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Highlight Review

Progress and outcomes 2007

foreword 1 about the Care Services Improvement Partnership how we work CSIP’s current priorities 2 recurrent themes integration and partnership working commissioning personalisation, choice and control equality and diversity contacts 2 3 4 6 8 8 10 12 14 16

about this review
This year’s highlight annual review gives stakeholders information about CSIP’s progress, achievements and current priorities. For readers not familiar with CSIP, Section 1 provides an introduction to the approach we take in our work and Section 2 gives an insight into how CSIP works with organisations to improve services. More detailed annual reports produced by individual programmes and regional development centres can be found on their websites. These are referenced in the contact information section page 16.


Welcome to this highlight review which we hope will give you a flavour of the work the Care Services Improvement Partnership has undertaken over the past year, to complement our more detailed programme and regional annual reviews.
Complex challenges that bring us together in search of shared solutions
We believe we have something important to say about how services can best equip themselves to respond to the immediate and future challenges we face. How do we gear services to support people to lead their lives fully and independently in ways they choose? How can services be more responsive to the needs of their local communities? How can we ensure everyone has equal access to high quality care? How can services work with society as a whole to plan now for the changing demands of an ageing population? Given the day-to-day pressures of delivering services, it is not easy to find space to think collectively about solutions to these complex but urgent questions. Our role is to support services to do just that, and in the process, bring about self-sustaining improvement.

Our skills, our impact, our value
We know that our work is valued. Of those health and social care stakeholders aware or directly involved in our work, 81% reported positive feedback on CSIP's impact in their region. Three in five people working in health and social care believe that CSIP has helped improve services in their region*. Our focus on integration and partnership working is recognised as one of the foundations underlying all that we do. While we have remained focused on delivering the business in hand, we are in the process of organisational change, as part of the Department of Health’s programme to strengthen its presence in the regions and the Strategic Health Authority (SHA) review of National Programmes. We welcome the increased involvement of the SHAs to ensure our work continues to be driven, and accountable to local need. We are working more closely with our regional public health and Government Office colleagues. We have strengthened links with social care leaders, the Association of Directors of Adult Social Services (ADASS) and Association of Directors of Children’s Services (ADCS). We now look forward to building on our already strong working relationships in the future. Through strength in partnerships, regardless of changes in organisational arrangements, work will continue where it is most needed and where it is making a difference to people's lives.

Peter Horn
National Director, CSIP

* Independent stakeholder research, Ipsos-MORI, August 2007


about the care service improvement partnership

1 about the Care

Services Improvement Partnership
Our main objectives are to:

The Care Services Improvement Partnership (CSIP) was created in 2005 with the integration of a number of initiatives supporting the development of services to help improve people’s lives.
Commissioned by the Department of Health and other agencies, CSIP aims to achieve this by supporting the implementation of national policy for local benefit. We work with communities, systems and organisations that are engaged with the health and social care needs of:

• promote the improvement of services to lead • support people to live more independently, • facilitate system change (for example,

to better performance and higher quality care for the people who use them by promoting more choice, improved access, and greater control for people in their dealings with care providers, and the reconfiguration of health and social care organisations and the improved relationships between statutory and non-statutory sectors).

CSIP provides support through eight regional development centres (RDCs) and a range of national programmes.

• people with mental health problems • people with learning disabilities • older people • people with physical disabilities or
sensory impairement

• children, young people and families • people in the criminal justice system, and • the families, carers and supporters
of these groups.


how we work
The everyday work of a regional development centre (RDC) includes a combination of locally and nationally driven priorities for its region.
Each centre also has responsibility for leading specific CSIP national programmes. We work with organisations that commission and provide services to solve problems and put them into practice. Each RDC employs an experienced team of people with a wide range of skills. Staff include practitioners and managers from health and social care, education and criminal justice, and people with experience of working in the statutory, voluntary and independent sectors. We also employ carers and people who use services directly to help ensure our approach is centred on people’s real needs. CSIP’s national programmes include:

The way CSIP works reflects the complex challenges that face today’s services. We work in three ways:

• building capacity and capability locally • supporting policy implementation, and • informing policy development.
Building capacity and capability locally
CSIP works with local staff to help build local capacity to deliver on lasting improvements. We use a range of service improvement tools to help local teams build on their own capabilities and on their current capacity. Examples include:

• reducing delayed transfers from hospital for

older people – improving data collection, analysis to map the journey of people who use services and identify problems in the system to reduce delays in transfer from hospital

• the 10 High Impact Changes in mental health
services – using evidence-based tools and technology to help to build a culture of service improvement by working closely with service providers and people who use services, and

• Adult Social Care programme • Children, Young People and
Families programme

• CSIP Networks • Health and Social Care in
England (NIMHE)

• the Care Services Efficiency Delivery

Criminal Justice programme

programme – which has worked closely with many local authorities to develop sustainable efficiency improvements in adult social care.

• National Institute for Mental Health in • Older People's programme • Physical Disabilities and Sensory Impairment
programme, and

Supporting policy implementation
Many of CSIP’s efforts have focused on providing practical support to improve the implementation of national policy. This includes developing online tool-kits, setting up training sessions, facilitating networks and taking a lead role in running local pilot projects or early implementation sites.

• Valuing People Support Team.
A small central team provides corporate support to all the RDCs in business management, human resources, communications, information and knowledge management.


about the care service improvement partnership

Examples include:

• The role of public health in integrating services,
a CSIP publication, with supporting learning events, describing and exploring how public health specialists can contribute to the design of joint strategic needs assessment and the development of whole systems approaches.

• developing national demonstration sites
through the Improving Access to Psychological Therapies programme. Promoting innovation and system reform, which follow on from policy development, is a central part of our work programme.

• The Children, Young People and Families

programme which has delivered an outcomes based children and adolescent mental health (CAMHS) leadership course. This supports the CAMHS workforce and those involved in services to develop and sustain progress on delivering a comprehensive nationwide CAMHS service, and with people in primary care settings to improve the experience of, and access to, services for people with learning disabilities.

Networking and sharing the learning
CSIP runs a number of learning and improvement networks that bring together a broad range of people in health and social care organisations, people who use services and carers to share the learning, and signpost good practice. These include the national programme CSIP Networks, incorporating the Integrated Care Network and the Better Commissioning Network, Telecare and Housing Learning and Improvement Networks (LINs). CSIP also facilitates a large number of regionally and locally based networks, including social care leadership, dual diagnosis, and mental health legislation implementation networks.

• The Valuing People Support Team works

Informing policy development
CSIP uses its local connections and networks to help advise policy-makers so that policy development is better informed by everyday practice. Examples of our work on policy development include:

• leading the Department of Health consultation

on the Commissioning framework for health and well-being with input from regional partners, and


CSIP’s current priorities
Looking forward, there are plans for CSIP’s work to have clearer governance and accountability arrangements especially at the regional level. We will continue to ensure that responsibilities and resources are devolved effectively to the regions. This section gives you a flavour of our current priorities.
Increasingly, we will be responding to local priorities by working with regional and local organisations to assist in the delivery of national policy for local benefit.

For example, the mental health programme will be looking at how priorities such as commissioning, delivering race equality, psychological therapies, and new mental health legislation can best be delivered. CSIP also plays a key role in the development of personalisation through the individual budget pilot programme, direct payments uptake and implementation of person-centred approaches. We also work with our commissioners and the Joint Improvement Partnership for adult social care to develop an enhanced social care function within the regions. Here, facilitating strengthened social care leadership is key as we continue to provide support for priority councils and assist in the negotiation of Local Area Agreements (LAAs).

Building capacity and capability locally

IMPROVED OUTCOMES Informing policy development Supporting policy implementation



about the care service improvement partnership

Other priorities include:

• supporting the implementation of the mental
health acute inpatient care and dual diagnosis programmes, and facilitating the mental health trusts collaborative project (delivered through NIMHE) Everybody's business, supporting the development of the dementia strategy; promoting Dignity in care, implementing the new NHS continuing care framework and facilitating Partnerships for Older People Projects (POPPs) and promoting independence competencies across NHS and local authority systems and disseminating good practice to influence better outcomes for local populations

• supporting strategies to allow people with

learning disabilities access to full employment, improved health services and care closer to home, including support for the closure of NHS campuses the implementation of Every child matters and Maternity matters, and

• regarding older people, implementing

• working with people and services to support • advising on improving the clinical
management of substance misuse problems among young persons and adults in the criminal justice system.

• working to support commissioning

CSIP has published a 07/08 business plan which provides more detail on programme priorities, which is available on the CSIP website


2 recurrent themes
integration and partnership working
CSIP aims to promote integrated working at all levels, from strategy development to system reform and service redesign. Here are some examples of how we have achieved this.
Joint improvement partnerships (JIPs)
In the past year CSIP has led in the development of JIP. This is a strategic partnership which unites improvement bodies to develop and oversee implementation of a comprehensive and coordinated improvement strategy for social care. We played a role in establishing the regional JIPs, underpinning the Association of Directors of Adult Social Services (ADASS) work plans and regional priorities. Many regions already have agreed action plans and others are currently developing them.

Local area agreements (LAAs)in focus: building capacity and capability
In the East of England, Southend Borough Council was in phase three of negotiating the LAA when CSIP lent its support. The Commission for Social Care Inspection (CSCI) identified Southend as a council requiring priority improvement. CSIP worked with the Government Office and Regional Public health group to support the council to develop an LAA. Southend planned to apply for a stretch target for direct payments. CSIP then worked with the Department of Health performance leads and CSCI to assist Southend in setting a challenging target. CSIP Adult Social Care regional change agent Amanda Reynolds says: "CSIP built a close working relationship with Southend. Take up of direct payments (see p10) was historically low, so we encouraged them to develop a more challenging direct payments stretch target. We then sought Department of Health and CSCI input to agree the new target". The council is now on track to exceed its target. "The council has used the challenge of the LAA as a catalyst for wider improvement in social care. This year, CSCI is likely to consider that the council's performance has improved. Southend council put in a huge amount of effort to strengthen social care and has introduced strong leadership mechanisms to drive this change. Due to our role supporting local authorities CSIP was able to be part of this step change.”

Local area agreements (LAAs)
Throughout 06/07 and again in 07/08, we played a key role in facilitating the implementation of local area agreements, (see box) to create better local integration across health and social care. The Integrated Care Network (ICN), the Commissioning, Housing and Telecare Learning & Improvement Networks, and Adult Social Care Programme all promote the development of strategic partnership working. This provides consultation and brokerage to localities seeking to strengthen partnerships and offers advice on leadership and governance arrangements.


recurrent themes

Improving local service redesign through integration
We know that effective integrated working brings about improved outcomes for people who use services. It reduces duplication of effort and generates efficiency savings. We work with commissioners and providers to redesign services to embrace a whole systems approach. Some of our achievements at a glance are: advising multi-agency boards in the Southeast to change their delivery of integrated commissioning services to give more emphasis to Dignity in care.

Reducing health inequalities: integrating services
CSIP has worked with public health colleagues to develop an initiative highlighting how public health can support local government and health professionals to identify need, set priorities and develop integrated services to maximise health and well-being. The ICN’s The Role of Public Health in Integrated Services is aimed at those who commission, manage or deliver integrated services in England and provides an overview of the scope of public health practice. It showcases some of the tools and techniques that might be used in designing and evaluating integrated services.

• introducing public health programmes with

offenders in prison and in the community, such as Walk your way to health, Exercise reform and Smoking cessation across all nine Government Offices for the Regions, and improve their Section 31 agreements around specific care group economies.

• providing advice to partnerships seeking to


Support for the development of commissioning has become another recurrent theme in CSIP’s work. The past year has seen a number of new policy recommendations, reports and other related activities around this theme. CSIP runs dedicated commissioning programmes and several commissioner development initiatives.
Informing commissioning policy development
CSIP has built its links with the Department of Health policy teams and across government departments and other agencies on commissioning development across care groups and settings. We conducted a consultation exercise for the Department of Health on the Commissioning framework for health and well-being, and advised on the production of the Next steps guidance (Autumn 2007), which identifies nine specific work streams that CSIP will support. We also provided input into the Department of Communities and Local Government (DCLG) review of local government commissioning and worked with Cabinet Office partners to support third sector development around commissioning.

Building capacity and capability for effective commissioning locally
CSIP has introduced regional commissioning management development programmes to build local commissioning competency. These are particularly informed by the skills gaps and other issues identified in the Fitness for purpose reviews of primary care trusts (PCTs).

Bringing policy development and practice together
In 07/08, CSIP provided a range of tools and guidance to assist commissioners in strengthening the link between policy and practice. We managed a range of conferences, networks and other regional groups to address commissioning development issues. Examples include practice-based commissioning learning events, seminars on developing long-term commissioning strategies and guidance on commissioning services for people with longterm neurological conditions. Tools developed include the introduction of online podcasts as training and awareness-raising products.

Some of our achievements 2006/7 at a glance.

• we supported the design and joint delivery
of a commissioning management development programme for teams from local authorities, health and third sector, including accreditation arrangement with Teeside University

• we worked with primary care trust

commissioners in London to increase awareness and investment in Telecare activity for people with long-term physical conditions


recurrent themes

One Commissioner in a unity authority says:
“The pace of change in commissioning is so rapid, and we are constantly being asked to work in different ways, to different priorities. As a relatively small unitary authority we struggle for capacity and our commissioning colleagues in the primary care trust are equally hard pressed. It's great to have the resources that CSIP makes available that short-circuit our developing them, or when events are brought into the region to help us get up to speed quickly."

• we supported the development of joint • we established the regional

strategic needs assessment plans in conjunction with the eastern regional public health group, and development network programme for mental health commissioners (including residential programmes).


personalisation, choice and control
Personalisation is a recurrent theme that runs through much of CSIP’s work. Throughout 06/07 CSIP worked closely with Department of Health colleagues to set up networking opportunities for local authorities to share learning around implementing a number of programmes that foster personalisation, choice and control.
in Control
Together with the Department of Health, CSIP has sponsored the in Control initiative, a cross government and voluntary sector partnership first set up by CSIP’s Valuing People Support Team, Mencap and other partners. in Control works with local authorities (LAs) to change how they organise social care so people who need support can take more control of their own lives. By the end 06/07, two thirds of LAs had joined in Control ( Individual budgets are currently being piloted in 13 LAs all of which now have the system up and running. This past year, CSIP has worked closely with the sites to identify legislative and organisational successes as well as barriers to implementation. As with direct payments, we brought sites together to share the learning, which led to the development of the Resource allocation system, a tool to assist councils in determining the most suitable types of individual budget for people who require them.

Improving access to psychological therapies – informing policy with evidence of what works
CSIP has facilitated the roll out of the Improving access to psychological therapies initiative (IAPT) which tests out whether psychological therapies for people with anxiety and depression and other 'common' mental health problems, such as Blue Middleton (see case study right), can provide measurable improvements in health. In supporting the sites, CSIP helped services to give people faster access to psychological interventions as well as access to returning to work.

Direct payments and individual budgets: implementing the policy
CSIP held a series of learning events which informed the creation of a direct payments national solution set, launched earlier in 06/07, to identify tried and tested solutions on improving the running and take up of direct payments across local authorities and healthcare settings. We also worked with LAs to support their use of the available solutions, including the selfassessment guide.

Some of our achievements 2006/7 at a glance

• In control set up a programme to support the • the Older People's Programme runs the

leadership of people with learning disabilities so that they are able to get strategically involved in making difference to improve services national database of registered Dignity champions on behalf of the Department of Health and provides support to champions through regional activity and regular newsletters


recurrent themes

Choice and improving access to psycological therapies – Blue Middleton, has experienced depression for the past 22 years. He has also had additional symptoms of chronic anxiety, insomnia, and panic attacks. Blue says:
“I first approached a GP about my depression when I was 19. I was given diazepam which made my state worse. Although I was in a happy relationship and full-time employment, I felt isolated within myself. I was unable to discuss my thoughts openly with friends and work. As time progressed my depression went untreated, due to fear. As I then matured I made new friends with whom I felt able to discuss my innermost feelings. By this time I was encountering panic attacks and insomnia. A succession of bad things happening in my life led me to seek out counselling, in the short term this seemed to be the support I needed. The counselling was a good "weekly outlet". Hitting 40 years of age and under guidance of my longterm GP I was offered a new service offering CBT in my local area. In the past year I have achieved exactly my objectives set out in my first session with my therapist, of being more confident within myself, and of having more control of the direction of my life. I am now taking steps to getting back into the workplace. Blue says he is indebted to this treatment, and would recommend that this service become more widely available.

CSIP’s support in this area has contributed to improvements in care for people such as Julia Winter who now has greater choice and control:
Julia Winter, who is disabled and a wheelchair user, has used her Individual Budget to adapt her home and hire a personal assistant to provide support for her as a parent and during work commitments. Disabled since 1996 Julia has an individual budget which means she is allocated a sum of money and can decide herself how best to use it. In the past year she bought equipment to help her breathe. She has also bought special ramps to allow her wheelchair access into the house. Julia says: "I was happy on direct payments. But it is all about assessment of your needs and very medical. The individual budgets questionnaire asks 'what is the most important thing in your life? ' I had never been asked that before. It has changed my life!"

• in the North West, CSIP supported one of the

Partnerships for Older People Projects (POPP) to establish a partnership board run by older people which receives a budget to commission services in their locality, enabling independent and active involvement, and Learning and Improvement Network jointly developed the extra care housing programme, supporting better telecare, personalisiation and use of Individual Budgets for people with learning disabilities.

• Valuing People Support Team and the Housing


equality & diversity
Promoting equal access and quality of care for all people, regardless of age, disability or race, is a central theme embedded across CSIP’s programmes. CSIP’s Regional Development Centre’s jointly plan with services and stakeholders to ensure our work is tailored and responsive to the needs of their local populations.
Specific workstreams and initiatives include the Delivering Race Equality mental health programme, Valuing People Equalities workstream, the Equalities workstream within the CAMHS programme, and the National Gender Equality and Women's Mental Health action plans. Some examples of CSIP’s equalities work follow. CSIP’s Physical Disability and Sensory Impairment Programme has a role in promoting equality and diversity. This past year, the national programme has worked with prison health teams to improve access to information and support for older and disabled people. Nationally CSIP has rolled out the Towards Equality and Access (TEA) initiative, promoting telecare, telehealth and telemedicine so that local authorities and health organisations can better understand how these systems improve access to local services for deaf people.

Working so local communities to take the lead – Delivering Race Equality (DRE) Programme
A major CSIP initiative is promoting the implementation of Delivering Race Equality in Mental Health Care (DH, 2005), a five-year action plan for reducing inequalities in Black and minority ethnic patients' access to, experience of, and outcomes from mental health services. CSIP has worked with local communities to strengthen DRE's regional implementation. In 06/07, 17 focused implementation sites were established to look at the needs of local communities. We also supported 80 community engagement projects nationally to forge partnerships between community and voluntary groups.

Working with services to promote awareness and action around equalities issues
In 2006/07 CSIP’s Valuing People Support Team (VSPT) ran events in partnership with the Local Government Association (LGA) for elected members of Local Authorities on the Disability Equalities Duty (2007). With sessions led by people with learning disabilities, the events aimed to awareness raise and explain the requirements of the new legislation.


recurrent themes
Equalities, Diversity and Policy implementation – Guilaine Kinouani believes the work of CSIP has enabled her to better implement DRE in her borough. She is a DRE community development worker attached to Fanon; a BME voluntary organisation and is funded by Lambeth PCT. She says: "I see my work as a CDW bringing about change both within mental health services and the BME population. Our role is to bridge the gap between services and BME communities."
Guilaine's work for DRE began last year and involves looking at care pathways of black men with mental health problems in forensic settings. She works as a link between formal criminal justice, mental health services and the prisoners whose views are generally unreported. She says: "There has been a lot of talk about increasing capacity in the BME community but we also need to build capacity in mental health services. It has been said that these communities do not engage with mental health services and that change has to come from within BME communities”

Some of our achievements 2006/7 at a glance

• developed Through Assistive Technology
(TATE), an initiative to help people with learning disability find employment

• incorporated the DRE into the choice,

suicide prevention, criminal justice, mental health legislation, and Improving Access to Psychological Therapies agenda service improvement initiatives competence training, and

• helped to mainstream the DRE in trust-wide • facilitated the roll out of CAMHS cultural • coordinated and support the Dignity in Care
(DH, 2006/07) Champions' work to prevent discrimination against older people.


CSIP regional development centres
North East, Yorkshire and Humber development centre Genesis 5, Innovation Way, Off University Road, Heslington, York, YO120 5DQ Sally Prescott, Director Phil Sculthorpe will be covering her role until December 2007 tel: 01904 717 260 North West development centre Dean Repper, regional director Hyde Hospital, 2nd Floor South, Grange Road South, Hyde, SK14 5NY tel: 0161 351 4930 East Midlands development centre Mary Clifton, regional director 3rd Floor, Mill 3, Pleaseley Vale Business Park, Outgang Lane, Mansfield, NG19 8RL. tel: 01623 812 941 The East Midlands RDC 06/07 annual review is available on their West Midlands development centre Ian McPherson, regional director The Uffculme Centre, Queensbridge Road, Moseley, Birmingham, B13 8QY. tel: 0121 678 4854 The West Midlands RDC 06/07 annual review is available on their website Eastern development centre Kieron Murphy, regional director 654The Crescent, Colchester Business Park, Colchester, Essex, CO4 9YQ. tel: 01206 287541 London development centre Melba Wilson, regional director 11-13 Cavendish Square London, W1G OAN. tel: 0207 307 2457 South East development centre Jackie Ardley, regional director 3000 Cathedral Hill Guildford, GU2 7YB tel: 01483 246500 The South East RDC 06/07 annual review is available on their website South West development centre Paddy Cooney, regional director Mallard Court, Express Park, Bristol Road, Bridgwater, Somerset, TA6 44RN tel: 01278 432 002

National programmes
Children, Young People and Families Dean Repper, acting national programme lead tel: 0161 351 4930 The Children, Young People and Families leaflet is available on the CSIP website CSIP Networks Jeremy Porteus, national programme lead tel: 0207 972 1330 Janet Crampton, acting commissioning programme lead tel: 020 7972 4606


Health and social care in criminal justice Alistair McIntyre, interim national programme lead tel: 020 7972 4464 Learning disabilities (Valuing People Support Team) Sue Carmichael, joint programme lead tel: 020 7972 1211 Debra Moore, joint programme lead tel: 0113 25 45652 Mental health (National Institute for Mental Health in England) Ian McPherson, programme lead tel: 0121 678 4854 Older people Ruth Eley, programme lead tel: 07789 653200 Physically Disability and Sensory Impairment Ian Salt, programme lead tel: 07812 337647 Adult Social Care programme Julia Ross, programme lead tel: 07979 505 327

CSIP Central
Peter Horn, national director tel: 0207 972 4803 Ingrid Steele, director of communications and knowledge services Ingrid is on maternity leave until Feburary 2008 Current contact is: Simon Pearson, team co-ordinator tel: 07884 473499 Phil Sculthorpe, director of business services tel: 0113 2545187 Communication and knowledge services team tel: 0113 2545127

Transition Planning Team
CSIP, with the Department of Health and working alongside key partners such as the SHAs, has set up a transition planning team for 07/08 to focus on changes to how CSIP operates. Key CSIP contacts include: Andy Nash, director of implementation Carmel Mann, human resources lead Alison Cooley, communications lead For general information on the transition planning, email:

For up to date news on CSIP visit our website at You can link from this site to individual development centre and national programme sites.