Community First Annual Report 2023 – 2024
Further and Faster Transformational Change Across the Health and Social Care System
A Shared Framework for Excellence, Prevention and Sustainability at Place
Foreword from Councillor Richard Hannigan
Welcome to the Community First Annual Report for 2023/24.
I am privileged to be the Chair of North Lincolnshire’s Place Partnership. From the insight I get in this role, I have absolutely no doubt that people of all ages in North Lincolnshire have access to exceptional health and social care.
Key to this is our Community First Strategy – a plan centred around three outcomes:
- People are safe and have good quality provision
- People have urgent needs met quickly
- People are enabled to keep well.
Councillor Richard Hannigan
Deputy Leader – Independent Families
Adults and Health – Cabinet Member
Chair of the North Lincolnshire Place Partnership
Here in North Lincolnshire all organisations involved in health and social care work together to enable people to live independently within their own homes, families, jobs, schools and communities.
This, together with our One Family Approach, where we work together to provide and commission integrated services for the whole family, is evidence of our relentless drive to achieve the shared ambition for North Lincolnshire to be the best place for all our residents to be safe, well, prosperous and connected; experiencing better health and wellbeing.
This Annual Report shines a light on the work that’s taken place over the last year to ensure that health and social care support meets this expectation. There is a clear focus on transforming how people are supported through increasingly integrated approaches.
The quality of this transformation and integration has brought about meaningful improvement to how people are supported to live healthy and independent lives now, and to how people will be enabled to be independent in the future. Senior leaders from across health and care in North Lincolnshire have both a robust determination and a plan to make sure this transformation and integration continues further and faster over the next year.
This report also sets out how through strengthening the Place Partnership governance arrangements, including our relationship with the Humber and North Yorkshire Integrated Care Board, North Lincolnshire will continue to ensure the vision, leadership, capabilities and culture are all right to sustain this transformation for the long term.
Health and social care for people of all ages in North Lincolnshire will face challenges, such as the increasing demand for services, prevention and enabling self-help, an aging population, enabling children and young people to recognise and achieve their potential, influencing and shaping the health and care sectors, tackling health inequalities and keeping people well in their own homes and communities.
In these challenges are also the opportunities to improve outcomes for people – improving their health and wellbeing, helping people live fulfilled lives in a secure place they call home and ensuring they have equality of opportunity.
I am assured by this Annual Report. It confirms good progress has been made and that health and social care in North Lincolnshire has the right conditions and a plan to achieve our shared ambition for children, families, adults and older people. Every organisation will play it’s part and we will continue to place people and families at the heart of everything we do.
Cllr Richard Hannigan
Deputy Leader – Independent Families – Adults and Health – Cabinet Member
Chair of the North Lincolnshire Place Partnership
Introduction
The Health and Wellbeing Board, Place Partnership and our relationship with the Humber and North Yorkshire Integrated Care Board ICB is key in maintaining a Place focus on transforming the health and wellbeing of the lives of all people in North Lincolnshire.
The role of the Place Partnership is to set the health and care strategy, approve the plans that will deliver the strategy, allocate NHS resource for North Lincolnshire, provide assurance of delivery of the plans through performance and risk management and assurance on the quality and safety of services for the population of North Lincolnshire.
Building on the foundations of the Strategic Intent set by the North Lincolnshire Health and Care Integration Plan 2021-2024, the Community First Strategy is North Lincolnshire’s Plan for health and social care integration.
Action to deliver the Community First Strategy has made good progress over the last year. Strong and committed system leadership and governance has both set the frame and enabled this. Recognising the scale of organisational change across the system over the last year together with the need for continued system transformation to deliver on the shared ambition to be the best place for all our residents, in early 2024 system leaders reviewed governance, strategic priorities and actions needed to continue health and social care transformation and integration.
Part of this review included a workshop hosted by the Place Partnership in April 2024.
The purpose of the workshop was to consider:
- progress and next steps on key matters for the Community First Strategy
- stronger place governance, and
- the potential for more delegated decision and influence from the ICB.
Following the workshop, some important approaches and decisions were agreed that will help achieve further and faster transformational change across the health and social care system.
The Workshop – Review and Reset
The workshop took place on 18 April 2024. At the workshop, 29 senior leaders from:
- North Lincolnshire Council (NLC)
- North Lincolnshire Health and Care Partnership/ICB
- Rotherham Doncaster and South Humber NHS Foundation Trust (RDaSH)
- Primary Care Networks
- Northern Lincolnshire and Goole NHS Foundation Trust (NLaG), and
- Social care providers
came together. The workshop was really positive with strong contributions from everyone in attendance, with engaging and lively debate. Over 75 innovative ideas and reflections were generated.
The intended outcomes of the Workshop were to:
- Further enhance systemwide understanding of North Lincolnshire’s Community First Strategy
- Review progress to date and co-produce the next steps and the outline plan, including strategic priorities and resourcing
- Agree the infrastructure to deliver the core purpose of the Place Partnership and raise awareness of the updated ICB framework, and
- Develop a better understanding of the role of the Health and Wellbeing Board.
More details on each of these outcomes is set out in the following sections. Some of this relates to progress over the last year and some this relates to agreed next steps.
A systemwide understanding of North Lincolnshire’s Community First Strategy
Under the oversight of the Health and Wellbeing Board and the Place Partnership, the Community First Strategy was launched in May 2023 at the ‘Making It Real’ health and social care integration event. The Strategy is centred on the shared ambition for Place for:
“North Lincolnshire to be the best place for all our residents to be safe, well, prosperous and connected; experiencing better health and wellbeing.”
The Workshop heard why the Community First Strategy matters through ‘Adam’s Story’ – a case study of a 37 year old with many health and care needs, prior to greater integration and transformation of the health and social care system would have been managed in silos and reactively. Our ambition is that through Community First, Adam’s Story changes as a result of the system working together. Consequently, Adam is enabled to keep well through Integrated Locality Working that is seamless, holistic and personalised. When he becomes unwell, he has his urgent needs met quickly, by a locality team with support from clinicians. He is supported to attend the emergency services without getting stressed and he returns home quickly with the locality team continuing to monitor and support him and his team. And when Adam’s needs become more complex, safe and good quality provision ensures he is able to live within his community, keep secure employment and have relationships outside of his paid support – this happens as a result of collaboration between providers of health and social care support and other agencies and the workforce supporting Adam having the skills and knowledge to make sure he is best supported.
Strategy Outcomes and Principles
Taking into account the strong contributions and engaging and lively debate at the workshop, the Place Partnership has confirmed it’s support for the three Community First Strategy Outcomes of:
- People are enabled to keep well
- People have urgent needs met quickly
- People are safe and have good quality provision.
It has also decided the Principles of the Community First Strategy should continue to be that:
- People of all ages are empowered and facilitated to self-care and have control over their lives
- People get the right care at the right time at the right place and people and communities are at the heart of health and care
- People get personalised care, closest to home and we use our collective resources to improve outcomes
- We prioritise the most in need
- We enable partners to manage risk effectively.
And the Place Partnership also decided that:
- The ‘Community First Strategy Induction Pack’ will be developed including its outcomes and principles, and it will be included in all staff inductions across all organisations that are members of the Place Partnership
- Children will be integral to Community First and where it makes sense an all age approach will be adopted
- Systemwide workforce development will be progressed across all three Strategic Priorities to further embed a common purpose for the workforce. This should be centred on the Principles described above, a single definition of integration and enabling systems, data/digital and process integration. The aim of this will be to:
- Bring the workforce together using an organisation development approach to enable integrated working is successful and to share and develop the capabilities and skills to enable a system approach
- Ensure the workforce contribution from within all respective partners is optimised and fits together across the system (the ‘team of teams’ approach)
- Everyone in health and care fulfils their potential in supporting people with the right care at the right time in the right place, and that
- Everyone in the workforce is enabled to look after their physical and mental health.
Finally, the Place Partnership has agreed that the Community First Strategy will be the route through which further and faster all age transformation and integration of health and social care is achieved.
Progress to date, co-production of the next steps and the outline plan, including strategic priorities and resourcing
To achieve the three Outcomes of the Community First Strategy, three associated Strategic Priorities have been identified as set out below:
Outcome
- People are engaged to keep well
- People have urgent needs met quickly
- People are safe and have good quality provision
Strategic Priority
- Integrated Locality Working
- Integrated Urgent Care
- Integrated Strategic Planning and Commissioning
Significant activity has taken place across all three Strategic Priorities. A summary of this is in the following sections.
Integrated Locality Working
The intent of this Strategic Priority is working across five localities in North Lincolnshire and across all age populations. Knowing our people and all their needs and nuances will improve outcomes and be person centred.
Collaborative learning in pilot work has taken place in the Scunthorpe South Locality. Case studies of people with health and care needs have been used to learn from and create changes to improve outcomes for individuals. In the Scunthorpe North Locality, work with a small population has co-produced better access arrangements to specific health care services.
A Population Health Management based Preventative Proactive Approach has been developed. This will enable a stronger focus on addressing the CORE20Plus5 Health Inequalities. This approach is data driven and brings together all that is known about people’s needs from across the health and care with interventions designed, targeted and implemented either at a personalised or cohort level. The focus of this is improving health and care outcomes in a programmed way based on a deep understanding of need derived from data, practice wisdom and the involvement of the person in their care planning. Joint working takes place in a co-located, collaborative and multidisciplinary way. Work happens both independently and as a team around the person. Within this, multi-disciplinary teams dynamically design, agree and implement an integrated response that best meets the needs to these people working in a way that goes beyond the interests of individual organisations.
The Place Partnership has agreed that:
- Further work should be implemented to roll out the Preventative Proactive Approach developed within pilot work across all areas of need and also embed them as business as usual in each of North Lincolnshire’s five localities
- A small number of performance measures should be rigorously applied to assure achievement of success
- The link to universal prevention services that are accessible to all should be strong to enable the system to manage demand, meet need at the lowest level and support those most in need
- Meeting people’s urgent needs in communities should be supported by Locality Teams, enabled by the Integrated Urgent Care infrastructure.
Integrated Urgent Care
The intent of this Strategic Priority is a single system approach enabling people to remain and return to their normal place of residence – this approach is centred around Home First.
Home First supports people to live independently by:
- Supporting people out of hospital as quickly and safely as possible
- Supporting people to regain essential daily living skills
- Supporting people in their own homes, helping them to with rehabilitation related needs and to retain or improve their daily living and mobility skills, enabling them to stay independent.
A specification for an Integrated Single Point of Access and Pathways has been developed. This is focused on ensuring we have the knowledge and skills required to deliver integrated responses, creating a psychologically safe places to work, learn and build a team together and ensuring the right workspace and data sharing arrangements are in place.
Integrated Urgent Care leads have researched and visioned what a fully Integrated Urgent Care system looks like. Process mapping is ongoing with new, person-centred urgent care integrated pathways being developed. A hospital discharge team is co-located within the hospital to ensure effective discharge arrangements are in place Digital, person centred data sharing arrangements are being implemented by both NLC and NLaG Digital, meaning people involved in deciding/providing urgent care can see the fullest information from across health and social care. This will make support more seamless and ensure people get the right care at the right time.
The Place Partnership has agreed that:
- The direction of travel is good and significant progress has been made on the Strategic Priority. The intent and activity to further develop this should continue
- Fully operationalising an Integrated Single Point of Access and fully Integrated Pathways with joint leadership arrangements and single point accountability for management of integrated pathways and processes should be implemented. This should include the optimised, proportionate use of tools such as a Single Dataset which is the ‘Single Version of the Truth’
- Urgent needs should be supported by Locality Working/Teams
- Universal prevention services that are accessible to all should be optimised alongside Information Advice and Guidance arrangements to enable people to self-help and ensure only unavoidable Accident and Emergency attendance. Use of digital tools such as Let’s Get Better and Live Well North Lincolnshire should be optimised and being aligned.
Integrated Strategic Planning and Commissioning
The intent of this Strategic Priority is to ensure and provide:
- Governance and system assurance oversight
- Planning and commissioning is transformational and based on future needs of the residents of North Lincolnshire
- Priorities and strategies are set in the context of Community First and the one family approach
- Finance and quality are well managed
- Strategy and performance is reviewed
- The outcome of this review informs analysis of purpose, markets, resources, needs and risk.
There has been a continued focus on integrated commissioning, with a transformational Care at Home model. A specification is being developed that will enable increased capacity to care for people in their own home including those with complex needs across the spectrum of physical, mental health and learning disabilities. This model will move to an outcomes-based focus, giving people more control of their care and supporting innovative approaches to supporting their care.
The ICB and NLC are working together to reduce the number of people with complex needs including mental health and learning disabilities and who currently receive care outside of our local area, by looking at how local solutions and support can be developed together with addressing any gaps in our local services. This will enable the most effective use of resources as well as providing better outcomes for our people as close to home as possible.
A Commissioning Plan was approved in December 2023. Care sector development and best value reviews continue. Recommissioning of the Carer Support Service is progressing.
An Autism self-evaluation project was completed in December 2023, co-produced by NLC and the ICB.
The Place Partnership has agreed that:
- The assurance and performance management of the Community First Strategy and all other relevant strategies and plans is a critical function that will be achieved within this Strategic Priority.
- There will be a focus on fully inclusive, all age and integrated commissioning with a single plan produced.
- A commissioning programme will be underpinned by a rigorous approach to planning to address the medium (5 – 10 years) and long term (>10 years) needs of the population. This should be part of a wider Commissioning Cycle with people and communities at the heart of this Cycle.
Leading the Change
Across all three Strategic Priorities, the Place Partnership has agreed that a Senior Responsible Owner for each of them will be confirmed, together with system leads with accountability from each of the organisations that will deliver the plans for each Strategic Priority. This will form part of a structured Programme Management approach to achieving the outcomes in the Community First Strategy.
The workforce development required across all priorities is significant and must be sponsored by each organisation and their respective organisation development/human resource departments.
Governance
The Core Purpose of the Place Partnership is creating the conditions for, and delivering, all age health and social care system transformation. The Place Partnership has identified six key functions. These are:
Creating the Conditions
1. Vision and Leadership – Executive level sponsorship and accountability for system design and the workforce
2. Capabilities, connection and culture – Systemwide workforce development focused on the common purpose and a systematic approach to learning and being better together
3. Aligning Operating Models – Setting the frame for shared Strategic Priorities.
Delivering Transformation
4. Diagnosis and redesign – System diagnostic hubs
5. Continuously improving – Quality and service performance through the Place Quality Board
6. Identifying and embedding innovations – Including working with business and provider on technology and innovation.
In support of effectively delivering the Core Purpose, a resetting of the governance arrangements for the Place Partnership was also agreed. This is centred around the Place Partnership and 9 Groups that perform the function system diagnostic hubs. This diagram shows how they all fit together.
Governance – A Shared Framework for Excellence, Prevention and Sustainability at Place
NLC and the ICB have been collaborating on a stronger framework between the 6 Places and the HNY ICB. This has been presented and discussed with the Place Partnership and is well on the way to be approved, opening the opportunity to develop a Joint Committee with a greater influence on local decision making and resource allocation and prioritisation.
There is now a need for a wider group of stakeholders to be formed and to further improve outcomes for people with learning disabilities and mental health by collaborating across the system.
Governance – The Role of the Health and Wellbeing Board
The Place Partnership supports the purpose of the Health and Wellbeing Board, which is to act as the overarching driver for reducing health inequalities, improving health and wellbeing and increasing healthy life expectancy. The Place Partnership believes the core principles to support this should be:
- Giving every child the best start in life
- Enabling all children, young people and adults to maximise their capabilities and have control over their lives
- Creating fair employment and good work for all
- Ensuring a healthy standard of living for all
- Creating and developing healthy and sustainable places and communities
- Strengthening the role and impact of ill-health prevention though connectivity with the Place Partnership.
Universal prevention services should be optimised to meet ‘bigger picture’ need at the lowest level.
Conclusion
Progress on delivering North Lincolnshire’s Community First Strategy during 2023/24 has been good. By taking advantage of the ‘review and reset’ that senior leaders have progressed, the Place Partnership will build on this progress through:
- further and faster action to deliver on North Lincolnshire’s 3 strategic priorities within the Community First Strategy
- a refresh of the Community First Strategy, particularly to ensure our approach to integration is all age and places equality, diversity and inclusion at the forefront of our work
- strengthening the governance of the Place Partnership
- moving towards a Joint Committee with increased delegations from the HNY ICB.
The ICB is providing Organisation Development support to accelerate workforce development. ICB support is also enabling the development of the Population Health Management based ‘data into deep understanding’ approach that underpins the Preventative Approach to Integrated Locality Working – this is in turn supporting work to understand wider need and the development of Community Specifications across all Localities in North Lincolnshire as part of NLC’s Transformation Programme.
Grant funding totalling just over £100k to Pump-Prime changes that are part of the Community First programme relating to tackling health inequalities has been secured for 2024/5. Any additional need for resources to deliver the transformational change and embed these as business as usual will need to be met from within existing resources held by all Partners.
It is critical that a Senior Responsible Owner for each of the Strategic Priorities within the Community First Strategy is confirmed, together with system leads with accountability from each of the organisations that will deliver the plans for each Strategic Priority.