Purpose

Recommendation(s) to the Corporate Director?
It is recommended that the
Council:
 

Adopt the
‘proof of concept’ approach to sharing of workforce
across the Council and NCIC to support pressures across the health
and social care system.

 

Enter into the attached workforce
sharing agreement with NCIC for the purpose of supporting social
care vacancies in Care Services Cumberland and increasing care
provision for hospital discharge and community unmet
need.

 
 
Background to the proposals
 
In North Cumbria there is a
significant and immediate pressure being experienced which means
that people are not being cared for in the right place at the right
time.  The impact of this is being felt
across all parts of the system, however, there is an immediate and
an urgent need to reduce the medically optimised cohort within the
acute in order to reduce the number
12-hour decision to admit breaches within A&E, make sure there
is enough capacity to treat medical trauma and emergencies and
reduce potential harms and ensure safe care.
 
The longer-term solutions to
this problem are to adopt a radically different approach to
delivery of care through developing shared workforce solutions and
managing the demand for health and social care services across
North Cumbria.  However, in the short
term there is an urgent need to decongest the hospital.  There needs to be an equal focus on both relieving
immediate pressure and continuing planned work on the long-term
sustainable solutions that focus on care and support at
home.
 
All activities immediate or
long term must be in line with the delivery of Transfers of Care
(discharge) from acute and community settings which is our
recently agreed system wide discharge policy adopted by all
partners.
 
In May 2022 a system reset plan
was agreed.  This replaced the former
improvement plan and sits alongside the Winter Plan (A&E
delivery board), Urgent and Emergency Care plans (internal Trust
improvements), a Promoting Independence Plan (internal Council
plan) and the NHS 100-day challenge. 
The system reset plan aligns the significant overlap in some of
these initiatives and provides a more focussed view on initiatives
and priorities.
 
Progress on priorities has been
hampered by a lack of capacity within the leadership and
operational services to support delivery and pressures across the
social care and health system  
Latterly this has been exacerbated by the impact of structural
changes including the establishment of NENC ICB and the Local
Government Reorganisation.  In response
to this and to support improvements over winter, two accelerated
priorities have been agreed and a programme set up to deliver
these:
 

Opening of additional
bed capacity to provide intermediate care solutions to reduce the
medically optimised cohort (and reduce potential admissions from
the community).
Formally flexing the
health and social care workforce and putting in place appropriate
service level agreements or equivalent legal arrangements to make
this happen.

 

Content

In October 2022 the Chief Executive of the
Cumbria County Council and Executive Director for People met with
colleagues from North Cumbria Integrated Care Trust (NCIC) and the
North East and North Cumbria Integrated Care Board (ICB) to agree a
set of immediate priorities to accelerate existing plans to support
winter.  The outcome of this was a small
set of focused priorities that would enable the opening of
previously closed Cumbria Care beds and a sharing of workforce
across health and social care.
 
In response to this commitment this decision
establishes the mechanism for delivering a cross working
arrangement between Cumberland Council and NCIC through the
establishment of a workforce sharing agreement.
 
Cumbria County Council previously signed off
the approach in principle. The agreement and associated
documentation, including standard operating procedures, have now
been developed and are ready for consideration and adoption.
Following the establishment of the two new authority areas on
1st April 2023, this is now a decision to be taken by
Cath Whalley on behalf of Cumberland Council. 
 

Reasons for the decision

Reasons for the
recommendation(s)?
 
There is a commitment to develop a flexible
health and social care workforce in North Cumbria, capitalising on
the recruitment potential of organisations to create a workforce
that can work in both health and care settings.  Initially this work will be focussed on flexing
staff from the Trust to work in social care settings, specifically
to enable the creation of extra capacity over winter.  The development of the formal agreements to enable
this to happen will enable the wider development of the approach by
the Trust and the Local Authority.
 
Using this ‘proof of concept’
approach in the short term will provide the ability to test, learn
and demonstrate success. Consideration can then be given to the
wider applications of this approach.
 
There is a group in place of which has
overseen the development of a workforce sharing agreement, which is
now ready for consideration and sign-off.  The Trust has identified some potential people to
take part in this on a volunteer basis based on an initial request
for Cumbria Care beds at Parkside which opened on 9th
January 2023. 
 

Alternative options considered

What options have
been considered?
 
There is the option to work collaboratively
across the Council and the Trust to use existing workforce flexible
to meet needs.  This is already in place
and working well on an adhoc basis across a number of services
however there are risks about scaling this up including:
organisations having different systems in place, variations in
terms and conditions, statutory responsibilities and CQC
requirements.  This is therefore not
recommended as the primary strategic approach.
 
There is an option not to try and use the
workforce flexibly across health and social care and each
organisation concentrate on the delivery of their own statutory
duties however this is not in the spirit of integration, is not
focused on meeting needs of population, and does not make best use
of an over-stretched health and social care workforce.
 
The development of a workforce sharing
agreement enables the system to test ‘proof of concept’
and set the foundations for a wider approach to a strategic
approach to developing the health and care workforce for the
future.