West Midlands Regional Workshop

Health & Social Care Reform
Regional Workshop
West Midlands
24th October 2014
#SocitmHSC www.socitm.net/linkedin

Agenda
Local introduction
Jenny Wood, Warwickshire County Council
Socitm Introduction
Martin Ferguson, Socitm
Video 1 – Statement of Purpose
Roundtable session 1: The ‘future state’ – a view on social care
Andrew Fenton, Department of Health
Roundtable session 2: Infrastructure - systems architectural framework
Julie Oxley, Leeds City Council
Roundtable session 3: Financial and care record matters
Richard Pantlin, ADASS IMG
Health & Social Care Reform – West Midlands Workshop

Agenda
Reflections on the sessions so far – open discussion.
Roundtable session 4: Planning the practical steps - what we need to do
Video 2 Restatement of the purpose of the workshop
Roundtable session 5: Engaging citizens - the service user perspective
Ian Swanson, ADASS-IMG & Julie Oxley, Leeds City Council
Roundtable session 6: IG toolkit
Roundtable session 7: Planning the practical steps - what we need to do
Concluding comments
Jenny Wood, Warwickshire County Council & Martin Ferguson, Socitm

Local Introduction
Jenny Wood
Warwickshire County Council

Care Act Readiness in the West
Midlands
Informatics and the second national
Care Act Stocktake Survey

Care Act Readiness Stocktake
Headlines
• There is increased confidence nationally and regionally that
councils will be able to deliver the Care Act reforms from
April 2015.
• Concerns about costs have increased nationally
• Responses indicate a need for support around costs,
information & advice, IT, market shaping and workforce
• Other pressures on councils (e.g. funding shortfalls, Better
Care Fund/Integration) compounded with uncertainty on
key guidance and information has delayed or otherwise
impacted upon preparations in a number of areas

IT and Finance Systems
Nationally Regionally
Confidence that financial and IT systems will be
adequate to manage the statutory duties from 2015
has improved and is strongest in London and the East
of England
In the West Midlands twelve councils are ‘fairly confident’ and
two are ‘not very confident’
Over 80% will engage with IT suppliers before Jan
2015
Twelve out of 14 will have engaged suppliers by November
2014
20% of areas are potentially behind with key changes
to IT systems. In particular 55% anticipate having
systems in place to cope with increased demand for
carers between January and April 2015, with 30%
before January and 15% after April.
Most councils are planning for systems to be live by April 2015.
Four councils will have systems in place to handle the
anticipated volume of Deferred Payment Agreements by
January 2015 and 2 will have a live system to cope with the
anticipated increase in carers assessments and support
planning by the same date. One council will not have a live
system to support carers assessment volumes by the April 2015
deadline.
7% of councils either don’t know or will be
rescheduling resources for changes after April 2015.
Two councils (14.3%) don’t know when they will be
rescheduling resources.
20% of councils are identified as potentially needing
support
Four out of 14 councils potentially need support in this area.
This is nearly 30%.

IT & Finance Systems – Milestones & Tasks 2014/15
Programme Milestones Oct Nov Dec Jan Feb March April
Regs & Guidance published for Apr
15 reforms
Consultation on 16/17 Regs &
Guidance
Public Awareness Campaign Phase
1
Care Act Stocktake
April 2015 reforms in place
Informatics Implementation Tasks Oct Nov Dec Jan Feb March April
Suppliers engaged re 15/16
changes
Software upgrades released
Install, test, configure
Go live for 15/16 reforms
Scope changes for case
management systems for 16/17
Suppliers engaged re 16/17
reforms

Socitm Introduction
Martin Ferguson
Director of Policy & Research

Video 1
https://www.youtube.com/watch?v=OvQLBt3dACY

Information and technology -
a key enabler of change . . .

15
. . . to Improve people’s lives

18
DH priorities for 2014/15
1. Focus on delivery of the core social care national programmes
and influencing broader national policy where appropriate
2. Working in partnership with other national and local agencies
to develop the underpinning work that will enable future
change and progress across the whole system
3. Supporting complimentary initiatives in which DH Social Care
has strong interest but does not have the direct levers

19
Care Act implementation
Integration &
interoperability -
Pioneers
Economic case Citizen-focused
technology
Market development
Achieving broader
strategic objectives
Current state
Target future state
Capability & leadership
Our national work programme
focused on two broad areas -
1) Delivery of core programmes
Information Governance
Transparency &
Comparative Data
Delivery of core priority
programmes
Integration &
interoperability -
Standards
Integration &
interoperability – IDCR
& Tech Fund
Infrastructure and
systems
2) How we can start to develop a
wider consensus around
investment and change in this
area?
DH priorities for 2014/15

Developing a target ‘future state’
for social care informatics
- and for delivering a holistic
health and wellbeing enterprise

21
Where are we headed?
Improved citizen outcomes and experience, the
transparency agenda, integration across service
domains, enabling citizen participation
Transparency
Transactional services
Participation and self care
Interoperability and trust
Community and locality-led health and wellbeing

22
Numerous challenges
Across services within
local government and
the community
Across service domains
– NHS, local
government, social
care, public health,
voluntary sector
• Identity management
• Information standards –
data and formats/ protocols
• Common terminology and
definitions
• Open architecture and APIs
• Customer focus
• Communications
infrastructure and culture
• Creating benefits case for
investment

23
Health and wellbeing outcomes focus
We need to explicitly link the key elements and actions to
how they will contribute to the delivery of Health and
Wellbeing outcomes:
• People will live longer and have healthier lives
• People will live full, active and independent lives
• People will enjoy the best possible quality of life
• People are involved in decisions made about them
• People will live in healthy and sustainable communities
DH – Leading the nation’s health and care

24
Informatics scoping: Oct ‘14 – March ‘15
Continuing Care GP – Social Care Referrals
Acute – Social Care
Admissions & Discharge
Strategic enablers
Information Standards
Client Level data
Quick wins
Secure email
Identity Management
(NHS Number)
Infrastructure
PSN/ N3
Digital Maturity
Model
Classification/ Terminology
Metadata
NIB Strategy:
Delivering locally
Capability &
leadership

25
We need your help!
To develop and establish in more detail and at a local level:
• What is the target state for information and IT enablement
and what are the steps along the way that we must prioritise
– what would success look like for citizens and how must we
change to deliver?
• For each organisation; where we are now and what must we
do first, second . . . and so on
• To develop a social care/local government digital maturity
model that embraces variation and innovation

26
Social Care - Digital Maturity Model
Goals:
1. Fully automated business processes
2. User portals transacting online
3. Digitally enabled assessments, reviews and transactions
4. On-line access to health and social care record
5. Joined up health and care ecosystem, including independent sector
6. User in charge of their data
7. Wider use of bespoke apps to encourage self-care
26

27
Digital maturity model
Information Standards, Tool Kits, Guidance
Mainly
paper
based
Partially
Digital
Fully Digital
Partial Integration
(within the
organisation)
Full Integration
(across all care
settings)
Health and Social Care Information sharing: Secure email, encryption,
structured messaging
Information for Citizens made accessible
in a format they prefer: paper, email,
smartphone, portal etc.
Integrated service models – locality based
Measured improvements in citizen experience

28
Supporting the scoping study
• What standards and what data would be valuable, why and
for whom?
• How and what needs to be done to collect / extract
information with less burden?
• What are the key barriers / challenges / blockages for
interoperability at a detailed level – can we expose the
priority issues / challenges that might be resolved by
national standards and national support initiatives?

29
Discussion
“95% of the audience at the National Summits were in favor of
developing a Digital Maturity Model”
Q. How ready is your local heath and care stakeholder
environment to begin developing and implementing a
collaborative plan?
a) Not ready at all
b) We've begun the process but have barriers to overcome
c) We are well on the way and have effective partnerships

30
Discussion
Q. What are the strengths, weaknesses, opportunities and
threats of a social care informatics maturity index and road
map?
• Strengths: https://viz.polleverywhere.com/free_text_polls/Ore9ElTheulAwmp
• Weaknesses: https://viz.polleverywhere.com/free_text_polls/c92WDFrzxHjZdal
• Opportunities: https://viz.polleverywhere.com/free_text_polls/CRVivtWF0HrjHOt
• Threats: https://viz.polleverywhere.com/free_text_polls/PDNylTqET2WB1tI

Developing a city ‘blueprint’

FIRST
Joined up governance………
(circa 2012)

Leeds Informatics
within the governance for Health and Social Care transformation
Leeds Informatics Board
Commercial and Academic
links
City-wide Leadership
Office
City-wide Clinical leader
Chair – Dr J Broch
CCG North, Chair
Informatics Director
LTHT
Executive
ASC
Senior
Officer
Children’s
Senior
Officer
LYPFT
Executive
LCH
Executive
CCG
Senior Officers
Variable resources inc.
Project Management, expert
advisors/specialists, admin, Finance
City-wide
Programme
Management Group
Programme Manager
Senior Reps from Local departments
Local Informatics departments and resources
Health and Wellbeing Board
via
Health and Social Care Transformation Board
LCC IT
Local
Authority
CTO
Primary Care
Senior GP/s
Partners:
- CCGs x 3
- Leeds Teaching Hospitals
- Leeds Community Healthcare
- Adult Social Care
- Leeds City Council
- Leeds and York Partnership FT
- Primary Care

‘Blueprint’ 1 (circa 2012)

‘Plan on a Page’ - Building blocks to achieve the Leeds informatics ‘Vision’
Provider organisations Between
organisations
Improved Contract Mgt Needs assessment
Improved needs assessment Improved health intelligence
Event linkage Costing analysis
Contract and additional data flows
Data Protection/Caldicott/Sharing
Risk Stratification
Pathway Management/Visibility/Clinical Decision Support Telecare and Telehealth
e-messaging Order Communications Risk Stratification
Summary Care Record (SCR)
Programme/Project Management Business Analysis and process re-design
IT Infrastructure linkages inc. LCC city-wide facilities e.g. ‘superfast cities’
Interoperability standards
Paper-light processing inc. Digitised/e-records
NHS Number
Wireless technology
Mobile working
Primary Care
Hosted
nationally
compliant
systems
LTHT
Full range
of
integrated
clinical
systems
LYPFT
Full range
of
integrated
clinical
systems
LCH
Full range
of
integrated
clinical
systems
IG Toolkit
Social Care
Full range
of
strategic
systems
Knowledge Management
Monitoring/
commissioning system
Patient/client
access to records
Independent
and
3rd
sector
systems
Leeds Care Record
Integration Engine
Data
Warehouse
Research
YAS

This common framework enabled……..

Allowed Informatics to be a key part of
joined up ‘transformation’ ………
(circa 2014)

TRANSFORMATION PROGRAMMES
West Yorkshire Workstreams
Leeds Health and Social
Care
Transformation ‘Portfolio’
Board
Children’s Urgent Care
Cancer Stroke
Identification
and risk
stratification
Primary
prevention
Pathway
development
Integrated
system change
HWB
Growing up
in Leeds
Nigel Richardson/
Matt Ward
Elective
Care
Simon Stockill/
Susan Robins
Adult Integrated
Care and
Prevention
Andy Harris
Ian Cameron
Urgent Care
Nigel Gray/Jason
Broch
Effective
admission &
discharge
Phil Corrigan/
Sandie Keene
Goods &
support
services
Chris Butler
Operational
group
Population
management
System
development
Emergency
admission
avoidance
Improving
hospital
discharge
Community
beds service
In-patients
Cancer
Best Start
Family support
Emotional and
mental health
Complex needs
Best transition
into adulthood
Estates
Supplies
ICE
Strategy
Group
ENABLING GROUPS
PMO
Self-management
Prevent entry
into Care
Finance Task
Group (DOFs)
Julian Hartley
Informatics
Board
Jason Broch
Workforce
Phil Corrigan/Bryan
Machin
Quality
Improvement
with Leeds
University
Gordon Sinclair
Estates Group
Chris Butler
Communications
and Engagement
Group
Rob Kenyon/Phil
Corrigan/
Primary Care
Gordon Sinclair
Pioneer
Rob Kenyon
BCF
Matt Ward/Dennis
Holmes
Outpatients
including
diagnostics

Simplification and
refinement:
3 TIERS of delivery:
Clinical Integration
Clinical Support
Tools
Business Intelligence
Tier 1
Tier 2
Tier 3
‘primary’
use’ of data
‘secondary
use’ of data
Time

Strategic requirements for transformational
change.……..
6 features of a transformational Informatics platform:
• Centred around patients or individuals
• Common data definitions
• Covers all types of care
• Relevant parts of the clinical record can be accessed by all
parties involved in care
• Templates and expert systems to support appropriate and
consistent quality of care
• Information collected and extracted to support holistic
analysis and intelligence

Overlay:
Clinical Integration
Clinical Support Tools
Business Intelligence

‘Blueprints’ 2 and 3 have enabled:
- Case to establish a city Intelligence Hub
- Case to progress citizen-driven health agenda
- Strengthened the city PSN case
- Recognition that more is required than
‘simply’ integration
- Formed part of our ‘Tech Fund 2’ bid [LCC led]
- Forms our dialogue with other Pioneer cities
- Dialogue around Better Care Fund
- Basis for a more formal exploration on end-user
compute opportunities

Recommend the use of shared (and evolving)
models/blueprints to form the basis for:
- Common language (internal and external)
- Common goals
- Engagement across sectors
- Development of business cases
- Programme of delivery
- Governance framework

1. Governance – have you established the appropriate
governance to support and enable the right conversations and
decisions at the right time by the right people?
AND is your governance linked into the right governance
framework – i.e. Health and Wellbeing?
2. Have you set out a clear blue print/ vision? Has this been
signed up to by all key stakeholders?
Do you have a plan which sets out how you will achieve
your blue print/vision?

Discussion
Q. What are the strengths, weaknesses, opportunities &
threats to/of a whole place informatics model?
• View the Strengths: https://viz.polleverywhere.com/free_text_polls/zNAyK3UygjIPrqd
• View the Weaknesses: https://viz.polleverywhere.com/free_text_polls/1P60Zb2OeVRvnbi
• View the Opportunities: https://viz.polleverywhere.com/free_text_polls/m6dVN5JMwLFh1bY
• View the Threats: https://viz.polleverywhere.com/free_text_polls/HsH8DGERCsHUdit

Core requirements
of the Care Act
for ASC case management &
finance applications
Information Management Group
West Midlands IMG / SOCITM workshop
Friday 24 October
Richard Pantlin

Changes for April 2015 – local
configuration
Requirements
• New eligibility, assessment & care plans – incl. recording non-eligible
needs
• Personal Budgets for carers & residential care – RAS?
• Carers asssessments, support plans – charging?
• Financial assessments including batch re-calculation
• Transitions from Children’s Services, Safeguarding, Prisoners
Questions
 Have your Care Act Leads indicated extent of process changes
required?
 Have you estimated staff time required to reconfigure and test
systems?
 Do you have the necessary skills?
 How much end-user re-training is required?

April 2015 – New / upgraded
software?
Requirement
• Deferred Payment Agreements – new interest
calculations
• Optionally: Continuity of Care – info transfer
Questions
• Have you assessed expected volume?
• What is your current process?
• Will you use a specialist system?
• Whose & when available?
• Will you need to load existing DPA data
or only use for new DPA’s?

Care Accounts
Requirement
• Accepting applications from late 2015
• Processing Care Accounts after April 2016
Questions
• Have you planned system upgrades with your
application provider according to their roadmap?
• Do you have confidence that your application
provider will engage with representative customers
and DH / IMG from Jan 15 in order to design
appropriate software enhancements?
• Are you clear on commercials?

Handling increased volumes
Requirement
• The combination of Care Accounts and higher
capital thresholds is likely to lead to a significant
increase in needs assessments & financial
assessments
Questions
• Has your council assessed local impact?
• Are you planning other process changes? E.g.
• More flexible working
• Using third sector / delegated functions
• Online self-service – more on this later

Roundtable Discussion
Q. How prepared are you in your locality to implement the
changes required to meet the requirements of the Care Act?
View the results: https://www.polleverywhere.com/free_
text_polls/Lzm9B6dCgvdBypm

Planning the practical steps
Q. Taking into account the discussion so far,
what do we need to do?
View the results: https://www.polleverywhere.com/disc
ourses/GP0cVWiZ0JVgTR2

Video 2
https://www.youtube.com/watch?v=3Fd-
S66Nqio

ADVICE AND INFORMATION
RESOURCES WITH LINKS
• ADASS resources
– Initial business case headings
http://www.adass.org.uk/AdassMedia/stories/Standards_and_Performance/Business_case_factors_v1.pdf
– A&I online report (guide to many more in
refs.) http://www.local.gov.uk/care-support-reform/-/journal_content/56/10180/6516198/ARTICLE
• TLAP resources http://www.thinklocalactpersonal.org.uk/Browse/Informationandadvice/
– Most recently 3 reports about creating a
strategy, and a draft strategy tool coming
• Socitm Insight reports http://www.socitm.net/research/socitm-insight/health-and-social-care-reforms/health-and-social-
care-reforms-ict-and
• WHICH report http://www.staticwhich.co.uk/documents/pdf/which_report_the-care-maze_jun14-372280.pdf
Ian Swanson ADASS Informatics Network Support Officer
Ianswanson.home@gmail.com 07906 333799

Ways to speedy service 2016
Person
with
needs
Quick
check
Eligibility
questions
Financial
check
Use tools and find services in directory
Eligible?
Needs eligible,
finance not
Needs
assessment
Outcomes
to be
planned
Personal budget (IPB)
Yes/maybe to both
Care Account
application
Financial
Assessment
Charges
No
Yes
Colours Services
Care Accounts – then normal assessments
Old procedure
Eligibility triage
Items in italic as candidates for self-service tools
Support
Plan

Engaging Communities and
Citizen Driven Health and Care
Tim Straughan
Programme Director Smart Cities – Health and Wellbeing
@timstraughan

Citizen Care in 2070
• In 2070 we will have our first Leeds
citizen reach the age of 120 years old
• She is 64 years old now and about to
retire with 56 years still to live
• She lives in North Leeds
• Linda will be continually monitored
by wearable devices and sensors in
her home
• Her care will be coordinated using an
app on her smart TV
• Her life plan will be based on her
‘riskogram’ DNA profile
• Medication will be
‘pharmogenicially’ designed just for
her
• Most of her care will be provided by
her local community

Citizen Engagement
• Bottom up not top down
• Use of existing networks
and communities
• Co-production- ‘doing
with’ not ‘doing to’
• From passive to active
• Providing tools to helping
people take control
• Building outcome
evidence through
prototypes

Citizen Driven Health
One example of Citizen Driven Health is about
connecting the people involved in the circle of
care around the individual, so they know who
each other are, can connect and be aware of
what each other are doing, across the whole
Neighbourhood Network and beyond and
therefore hopefully become more effective at
supporting the health and wellbeing of the
individual.

What is a Neighbourhood Network ?
• Neighbourhood Networks are community
based, locally led organisations that
– enable older people to live independently
– pro-actively participate within their own
communities by providing services that reduce
social isolation
– provide opportunities for volunteering
– act as a “gateway” to advice/information/services
promote health and wellbeing and thus improve
the quality of life for the individual.

Neighbourhood Networks - Some facts
• 32 NNs currently support over 21,900 older people
• Volunteers doing this fantastic work have gone up by
over 200 in last 12 months, rising to 1,910
• Prevented 1,450 older people from going into hospital
and supported 617 being discharged from hospital.
• 26 safeguarding referrals have been made to Leeds
Safeguarding Units.
• As a measure of how the Networks are appreciated by
users, families and friends, a massive 2,427
compliments were received over the past 12 months,
with just 4 complaints!

The process of social innovation
Young Foundation – Engaging Citizens in Social Innovation June 2013

Q. What are the strengths, weaknesses,
opportunities & threats to the online aspect
to extending help to all citizens, not just those
applying for council care
• View the Strengths: https://viz.polleverywhere.com/free_text_polls/uE62RO6
Lp26xnW0
• View the Weaknesses: https://viz.polleverywhere.com/free_text_polls/Rukxifb
vFX5yb1t
• View the Opportunities: https://viz.polleverywhere.com/free_text_polls/sJsTU
p83yINEGrj
• View the Threats: https://viz.polleverywhere.com/free_text_polls/v44OjuXSO
7EbEhk

IG Toolkit
Information Governance
Information sharing for direct care
• Proposed private Member's bill on information sharing and use of the NHS number for direct
care purposes;
• Data sharing guidance for front line staff; and
• the information governance alliance
Information sharing to support commissioning functions
regulations to support and regulate the use of information for
• case management, and
• essential functions (e.g. invoice checking, risk stratification)
Information sharing for other purposes, e.g. research
• care.data programme,
• the package of measures, some legislative, announced by the Health Secretary in March 2014
Governance and accountability
• robust oversight and assurance of national and local information governance practice.

Open Discussion
Q. How well-prepared are you in your locality for the
information governance arrangements needed to
enable the new and different approaches:
• ways of working,
• delivery,
• co-creation,
• integration,
• personalisation, etc.
required by the health and social care reforms?
View the results: https://www.polleverywhere.com/free_
text_polls/90dhmHOdGX1hkEH

A framework - one suggestion
• User needs
• Governance
• Infrastructure
• Service redesign
• User Experience
• Intelligence
Martin Greenwood
Socitm Insight Programme Manager

Agenda
12:00 Reflections on the sessions so far – open discussion.
12:15 Roundtable session 4: Planning the practical steps - what we need to do
12:45 LUNCH
13:30 Video 2 Restatement of the purpose of the workshop
13:35 Roundtable session 5: Engaging citizens - the service user perspective
Ian Swanson, ADASS-IMG/Julie Oxley, Leeds City Council
14:05 Roundtable session 6: IG toolkit
14:35 Roundtable session 7: Planning the practical steps - what we need to do
15:05 Concluding comments
Jenny Wood, Warwickshire County Council/Martin Ferguson, Socitm/Pete Jackson, West Midlands I
EP
15:10 Close

Planning the practical steps
Q. Taking into account the discussion
throughout the day, what do we need to do?
View the results: https://www.polleverywhere.com/disc
ourses/EMSkqGv7zZ8qniL

West Midlands Regional Workshop

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