Can Do Health & Care - Thinking Differently Together - Social Care

Thursday 05 October 2023 Suffolk and North East Essex Integrated Care System (ICS) ‘Thinking Differently Together’ about… It is vital that the health and care system recognises the strengths and the achievements of social care providers, but the challenges the sector faces are significant. Today’s event is about bringing people together NOT ONLY to talk about what’s wrong but also what’s strong, and how we can build on what’s good and what works. Achieving that means building good relationships, and describing together what good could look like and feel like. Our presentations and our discussions today are the start of this process, and we look forward to hearing a range of partners’ views and perspectives. Working in partnership with social care providers in Suffolk Susannah Howard, Director, Suffolk and North East Essex Integrated Care Partnership 1. Introduction 1 | Suffolk and North East Essex Integrated Care System

Thinking differently is very important in healthcare… Our staff and our management, not assuming what our clients want but involving them in all the decision-making with regards to their care. I think this is about getting everyone involved… it is my health it is my care I should know what works best for me. The utilisation of digital technology or digital care [to] help support people and support people to live longer in their own home and more independent lives. We all have huge aspirations for how we want people to be supported but we only have a very limited budget and limited resources. And sometimes those aspirations can feel like a pressure to those people that are actually doing their best… bending over backwards to try and work very, very hard. We need to recognise the [social care] industry as professional, that the nurses that work in social care are as qualified as health nurses that the carers in social care are as qualified and skilled as... in the NHS. Our local doctor’s surgery has meetings monthly regarding the people we look after but never once have we ever been invited along... If we were, we would have a bit more information on the people we look after and a bit more input on their conditions and how we can save them from going into hospitals and costing a lot more money. Health and social care need to work together… I think it needs a kind of joined up approach that keeps the outcome the same. And at present there’s an element of competition in relation to who wants or who does not want to pay for someone’s individuals support and care. You need a regular dialogue with people on the ground to see what’s going on to be able to react to what’s going on… I don’t think any one person has a right or wrong answer, another reason to talk to each other and communicate properly with people who are there day-to-day. At Suffolk Care Association’s conference in 2022, our Integrated Care Partnership provided a pop-up video booth where people could share their thoughts and ideas to help us develop our health and care strategy for the population of Suffolk and North East Essex. Below is a selection of their comments. You can view the full video HERE. 2. ‘What matters to you? And why?’ What you told us Thinking Differently Together | 2

High quality care, delivered in partnership with other health and care partners, keeps people safe, prevents deterioration in their health and wellbeing, and helps prevent abuse and self-neglect. In exploring the evidence of how agencies can work together as equal partners, it is interesting to focus on safeguarding reviews, as although they can be challenging, they provide us with opportunities to learn and recommendations on how we can all work better together. In 2020, The Local Government Association (LGA) published an Analysis of Safeguarding Adult Reviews over a two year period, focusing on direct practice, how practitioners and teams work in their organisations, and collaboration between professionals and between organisations. This presentation will look at evidence and learning on those three aspects from the LGA, but also from the Suffolk Safeguarding Partnership which commissions local Safeguarding Adults Reviews, and from Healthwatch Suffolk, which has a remit to listen to local people and gain insights into health and care. Direct work The LGA highlighted a number of personal qualities and skills that enabled people to stay safe, including: • Assessing and meeting needs, including mental capacity. • Communication skills to deliver sensitive, respectful and creative care. • Commitment, compassion and professional curiosity to truly know your service users. • Perseverance and determination, flexibility and creativity to build trust and to keep people safe. • Continuity of care, for example when people move into hospital or change provider. Social care providers do all this really well, to enable people to live as full lives as possible. The LGA report looked specifically at self-neglect, highlighting the importance of training staff to recognise self-neglect and the associated risks. In Suffolk, a safeguarding review was carried out regarding TL, who was disabled after a car accident and later lost his parents. He was a solitary man who neglected himself and his environment, and had trouble managing his money. He moved into residential care where he thrived, but he later returned to live in the community where his situation deteriorated again. TL’s family was supportive, but information was either not shared with them, or not shared promptly. The review found that while the agencies involved respected TL’s choices and individually worked to support him, there was a lack of professional curiosity around his lack of support networks, no follow up when support was withdrawn to ensure his needs were met, and a lack of professional join up and co-ordination between agencies involved in his life. In 2022 Healthwatch Suffolk, in partnership with Lofty Heights, reported on the health and wellbeing of people waiting for elective care. They found that more people are living in cluttered 3. Integrated working: what we can learn from evidence and experiences Sharon Rodie, Suffolk and North East Essex Integrated Care Partnership 3 | Suffolk and North East Essex Integrated Care System

circumstances due to their limited mobility and ability to maintain their homes, leading to trip hazards and unhygienic environments. After their treatment and discharge home they may need more support to maintain a safe environment, so early, collaborative discharge planning is essential. The report recommends better and earlier discharge planning after elective care and good, timely information sharing across the system. Good relationships, and feeling safe, are vital for people who need care. Working together well enables us to identify potential risks and to intervene early to make sure people have access to the services they need to prevent injury and ill-health. Inter-agency communication and collaboration The LGA identified a range of best practice in joint working, including joint visits, joint assessments, collaborative plans, but also involvement in interagency and multi-disciplinary meetings, case reviews, and best interests meetings. Partners in people’s care should support each other, for example training carers in safe practices, mutual support in emotionally demanding cases. However partners should also be able to challenge where appropriate, for example if a proposed care package cannot meet the person’s needs. And effective systems need to be in place to support this work. The Suffolk Safeguarding Partnership highlighted, in their review of Brian, the importance of involving families and partner organisations in keeping people safe. Brian lived with physical and mental health problems, and had been a carer in the past for his mother who had dementia. He later died by suicide. A learning review meeting found that in an acute phase of ill health the agencies providing support to Brian did not involve the family to consider and manage his risk of suicide. The review recommended the NHS review its multi-disciplinary team arrangements to include families and partner agencies when managing risk. In July 2021 Healthwatch Suffolk reported on end of life care, another area where working with families and partner agencies is crucial. They found that people valued the support they received from the local hospice and other charities, carers, the NHS, and friends and family. People wanted better information and communication, and better support from health and care especially at night. And respondents from ethnic minorities spoke about the importance of being able to trust that services can deliver culturally and religiously sensitive care. One relative had a positive experience of their father’s care home at end of life, but was concerned at the lack of response by the NHS: “The NHS system is disjointed - by the time mental health, social services and the nursing team had met and written their reports, it was too late for my dad. End of life care often seems poor for the elderly - it felt like he didn’t matter… I watched my dad have fall after fall and further hospital admissions. He wanted to die because he was so confused and in so much pain. My dad had myself and my sister to help fight for him - it shouldn’t be a fight.” Organisational and systemic issues The LGA report identified several organisational and system issues that impact on care. Chronic staff shortages meant agencies not being able to fulfil contracts, and a lack of the right services to meet complex needs meant people did not receive the best quality care. Staff need to be qualified, trained and experienced, supported through supervision, leadership and oversight, and working in a positive organisational culture. Periods of change also impact care, including reorganisations or new NHS trust provider contracts, Adult Social Care closing cases between reviews, and a lack of sharing of records impacting on access to services and joint working. One key area where multi-agency working is vital is when care provision changes, for example going into hospital. Suffolk Safeguarding Partnership carried out a thematic review of its cases over a 10 year period to 2019. It found that when people move between services and settings, good communication and information sharing are vital to ensure care plans are coherent and to Thinking Differently Together | 4

support people and their carers effectively. We must therefore ensure that care planning is always joined up and no one falls between the gaps. Healthwatch Suffolk also has recommendations for working together in dementia care. We should improve integrated care so that we work together every time. We should coordinate resources and improve communication and information sharing to provide effective person-centred care and support. We should support families to participate in multi-disciplinary discussions, as the LGA also recommended, and finally we should prevent people from being passed between services at the end of life. Working together is not a one-off task, it is a long term commitment. Summary To provide high quality integrated care, together we need: • Professional curiosity to identify and manage risks together with people, carers and partner agencies. • Assessments that incorporate all the information available, people’s needs and choices. • Plans that are devised together with people, their supporters, and partner agencies. • Agencies sharing responsibility for people’s health and wellbeing. • The right social care services commissioned and available, and their staff are supported. • Continuity of care being maintained whenever people move between settings. 5 | Suffolk and North East Essex Integrated Care System

I want to pay tribute to all of the work ongoing social care providers do day in day out not only during the pandemic but post-pandemic. And we must remember unpaid carers too, around 4 million across the country doing an incredible job holding together our lives and our families as well as health and care. There is a lot to be proud of in terms of health and social care integration in Suffolk and North East Essex. Integration is difficult, it takes time and effort to build partnerships, to build trust, to agree common opportunities, and to share risk. But we have made a lot of progress both in children’s and in adult services, for example joint roles across social care and the NHS, and integrated neighbourhood teams that bring together health and social care teams at a locality level to make a real difference to people’s health and independence. We are very lucky to have the progress we’ve made, but there are also huge challenges in terms of the workforce, with 1.5 million people in social care roles across the country but an almost 11% vacancy rate. We have seen a 22% increase in demand for social care services for working age adults since 2015, but since 2010 a 55% reduction in government funding into the sector. The workforce fragility, rising demand and falling funding means it is really important that we work together. We really value everyone’s voice in our Integrated Care System (ICS), and we try hard to create, as much as possible, a level playing field because I strongly believe the solutions are going to be in the partnerships and the creativity that we can develop together. In the past, to be honest, we have not worked enough with social care providers, so today is an opportunity to reset that relationship and do a lot more with our provider sector in the future. The ICS is a great opportunity to build much stronger partnerships, stronger services and therefore improved outcomes for our population. The headline today is about solutions, and I know in our system we are leading the way in terms of digital, the use of Cassius and other care tech solutions. We are working with the University of Essex, and looking to create a space where care tech providers, commissioners and service users can come together to look at potential tech solutions for the future that will not only support the users of services but also our workforce too. Secondly, I want to develop more sustainable models for our workforce. Some years ago in Suffolk we developed a Buurtzorg model of care which brought together health and social care roles, and the work that was delivered at that time was fantastic, but it withered on the vine unfortunately. I am really keen to come back to looking at how we can work with our universities and other partners to develop more integrated health and care roles for the future. Thirdly, in the NHS we have moved away from a commissioner provider split, and we are finding that we perform much better by working collectively together rather than having a divide between commissioner and provider. I am keen to explore how our learning can help health and care commissioners and providers to work much more together as a team in partnership, having less of a division between the two. My final message is the importance of working in partnership, and the NHS’s commitment to do so with social care both children and adults services in Suffolk and North East Essex. I am really determined that we make some big gains together, if we can build that trusting partnership together. Suffolk and North East Essex Integrated Care Board 4. The vital contribution of Social Care to integrated health and care Ed Garratt OBE, Chief Executive, NHS Suffolk and North East Essex ICB Thinking Differently Together | 6

5. Collaborating across sectors in dementia care: Suffolk Dementia Partnership Dementia statistics Jason Joseph, NHS Suffolk and North East Essex ICB The statistics relating to Dementia in Suffolk paint a stark picture. We have a population of around 773,000, with nearly 1 in 4 people aged 65 and over. 2020 data indicates there were around 13,000 people with dementia living in Suffolk, nearly half of whom are undiagnosed. Many of these are over 65, but there are also a lot of people under 65 living with early onset dementia. From the 2021 census the estimated number of unpaid carers is around 65,000, however this is likely to be an underestimate. In 20 years’ time our total population is expected to increase by 7%, but the proportion of older people within the population is expected to increase by 34% and by 2040 there are likely to be 21,000 living with dementia in Suffolk, with the increase primarily driven by the ageing population. (source State of Suffolk report) Diagnosis is crucial to getting people the support they need. The national rate for diagnosis of dementia is 66.7%, but in Suffolk dementia diagnosis rates are lower, at 57.6% in Ipswich & East Suffolk, 55.3 % in West Suffolk, and 58.3% in Waveney (August 2023 data). Dementia collaborations Helen Clarke, Suffolk County Council Collaboration around dementia in Suffolk has developed over recent years. The Suffolk Dementia Forum was established by Healthwatch Suffolk in 2017 and now brings together over 50 organisations representing statutory, voluntary, community and lived experience. It has a group Facebook page to promote and share community resources, education and information, and for people to ask questions. Co-production opportunities include people with dementia, their carers and families, to ensure the voice of lived experience is heard, and has contributed to Suffolk’s forthcoming new Dementia Strategy. We want everyone involved, including paid and unpaid carers and volunteers, to be part of the Forum to act as “critical friend” to statutory services. At a strategic level, the Dementia Action Partnership (DAP) was established in May 2021 as a direct response to a request by the Dementia Forum to the Suffolk Health and Wellbeing Board to make Suffolk a Dementia Friendly County. The DAP meets bimonthly and is co-chaired by the Director of Adult Social Care and chair of the Stowmarket and District Dementia Community Group. Around 30 organisations are represented from across the system including Suffolk Care Association, statutory, voluntary, community and lived experiences to ensure dementia remains high on strategic agendas. The DAP brings organisations together to stimulate ideas and dementia-friendly actions, to review and share best practice, and to review national and local initiatives supporting people living with dementia their carers and families at every stage of the dementia pathway. We identify opportunities to join up or extend dementiarelated activity system wide to improve the lives of people living with dementia. Our dementia engagement exercise led to Healthwatch Suffolk’s recently published report “A roundabout without signposts” which will be used to inform the new Suffolk Dementia Strategy. The DAP and the Dementia Forum will be key to driving the resulting action plan, clarifying asks and expectations, coordinating activity and measuring impact. Key to the success of this will be continuing to maintain organisational commitment and momentum across the system to bring about real change. During Dementia Action Week in May 2023, the DAP held its first annual market-place event for people with dementia and their carers. The event was co-produced to ensure it was accessible and relevant to meet people’s needs, and over 50 Collaborating across sectors in dementia care: Suffolk Dementia Partnership 7 | Suffolk and North East Essex Integrated Care System

different organisations were present including health, social care, emergency services, providers, voluntary sector, providing information and advice. Guest speakers included people living with dementia, and services supporting people with dementia and their carers. We arranged a breakout room for people who have dementia and activities like singing for the brain, memories and art activities. Meanwhile their family members look at the stalls and hear about the different support available for people with dementia both before, during and after the diagnosis process. Dementia Friendly Suffolk Nicola Bradford, Ipswich Dementia Action Alliance For many years now Suffolk has had the ambition to be dementia friendly, and I imagine that for each person that might look slightly different. Undoubtedly there is a wealth of knowledge and experience within the county and lots of dementiafriendly work is going on, but it is often hyper local, only known to those who are involved. And whilst it is so fulfilling for those who are engaged wouldn’t it be fantastic if every single person living with dementia and their families were able to access some of this offering? Dementia Friendly Suffolk exists often through informal networks, volunteers and charities, community groups, who are working in their local neighbourhoods with people who are living with dementia and their families. Memory cafés are safe spaces where those living with dementia can enjoy some meaningful activities, person centred to their own lived experience. It also gives their unpaid carers the perfect opportunity to be supported, always over a cup of tea or coffee but also to receive information at their pace when they are ready around things like benefits, their own mental health and well-being, practical things, incontinence and feeding. Dementia Friendly Suffolk does not have a pot of funding that comes down to communities by right so a lot of this work is done by local people who are fundraising themselves to make these things happen. My ambition is for this work to be county wide and that everybody has a hyper local offer that they feel they can access. Our ambitions in Suffolk Jason Joseph, NHS Suffolk and North East Essex ICB In the last year or so we have been going out to communities, listening to professionals, carers, and people living with dementia about what they might need. Our five strategic ambitions are: Preventing Well: understanding how to make changes where possible to your own lifestyle limiting the risk and delaying onset dementia. Supporting Well: increasing awareness and understanding of dementia to reduce stigma; and understanding how to recognise the signs and symptoms of dementia and support people and their families Diagnosing Well: delivering a compassionate assessment process and diagnosis, including the benefits of digital technology. Living Well: with dementia for longer in your own community by accessing inclusive groups and activities; and as dementia develops, working together as a system with the person with a diagnosis of dementia and families to agree when increased support at home or elsewhere is required. Dying Well: providing a palliative and end of life care pathway that is meaningful to people with a diagnosis of dementia and their families. Thinking Differently Together | 8

We want Suffolk to be the best place to support people with dementia, and we want to make sure that there are no gaps in people’s support, so when our strategy is published we will also be listening to people about how to make the strategy a reality in practice. Please do join our Dementia Action Partnership or our Forum to be part of our work. If you would like to join the Dementia Action Partnership please email Join Dementia Forum Facebook Group Suffolk Dementia Forum | Facebook For more information about digital care: Cassius Technology to help you live independently - Suffolk County Council Support for people and family carers, pre and post diagnosis: Dementia Connect Dementia Connect - Suffolk | Alzheimer’s Society ( Support for family carers: Suffolk Family Carers Suffolk Family Carers | Support for unpaid family carers Useful resources: icaredementia app Speak for Me YouTube clips from the Alzheimer’s Society Norfolk and Waveney Communication & Dementia - Video 10 - Dementia Training for Adult Social Care - YouTube Suffolk and North East Essex Integrated Care Board 9 | Suffolk and North East Essex Integrated Care System

In West Suffolk we have a wealth of knowledge and experience, particularly with social care providers and the care market, and it is really important to build on these strengths within our system. There are over 600 care services in Suffolk, delivered by over 400 separate organisations, delivering high quality care: 81% of CQC registered providers in Suffolk are rated Outstanding or Good (compared to a national average of 73%). The Suffolk Market Sustainability Plan was published by Suffolk County Council in March 2023, detailing ambitions for how we work with the care market: • Grow and develop the care workforce (Quality) • Respond to increasing costs to deliver care (Sustainability) • Prepare for an aging population with increasing care needs (Independence) • Ensure there is the right range of care opportunities available to people as they need them (Customer Voice). We are mindful of the increase in costs and care delivery and the increase in the demand that we are seeing across all populations who require health and care services, so it is important that we work as a collective to consider the sustainability of providing support to the Suffolk population. We must place independence at the centre of how we support people, delivering the right level of tailored support that is specific to meeting an individual’s needs in a person-centred way whether in their own homes or within care settings. It is equally important that as we develop our ways of working that we achieve this in partnership, co-producing our approaches and our strategies with people who receive services and listening to how they would like to be supported in order to help with shaping our direction of travel as well as responding to the future needs of those who require support. The Council has identified strategic development areas in supporting the care market as a whole. These are expected to be central to the strategy refresh. We will be engaging with the market and partners on these to ensure the strategy reflects and promotes these responses. The Service Development and Contract teams within the County Council are responsible for working towards market shaping, our commissioning, strategies, and contract management. Each care provider, including our specialist services such as Learning Disabilities and Mental Health, Progression and Housing Development, has a named Contract Manager and allocated Contracts team. Contracts management is focused on relationships and building on the strengths within the system, giving tailored support to providers as and when required. With this approach we are able to do better and build better for the Suffolk system and the Suffolk population. The County Council has recently introduced the new Provider Assessment Market Management System to enable us to work effectively and improve partnership working with providers. The Provider Support Team continues to work alongside Suffolk’s providers to develop and maintain foundations of quality. It supports care providers by delivering time limited and focused support interventions to bring sustainable change to services. Through these teams we can develop and ensure high quality in the delivery of the support provided to our population. The Developing Skills in Health & Social Care Project is part-funded through the European Social Fund, and provides fully funded training to employees working in the adult health and social care sector across Norfolk and Suffolk. I would encourage you to recommend colleagues within 6. Relationships between NHS services and local Social Care Providers Clement Mawoyo, Director of Integrated Adult Health and Social Care, West Suffolk Thinking Differently Together | 10

your different organisations to take advantage of this level of support to help grow the skill set of the workforce in Suffolk. Healthwatch Suffolk’s survey is exploring people’s experiences of receiving and providing home care services. It will enable us to really understand what is happening within the home care market, to build on the existing strengths and to focus on areas where we need to improve. By listening to people in receipt of services, they can help us deliver support that can make a continued difference in their lives moving forward. Care Home Liaison Trusted Assessments support the timely and safe discharge of people leaving hospital. The Care Home Liaison team is part of West Suffolk NHS Foundation Trust’s Transfer of Care Hub and works in partnership with many local care home providers to support and facilitate discharges. The Trusted Assessors act as a point of contact when residents are admitted to hospital to monitor progress. The model ensures that patients experience an optimal length of stay and timely transfer from hospital. The model places trust in how we work as a system but also demonstrates the level of maturity between care providers and the health system in understanding the needs of individuals and how they should be supported. It is a really positive example of strong partnership working, and work is underway to co-produce with the care market replicating the model in the community in West Suffolk, as well as rolling out the model in our other acute hospital settings. Digital care initiatives are also currently underway in West Suffolk. Cassius is a digital innovation that is supporting to meet the needs of people who live within their own homes. It is also helping us to understand the needs of people in residential care settings for short stays, contributing to the assessment of their longer term needs. Initiatives in care homes are supporting effective delivery of care across Suffolk. The Medication Optimisation in Care Homes team provide dedicated support to care homes with their medicines including ensuring that medicines are used and stored safely as well as supporting GP practices with medication reviews. Work is underway to explore if this offer could also be replicated to support community care providers. Our Care Home Support Team provides specialist support, advice and education around falls prevention, pressure care management, complex wound management, dementia support, positioning and seating advice, continence, and hydration. Finally, we need to truly ensure that the voice of the Suffolk Care Association is heard and represented within each of our Alliances. We have had some engagement, but we want to build our relationship so that the voice of providers is heard on an equal footing within our work. We can make a huge difference for the Suffolk population, but we can only achieve this working together. We can change tomorrow today by committing to working in partnership for our Suffolk residents. 11 | Suffolk and North East Essex Integrated Care System

When considering how we manage winter pressures in Health and Social Care, we must consider the crucial role of social care. Fixing social care will in turn benefit how the health and care system manages winter pressures. We must identify the organisational systems that already work well, for example looking at our own successful pilots and research from other counties. We must have a clear vision of the processes that will work well in the long term, not just the short term fixes that have been tried in the past. We must plan and prioritise the processes and systems that will work well. And finally we must implement a proposed model. Our experience in 2022/23, during the worst of our recruitment crisis, clearly evidenced the fact that pressures eased when social care capacity dramatically increased through international recruitment of staff. We are now in a very good position to manage winter pressures this year however, it has to be planned alongside health, social care and the voluntary sector to provide a completely holistic service. We consider that an effective service offer would comprise: • A ll carers undertaking training which has the principles of occupational therapy and physiotherapy embedded in the course. We cannot support people with building their independence and functional skills without also supporting therapeutically to strengthen muscles, for example. • Training carers to undertake basic clinical tasks, falls prevention and to recognise the early signs of deterioration in the health of the person. • Empowering effective communication directly with GPs and community health professionals, using technology to share clinical information in all care settings. • Offering realistic remuneration to highly trained carers for the extra responsibilities that they will undertake. We can make this happen by sharing power, listening actively and facilitating more creative discussion about our natural spaces, we would generate more radical and active engagement and develop new and exciting projects that promote health, physical activity and wellbeing for all the people of Suffolk. Empowerment is powerful, but at present social care is not empowered enough. Providers are ready to engage and take up the challenge to provide these services, we need the right conditions and to overcome the blockages that prevent them happening in practice. With the right training and support, care providers can offer a more proactive service. This includes being better able to recognise deterioration in a person early enough for treatment, either in the care home or in their own homes, and providing equipment such as Raizer chairs and support to manage falls effectively in any care setting. Measures such as this would help to reduce hospital admissions and ambulance callouts after a fall. Staff could also better promote independence and wellbeing through social activities with friends, family and external organisations, with this way of working becoming the norm. Our ultimate aim is to provide a seamless service which enhances health and wellbeing and allows people to remain in their own homes (including their care home) for as long as possible. We know there will be barriers. We will need to instigate a change in working culture, which will involve all of us taking ownership of what we want to do, and working together to achieve it, which will take time. One possibility is for care providers to work together in small consortiums. This would enable providers to recognise each other’s strengths and weaknesses, boost each other and provide all round capacity to tackle particular problems and to even take on more complex cases. We are hoping to progress this idea in the future. The other main barrier is that we need to be funded realistically. If we have no resources, we cannot put our ambitions into practice. We want to work with health and social care to achieve our aims, we recognise this will not happen overnight, it will take time, but our care providers are ready for the challenge. 7. A whole system approach to managing winter pressures in Health and Social Care Prema Fairburn, Chair, Suffolk Care Association Thinking Differently Together | 12

Participants from social care and health leaders held table discussions on two themes around building effective partnerships: what does good look like, and what needs to change to enable us to achieve this. Below is a summary of the key themes that emerged, and some potential actions we could take now. What does good look like? What needs to change? Keeping people at the heart of everything we do • Care is properly and equitably funded. • Our focus is always the best outcomes for people and their family, not our organisational aims or ways of working. • A more joined-up approach to assessing, planning and providing people’s treatment, care and support. • Give people meaningful choices about how, when and where they receive care. • Share information systematically between organisations about people’s needs and circumstances, in a single, transparent record. • Respond flexibly and promptly to people’s changing needs. • Provide wrap-around support to care homes, ensuring residents have equity of access to community-based physical and mental health services. Delivering integrated care • Services meet the level and types of demand locally. • Care providers understand the support available for the people using their services. • Care providers are involved in people’s care as full partners. • Map and share information on the support available for service users, who provides it and how to access it. • Enable continuity of social workers and partner health professionals. • Develop common ways of working across NHS and Adult Social Care practitioners and teams, and involve care providers in assessments, decisions, plans and reviews. • GPs visit care homes in person to discuss and support residents with complex needs, in particular at end of life. • Involve care providers in integrated neighbourhood working and multi-disciplinary forums. Valuing the social care workforce • Carers’ skills, knowledge and expertise are recognised and respected. • Staff are rewarded through fair pay and access to professional development. • The role of carers in preventing avoidable admissions to hospital is recognised and supported. • Encourage health and care employers to value social care vocational qualifications. • Create trust, by listening to and valuing carers’ expert opinions. • Communicate effectively with carers, using less jargon and fewer acronyms. • Upskill carers to recognise people’s deteriorating health conditions and to manage falls safely and effectively. • Invest in and actively encourage innovation, best practice and leadership development. • Promote placements in social care and health settings to enable carers and health colleagues to better understand each other’s roles. Creating an inclusive culture in our health and care system • Our shared system vision gives parity of esteem to social care as well as healthcare. • All partners recognise and respect the contribution social care makes to people’s lives and to the health and care system. • Enable the care provider sector to have equal voice in the health and care system. • Create trust by actively seeking to understand the care provider sectors’ strengths and challenges. • Involve care provider representatives in strategic forums involving the NHS, Adult and Children’s Social Care, CQC and other regulators. 8. Principles for effective partnerships 13 | Suffolk and North East Essex Integrated Care System

Thinking Differently Together | 14 The contributions of Suffolk Care Association members today, and the way we have brought the Integrated Care System into our conference, is testament to our commitment to new ways of working together. Our members’ continued support of the Association is valued by us and by our colleagues in health and care. Thanks were given to the speakers, and both Susannah Howard and the Integrated Care Partnership team, as well as SCA’s team, for arranging the event. We hope we can take forward together the great ideas we discussed today. Prema Fairburn, Chair, Suffolk Care Association Listening to everyone today, the theme of equality stood out, the need for parity of esteem for the social care provider sector. We need to change the culture in our health and care system so that social care providers feel respected and valued. It has been great to come together to talk about these issues, but the challenge now is how to take action so that we don’t find ourselves in a year’s time having a similar conversation. We need some practical actions that we can take, for example one recurring theme has been the importance of good communication with GPs. Together we can start some programmes of work that can make a real difference to both social care providers and the people we care for. Ed Garratt OBE, Chief Executive, NHS Suffolk and North East Essex ICB Suffolk and North East Essex Integrated Care Board 9. Conclusions

10. Next steps Keeping people at the heart of everything we do • Engaging social care providers in planned work to develop a first integrated ‘One’ clinical strategy for the ICS. • Supporting care homes to improve awareness of, and access to primary and community healthcare services. • Arranging opportunities for the lived experience of users of social care services to be heard in ICS programmes and at ICS events. Delivering integrated care • Strengthening the presence of social care providers across the various ICS collaborative forums (our Alliances, Integrated Neighbourhood Teams, Integrated Care Partnership, and ICB sub-committees), taking an inclusive approach that recognises the challenges for social care providers in freeing up capacity for this work. • Further developing links between social care providers and ICS digital programmes, and the work of the ICB’s Strategic Digital Investment and Assurance Committee. Valuing the social care workforce • Creating closer links between social care providers and ICS workforce programmes, co-producing a One Workforce strategy with the social care provider sector, and embedding social care involvement in the ICB People Committee. • Supporting nurses in the social care workforce in carrying out their roles, in training the future nursing workforce, and in their own continuing professional development. • Arranging opportunities for the diverse lived experiences of the social care workforce to be heard within ICS workforce programmes. Creating an inclusive culture in our health and care system • Organising a discussion with Essex Care Association to establish how far the issues we have discussed are also shared in North East Essex. • Creating systems for closer joint working between health and social care providers as equal partners at all levels and in all parts of the heath and care system, removing the myths and the realities of divides between the two sectors. • Developing an ICS Charter for working in partnership with social care providers. Following our Thinking Differently Together event, we now have the opportunity to evolve relationships between health and social care, to work together more closely and more collaboratively as equal partners. We will develop a programme of work to achieve our aims for ‘what good looks like’, which will incorporate the following initial actions: 15 | Suffolk and North East Essex Integrated Care System