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Integration, cooperation and
partnerships workbook
1.
How to use this workbook
This work book forms part of the suite of learning materials that have been
developed to support the implementation of part one of the Care Act 2014. These
materials summarise and explain the ‘Care and Support Statutory Guidance’
(October 2014) [“the guidance”] and are designed to help those involved in care and
support services to understand and implement the Act.
The suite of learning materials contains workbooks, PowerPoint presentations and
other material for each of the following topic areas:
1. Introduction and overview
2. Information and advice
3. First contact and identifying needs, including assessment and eligibility, and
independent advocacy
4. Charging and financial assessment, including deferred payment agreements
5. Person centred care and support planning, including personal budgets, direct
payments and review
6. Transition to adulthood
7. Integration, cooperation and partnerships
This workbook is about the integration, cooperation and partnerships requirements of
the Act and its statutory guidance. It has been written for learning facilitators and
includes exercises, suggested group discussions, and points of reflection that
facilitators can use either in their entirety or to pick and choose from as they see fit
when designing a learning programme based on the PowerPoint presentation.
The workbook can also be used by individuals who wish to learn more about this
topic area. You can watch the presentation, read the notes below, and undertake the
exercises at a pace and time to suit you.
As well as this workbook and PowerPoint presentation, there is also a summary of
what the Act says and a shorter, overview presentation on this topic area.
The implementation of the Act requires whole systems change and underpinning this
is a need for cultural change. These learning materials alone will not affect such
change, but they are one tool that can be used to support people along the journey.
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In many instances, implementing the Act successfully will require those involved in
the care and support system to change the way they work i.e. behaviour change.
Research suggests that the way people behave is influenced by their knowledge,
skills and attitudes:
Knowledge
Skills
Behaviour
Attitudes
The PowerPoint presentation and summary are designed to increase knowledge
about the Act or guidance. The questions and exercises in the workbook are
designed to spark conversations that encourage people to reflect on their own
attitudes and the attitudes of others. They aim to give learners the opportunity to
discuss the complexities of implementing the changes in practice, and/or provide a
safe way of challenging attitudes that go against good practice.
Key learning point
These are used in the workbook as a way of highlighting changes that are likely to
have a significant impact on practice i.e. the major changes that the Act brings in.
The facilitators’ hints and tips in the workbook signpost facilitators to existing good
practice resources on this topic area and/or highlight key changes that are likely to
have the most significant impact on practice. The aim is to help facilitators to design
interactive learning programmes that are appropriate for their audience.
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Facilitator’s hints and tips
To successfully facilitate this module we suggest that you need to:

have read the relevant sections of the Act, regulations and guidance

have a good understanding of best practice in this topic area, including
understanding the Better Care Fund plans agreed in the locality

remember that there are various modules available and you need to choose
the most suitable ones for your learning programme

also remember that you can pick and mix questions, exercises and case
studies from this workbook or from other topic areas

design your training session in a way that accounts for the learning pyramid
so as to maximize the experience and learning outcomes for your participants
Average retention rates
Lecture
5%
Reading 10%
Passive teaching
methods
Audio visual 20%
Demonstration 30%
Discussion 50%
Participatory
teaching methods
Practice by doing 75%
Teach others 90%
Source: Adapted from National Training Laboratories, Bethel, Maine
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2.
Who is it for?
This workbook is about integration, cooperation and partnerships. It explores
Sections 3, 6, 7, 22, 23, 43, 74 and Schedule 3 of the Act and the Provision of Health
Services Regulations. It is intended to be used to develop learning programmes for:
 those responsible for planning and delivering integrated care and support.
This would include lead commissioning staff in Adult Social Care, the CCG
and in other elements of the local authority such as planning and housing
3.

managers in adult social care and in other parts of the local authority, health
services (including the acute trusts, private hospitals, ophthalmic and
pharmaceutical services) and housing providers. This would include
managers of local authority, private and voluntary sector service providers

those involved in the governance of these organisations, in particular elected
members and others who may sit on Health and Wellbeing Boards

staff who are impacted by, or likely to be impacted by, greater integration,
cooperation and partnership working and who wish to understand some of the
legislative and strategic implications of the Act.
Contents
This workbook starts with an overview, which summarises the topic area and
identifies key words relevant to this topic area. It then contains the following sections
that match the slides in the PowerPoint presentation:
 Introduction
 What the Act says and the duties that fall to local authorities
 The duty to promote greater integration
 The duty to cooperate
 Integration, cooperation and partnerships in practice
 Working together: examples
 Summary
Appendices: Links to key resources
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4.
Overview
Integration, cooperation and partnerships have been a cornerstone of public policy,
particularly across health and social care, for many years. The Care Act now makes
integration, cooperation and partnership a legal requirement on local authorities and
their public sector partner agencies. The guidance states that “For people to receive
high quality health and care and support, local organisations need to work in a more
joined-up way, to eliminate the disjointed care that is a source of frustration to people
and staff, and which often results in poor care, with a negative impact on health and
wellbeing. The vision is for integrated care and support that is person-centred,
tailored to the needs and preferences of those needing care and support, carers and
families.” (15.1)
Although integration, cooperation and partnerships in their own right is a theme in a
number of significant sections of the Act, it is intended as a holistic piece of
legislation and therefore integration relates to prevention, information and advice,
and coordinating a shared approach towards the market – not just when someone
has a specific care and support need. In making Safeguarding Adults Boards a legal
requirement the Act underpins the principle that relevant organisations must work
together in partnership beyond integration of services.
The Act and its accompanying guidance is also clear that integration, cooperation
and partnerships are tools and processes for improving care and support, as
compared to the desired outcome i.e. integration simply for its own sake, is
meaningless; it is only relevant in the context of what it can achieve for end users
and in terms of ensuring that the delivery of care and support is cost effective.
5.
Key words
The suite of learning materials contains a glossary of key words used in the
statutory guidance. The following key words, definitions of which can be found in the
glossary, are relevant to this topic area: commissioning, cooperation, duty,
information, integration, partnership, preventative, provider, rights, safeguarding,
signposting, transition, wellbeing.
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6. Introduction
Slide 1
Notes
1. This workbook forms part of the suite of learning materials that have been
developed to support the implementation of Part One of the Care Act 2014.
These materials summarise and explain the ‘Care and Support Statutory
Guidance’ (October 2014) and are designed to help those involved in care and
support services to understand and implement the Act.
2. The presentation is about integration, cooperation and partnerships. It is intended
for:
 those responsible for planning and delivering integrated care and support.
This would include lead commissioning staff in adult social dare, the CCG and
in other elements of the local authority such as planning and housing
 managers in adult social care and in other parts of the local authority, health
services (including the acute trusts, private hospitals, ophthalmic and
pharmaceutical services) and housing providers. This would include
managers of local authority, private and voluntary sector service providers
 those involved in the governance of these organisations, in particular elected
members and others who may sit on Health and Wellbeing Boards
 staff who are impacted by, or likely to be impacted by, greater integration,
cooperation and partnership working and who wish to understand some of the
legislative and strategic implications of the Act.
3. The aim of the presentation is to help people reflect on how and why adult social
care needs to work with other bodies (and vice versa) if care is to be successfully
delivered and supported, and the levers with which the Act enables organisations
to work more collaboratively together.
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Slide 2
Slide 3
Notes
1. The expectation on public bodies to work together is not new. There has been a
whole series of legislation, policy and guidance calling for better joint working
between health and social care, dating back as far as 1973, when the NHS
Reorganisation Act placed a statutory duty on health and local authorities to
collaborate with each other through Joint Consultative Committees.
2. In 1997 ‘The New NHS: Modern, Dependable’ charged strategic health
authorities to produce local plans for improving health, based on cooperation
between health (PCTs as was then) and local authorities.
3. Cooperation between health and social care agencies was encouraged by the
Health Act 19991, which placed a duty of partnership on the NHS and local
authorities, along with powers to be able to develop lead commissioning
arrangements, integrated provision and pooled budgets. These legislative
flexibilities, that enable joint working, still apply under the Health and Social Care
Act 2012
1
Section 31 The Health Act 1999 as amended by section 75 the National Health Services Act 2006
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4. In 2005 ‘Independence wellbeing and choice’ called for better integration
between social care and health (PCTs as was then) in order to deliver
personalised care for individuals. Whilst in 2006 the National Health Service Act
consolidated previous legislation and put in place arrangements to allow the NHS
and local authorities to pool budgets.
5. The drivers for change have included2:
 Better access to services, more local provision and commissioning services
aimed at preventing or delaying care needs.
 Ensuring equitable access to services through needs based commissioning
and developing community based support systems.
 Harnessing the whole system to deliver better outcomes for people through
extensive needs and market analysis to shape the care environment, and the
transformation of communities through high quality health and wellbeing
services, infrastructure, housing, transport and education, training and
employment opportunities.
6. In practice, however, this has often been difficult to achieve for a number of
organisations due to historical and structural differences in the way they operate
and commission services. The Care Act aims to clarify expectations and
boundaries and enshrine the principle of joint-working in statute.
Slide 4
Notes
1. Why are integration, cooperation and partnerships an important theme? Why is
there a new expectation placed on local authorities and partners to cooperate?
2. “Organisational barriers” and “having to repeat information” are complaints often
levied at the health and social care system and can prevent people from
accessing the types of care and support they need – when they need it.
2
Institute of Public Care, Oxford Brookes University (2010) From the Ground Up: A report on
integrated care design and delivery. Department of Health, Integrated Care Network and Community
Health Partnerships.
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3. The benefits of cooperation, partnership and integration are well documented by
the likes of the Kings Fund and the Joseph Rowntree Foundation. A “joined up”
or “whole-system” approach has been shown to deliver benefits to organisations,
staff and, above all, service users.
4. Increased integration, cooperation and partnership working can:
 improve the service user experience – Coordinated and integrated care
makes sure the diverse and multi-faceted care system works as smoothly and
efficiently as possible. There are benefits in this for organisations in terms of
efficiency, for professionals in terms of effectiveness, but above all for service
users in terms of a smooth, easily understood and responsive single
experience.
 eliminate duplication – Individual circumstances are not always neatly
delineated against our own professional or organisational functions and a
variety of professional disciplines (and organisations) can contribute to
addressing the needs of an individual or community. Without a collaborative
and coordinated approach, these frequently lead to confusion and duplication
for the both the professionals supporting the person, and also the person
involved. This is often wasteful of public resources and frustrating and
disempowering for individuals and families. Better alignment and coordination
can reduce the number of different inputs people receive and eliminate
duplication.
 streamline care pathways – As individuals or families develop the need for
information, support and care, they will encounter a variety of agencies and
professionals. They are required to navigate a journey, or “pathway” through
the care system. If agencies collaborate effectively, then that pathway can be
simplified and streamlined making easier it on the end user to access what
they need.
 earlier intervention and prevention – If agencies and professionals work
together in a more structured way and draw together their collective
knowledge and expertise, the needs - or potential needs - of individuals,
communities and specific groups of people can often be identified earlier.
This can offer the opportunity to those agencies and professionals to develop
and implement coordinated responses aimed at preventing crises that lead to
the need for intensive or long term care. Examples can include falls
prevention programmes or reablement services which can also support the
return of individuals to much greater levels of independence.
 improve safeguarding - Partnership working improves responses to
safeguarding alerts, outcomes and protection for adults who are at risk of
harm or are suffering abuse. It also promotes a more joined-up approach to
promoting an asset based approach to prevent abuse happening.
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5. There are many different approaches to improving joint-working, and the Act
presents three approaches – integration, cooperation and partnerships. We will
come onto the detail of these in the following slides, but it is important to note that
they are not the same (although they may have the same desired outcomes); that
there are many different models of each; and that no one model is better than the
other but that it should be chosen based on the agencies involved and the issues
that greater joint working is designed to address.
Slide 5
Notes
1. There are many definitions we can use to understand the difference between
integration, cooperation and partnerships. For the purposes of understanding the
Act, however, we define:
 integration – ‘… as an organising principle for care delivery with the aim of
achieving improved user and patient care through better coordination of
services provided. Integration is the combined set of methods, processes and
models that seek to bring about this improved coordination of care’3.
 cooperation – public organisations working together in partnership to ensure
a focus on the care and support and health and health-related needs of their
local population. The guidance refers to this as being a general principle for all
those concerned and gives details on who should be involved and how this
should happen4.
 partnership - A joint working arrangement where the partners: are otherwise
independent bodies; agree to co-operate to achieve a common goal; create a
new organisational structure or process to achieve this goal; plan and
implement a joint programme; share information, risks and rewards5.
3
Shaw,S., Rosen, R., and Rumbold, B. (June 2011) What is integrated care? An overview of
integrated care in the NHS. Research report, Nuffield Trust.
4 Department of Health (2014) Care Act Guidance.
5 Audit Commission (1998) A Fruitful Partnership
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Facilitator’s hints and tips
Consider getting people to work in pairs to consider the differences between these
terms and consider the following questions:
 When would one approach be more suitable than another?
 Have you got examples?
 What are the challenges in each scenario?
7.
What the Act says and the duties that fall to local authorities
Slide 6
Notes
1. The requirement on local authorities to cooperate with others, and to ensure
partnership and integration is a theme throughout the Act and much of it cannot
be achieved without authorities considering how they should work with other
organisations to deliver care and support.
2. The key sections for local authorities are:
 section 3 – the duty to share care and support responsibilities through greater
integration with health services
 section 6 – the duty to cooperate with each of its relevant partners. In turn,
each relevant partner must also cooperate with the authority, in the exercise
of their functions relating to adults and carers
 section 7 – with regard to the care and support needs of an individual and/or
carer, this section places a duty on the local authority to cooperate and on a
“relevant partner” to cooperate in meeting care and support needs
 sections 22, 23 and 74 lay down some of the boundaries to local authority
provision in relation to health and housing services, whilst Schedule 3 relates
to hospital discharge
 section 43 - the duty on each local authority to establish a Safeguarding
Adults Board for its area comprising of itself, the NHS and the police as core
members, plus other relevant partners, with the objective of working together
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to help and protect adults by co-ordinating and ensuring the effectiveness of
what each of its members does.
Questions
 What key words or phrases (on the slide) stand out to you? Why?
 What might your local authority need to do to improve the way it works with
partners to improve adult safeguarding?
8.
The duty to promote greater integration
Slide 7
Notes
1. The necessity and benefits of integration are summed up in this sentence taken
from the statutory guidance which accompanies the Act.
2. The Act seeks for the first time to place a legislative duty on local authorities to
ensure citizens experience person-centred care, which is delivered through
greater integration.
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Slide 8
Notes
1. Section 3.1 of the Act defines the circumstances under which the duty to ensure
integration applies:
 to promote the wellbeing of adults with care and support needs and carers
 to contribute to the prevention or delay of support needs
 to improve the quality of care in its area
 local authorities must carry out their care and support responsibilities with the
aim of promoting greater integration with NHS and other health-related
services (for example, housing or leisure services).
Slide 9
Notes
1. It is important to note, that the Care Act also reflects similar duties on NHS
England and the Clinical Commissioning Groups (CCG) outlined in the Health
and Social Care Act 2012.
2. Under this provision, this means NHS England must encourage partnership
arrangements between CCGs and local authorities where it considers this would
ensure the integrated provision of health services and that this would improve the
quality of services or reduce inequalities.
3. Similarly, every CCG has a duty to exercise its functions with a view to securing
health services that are provided in an integrated way, where this would improve
the quality of health and/or reduce inequalities in access or outcomes.
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Key learning point
The Act places an expectation on local authorities to understand and deliver the
benefits of integration in partnership with other organisations such as the
NHS. This is reciprocated under the Health and Social Care Act 2012.
Questions
 What additional levers for change and integration do you feel the Care Act
offers you in planning services to improve wellbeing?
 Can you identify any potential services in your area or team, where greater
integration could mean more person-centred care that promotes wellbeing,
prevents or delays the development of needs and improves the quality of
care?
9.
The duty to cooperate
Slide 10
Notes
1. Alongside the requirement to integrate provision there is also a wider duty of
cooperation with a range of services. For example, the police or children’s
services, and local offices of the Department of Work and Pensions. This is both
in terms of a general duty to cooperate as well as a duty to cooperate in relation
to the specific circumstances of individuals or carers6 and as such is a general
principle to all those concerned. It also opens up opportunities for local authorities
6
Sections 6 and 7 of the Act
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– where appropriate – to work with other organisations such as independent and
private providers through a range of contractual agreements.
2. In Section 6 the Act sets out five aims of cooperation between partners which are
relevant to care and support, although it should be noted that the purposes of
cooperation are not limited to these matters:
 “promoting the wellbeing of adults needing care and support and of carers;
 improving the quality of care and support for adults and support for carers
(including the outcomes from such provision);
 smoothing the transition from children’s to adults’ services;
 protecting adults with care and support needs who are currently experiencing
or at risk of abuse or neglect;
 identifying lessons to be learned from cases where adults with needs for care
and support have experienced serious abuse or neglect and applying those
lessons to future cases.”
3. The Act and its associated guidance is quite clear on this issue. Local authorities
and their partners must cooperate when exercising their respective functions
relevant to care and support. That cooperation can be achieved through various
means and that some actions may actually overlap with those associated with
integration (for instance, pooled budget arrangements or information sharing).
4. Note that the Act gives the lead on safeguarding to local authorities but they will
largely achieve this through Safeguarding Adults Boards (SAB). The Act sets out
changes to SABs' responsibilities to commission Safeguarding Adults Reviews
more flexibly to identify lessons to be learned from cases where adults with
needs for care and support have experienced serious abuse or neglect and
applying those lessons to future cases.
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Slide 11
Notes
1. Under the Act local authorities have a duty to cooperate with a number of
statutory organisations, including the NHS, other local authorities, the
Department of Work and Pensions, the Police, and Prison and Probation
services, as well as other local authorities (for example district councils or other
authorities arranging care for a person in the area). These organisations also
have a reciprocal responsibility to cooperate and any failure to do so would
constitute a breach of the Act.
2. However the guidance makes clear it is also not just cooperation between the
local authority and other statutory agencies, but also cooperation within the local
authority which is essential to delivering care and support – such as housing,
trading standards, children’s services and public health - the corporate
responsibility of elected members towards the safety of adults at risk of harm
applies. Local authorities may also want to think about how transport, planning
and leisure contribute to the wider wellbeing agenda.
3. The local authority may also wish to consider other persons or bodies that would
be appropriate to cooperate with. These may include the independent or private
sector and can include providers, voluntary organisations and the Care Quality
Commission. The extent to which local authorities choose to cooperate with these
organisations would need to be explored in depth, however, and mechanisms
would need to be put in place to ensure there was mutual cooperation from all
parties through the use of contracts and other means.
Key learning point
The Act specifies the public bodies that the local authority must cooperate with, and
that these bodies must reciprocate.
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Questions
 What arrangements does your local authority have in place to ensure that the
five aims of cooperation between partners which are relevant to care and
support, can be delivered?
 How effective are these?
 What other organisations might you consider cooperating with in the future?
Slide 12
Notes
1. Cooperation as described in the Act and guidance does not just relate to the
general duty to cooperate, but also to a duty in respect of individual cases. These
cases may include safeguarding enquiries; the move of an individual from one
area to another where both authorities involved need to cooperate; or where the
assessment of care and support highlights other specific needs such as a
continuing healthcare eligibility.
2. In practice, many of the arrangements that will either already be in place or put in
place in response to the Act will address most instances relating to specific
cases. However, this part of the Act does enable local authorities – and their
partners – to ask for (and expect) cooperation in individual cases unless it is
incompatible with their own duties or have an adverse effect on the exercise of
their functions.
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3. It is designed particularly for those cases where targeted cooperation is required
and where a more tailored responses is necessary.
4. If this mechanism is needed either the local authority or the partner requesting
cooperation should notify the other in writing making it clear that this is under
their duty to cooperate in specific cases under the Care Act.
5. The guidance is clear that any failure to respond within a reasonable timeframe
could be considered a breach and subject to a judicial review.
6. A Safeguarding Adults Board can demand information from persons or agencies
where: the request is made for the purpose of enabling or assisting the SAB to
exercise its functions and the Board considers that the person is likely to have
such relevant information.
Key learning point
Partner organisations must cooperate with specific requests for cooperation from the
local authority in relation to particular individual cases, unless doing so would be
incompatible with the partner’s own functions or duties. The converse also applies.
Questions
Cooperation in specific cases enables partners to request cooperation from other
public sector organisations:
 Under what circumstances might you need to use this duty?
 Can you think of a time when doing so might prove incompatible with your
own organisations functions or duties?
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10. Integration, cooperation and partnerships in practice
Slide 13
Notes
1. Integration, cooperation and partnerships need to be seen as a key component of
a local authority’s strategic approach for improving care and support.
2. National Voices and the Making it Real initiative have identified the core elements
of good integrated care, through the development of a series of ‘I statements’
exploring the service user perspective and producing a narrative for the basis of
all integrated care and support. These statements challenge organisations to
ensure that service users and their carers experience care where “…care is
planned with people who work together to understand me and my carer(s), put
me in control, co-ordinate and deliver services to achieve my best outcomes”.
3. The Care Act puts in place the legislative framework to enable local authorities to
do this by working closely with other organisations – either in partnership or
through more formal integrated mechanisms. It also challenges the authority to
work more closely across its own functions such as social care, leisure, planning
and housing.
4. The mechanisms by which the authority may do this can include planning and
commissioning – through joint commissioning teams, or aligning plans and
strategies; joint assessments and information, advice and guidance; integrated
care delivery; and joint or integrated quality assurance mechanisms.
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Slide 14
Notes
1. The Care Act is quite clear, integration and cooperation must be delivered in the
context of improving care and support, and in line with promoting wellbeing and
the quality of care.
2. At a minimum this should include local authorities seeking to integrate or
cooperate with services such as health and the NHS, housing, and those relating
to individual employment, training and educational needs .
3. There is an expectation that public sector organisations will cooperate in return,
and - in the case of the NHS – there is a reciprocal duty placed on any NHS body
within the local authority’s area including clinical commissioning groups, hospital
trusts, and NHS England.
4. Existing mechanisms for pooling budgets such as section 75 and the Better Care
Fund can help to implement greater integration.
Facilitator’s hints and tips
Either in pairs or as small groups, get the group to consider:
 examples of integration and partnership working that they have experienced
 what has worked well, or not so well?
 bearing in mind the definition of integration from the service user perspective
(National Voices/Making it Real) how could their own approaches be
improved?
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Slide 15
Notes
1. The limits of the local authority in relation to providing healthcare have not
changed under the Care Act 2014.
2. Local authorities must carry out an assessment where someone appears to have
need for care and support. They have a duty to meet those needs for care and
support that meet the eligibility criteria.
3. Under Section 42 the local authority must make enquiries, or ensure others do
so, if it believes an adult is subject to, or at risk of, abuse or neglect. An enquiry
should establish whether any action needs to be taken to stop or prevent abuse
or neglect, and if so, by whom. If the enquiry results in recommendations for
provision of services to stop or prevent abuse then the local authority must
provide them regardless of the eligibility status of the person.
4. Section 22 of the Care Act sets out the limits on what a local authority may
provide by way of healthcare and so, in effect, sets the boundary between the
responsibilities of local authorities for the provision of care and support, and
those of the NHS for the provision of healthcare.
5. Local authorities cannot lawfully meet needs by providing or arranging services
that are clearly the responsibility of the NHS. The two most obvious examples
that are clearly the responsibility of the NHS are where the individual is eligible
for NHS Continuing Healthcare, or NHS-funded nursing care.
6. Occasionally the local authority may provide some limited healthcare as part of a
package where it is “incidental and ancillary”, which means where the healthcare
component is only a minor part of a broader package being commissioned or
delivered, and where the services are the type of support that an authority whose
primary responsibility if to provide social services could be expected to provide.
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7. Effective joint working in these cases will require organisations to be clear about
care pathways, handovers and the contribution local authorities and health
organisations make to care.
Slide 16
Notes
1. The Act and its accompanying guidance also deal with hospital discharge where
a person may have care and support needs.
2. The provisions on the discharge of hospital patients with care and support needs
are contained in Schedule 3 of the Care Act 2014 and the Care and Support
(Discharge of Hospital Patients Regulations 2014). These provisions aim to
ensure that the NHS and local authorities work together effectively and efficiently
to plan the safe and timely discharge of NHS hospital patients from NHS acute
medical care facilities to local authority care and support. Schedule 3 covers:
 the scope of the hospital discharge regime and the definition of the patients to
whom it applies
 the notifications which an NHS body must give a local authority
 the period for which an NHS body can consider seeking reimbursement from
a local authority, where that local authority has not fulfilled its requirements to
assess or put in place care and support to meet needs.
3. The provisions also shouldn’t be seen in isolation. Many of the discharge issues
are attributable to the NHS and are within their gift to address, but equally there
are opportunities for local authorities and the NHS to work together to improve
performance on delayed discharge. Whilst general duties to cooperate and
integrate services should also encourage improved performance in this area. The
Better Care Fund is one such example.
4. The requirements for discharge provision however, do not apply to:
 mental health care where the arrangements are the primary responsibility of a
consultant psychiatrist. If however, the individual is within an acute care
setting, but with mental health care needs, because they are under the care of
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


an acute medical consultant the case could fall within the scope of these
discharge arrangements
patients with palliative care needs
private patients unless they elect to change their status and become NHS
patients
other types of care such as maternity care, intermediate care and care
provided for recuperation or rehabilitation.
5. However, it is worth noting that patients who receive acute treatment arranged
and funded by the NHS, but within a private hospital setting are covered by the
provisions for discharge within the Act.
Key learning point
Local authorities and the NHS need to be clear about the boundaries between care
and support and the NHS. They should work together to improve delayed transfers
of care, and there are opportunities to do so in the Act, guidance and Better Care
Fund.
Questions
 What are the key implications of the Act on the way you currently work across
health and social care to plan and manage discharge from hospital?
 How might you work better together to improve performance around DTOCs?
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Slide 17
Notes
1. Suitable living accommodation plays an integral part in meeting the aims of Care
Act, particularly if local authorities are to meet the challenges it poses around
promoting physical and emotional health and wellbeing.
2. Housing is seen as a means to enable people to live independently and should
be safe and secure, supporting people to build full and active lives. In terms of
the wider social care market and the wellbeing principle cooperation with housing
relates not only to the provision of accommodation but the range of housing
related services, such as housing adaptations, supported living and social and
private registered providers.
3. In terms of prevention the right housing can:
 help prevent falls – by improving accessibility or through the provision of aids
and adaptations
 reduce ill health - through good quality heating or through integrating assistive
technology into design of housing schemes
 reduce social isolation – through facilitating better contacts with neighbours
and through people feeling safe
 speed up hospital discharge – by having safe accommodation into which a
range of health and support services can be delivered
 reduce and prevent adult abuse - by increasing awareness of its possibility
among housing providers so potential risks are spotted earlier and more
people know how to respond if they suspect a person is being abused
 enable people with dementia or with visible impairments to remain in the
community longer – through housing design that lessens the impact of these
conditions
 reduce costs – through design that saves on energy bills and reduces
maintenance.
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4. Given this, the Act and its guidance are clear that local authorities must work with
housing authorities and providers. It will also require considerable work within the
authorities across social care and planning to ensure that opportunities to
develop the right type of housing stock to meet needs, promote wellbeing and
prevent or delay care needs developing are in place over the longer term.
5. Local authorities also need to make sure that people have access to information
and advice on housing and housing-related support. For example local authorities
should provide information on:
 the range of services that are available to people in their own homes
 where to obtain advice about different types of supported housing (state,
voluntary and private)
 what to look for in assessing a sheltered housing, extra care or residential
care scheme
 how to get help with moving, or with maintaining a property
 financial advice on different care options that may be available.
Key learning point
Housing is seen as an integral part of improving wellbeing and in delivering care
and support. Local Authorities are expected to work closely with housing providers
and planning departments.
Questions
 Based on your own experience and knowledge, what ways can housing
improve care and support?
 How might your organisation work more closely with housing providers in your
area to improve wellbeing?
 What steps would you need to take to achieve this?
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Slide 18
Notes
1. Employment, training and education form a fundamental part of the wellbeing
principle and as such local authorities must consider whether participation is
relevant when they are promoting individual wellbeing.
2. This has a number of implications for how assessments are conducted and how
local authorities and their partners (for example, the Department of Work and
Pensions local offices (e.g. JobCentre Plus), children’s services, and colleges)
work together.
3. For example:
 when carrying out a needs assessment, carer’s assessment or child’s carer’s
assessment, local authorities must have regard to whether the carer works or
wishes to do so, and whether the carer is participating in or wishes to
participate in education, training or recreation
 sections 37 and 38 of the Act support people to move areas, including to
pursue employment opportunities or move closer to family members. Local
authorities must ensure continuity of care and support when people move
between areas so that they can move without the fear that they will be left
without the care and support they need.
4. Finally local authorities must ensure that good quality information and advice on
employment, training and education opportunities is available, and that there is a
good mix of providers available to support people with these needs.
5. The Act also makes provision for local authorities, working with their partners, to
make use of the wider opportunities to provide targeted information and advice at
key points in people’s contact with the care and support, health and other local
services. This should include application for disability benefits such as
Attendance Allowance and Personal Independence Payments, and for Carers
Allowance and access to work interviews.
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11. Working together: examples
Slide 19
Notes
1. In conjunction with other legislation the Act paves the way for greater joint
working across and within Local Authorities, public sector organisations and other
organisations with care and support functions as appropriate.
2. Therefore whilst the Act sets out explicitly its minimum expectations in relation to
discharge planning, working with housing and employment, education and
training, it also offers the chance to build on existing responsibilities and to
explore new opportunities through:
 strategic Planning by building better commissioning arrangements or joint
commissioning teams
 commissioning integrated services, or jointly commissioning specific
services such as advice and advocacy services
 assessments and information such as integrated health, care and housing
assessments
 delivery or provision of care via integrated community teams, or working
with housing providers to ensure that adaptations support independence,
reablement or recovery.
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Slide 20
Notes
1. Strategic planning is the set of activities by which the Local Authority works with
its partner organisations, own departments and – where appropriate - providers
to ensure there is enough provision of services, housing, and facilities to meet the
needs of its local population. Through this there are a number of tools by which
Local Authorities can develop greater collaboration, cooperation and integration
and in the case of care and support services these include:
 Joint Strategic Needs Assessments
 Joint Health and Wellbeing Strategies
 Local Development Frameworks
 Market Position Statements, and
 Joint functions such as joint commissioning or procurement teams.
2. However, the statutory guidance notes that strategic planning on its own “…will
not be sufficient to fulfil the requirement to promote integration; it will be the
agreed actions which follow the strategies and plans that will have the greatest
impact on integration and on the experience and outcomes of people” (15.10).
How local authorities respond to the analyses and commitments laid out in their
assessments and strategies will be crucial to the successful implementation of
the Act.
Questions
 How effective are your current approaches to strategic planning?
 Are there opportunities within the Act to improve cooperation and
collaboration across the key agencies?
 What steps could you take to improve how well your plans are put into
practice?
Page 29
Facilitator’s hints and tips
Depending on the group you are working with you might want to consider how
challenging you can be with these questions. For example the questions could be
used to:
 support strategic commissioners and senior managers to reflect on how well
their planning and commissioning arrangements meet the needs of their local
populations
 offer operational managers chance to understand how their service responds
to the challenges facing them in their strategy and plans and whether the
plans currently offer them enough information on which to base decisions
about the shape and type of services on offer
 challenge partners to reflect on what works well currently and what could be
improved.
Slide 21
Notes
1. There are a number of ways in which local authorities can respond to the Care
Act and ensure that services are more integrated where possible. Alongside
strategic planning, commissioning is one tool available to deliver this and there
are a range of models available to organisations to consider. You may find it
helpful to think of collaborative commissioning on a spectrum of four levels of
‘jointness’.
 Separate Approaches: Where objectives, plans, actions and decisions are
arrived at independently and without coordination.
 Parallel Approaches: Where objectives, plans, actions and decisions are
arrived at with reference to other agencies.
 Joint Approaches: Where objectives, plans, actions and decisions are
developed in partnership by separate agencies.
 Combined Approaches: Where objectives, plans, actions and decisions are
arrived at through a single organisation or network.
Page 30
2. Some examples are given of commissioning activities, in this table, to illustrate
separate, parallel, joint or integrated approaches.
3. Regardless of the route chosen the Nuffield Trust offers a helpful checklist to
good practice7.
 Recognise that planning and implementing large-scale service changes takes
time.
 Define the intervention clearly and what it is meant to achieve and how, and
implement it well.
 Be explicit about how desired outcomes will arise and use interim markers of
success.
 Generalisability and context are important. What works in one context may
not work in another.
 If you want to demonstrate statistically significant change, size and time
matters. It is important at the outset to decide what level of evidence and
findings are going to be necessary to show that the approach works.
 Pay attention to the process of implementation as well as outcome.
 Carefully consider the best models of evaluation.
 Work with what you have. Organisation and structural change may not deliver
outcomes.
4. Commissioners may also want to consider using pooled budgets to commission
jointly agreed services and minimise overlap/gaps in service delivery, increase
efficiency and improve value for money.
Question
 Reflecting on the collaborative commissioning spectrum, which
commissioning activities do you currently do separately, in parallel, jointly or
combined? Where are you now as and where do you want to be?
 Thinking about the implications of the Care Act in relation to promoting
wellbeing, preventing or delaying the need for care and developing high
quality services:
 What approaches to commissioning might best help you achieve these?
 What could you do differently?
Evaluating integrated and community based care – How do we know what works? Nuffield Trust,
June 2013.
7
Page 31
Slide 22
Notes
1. The statutory guidance suggests that an integrated approach can most fruitfully
be taken by having a joint information and advice service (covering health,
care and housing) which links assessments with advice and information on,
among other issues, housing and finance.
2. This may include integrating an assessment with information and advice about
housing, care and related finance to help develop a care plan (if necessary), and
understand housing choices reflecting the person’s strengths and capabilities to
help achieve their desired outcomes.
3. There may be occasions where a housing staff member knows the person best,
and with their agreement may be able to contribute to the assessment process or
provide information.
4. An integrated assessment process covering health, social care and housing
needs will allow for a clearer picture of the person’s needs holistically, and for a
single point of contact with the person to promote consistency of experience, so
that provision of different types of support can be aligned.
5. Local authorities have powers to carry out assessments jointly with other
parties, or to delegate the function in its entirety. A number of local authorities
together with community health services have been developing joint assessments
for some time. The key benefit to end users is through cooperation by services
knowing what each is doing and also through not having to repeat the same story
several times.
6. The guidance makes it clear that even if joint assessment is not possible this
does not lessen the need to cooperate.
“….combining assessments may allow for a clearer picture of the person’s needs
holistically, and for a single point of contact with the person to promote
consistency of experience, so that provision of different types of support can be
aligned. A number of assessments could be carried out on the same person, for
example a care and support needs assessment, health needs assessment and
continuing healthcare assessments.
Page 32
Where it is not practicable for assessments to be conducted by the same
professional, it may nonetheless be possible to align processes to support a
better experience, for example, the 2nd or 3rd assessor could be obliged to read
the 1st assessment (provided there is a lawful basis for sharing the information)
and not ask any information that has already been collected, or the different
bodies could work together to develop a single, compatible assessment tool.
Local authorities have powers to carry out assessments jointly with other parties,
or to delegate the function in its entirety”. (15.14)
7. At the individual level, initiatives to promote the integration of care and support
could include recruiting and training individual care coordinators who are
responsible for planning how to meet an adult’s needs through a number of
service providers. Another example could be in relation to working with people
who are being discharged from hospital, where staff from more than one body
may be involved with providing or arranging care and support to allow the person
to return home and live independently.
8. Although not explicitly described in the Act, regulations or guidance, integration is
also a significant concept for carers given that virtually the entire Act applies to
individuals, who may or may not be in receipt of care and support, also applies to
carers. They should be able to experience ‘joined up’ provision equally as much
as the person or persons they look after. This may manifest itself in a number of
ways:
 information for carers that helps them to remain in employment whilst carrying
out caring responsibilities
 fast track healthcare provision that enable carers to access health resources
without neglecting the person they are caring for
 information about the health and care concerning particular conditions such
as dementia or at particular times such as the diagnosis of a learning disability
that enables people to consider the implications of the caring role.
9. However, integration for many carers also means being seen as part of a care
and support service rather than their role being taken as read or as subservient to
paid for care. Therefore, whilst carers are entitled to their own assessment and
different help and support from the person they care for, they also need to be
seen as significant providers of care or as partners in a range of provision and
hence one where their offer needs to be integrated with that of others.
Key learning point
The key benefit to end users is through cooperation by services knowing what each
is doing and also through not having to repeat the same story several times.
Page 33
Questions
 What steps do you think could be taken to combine or align key processes in
the care and support journey in your locality?
Slide 23
Notes
1. In terms of its work with the care market the Act provides the legislative
framework for local authorities to consider how they can commission integrated
services from providers to improve the quality of care for people.
2. Integrated services must be seen to be offering real change within the system,
addressing service user needs and becoming more person-centred in order to
meet the aims of the Act.
3. There is considerable research and guidance into what constitutes good
integrated care and how to implement it, but this still remains a challenge for
many authorities and provider organisations.
4. The recent National Voices and Making it Real “I statements” build the narrative
for integrated care and are increasingly being used as the basis for modelling
services. They challenge commissioners and providers to ensure that care is:
 “planned with people who work together to understand me and my carer(s),
put me in control, co-ordinate and deliver services to achieve my best
outcomes”.
Page 34
5. Services which could be more integrated could include community teams,
reablement services, and housing with care services. They should not be limited
to just one group of service users and Local Authorities will be expected to work
with their partners to think creatively about how they can better align, integrate
and cooperate to develop more person-centred care.
6. This should draw on the full remit of duties under the Act, from assessment,
information and advice through to market shaping and commissioning and – in
some cases – may require a fundamental rethink in how care is delivered.
Key learning point
Integration must be seen as an opportunity to improve the quality and provision of
care for the service user and their carer. It must be outcome focussed and may
mean significant changes in the way care is commissioned and provided.
Questions
 What local services do you think would benefit from more integration at the
frontline and why?
 What would be the challenges?
Facilitators hints and tips:
Use the National Voices and Making it Real statements to base discussions on how
services might need to change and become more integrated in order to deliver care
and support which fulfils these statements.
Consider using models with your groups, to understand how holistic integrated care
can be shaped and delivered, examples include:
 The Institute of Public Care (2010) From the Ground Up: A report on
integrated care design and delivery
 The Centre for Workforce Intelligence (2013) Think Integration: Think
Workforce
Page 35
12. Summary
Slide 24
Notes
1. The Care Act provides the legislative framework for greater integration,
cooperation and partnership working across health and social care, and other
relevant partners in the delivery of care.
2. It is intended to be a holistic piece of legislation which encourages local
authorities and their partners to think about wellbeing in order to deliver quality
care designed to meet the needs of individuals.
3. Local authorities and their partners will have a duty to cooperate, and a duty to
integrate services where there is a perceived benefit for wellbeing; or where
integration, cooperation and partnership working can contribute to the delay or
prevention of the development of care needs; or where the quality of care and
support can be improved.
4. The local authority is not solely responsible for promoting integration and
cooperation. Similar duties are also placed on the NHS under the Health and
Social Care Act 2012. Other public sector organisations are also expected to
cooperate including the Police, Prison and Probation services and local
authorities may also seek cooperation from other organisations or bodies if it
considers this appropriate when exercising care and support functions. These
could include care and support providers and primary care providers.
Questions
 What has struck you most about this session?
 Thinking about what you have learnt about this topic area (and on any other
modules you have completed so far).......
 What links can you make between topic areas?
 How might the necessary changes impact on your current arrangements?
 What might the key challenges be?
Page 36
Exercise
 What are your top three priorities in relation to integration, cooperation and
partnerships?
 Complete the action plan to identify the next steps for each priority.
Page 37
Appendices
Links to key resources
The Kings Fund (2013) Making use of the Better Care Fund: spending to save?
The creation of the £3.8 billion Better Care Fund offers a real opportunity to lay the
foundations for a much more integrated system of health and care. This paper
summarises the evidence from work by The Kings Fund and other research about
which approaches are likely to offer commissioners maximum impact in a way that
will benefit both the NHS and social care.
The Kings Fund (2014) Integrated Care and Partnership Working Reading List
NHS England Better Care Fund Planning Available at
http://www.england.nhs.uk/ourwork/part-rel/transformation-fund/bcf-plan/ (Accessed
29 August 2014).
Nuffield Trust (2013) Commissioning High-Quality Care for People with Long-Term
Conditions
Sara Shaw et al (2011) What is integrated care? A review of integrated care in the
NHS. Nuffield Trust. This research report examines what is meant by 'integrated
care'. It explores integrated care from an NHS perspective, identifies the concepts
that underpin integrated care, suggests how these can be used to inform practical
integration efforts both within and beyond the NHS, and sets out how integration
might be measured.
Think integration, think workforce: three steps to workforce integration, Centre for
Workforce Intelligence (2013). The paper identifies three steps for workforce leaders
to promote integration from a workforce perspective:

Be clear about the local integration agenda, including the various routes to
integration.

Address the integrated workforce management challenge to ensure the right
people with the right skills and behaviour are in place to deliver integrated
services around individuals’ needs.

Implement successful workforce change by addressing a range of operational
and strategic questions by taking an inclusive approach.
Page 38
National Voices, a national coalition of health and social care charities have
produced a narrative for person-centred, co-ordinated care and support, More details
can be found here: http://www.england.nhs.uk/2013/05/14/c-care/
Four Nations United: Critical learning from four different systems for the successful
integration, ADASS (2013). Draws upon practice and research knowledge and
outlines the critical factors found within successfully integrated practices and the
contribution of social services to this work. It aims to provide staff across key
services with an informed, sophisticated but accessible and practical ‘ready
reckoner’ of best approaches to the challenge of successful integration – a short cut
to increased capacity and improved performance.
The integration clauses mirrors similar duties placed on Clinical Commissioning
Groups and NHS England. There are a number of relevant documents that local
authorities may find of interest:

The Functions of Clinical Commissioning Groups, NHS England March 2013

Statutory Guidance on Joint Strategic Needs Assessments and Joint Health
and Wellbeing Strategies, Department of Health, April 2012. See part 4:
Promoting integration between services.
The following links provide further sources of information in relation to housing
service and practical examples which support integration with care and support on a
local level:

http://www.housinglin.org.uk/Topics/browse/Housing/hwb/?parent=3691&child
=8169

http://www.cih.org/publicationfree/display/vpathDCR/templatedata/cih/publicationfree/data/Developing_your_local_housing_offer_for_health_and_care

https://www.gov.uk/government/collections/housing-health-and-safety-ratingsystem-hhsrs-guidance

http://www.housinglin.org.uk/hospital2home_pack/