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hindrance mentioned by several interviewees. At the same time, several local

health leaders questioned the robustness of Clinical Commissioning Groups,

arguing that some are too small, which they felt made it almost inevitable that

they would find themselves operating in deficit.

Fragmentation also increases the costs of providing services across health and

social care. Government ministers are aware of the problems. As Jeremy Hunt

said: "…the interconnected relationship between the services we both [NHS and

local government] offer to vulnerable people means that we in the NHS have

a responsibility, as we move to fully integrated services, to help you [in local

government] deal with a tough financial settlement. If we operate in financial

silos, the costs will be higher for both of us."63 His colleagues Norman Lamb

and Paul Burstow have echoed these views and championed an interconnected

relationship between the NHS and local government.

63 Wiggins, K, "Hunt: NHS has

'responsibility to help councils"

LGC (31 October 2014)

Cheshire West and Chester Integrated

Neighbourhood Teams

Case Study: Cheshire West & Chester Council

There are approximately 63,000 people

living in Cheshire West and Chester (CWC)

aged over 65, with about 8,000 of these aged

over 85 years, and those numbers are set to

go up substantially. They live predominantly

in the rural areas of the borough so creating

additional pressure on services and

increasing the importance of outreach and

community-based provision.

CWC has committed to work with

partners to fundamentally reshape the

delivery of care to this population to make

it 'client centric', working with patients,

their carers, local clinicians, our staff and

the numerous partner organisations (from

all sectors) to design a new model of care provision. In so doing they have built a

far deeper understanding of the needs of their communities, not just in terms of

clinical requirements, or those known to social care services, but in all aspects of

personal and community wellbeing. It is this that drives truly integrated working

and the delivery of whole-system, seamless care. Importantly, this is also driving a

fundamental shift from reactive, acute care to proactive care closer to home.

The transformation work is split into four major strands, all of which deliver

complimentary changes to service delivery and budgetary alignment. Crucially,

in moving toward a whole-system approach, no single element of delivery is

undertaken in isolation:

• Service integration between CWC and Cheshire and Wirral Partnership

NHS Trust - removing the boundaries that used to exist between the major

providers of care.

• Roll-out of Integrated Community Care Teams - delivering care and support

in the community, in a co-ordinated and client-centred manner. Teams

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