BOROUGH OF POOLE Agenda Item 6 PEOPLE OVERVIEW AND SCRUTINY COMMITTEE (HEALTH AND SOCIAL CARE) 11 December 2017 Adult Social Care Shared Services with Bournemouth Borough Council 1. PURPOSE 1.1 The purpose of this report is to advise the Committee of the progress made in establishing a joint management team for Adult Social Care between Bournemouth Borough Council and Borough of Poole. The report also identifies a number of service areas within Adult Social Care which have either implemented or are developing shared services. 2. DECISION REQUIRED Committee is asked to: 2.1 Scrutinise the shared services management structure for Adult Social Care. 2.2 Comment upon the emerging shared services proposals and make observations from visits that Members of this Committee have made to front-line Adult Social Care services. 3. BACKGROUND 3.1 Borough of Poole took the opportunity in late 2016 to create, with Bournemouth Borough Council, a joint Head of Service/Service Director post for Adult Social Care. Following this appointment, a case for change was made in March 2017 and, subsequently, approved by the Joint Services Management Group to create a shared management team for Adult Social Care. 3.2 The case for a joint management team noted that such a shared leadership approach for Adult Social Care would be consistent with proposals for local government reorganisation and the emerging shared services approach between Borough of Poole and Bournemouth Borough Council. The case also made supplementary arguments including: financial savings, greater resilience provided by a shared management team and the opportunities for service redesign and modernisation that would only be possible with a formally shared management structure. 3.3 The case for change is also consistent with the wider health and social care context across Dorset, Poole and Bournemouth - which is described in Our Dorset, the local Sustainability and Transformation Plan (STP). The STP is the blueprint for delivering a transformed health and social care system and, principally, greater prevention of ill-health, a more connected network of acute hospitals and integrated community services operating from locality based hubs. Community Services provided by health and social care will need a more integrated approach as part of this new model and it will be important to approach 1
this with consistency across Bournemouth and Poole. 3.4 A further argument for a joint management team is to develop a platform for sustainable financial savings. Joint management posts will lead to further service redesign work, joining teams across Bournemouth and Poole and more opportunity for different ways of working. Without joint managers, efficiency initiatives risk being replicated across Borough of Poole and Bournemouth Borough Council leading to less effective outcomes. 4. NEW STRUCTURE 4.1 Following approval to proceed with a shared management team, a series of appointments were made in May 2017. These six new joint service management posts are set out in table 1. Table 1: Adult Social Care Joint Service Management Team 4.2 Service Development The newly formed joint Service Development team is responsible for most Adult Social Care project work, some elements of business planning, service redesign, policy, procedure, practice guidance and change management. The nature of the team means that it has been very well placed to quickly take advantage of the shared services arrangement and has begun to develop joint procedures, guidance and standards for Adult Social Care. There is an opportunity within this service to identify best practice in each local authority and apply this across both organisations. Emergency Planning and Business Continuity Plans, for example, are being re-written to recognise that accommodation and staff resources can now be more easily shared in the event of a major incident in either local authority area. The service development team also providing the project capacity and expertise to develop many of the emerging shared services noted in this report. 4.3 Long-Term Conditions The Long-Term Conditions Service, that is services to older people, people with a sensory impairment, people with a disability and hospital social work, operate across six GP localities, three in Poole and three in Bournemouth. Both the large span of this service area and the nature of the teams (which are aligned to GP 2
localities and acute hospitals) required two management posts, one with a locality focus on Bournemouth and another with a locality focus on Poole. This arrangement allows for the two service managers to cover for each other s absence and for either to represent the whole service when working with partners, which brings consistency and time efficiencies. Specialist lead responsibilities are also shared, with the Poole based Service Manager holding a lead role for Continuing Health Care (CHC) and the Bournemouth based Service Manager holding a lead role for Carers Services. 4.4 Learning Disability and Mental Health Learning Disability teams and Community Mental Health Teams (CMHT) are integrated services between Borough of Poole or Bournemouth Borough Council and Dorset HealthCare, operated by jointly appointed single line managers. The CMHTs and Community Learning Disability teams naturally align in terms of joint governance with Dorset HealthCare and consequently have been combined under a single service manager. 4.5 Statutory Services Although much of the work of Adult Social Care is undertaken under the Care Act (2014), other more specialist work is undertaken under the Mental Health Act (1983) and Mental Capacity Act (2005). This service area includes safeguarding, Deprivation of Liberty Safeguards (DoLS) and statutory mental health assessments. The functions are distinct from long-term fieldwork mental health services because they typically rely on urgent and short term intervention, often lasting only a day or two. These functions are gathered under a single Statutory Services Manager. 4.6 Specialist Services The specialist services post holder is responsible for Adult Social Care finance functions such as billing clients and managing invoices from care providers, as well as the Direct Payment support team and the team which manages clients finances when they are unable to do so themselves. These financial functions are broadly replicated for Bournemouth Borough Council. The post does, however, also manage a range of services which are unique to Borough of Poole Adult Social Care, such as the Helpdesk, Reablement team and Brokerage team. 4.7 Other Services Borough of Poole hosts the Out of Hours Service for Adult and Children s Social Care. This service has a discrete Service Manager who is not currently a joint appointment. The joint management team also oversees Shared Lives and Supported Living Services for Borough of Poole, but as these services are not provided to Bournemouth Borough Council they also remain a Borough of Poole post only. Borough of Poole is also the host for the business support function of the Bournemouth and Poole Safeguarding Adults Board. This post reports directly to the Chair of the Safeguarding Adults Board and, as such, holds a function that is at arms-length from Borough of Poole; although the Council provides corporate support such as Payroll, HR support and accommodation. 3
5. FURTHER SHARED SERVICES OPPORTUNITIES 5.1 The shared Adult Social Care management team has introduced greater resilience and consistency alongside a reduction in duplication. For partner agencies that operate across Bournemouth, Poole and Dorset, there is less duplication of meetings and best practice is more easily shared between the two organisations. The joint management team also provides the framework from which new shared Adult Social Care services can be developed. 5.2 Although many of the shared services opportunities for Adult Social Care are yet to be realised, and indeed may follow the proposed local government reorganisation, a number of initiatives are actively being considered or implemented. 5.3 The Service Development team have approval to proceed with a team restructure which will share expertise more evenly across the two local authority areas. In doing this, for example, Borough of Poole will benefit from greater project management capacity provided by Bournemouth Borough Council staff and Bournemouth Borough Council will benefit from business analysis expertise provided by Borough of Poole. The Service Development team will be at the heart of future redesign projects, which will include delivering financial savings as part of both organisation s medium term financial plans, structural redesign as services begin to better align and joint business planning. This arrangement has been implemented through reciprocal agreements rather than staff TUPE transfers. 5.4 A case for change is being prepared to create a single local authority Continuing HealthCare (CHC) service, which will be called the CHC Hub. CHC is the funding made available by the NHS for people with complex health related needs. There is often a lack of clarity for some very high cost packages about whether they should be funded by the local authority or NHS. A single Hub will create an expert team to ensure that the correct funding decisions are made and appropriate care packages set up for this small but very high cost cohort of clients. The proposed CHC Hub will replace the two CHC teams that currently exist across Bournemouth Borough Council and Borough of Poole, although it will be implemented through reciprocal agreements rather than TUPE arrangements. It is anticipated that by bringing both teams together and having a single Service Manager, better outcomes for clients will be achieved and the service will operate more efficiently; for example there will be greater capacity for the team to attend a range of CHC meetings to progress individual cases and, consequently, reduce delays in reaching an outcome for some cases. A single local authority CHC Hub will also form a foundation for further integration of this function with Dorset CCG. 5.5 All Adult Social Care departments have a Principal Social Worker (PSW). This is a statutory post responsible for the training and development of social workers as well as promoting the profession and ensuring high professional practice. Consideration is being given to a shared PSW between Bournemouth Borough Council and Borough of Poole. 5.6 Practice guides and quality assurance processes for Approved Mental Health Practitioners (AMHPs) and Best Interest Assessors (BIAs) have been jointly developed with further consideration now being given to how these specialist practitioners who undertake statutory assessments under the Mental Health Act 4
and Mental Capacity Act can work more closely across the two local authorities. Consideration is also being given to co-locating these staff with other Mental Health services, including those provided by the NHS. 5.7 Debt management for Adult Social Care has been joined under a single Service Manager for the first time, presenting opportunities to share best practice and a common approach. Consideration is also being given to a common approach to financial assessment services. 5.8 Direct Payment Support Services, which are duplicated in each local authority, are the subject of an emerging case for change which will propose combining both into a single shared service and in doing so release savings. 5.9 A joint addictions team is being formed which will bring together the specialist social workers who support people with drug and alcohol dependency into a single team with a joint line manager. This team will be formed in late Autumn 2017 at the same time as the Poole Addictions Community Services is disaggregated. The treatment element of the service will pass to an independent provider, leaving two social work posts within Adult Social Care. Bournemouth Borough Council has a similar arrangement; that is, an external treatment provider and in-house social work provision (two social workers). These four specialist social work staff will be brought together into a single team for the conurbation. It will be important for each local authority to receive a level of service commensurate to the resources contributed to the team but, allowing for this, the new service will be able to share capacity to cover for sickness absence and respond more flexibly to this cohort of clients, some of whom are known to be transient and move regularly between Bournemouth and Poole. 6. FINANCIAL IMPLICATIONS 6.1 The Medium-Term Financial Plan (MTFP) for Adult Social Care and Commissioning and Improvement identified 100k in efficiencies from the shared services activity in 2017/18. This sum is projected to be achieved through savings in management costs, with the management changes described in this report having achieved an 81k efficiency at the time of reporting. 6.2 Many of the further opportunities for efficiency in Adult Social Care as a result of a shared services approach will come from service change that will be driven by new structures and approaches, for example the Continuing HealthCare Hub. 7. LEGAL IMPLICATIONS 7.1 The shared services approach continues to deliver Borough of Poole s primary Adult Social Care responsibilities under the Care Act (2014), Mental Health Act (1983) and Mental Capacity Act (2005). 7.2 Organisational accountability has been established based on joint job descriptions and underpinning secondment agreements. 8. EQUALITY IMPLICATIONS 8.1 The recruitment process used to develop the joint management team has followed Human Resources policy to ensure a fair and equal opportunity approach. 5
8.2 The service changes described in this report will be accompanied by an Equalities Impact Assessment, where appropriate. REPORT OF: Jan Thurgood, Strategic Director 01202 633207 CONTACT OFFICER: David Vitty, Head of Adult Social Care - Services 01202 261132 6