Agenda item

Proposal on Integrated Locality


Vicky Willett presented the proposal to move services forward to meet the challenges set by the Public Service Reform Strategy, including the three year workplan, in particular in Year One looking at Integrated Services and perfect localities.


The paper gave context and challenges including demographic change, budgetary pressures, and policy change and reforms with considerations and decisions required from the Executive members.

A summary definition of a perfect locality has been developed to describe our collective intentions as: making communities more resilient, creating opportunities for improved outcomes, and a focused support from services.


Aims and objectives are set out to support the partnership in the pursuit of a perfect locality, embedding early interventions, sharing data and intelligence, supporting frontline services and developing community support.


Proposals are a collective understanding from the datasets gathered, of which a summary has been provided. This includes foundation activity as well as some quick wins which should be seen within a short timescale. Proposals impact all areas of the partnership, and will need a commitment and resources to support the outcomes stated.


The proposals will manage high cost cohorts, support vulnerable people, tackle wider determinants and produce a different way of working in the community. They are based around three themes which are:


1.       Building community capacity – will include a commission for an organisation to cover community potential, identify gaps and assets with proposals for campaigns


2.       Establishing the single front line – using collective resources develop consistent and improved referral pathways, embed the Lancashire Wellbeing Worker service, testbed joint interventions including standard question sets, and utilising digital opportunities


3.       Enhanced multi-discipline approaches – using principles of Integrated Action Team, develop testbed in locality, including primary care through a possible local management group, looking at earlier interventions, scalability and risk stratification.


Proposals are expected to be delivered within 3-6 months, with results and evaluation being provided around the six month stage. The Executive had assurance that any work done in a specific area will look to be focused in the locality, to test principles and approaches with a view to be scaled up as part of the evaluation process and next phases of work. Using the LSOA as a test bed area seemed reasonable given the population is around 1700 residents.


The report also covers the wider transformation agenda, and it was agreed to have further detail on how the programme fits from a district and county level perspective at the next meeting.


The outcomes stated are aspirational and will be challenging. Measures will be in place and the Executive supported the need to be able to show improvements to focus activity, but be flexible enough to understand if the target proposed is not at the right level.


Financial benefits will focus on the high cost cohort, and it was noted that savings on measures relating to wider determinants may take longer to achieve. Review of cost savings will form part of the evaluation process.


Resources and capacity to deliver the proposals will need to have the authority from the Executive, and approval to actively engage with staff to re-shape relevant areas was also being sought.


Funding from the Transformation Challenge Award (TCA) has been secured to support specific proposals, and the Executive are the accountable body to manage local delivery as part of a wider programme. Any extended or additional work would need to be funded through the partnership, although this is mainly considered to be resource and capacity at this stage.


Comments were invited from the Executive members, which are summarised:

·         Need to understand timescales against the proposals, ensuring that work proposed is realistically deliverable;

·         Engagement and awareness of the work to front line worker now to be developed;

·         Involvement of the voluntary sector is key to understanding how services fit with the work done in the community;

·         Opportunities to in-reach specialists to support community delivery and potential locality based test bed;

·         Referral routes are part of this activity in terms of ensuring best direct route to support, and manage at first point of contact to reduce “referral fatigue” i.e. levels of signposting, as well as an understanding of how support is escalated/de-escalated;

·         Extend the partnership to other areas such as public houses and gambling establishments to understand root causes, develop social responsibility and access to support networks;

·         Consider who in organisations should be linked into the Implementation Group to deliver the next stage and ensure alignment with organisational business plans;  the hospital will be supplementing activity with relevant managers and clinical directors.

·         As part of measures to make sure prevention and early help are delivered as well as reducing pressures from high end services i.e. helping prevent people being admitted to hospital we well as supporting people leaving;

·         Overall the report was clear and concise, and is flexible to complement and support wider transformation programmes;

·         It was acknowledged that there are similar projects Executive members are involved in which helps to validate the approach. Jon Clegg advised that the Police are involved in two similar projects which involve LCC and Ribbleton East, and Transforming Lives in East Lancs. Vicky confirmed that we are linked into Transforming Lives to share findings from both areas;

·         Outcomes are challenging, and as part of developing the measures consider phased approach; and

·         As part of the cost savings, and impacts on areas, it was noted about funding streams from other areas, in particular VCFS organisations.


Discussion included the potential risk of capacity and funding  issues against activity in work programme, as testbeds may reduce impacts in some areas, and potentially reduce payments, but create capacity demand elsewhere which are not funded.  This is mainly due to how services are currently commissioned. Work on building community capacity is in the work programme, and initiatives will be monitored and measured as activity takes place. A risk has been raised to capture this issue.


Executive members approved the outline proposals, and gave commitment to:

·         Trial new ways of working;

·         Obtain wider organisational sign up and engagement;

·         Authorise and support the redistribution and allocation of resources to support locality based working;

·         Influencing and challenging where necessary to overcome barriers to data sharing


Next Steps

The Implementation Group was tasked with developing a more detailed action plan to operationalise proposals including assuming lead responsibility for aspects of the programme, which will be confirmed at the Executive in February, including quick win elements of the programme.


An evaluation will be completed and brought back to the Executive after six months