Finding new and effective ways to tackle complex public health issues is challenging enough even when the going is good. Doing it during a period of unprecedented budgetary constraints and shifting government policy would appear nigh on impossible.

Yet that’s the challenge facing local authorities. In an effort to address health inequalities, reduce the burden on hospitals and tackle many of the issues brought by an ageing population, the Government wants resources to be increasingly focused on prevention and early intervention.

With that in mind it has created the Better Care Fund, a pooled budget for clinical commissioning groups and councils aimed at joining up health and care.

Councils therefore find themselves tasked with improving local health – working more closely with NHS partners,

taking the lead in their areas and ultimately being judged by results on the ground.

In searching for the most cost-effective solutions, local government commissioners can be confronted by confusing and fragmented provision on the ground. Who is best positioned to deliver, how will they work with other organisations to ensure maximum impact, will they get the most out of limited resources?

On the other side of the fence, in times of such rapid change many service providers – whose knowledge and insight should be helping to shape strategic priorities – struggle to have their voices heard. With that comes the danger that some of the most effective solutions, such as home-based support to help people live independently, aren’t reflected in the way services are commissioned locally.

Yet the picture that’s emerging

Organisations have come together in Lincolnshire in a bid to deliver wide reaching health and care services in the region. Austin Macauley reports.

in Lincolnshire offers inspiration to parties on both sides.

In November, six local organisations signed a joint venture agreement to form a consortium capable of delivering a wide range of health and care services, from home adaptations and needs assessments to respite support and practical help in the home. Lincs Independent Living Partnership (LILP), which will officially be launched in March, brings together two social landlords – Lace Housing and Boston Mayflower – Lincolnshire Home Improvement Agency, Age UK Lincoln, St Barnabas Lincolnshire Hospice and community support provider Adults Supporting Adults.

It effectively creates a one- stop shop for support for vulnerable people, offering them a comprehensive service while creating economies of scale for the organisations involved.

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Mick King, agency director at Lincs HIA, believes the six members can ‘deliver anything anyone ever asks of us’. Feedback from the county council and Lincolnshire’s three health trusts has been positive. ‘They understand the joined up approach we are offering and how it should lead to seamless delivery,’ he says.

The seeds for LILP were sown in 2012 when Lace Housing, Age UK Lincoln and Adults Supporting Adults were asked by one of the local NHS trusts to pilot a new approach to supporting vulnerable people when they had been discharged from hospital.

Working together, they offered a package of support designed to help people live independently and reduce the risk of re- admission to hospital. The project proved so successful it has since been rolled out countywide.

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pilot, Lincolnshire HIA launched a campaign aimed at bringing together commissioners, service providers and others concerned with promoting independent living. A think-tank was launched and a series of discussions held which eventually brought LILP’s six partners together with commissioners.

‘We felt that collectively we could effectively respond to people’s needs and avoid the need for people to be referred back into the system,’ says Nick Chambers, chief executive of Lace Housing. ‘It has involved organisations coming together who under normal circumstances wouldn’t do so. But together we can deliver joined up and holistic services.

‘The beauty of this is the six are regulated, not for profit organisations with their own governance arrangements that are well known to local people, well established, and have an excellent reputation.

‘As charitable organisations our surpluses are reinvested into future provision. Elected members see it as a better approach, it feels right and I think it’s the way forward to provide services in a more cohesive manner.’

The consortium may have arrived at an opportune time: With a county council, seven district councils, four health trusts and four clinical commissioning groups (CCGs), Lincolnshire faces a tough task in making services more joined up.

This large, rural county also has pressing demographic challenges with 40% of the population aged over 50, significantly higher than the 34% average across England. High net migration to coastal areas, particularly of retirees, and the influx of seasonal workers bring added pressures in east Lincolnshire.

The response has included the creation of a joint directorate for public health – bringing the county council and local NHS together in 2010 – more than two years before responsibility for public health transferred to local authorities.

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Ask MYB

Q What percentage of Lincolnshire’s residents are aged 65+?

A: 21%

A countywide Wellbeing Service, to be launched in April, will aim to make care and support services easier to access and drive earlier intervention to enable people to live independently and reduce the need for long-term care or hospital visits.

It reflects the council’s aim to have fewer – and therefore larger – commissions and to put the emphasis on prevention by focusing on outcomes such as reduced falls and the use of assistive technology in the home.

The contract to deliver the Wellbeing Service was due to be awarded as Local Government News went to press, but it would appear to be an ideal fit with LILP.

‘Lincolnshire’s rurality makes it difficult for service providers to recruit and retain staff,’ according to Tony McGinty, the county council’s assistant director of public health.

‘Where really good initiatives like the consortium development come in is through helping to address a lot of these things. The better the service offer, the more likely you are going to get good quality people coming to work in them.’

Andy Chaplin, director of Foundations – the national body for England’s 200 home improvement agencies and handyperson services – believes what’s happening in Lincolnshire could provide a blueprint for similar areas.

‘What the consortium is doing is enabling each member to focus on delivering what it’s best at. It’s a better experience for the customer and it’s better for commissioners who are watching the pennies,’ he says.

‘By bringing the partnership together it also makes it easier for commissioners to see what innovation and integration can look like.

‘It transfers the burden of responsibility from them to those in the consortium and that way you will get more creativity and give those organisations the chance to shape the services, not just deliver them.’ n