constructed – is there a ‘normal/lay’ person included on the board, who is talking to the patients?

A.TheBoardfollowsastandardNHSBoardformatofnonexecutiveandexecutivemembers.Patients,families,carers,andcustomersareinvitedtoattendeachBoardmeetingandthisisworkingwell.TheBoardmeetingsareheldinpublicandanyonecanattend.

Q. We would welcome reassurance on how the jobs, pay and conditions of current county council employees who are moved into the new Trust will be protected. Who will have the say on salary levels, conditions of working and performance management?

A.TheTUPERegulationswhichgovernthetransferofstafffromoneorganisationtoanotherprotectthetermsandconditionsofthestaffthatmove.Thismeansthatcountycouncilstaffwouldtakealltheirtermsandconditionsofemploymentatthepointoftransfer,withthem.Existingcollectiveagreementsarealsohonoured.Conditionscannotbevariedtothetransferringemployees’detrimentiftheonly,orprincipalreason,isthetransfer.

National changes

Q. Concern that proposals are being driven forward at a time when the outcome of discussions on the future of the NHS nationally is not clear – what are your views on this?

A.ThenationalchangescurrentlyproposedrelateprimarilytohowcommissioningwillworkintheNHS.ThedirectionoftravelforproviderorganisationsisclearsincetheNHSOperatingFramework2010/11wasissued.

Q. Can such a complex restructuring work when the NHS is also undergoing organisational change?

Q. Concerned that Staffordshire view is moving forward when the National View is to take stock. We are impacting on so many peoples’ lives: what will our position be if the national consultation is a different model?

A.Thereisneveranidealtimeforchange.HoweverthereareprocessesinplacetoensurewetakeregularstockofthechangesthataregoingonacrosstheNHSwhichcouldimpactonthePartnershipTrust.Generallythemainorganisationalchangerelatestocommissioningfunctionsandnotproviderservices.

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Localisation

Q. What arrangements will be put in place to ensure that such a big trust ascertains and addresses needs at local area levels?

Q. I am concerned about the lack of local accountability for local services when they are taken out of county council control – what assurances are you offering?

ThelargescaleofthePartnershipTrustallowsforthedeliveryofmoreconsistentservicesacrossthecounty.Atthesametime,itiswidelyrecognisedthatlocalvariationsforneedarerequired.ThePartnershipTrusthasanorthandsouthdivisiontoallowfordecisionstobetakenatseniorlevelatamorelocallevel,andhaswidelyconsultedacrosshealthandsocialcareonamodelforlocalteamdevelopmentwithautonomyforlocalmanagers.Inthesouththisisknownasthe“neighbourhoodmodel”.AsimilarphilosophyexistsaroundLeekandCheadleinthenorthdivision.MoredetailedworkisneededontheapproachintheNewcastlearea,becauseoftheoverlapofserviceswithStokeonTrent.

ThePartnershipTrustwillremainfullyaccountabletothecountycouncilfortheservicesitcurrentlydirectlyprovides.Thecountycouncilwillsetoutthespecificationsfortheservice,theeligibilitycriteriaandthechargingpolicy.ThePartnershipTrustwillberesponsibleforthedeliveryoftheservicesandwillreporttoacommitteeofthecountycouncilwhowillperformancemanagethePartnershipTrust.OtherarrangementsmaybeputinplacebetweenthePartnershipTrustandthecountycounciltoensureperformanceismanagedeffectivelyonadailyandweeklybasisandpartoftheoperationalrunningofservices.

Occupational therapy

Q. I would like some further clarification regarding the provision of Occupational Therapy [OT] Services. I feel the paragraph on equipment services does not fully explain the role of OT. Working in social care as an OT, we are not specifically called an ‘equipment service’ as there are many other parts to our role. The paragraph describing health and social care OTs reads as if there is duplication in services. However this is not the case.

A.Itisacceptedthattheroleofoccupationaltherapyisdiverseinthecountycouncilandisequallydiverseanddifferentincommunityhealthservices.SomeoftheOTpracticeleadsareundertakingapieceofworktoscopethisoutandconsultpeopleaboutwhatthefuturedevelopmentscouldbe.

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Borough councils

Q. How will the borough councils and district councils be involved?

A.AtastrategicandoperationallevelthePartnershipTrustwillworkcloselywithallpartnersincludingboroughanddistrictcouncils.Thisisbecausepeoplehavemultipleneeds,especiallyrelatingtohousing,transport,beingsafeintheircommunity,homeadaptationsandleisurematters,whichrequiresignificantpartnershipresponsestoresolve.

Monitoring

Q. When it happens will inspections be carried out on a regular basis and who by?

Q. As a Partnership Trust how will we keep people safe and drive up standards in care homes, local providers, whose role will this be?

ThereareavarietyofmechanismsforinspectionofservicesprovidedbythePartnershipTrust.ThePartnershipTrustwillhaveitsowninspectionregime,whichwillincludeNonExecutiveDirectorsinannouncedandunannouncedvisits.Inaddition,thecountycouncilandthePCTClustercarryoutinspectionvisitsaspartofthecontractualarrangements.TheCareQualityCommissionwillalsocarryoutinspections,includingHygieneCodevisitsaspartoftheregistrationrequirementoftheTrust.

Theinspectionregimeforpatientgroups,suchasHealthWatch,areexpectedtobedefinedduringthepassageoftheHealthBillthroughparliament.

ThePartnershipTrustwillhaveclinicalstaffwhowillinteractwithotherproviders,includingcarehomes,whowillraiseconcernsshouldtheyhavethem.

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