Joining Up Care Programme Update

Purpose of report

For direction.

Summary

This report follows on from the previous introduction to the new joint programme between NHSX, the LGA and ADASS called Joining Up Care and provides Member’s with an update on progress in key areas.

Recommendations Members of the board are asked: to consider the update above and provide any comments, feedback or steer; to consider and endorse the narrative (annex B) and co-leadership principles (annex C), subject to any feedback and comments. Action Officers will engage with the Board in line with their decisions and recommendations.

Contact officer:	Jamie Cross / Hannah Gill

Position:	Programme Lead Advisor / Programme Manager

Phone no:	07856289407

Email:	Jamie.cross@local.gov.uk / Hannah.gill@local.gov.uk

Joining Up Care Update

Background

As Members will now be aware, NHSX are working in partnership with the LGA and ADASS on a new joint initiative called Joining Up Care.

Joining Up Care aims to break down the barriers between health and care through the improved use of technology and data. The initial focus is to support people to stay well, maintain their independence and wellbeing, and to access health and care services from home, including people who live in care homes.

It brings together new initiatives and existing programmes of work to ensure:

All care providers have the basic technology infrastructure needed to deliver effective care;

NHS and local authorities can deliver remote health and care services for people with long term conditions or people with social care needs and can support people make the best use of technology to manage their own health and care and support the role of informal carers where appropriate; and

National and local organisations work together to create the environment for a fully integrated health and care system that enables information to flow between services.

There are three workstreams:

Connecting care providers: Improve the health and well-being of people who use services and care home residents by providing better care and support through better connectivity and the delivery of remote health and care services where beneficial

Supporting people at home: Supporting people to stay well and to help them access and receive health and care services from home and to manage their own health and care where they can alongside their informal support networks.

Sharing care records: Supporting local plans for accelerating and creating shared records across care and health, to drive better and more linked up care of the person and to identify and address population health needs.

Members received an introduction to Joining Up Care at the October Board meeting and asked for regular engagement opportunities to provide political direction.

Programme Update

Since the first update, many of the projects and programmes that make up Joining Up Care have progressed significantly.

Connecting Care Providers

The roll out of iPads to Care Homes progresses with 10,706 iPads having been allocated to 9,333 care homes. This will allow care providers to access remote health assessments this winter and help to keep loved ones in touch.

The Data Security and Protection Toolkit has been simplified and is waiting for approval before being published, with a support offer for care providers available through the Better Security Better Care programme. This will help to ensure that care providers are keeping their residents’ data safely and securely.

Guidance has been published for care homes to implement proxy access for reordering medication and further access to information in the GP record. This will allow registered care staff to more quickly reorder medications on behalf of residents.

Supporting People at Home

The regional scale plans for remote monitoring tools for COVID are progressing and the Innovation Collaborative has been launched. This will lead to increased use of remote monitoring as a mechanism to monitor COVID symptoms at home.

Sharing Care Records

The programme is now being set up to take the place of the previous Local Health and Care Records programme. This pulls together and builds on the work done previously.

The analysis of each Integrated Care System’s plan for a shared care record is taking place with confirmation of the national delivery trajectory to follow. Both of which will allow for better shared care information to improve the care people receive.

Most of this work is understandably Covid-related and focussed on short-term initiatives over Winter, indeed some are part of the Adult Social Care Winter Plan. These are also very much aimed at ensuring that people receiving social care, particularly in care homes, can continue to get the health services they need. Alongside support for delivery of this critical short-term work, we are also working hard to establish a longer term partnership approach that recognises the fuller range of social care digital challenges and opportunities and recognises the need for support to people living independently as well as to informal carers.

A full update can be found in Annex A.

There are also several initiatives taking place at the Joining Up Care partnership level to ensure our joint work is delivered with health and social care leading as equal partners in this complex environment.

Narrative

Members will recall that one of the initial challenges was developing a single unified narrative that brings together the strategic aims of this partnership. Plenty of work has now taken place to create a cohesive one-page narrative which can be used by all partners to talk about what Joining Up Care is and why it matters.

This is a working document at present as other partners continue to contribute and refine. A copy of the most recent version is attached in Annex B.

Regional Health and Care Co-Leadership

Another key challenge was how we ensure that these partnerships are successful at the local, regional and national levels of the large and complex health and care system. Colleagues have begun to build consensus towards the idea that we will all need to coordinate, engage, communicate and support each other within the large and complex system that is health and care.

In particular this will involve facilitating the involvement of senior leaders from across the health and care system. This has local (e.g. council/CCG), sub-regional (e.g. STP/ICS), regional (e.g. NHS and Local Government) and national dimensions in addition to leadership interests in NHSx, NHSEI, local government and social care provider bodies, and all are important to making this work.

A key element of this will be developing an approach to regional co-leadership across health and care. This is particularly important for local government and ADASS where the regions are strong, but rely on voluntary coalitions of councils and Directors of Adult Social Services working together to support mutual interests and programmes. There is already a lot of work going on at regional level across many projects and programmes which will need to be understood. LGA colleagues have begun to have conversations with regional leads to understand how partnerships between national, regional and local teams can best be facilitated.

Before that work begins the LGA and ADASS have been pushing for a set of co-developed principles by which all partners can use to underpin our partnership approach to regional co-leadership for the future.

There are plenty of other more practical considerations that we will all need to identify and understand as we move forwards including, but not limited to, the differences in regional geography, varying roles and structures across the country, and existing co-led initiatives and projects which have their own set-ups. However, the purpose of these principles is to be a starting block for building consensus towards the right principles which we can all get behind and to discuss some of the other activities and considerations which are relevant to the conversation.

The working principles are attached in Annex C.

Spending Review/ Post March 2021

Finally, so much of this work relies on the outcome of the spending review, which at the time of writing has not yet been announced.

Funding for Joining Up Care post-March has been included in several Comprehensive Spending Review bids, but depending on the outcome, there may be an internal negotiation process within NHSX to prioritise funding for projects and programmes.

LGA colleagues will play a key role in influencing the outcome of this in order to maintain the focus on partnership working and improved health and care outcomes to people.

Implications for Wales

No specific implications for Wales.

Financial Implications

Joining Up Care remains primarily funded by NHSX. The outcomes of the Spending Review (bids totalling c£940m for FY 2021-24) will have a huge implication on the ability to deliver this ambitious programme of work.

The outcome of the SR will also have an implication on the LGA’s continued ability to commit resources to the partnership.

Next steps

Members of the board are asked:

to consider the update above and provide any comments, feedback or steer;

to consider and endorse the narrative (annex B) and co-leadership principles (annex C), subject to any feedback and comments.

Officers will engage with the Board in line with their decisions and recommendations.

Annex A – JUC Project/ Programme Updates

Project Title	Project Outcome Ambition	Update
Connecting Care Providers	Devices for Care Homes (short-term for winter)	Care homes will have access to tablet devices to support remote health consultations and enable contacts with friends and families.	The roll out of iPads to Care Homes progresses with 10706 iPads having been allocated to 9333 care homes. A full roll out is expected during the second week of Dec.
Care Provider Connectivity (strategic, longer-term)	Care homes who want to upgrade broadband/ Wi-Fi do so with co-ordinated discounted deals.	NHSDigital have published a discovery into the barriers to connectivity for care providers and quick wins will be taken forward for the remainder of this FY.
Care Provider IG & Cyber Compliance (strategic, longer-term)	There are increased levels of compliance with data security and IG, following simplification of guidance.	The Data Security and Protection Toolkit (DSPT) has been simplified and is waiting for approval before being published, with a support offer for care providers available through the Better Security Better Care programme.
NHS Mail and Care365 (short-term for winter)	NHSmail / secure email in use by 80% of care homes by March 2021, with increased uptake of MS teams and Microsoft Tools.	Over ⅔ of care homes and ⅓ of care providers have been connected to NHSmail however this will be dependent on meeting DSPT standards longer-term.
Access to Information GP Connect (strategic, longer-term) Carer proxy access (short-term for winter) Summary Care Record (short-term for winter)	Care providers can access GP records (read only) for the people in their care via GP Connect website. Care staff have proxy access to medication re-ordering, and GP record access. Care providers can access GP records (read only) for the people in their care, via the Summary Care Record mobile application.	Conversations continue with system suppliers to enable the display of GP record within their systems to appropriate care provider staff. Guidance has been published for care homes to implement proxy access for reordering medication and further access to information in the GP record. Funding to support local roll out available. Consideration of an extension of the Summary Care Record mobile application private beta for use on the NHSX managed iPads but this is still subject to internal approvals.
Digital Social Care Records	Care providers in deprived areas will have access to reduced rates for implementation of digital care management systems. A list of common interoperability standards for Digital Social Care Records published. An assured list of digital care management systems suppliers will be available for care providers to use and have access to buyers guidance to support care providers’ decisions.	Procurement for the second phase of user research is ongoing which will help to define the user requirements and the core capabilities of a digital social care record. The Standards and Interoperability work is progressing with a procurement process to commission this work package. Engagement with suppliers continues, as does the development of the scope, assessment criteria, contractual terms and procurement documentations to support the launch of the DPS.

Supporting People at Home	Regional Scale Plans for Remote monitoring (short-term for winter)	Remote monitoring of health in homes and care settings, tested across all regions and covering people with particular long-term conditions.	All regions have developed a scale plan for remote monitoring and are progressing. The Innovation Collaborative has been launched.
Outpatient transformation (medium-term)	Outpatient transformation for ophthalmology and other digital pathways implemented regionally for particular conditions.	Joint work to implement image sharing and enhanced referral technology across primary and secondary care progresses. Standards and procurement framework to be launched in Nov, alongside the publication of five playbooks.
Scaling Social Care Tech (strategic, longer-term)	A national strategy for scaling the use of technology in social care. A taxonomy to identify tech that solves particular problems. A procurement framework that supports local authority investment in care tech. Sharing local guidance and good practice.	Currently tendering for new research into the current use and effectiveness of technologies and the barriers to adoption and scalability.
Digitally Connected Households (strategic, longer-term)	The needs of housebound population and ways to support them digitally are understood, with local exemplars leading innovation in home settings for health and care. Plus, associated maturity model. Digital innovations that support self-care for different health and care issues are categorised by the type of tech platform, the level of evidence of benefit to resident, and evidence of reducing health and care inequalities.	Project paused.

Sharing Care Records	Shared Care Record roll out	Each Integrated Care System area and Sustainability and Transformation Partnership area has a plan for sharing care records which is aligned with a strategy and accompanied by architecture. Clear guidance and support for building or buying sharing solutions with associated delivery plan and support for unblocking local procurement issues.	The programme is now being set up to take the place of the previous Local Health and Care Records programme. The analysis of each Integrated Care System’s plan for a shared care record is taking place with confirmation of the national delivery trajectory to follow.
Strategic use of linked health & care data	Strategic delivery plans for Shared Care Records which include how data can be used strategically for health and care outcomes, and for population health management and research.	No update.
Standards (medium-term)	Mapped standards for sharing records with analysis for any changes that need to be made.	No update
Simplified Information Governance (short-term for winter)	Legislative environment reviewed with simplified information governance across health and social care.	NHSX has launched a new online Information Governance (IG) portal which showcases clear and consistent IG guidance and advice for IG professionals, service users, patients and health and care staff - empowering them to use and share information appropriately to support care.
Digital Community Services Interoperability	Digital transformation challenges for community services and providers, and options for solutions.	No update

Annex B – Joining Up Care Draft Narrative

Joining Up Care will help break down the barriers between health and care through the improved use of technology and data. The initial focus is to support people to stay well, maintain their independence and wellbeing, and to access health and care services from home, including for people in care homes.

Joining Up Care is a partnership initiative between NHSX, the Local Government Association and Association of Directors of Adult Social Services, and involves a wide range of stakeholders. These partnerships will ensure our work is delivered with health and social care as equal partners.

It brings together new initiatives and existing programmes of work to ensure:

All care providers have the basic technology infrastructure needed to deliver effective care;

NHS and local authorities can deliver remote health and care services for people with long term conditions or people with social care needs and can support people make the best use of technology to manage their own health and care and support the role of informal carers;

National and local organisations work together to create the environment for a fully integrated health and care system that enables information to flow between services.

Covid-19 has seen a sharp acceleration in the uptake of digital services across the NHS and social care sector to reduce the spread of the virus while continuing to deliver care. Remote consultations and remote vital signs monitoring have helped to avoid unnecessary appointments or reduce hospital stays.

However, the pandemic has also highlighted the long-term lack of investment in technology infrastructure for social care and the need for greater focus on skills and digitisation, to both support the sector and to enable health and social care services to work more closely together.

Joining Up Care will support NHSX’s wider ambitions to digitise, connect, and transform the health and care system, and will support the Government’s adult social care reform plans.

There are three workstreams:

Connecting care providers: Improve the health and well being of service users and care home residents through better connectivity and the delivery of remote health and care services

Supporting people at home: Supporting people to stay well and to help them access and receive health and care services from home and to manage their own health and care where they can alongside their informal support networks.

Sharing care records: Implementing records across care providers and accelerating sharing of care records, to drive better care and population health.

These are supported by enabling work on:

Digital skills for the care workforce

Standards

Information governance

What good looks like

The initial focus of these workstreams is on in-year activity to respond to the needs identified during the pandemic and to support preparations for winter. But our aims are not easy, and they will not be achieved overnight. Joining Up Care will take a multi-year view to support the investment, business change and cultural change required to achieve our outcomes.

We are working closely with the Department of Health and Social Care and NHS England/ Improvement to align this work with ministerial priorities and other complementary programmes of work such as NHS@home and Enhanced Health in Care Homes.

Annex C – Principles for Regional Health and Care Co-Leadership

The following draft principles are a starter for ten and have been put together following

conversations with partners and facilitated meetings with regional colleagues.

Improving Lives – We exist to improve people’s lives and will keep that at the forefront of all we do

Co-Leadership – development and delivery of projects and programmes will be co- led by national and regional health and care leaders

Parity – health and care leaders will be afforded parity of esteem

Inclusion – technology is an enabler which supports delivery of health and care, hence we will involve an appropriate range of service interests to ensure effective planning and delivery.

Unity – We will work to create a unified narrative that is owned and promoted by all partners which can be used consistently across initiatives

Subsidiarity - change happens locally hence we will ensure regional and national work supports local delivery.

Early and throughout – we will ensure we engage early and throughout planning and delivery

Resources – we accept co-leadership needs resources and will build this into planning assumptions

Difference – One-size won’t fit all regions, so will be pragmatic in supporting what works for different locations; we won’t let geography get in the way

Pressures – we all work under service and operational pressures that mean we can’t always engage everyone all the time on everything. We recognise that. (NB this is not a get-out from all the above!)