Diagram 1

Adult Social Care and NHS: Key Joint Arrangements:

• ICSs are required to produce these two documents, informed by joint Health and Wellbeing Strategies produced via each Health and Wellbeing Board. Think about what needs to be included in these documents to ensure council, social care and local communities’ priorities are represented.

• Financial issues are one of the main areas where tensions can arise. Make sure you understand the local arrangements and put in place improvement plans where there are issues.
• Particular areas you need to ensure are working well include: Better Care Fund plans; joint funding decision arrangements for complex care including Section 117 related support; local protocols to manage the interface between Continuing Health Care (CHC) and social care, and capital or infrastructure costs for building with multi-agency services running in them

• Increasingly, ICB meetings, and in due course, ICS CQC inspection will be looking at health and council performance and outcomes in the round.
• Consider how to achieve transparency of social care activity, performance and impact without engendering a culture where your local NHS partners try to take control of the oversight. The balance is through maintaining equal partnership, alongside ensuring effective local democratic oversight.

• The NHS shift to ‘strategic commissioning’ and a more collaborative approach to planning and improving services, with reduced competition between providers is quite different to the ongoing responsibilities of councils with respect to procurement of adult social care services, and locally both NHS and social care leaders will need to understand the differences and their implications
• Options, such as Section 75 partnership agreements, can be utilised to delegate some commissioning and contracting (to the NHS) or take on additional responsibilities from the NHS. Legal advice on the specific local proposal is always essential, with particular regard to how to navigate subsequent disagreements or remedy poor performance or cost pressures.

• Most DASSs lead, or are closely engaged with, work to improve services for older people, including hospital discharge and appropriate admissions avoidance support (intermediate care services).
• It is important DASSs understand the local services, performance, costs and improvement plans and have oversight of the associated improvement plans, even if they don’t lead directly. It is also essential to understand the interplay with the BCF arrangements and the contribution this fund makes to the overall services’ capacity and their impact.

• Co-ordinating mental health related services across multiple organisations and across multiple council departments (e.g. Adult Social Care, Children’s Social Care, Public Health, Communities and Economy) and enabling delivery in a way that feels accessible and seamless for residents, continues to be a major challenge.
• Both ICS or ‘Place’ level mental health forums to co-ordinate multi-agency activity are essential. If you do not have this established, consider leading on the establishment of it. In particular, consider service accessibility and the experience of local people in seeking the relevant information and support and use this feedback to inform further improvements.

• There are usually multi-agency project or development boards or workstreams in place to co-ordinate the development and oversight of strategies and associated delivery plans for specific areas or types of care and support, such as those opposite. These are often informed by national policy or strategy requirements, so staying up to date with these national publications is key.
• The forums can cover service developments relating to the local council geography (often co-terminus with ‘place’), or a larger geography (such as where the ICS covers multiple council areas). You will need to determine what is most appropriate to best achieve improvements for the population you are responsible for.

• Although there are statutory responsibilities for the NHS and police with respect to the effective functioning and impact of local Adults Safeguarding Boards, it is the council which has lead responsibility. As a result, DASSs will want to keep a careful eye that NHS ownership, attendance and contributions to safeguarding arrangements are sufficient and that there is pro-active executive level ICB leadership of the area. Constructively engaging executive level NHS colleagues to improve input can be one of the more sensitive discussions that DASSs need to progress, when there are issues in this area.

• DASSs can utilise their statutory responsibilities to assist in building relations across councils and NHS organisations with the aim of improving NHS contribution to (and investment in) broader social and economic development, bringing the opportunity of improving longer term population health and wellbeing improvements, in collaboration with public health. Housing, local planning, accessibility to services and prevention are all key considerations here.