VCS Adult Health and Social

Care Forum

Health Transition - An Update from Leicester City

November 2011

Deb WatsonDirector of Public Health

NHS Reforms

3

NHS White Paper, published 12 July 2010

Signalled major change to the NHS

Followed by the Public Health White Paper Healthy Lives, Healthy People in November 2010

Built on NHS White Paper re changes to Public Health responsibilities and new Local Authority roles

NHS Reforms - Background

• Abolition of Primary Care Trusts and Strategic Health Authorities in April 2013 (SHA’s clustered in Oct 2011)

• NHS Care services to be commissioned locally by Clinical Commissioning Group overseen by the new NHS Commissioning Board. NHS CB will also commission some specialist services

• Provider NHS organisations to become Foundation Trusts with greater autonomy

• Health responsibilities transferring to Local Authorities =

a) lead for public health and b) lead responsibility for health strategy and partnership

through new Health and Well Being Board arrangements

Population health - Background • Poor population health in Leicester. • High levels of need for care services and prevention• Likely to worsen in light of recession• Significant health inequalities• Gap is not narrowing.• Poor health driven by deprivation & exacerbated by

lifestyle factors embedded within communities. • Public Health priorities agreed at 1st H&WB Board• Health Inequalities Improvement Plan – important to

maintain momentum and delivery across all partners• Risks re reductions in public funding and transition

Financial Context

• 30% reduction in local authority funding over 3 years

• Period of significant growth in NHS funding has ended

• Demographic change, plus new medicines and technologies = approx 4% cost pressure each year for the NHS - To be found through efficiency savings across the NHS.

• Risks of cost-shifting• Need to strengthen partnership through

transition and beyond

Health Transition - Workstreams

• LLR PCT Cluster responsible for NHS aspects of transition (e.g. establishment of Clinical Commissioning Groups)

• Shared oversight and responsibility for joint NHS and Local Authority transition workstreams:

Establishment of Health and Wellbeing Board Public Health Transition Joint Commissioning Transition to Healthwatch

Health and Wellbeing Boards - Background

• Included in the NHS White Paper ‘Equity and Excellence’ Liberating the NHS (July 2010)

• Health and Social Care Bill (January 2011) makes the establishment of a Health and Wellbeing Board mandatory for each upper tier authority

• The purposes of H&WB Boards is to: Lead on improving the strategic coordination of commissioning

across NHS, social care, and related children’s and public health services

Bring together the key NHS, public health and social care leaders in each local authority area to work in partnership

Provide a key forum for public accountability of NHS, public health, social care for adults and children

• To co-ordinate Joint Strategic Needs Assessment (JSNA) and Joint Health and Wellbeing Strategy (JH&WBS)

Health and Wellbeing Boards – Background (2)

• Deep and productive partnerships, that develop solutions to commissioning challenges…

• Based on mutuality and co-creation. Collaboration as the norm.

• Elected representatives, with other key local stakeholders, to be engaged in early conversations about how local services can best meet needs rather than reacting as commentators and critics

• Statutory H&WB Board expected to become an Executive Committee of the Council once legislation is passed

Shadow Health and Wellbeing Board – Progress

• Leicester City is an early implementer (member of a learning network, sharing good practice)

• Promotes integration and partnership working between the NHS, Social Care, Public Health and other local services;

• Shadow Health and Wellbeing Board in place from August 2011 as an advisory body to Leicester City Council Cabinet, the One Leicester Clinical Commissioning Group and the Leicester, Leicestershire and Rutland Primary Care Trust Cluster

• Chaired by the City Mayor• Aim = To achieve better health, wellbeing and social care

outcomes for Leicester City’s population and a better quality of care for patients and other people using services.

Shadow Health and Wellbeing Board – Progress (2)

• Board has met 3 times including development sessions. Now meeting bi-monthly

• Discussions to date on:– Transition workstream progress (inc Healthwatch progress,

principles for joint commissioning)– Public Health priorities and expectations of health service providers, – JSNA refresh, – Interim Health and Wellbeing Strategy

• Shadow board has replaced the former Health and Wellbeing Partnership as part of Leicester Strategic partnership arrangements

• Early discussions about engagement – mechanisms not yet developed

Shadow Health and Wellbeing Board – Initial Membership

• The City Mayor (Chair)• The Deputy City Mayor• Asst Mayor for Health and Community Involvement• Two representatives of the Leicester City Clinical Commissioning Group

(one Co-Chair and the Managing Director)• CEO of the LLR PCT Cluster• Strategic Director, Adults and Communities, LCC• Strategic Director, Children, LCC• Joint Director of Public Health, LCC and NHS LC• Local Health Watch and other representatives includes:

– One representative of the local health watch organisation for the area of the local authority, i.e. currently Leicester Local Involvement Network Board member

– Such other person (s) as the local authority and/or health and Well Being board thinks appropriate. (None yet agreed)

Shadow Health and Wellbeing Board – Communication and Engagement

• Shadow H&WB Board will:• Develop and implement a Communications and

Engagement plan, outlining how the board will be influenced by stakeholders and the public, and how the board will disseminate specific duties required by the board, including consultation on service changes.

• Communicate and engage with local people in how they can achieve the best possible quality of life and be supported to exercise choice and control over their personal health and Well Being.

Partnership Approach

PA Consulting (2004) NRU Systems Thinking Seminar

Public health - Priorities

• Public Health Priorities agreed at 1st Health and Well being Board

• Our priorities for public health are to accelerate improvements in:

Lifestyle factors (smoking, physical activity, healthy weight, alcohol)

Care services (esp access, take–up and quality of preventative services provided by GPs)

Wider factors that influence health over the long term (educational attainment, skills, employment, housing transport, crime etc).

Plus vigilance and capacity to protect the health of the population e.g. from communicable diseases and any new or emerging threats

Public Health Transition - Background

• Healthy Lives Healthy People Consultation closed 31st March 2011.• Lots of uncertainties – more detail still to come• Local government to be responsible for Public Health locally from April

2013• Backed by ring-fenced budgets, plus an incentivised ‘health premium’ • Directors of Public Health in local authorities will be strategic leaders of

these efforts• A new dedicated, professional public health service – Public Health

England – to be set up as an executive agency of the Dept of Health, ensuring independent expert scientific advice

• Best evidence and evaluation will be used, supporting innovative approaches to behaviour change. New research nationally

• Guidance awaited on transfer of responsibilities, staff transfer, funding, performance framework etc

What’s happening now and next?• The Leicester H&WB Board will continue to:

– Learn from other early implementers – Develop stakeholder engagement mechanisms– Develop sub-structures for the H&WB Board– Complete JSNA refresh– Develop Joint Health and Wellbeing Strategy– Focus on major priorities for health and wellbeing– Identify and develop opportunities for joint work to

improve effectiveness and efficiency• Public Health transition plans to be developed January –

March 2012 based on further guidance

Questions and Discussion

• What mechanisms should we use to develop good communications between the Health and Wellbeing Board and the Voluntary and Community Sector? 

• How can the Voluntary and Community Sector help to build community capacity to improve Health and Wellbeing? 

• What more can be done to involve stakeholders in refreshing the Joint Strategic Needs Assessment. 

• How should stakeholders be involved in developing the Health and Wellbeing Strategy?

Contact Details

Deb Watson

Director of Public Health and Health Improvement

Leicester City Council and NHS Leicester City

And

Interim Director of Adult Social care

Leicester City Council

deb.watson@leicestercity.nhs.uk

0116 252 6095