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.

Decision

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.