St Helens Cares Place Development Framework
AMBITION & VISION
Clarity of purpose
- Our Place vision was developed in 2017 with all stakeholders and has evolved along with the evolution of the Partnership, adapting to the dynamic environment and continued challenges pre, during and post pandemic. Partners have a good understanding of how this translates from place to action at an organisation level (see our Plan on a page).
- Partners can articulate the connectivity between the wider determinates of health (housing, environment, employment, education and societal factors) and the collective vision is routed in the ambition of all partners to deliver improved outcomes and reducing health inequalities – this is our mission! (see our Closer Together – Health Inequality Strategy).
- The partners have a relentless pursuit of improving the lives of people in St Helens, reducing health inequalities and an absolute focus on three priorities which will help shift the dial of many of the NHS LTP aims (see our St Helens People’s Plan 2021-26).
- St Helens Cares had a partnership collaboration agreement in place in 2019, this was refreshed and widened the scope and approved in March 2021 ahead of our your of transition. Our approach is beyond been established, we are thriving (see our Collaboration Agreement).
Objectives & Priorities
- Our priorities were developed using a suite of PHM data, engagement with local stakeholders and alignment patients and carers voices to define key objectives. Further refinement of these objectives was undertaken with the full engagement of partners to concentrate on just three priorities to enable the targeted delivery of support and interventions that will have the biggest impact on improving health outcomes and reducing health inequalities. (St Helens People’s Plan 2021-26).
- We have set ambitious breakthrough goals to really target some of our most stubborn indicates and developed a performance dashboard which is monitored at the Integrated Finance and Performance committee (CCG and LA) (Our Dashboard) (CCG and LA) (TOR) and at the Place Based Partnership Board.
- We constantly revisit priorities and ensure that our model continues to evolve. An example of this recently is a targeted piece of work to examine our PCNs role as the heart of our local care communities, baselining the effectiveness of their engagement with wider partners and agreeing next steps to develop these wider partnerships further. We will work over the coming year to develop these care communities, ensuring that PCNs are the centre of true multi-disciplinary care communities.
Population Health Management (PHM) to address health inequalities
- St Helens makes use of a suite of PHM tools from PH and CIPHA (the borough was the test-bed for this product, which was then rolled out across C&M) and our shared care record has a resident case-finding tool enabling clinicians at PCN/ward/practice level to stratify or segment residents who may be at risk of severe illness or chronic disease enabling a proactive approach to the management of care. (see the extract from the case finding tool).
- St Helens has a comprehensive understanding of PH and care needs. The current and previous strategic place plans have been developed using this evidence base for planning, commissioning and service delivery.
- Our JSNA provides some insights and we have made full use of the CIPHA product (first implemented in St Helens before a wider C&M roll-out) and this has been used to target health inequalities interventions particularly for COVID-19 action and the vaccination programme to target the underserved communities in our Borough (see CIPHA screenshots)
- We have strong PHM capability at the place level and in some aspects of the neighbourhood level. Modules attached to our shared care records provide this capability. Our next stage of development is to establish this capability consistently at a neighbourhood/ward level.
LEADERSHIP & CULTURE
Place based leadership
- St Helens has had a jointly appointed CCG Accountable Officer/LA Executive Director as Place Lead and a jointly appointed Director of Integration (CCG/acute trust) since 2018 to support the development of the partnership. The Place Based Partnership Board and its supporting groups provide diverse and inclusive for a with a highly collaborative dynamic.
- The St Helens Executive Leadership Team is led by the jointly appointed CCG Accountable Officer/LA Executive Director with directors from the CCG (Commissioning, Medical (GP), Nursing, Finance and LA Social Care and Public Health). Decisions are taken collectively in an open and transparent way to maximise the St Helens pound and minimise risk. We believe this form of organisational structure offers a model for adoption across Cheshire and Merseyside providing a safe vehicle for delegation.
- Place based partners recognise, support and helped shape the current leadership arrangements. The Place Based Partnership Board is chaired by the CCG's lay chair and our current focus is evolving our arrangements as a committee of the ICB to provide a potential test-bed for Cheshire and Merseyside.
- There is strong clinical engagement and support from the PCN clinical directors and medical director on all key strategic and delivery groups. This is supplemented by effective clinical leadership in our service redesign, examples include urgent and emergency care, mental health, PHM, and digital and data development (see our governance chart)
- The Chief Nurse is a member of the Cheshire and Merseyside Clinical and Care Leadership group which will ensure we drive priorities and provide clinical involvement in Place based design and decision making
- Our Placed Based Partnership Board has representation from all PCN clinical directors. PCN clinical directors actively contribute to the development of the Place plan, vision and priorities as well as the delivery.
- St Helens have developed a care communities model with PCNs at the heart of the approach. This will be developed further through our 'Resilient Communities' workstream. The focus for this piece of work is on establishing clear priorities for the development of PCS at the heart of our local health and care community. A key aspect of our plans going forward include the development of frailty teams that include primary care, community teams, acute frailty teams, occupational therapists, pharmacists and social workers is the first step of this project.
- Our Place Based Partnership Board and its sub groups have membership that spans the borough including representation from the health and care sector housing, schools and voluntary, community social enterprise (VCSE) sector. This diverse membership continues from the strategic to delivery and enabling activities of the partnership, the value of different perspectives and experiences makes for a strong, rich and effective partnership.
- St Helens Cares has been shortlisted for and won a number of national awards as evidence of its partnership working including winning the care and health integration category at the 2018 Municipal Journal awards and receiving a 'Highly Commended' in the health and local government partnership category at the 2020 Health Service Journal awards) (see our award certificate).
Culture and Organisational Development (OD)
- St Helens Cares ICP has developed a culture of shared learning and sharing experience, best practice to support shared decision making. Evidence published on impact of this during Covid-19, widely shared with partners (see the report from Hill Dickinson - Place versus Pandemic).
- The ICP has an OD Framework & Plan in place, we have undertaken development sessions during the development of our strategic priorities in 2020 and further development sessions have taken place with the Place Based Partnership Board in the summer 2021 and with our stakeholder forum (statutory, voluntary, business sectors and carers). These sessions have help to embed our ways of working and system leadership within and across the borough.
- Partners have worked together on agreeing set of values and principles of partnership (see our Plan on a page). The partnership is almost five years old in its current form and over that time our colleagues have collectively developed culture of trust and confidence in partners’ ability to represent each other on behalf of place at regional and national level.
- A Workforce & OD Enabler Group was established to shape St Helens Cares 'One Workforce'. There is a subgroup reporting to the system resources group that is supporting the ongoing organisational development. The most significant testament to our 'One Workforce' approach is the co-location and where appropriate single leadership of teams across organisational barriers. Examples include commissioning and transformation programmes in Children's, Adults, Mental Health and Public Health. We have a joint business intelligence hub – Trust, Public Health and CCG staff co-located to provide a single service.
Voice of our communities
- Our established stakeholder forum, led by the CCG's Lay Member for Patient and Public Involvement demonstrates a wide ranging representation of the citizen’s voice at neighbourhood and place. It has played an important role in the development of strategic plans and acts as a sounding board for new initiatives.
- St Helens Together is led by a voluntary, community social enterprise (VCSE). We have a place engagement plan agreed by all partners and a community strategy refresh in development with the LA.
- Our PPG Forums are well developed and there is PCN level representation on our stakeholder forum.
- The Partnership has wide reach across communities. Our stakeholder forum is firmly embedded within the Place governance framework, acts as engagement and consultation platform to provide assurance to the Place Based Partnership Board and informs the programme development group in all priority areas.
DESIGN AND DELIVERY
- St Helens have established an Integrated Finance and Performance Committee (CCG and LA) since 2019 which monitors the allocation and performance of jointly deployed resources. At a programme level there is a system resources group that oversees the enabling actives of Digital, Data, Workforce and Estates and Finance across the Place based Partnership.
- Partners are fully represented and have come together to deliver a place view of finance and performance back to the system.
- Our Section 75 and risk share agreement is amongst the most comprehensive in C&M and has been agreed and endorsed by partners for the pooling of budgets.
- Investment decisions across health, public health and Adult Social Care are taken by the integrated leadership team within the approved delegated limits.
- The System Resources Group (with membership across health, LA, Acute and MH providers and housing association) is developing financial mapping across three St Helens priority areas (Mental Wellbeing, Obesity and Resilient Communities) so that financial flows and impacts between organisations are understood and can be used to support the delivery of priority objectives.
- Joint financial investment decisions will be taken through the Integrated Partnership Board, with those decisions being supported by recommendations from the three integrated sub groups (System Resources, Programme Delivery and Stakeholder Forum).
Planning and Delivery
- St Helens is in a strong position as the Health, Public Health and Social Care Executive Leadership Team (LA & NHS) and pooling resources and shared appointments have been integrated since 2018. Migrating to ICB and PBP arrangements will present a much lesser challenge in St Helens as we believe we have already have in place, an integrated approach to strategy, planning and delivery.
- We are in a state of readiness to receive the delegations from the ICB and could operate as a shadow committee from 1 January 2022 and be fully operational by 1 April 2022.
- Planning is underway to deliver the above, but will require support from system colleagues. Pathway redesign is led by clinical and professional leaders. The SROs for our three priorities are from Health, Public Health and the LA. There is wide representation in the working groups and we have a PMO which supports the delivery of our ambitions
- The evidence illustrated in the whole of this framework demonstrates our maturity on the integration continuum.
- St Helens has had a shared care record (SCR) in place for the past four years; it integrates the records of the acute trust, community services, mental health, primary care and social care. It is widely used by clinicians and practitioners for the benefit of our patients and services users who receive quicker and seamless care.
- This data is used in real time to inform the care required by the service user. The platform used by St Helens is currently forerunner for a Cheshire and Merseyside solution. The data quality is high and the infrastructure is sound. It is supported by robust governance and the data sharing protocols were made much easier because of the high degree of trust and confidence amongst partners.
- The SCR has additional modules such as a case-finding tool that allows the clinician to stratify and/or segment residents who are at risk of chronic illness and proactively intervene or support patients to access services or lifestyle changes.
- Place partners have developed a number of dashboards for patients with long-term conditions such as cardiovascular disease and frailty with PCN clinical directors central to their design. St Helens has implemented the CIPHA PHM system ahead of the wider roll out to the system.
- We have a Place based strategic estates group with representation from all partners to ensure we optimise our built assets.
- The group make use of an interactive estates mapping tool that provides users with intelligence to inform decision-making to ensure optimum use of local assets. http://u.osmfr.org/m/154483/ - this map contains public sector buildings across the borough. It contains Health Centres, GP’s, children’s centres, libraries, nursing homes, schools etc. This map gives an overview of the estate across St Helens and is useful to understand what building we have providing health and social care in St Helens. We have used it to align care homes to networks and practices, look at impact on practices where services are changing etc. http://u.osmfr.org/m/155718/ - this map is specific to primary care. It has key data in about GP practices including boundary lines and is useful for planning purposed when considering primary care services. The first is more useful, but highlights level of local data we hold to drive estates decisions.
- This group links into the system resources group, the Chair of which has a position on the Place Based Partnership Board.
- Integral to the St Helens Cares Partnership MoU signed up to by all partners is a robust governance framework that has undergone an effectiveness review. The governance clearly sets out the mechanisms through which functions are discharged. (see our Collaboration Agreement)
- The partners are represented at Board level and in all of its sub-committees. The Partnership is been asked to design a model governance framework for sharing across all place based partnerships in Cheshire and Merseyside.
- The operating model has been designed with involvement of all partners and an on-going OD programme has been delivered to ensure the on-going resilience of the framework in supporting effective decision making (see our governance chart).
- We have clear lines of accountability from the Place Based Partnership Board up to a future ICB and down to the sub committees (Quality, Finance, Delivery, Enabling)
- We are working with the ICS and Hill Dickinson to move the current governance arrangements into a shadow committee of the ICB in a state of readiness for future delegations.