Health & Wellbeing in the West Midlands:

Making it work across the NHS & Local Government

14th March 2013

Logistics

Mobiles to silent please No scheduled fire alarmWiFi password is…Refreshments and lunch will be served next doorLinks to slides and outputs from the day will be available on iewm blog: www.iewm.net/making-it-work

Welcome & introduction to day

Richard HumphriesThe King’s Fund

Our purpose today:

To identify the big challenges for the West Midlands arising from national developments

To better understand each other’s agendas – for local government, public health & CCG leaders

To showcase examples of behaviours leading to innovation & transformation across the region

To consider options for how you work together across the West Midlands

The national picture

Four burning platforms

• Changing needs & demography• Organisational change• Austerity• Quality & safety

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NHS structures have become more complex...and new roles for local government-

....in the West Midlands

Source: NIESR

Austerity - economic & fiscal prospects are dismal

Quality & safety

Local authority total

£6.9 billionEducation

£4.5bChildren’s social care

£0.7b

West Midlands spend on health, care & wellbeing

Adult Social Care

£1.5b

Housing£0.2b

CCG allocations

£6.6 billion

Public health£0.3b

Other health commissioning (NHSCB/CSU)

Total

£13.8b billion

The total resource

Not including:• Commissioning spend on primary care etc• Specialised commissioning• Public health spend by PHE and NHSCB• Local govt spend on wellbeing related provision• Housing revenue account & RSLs• Other relevant government spending• Private spend on care services & support• Value of estate• Community assets & social capital• Monetised value of unpaid carers, volunteers

Nick Bell, CEO, Staffordshire County Council

David Hegarty,CCG Lead, Dudley

What’s it like for you ?

Jo Davidson, DASS/DCS,Herefordshire Council

Dr Richard Harling, DPH, Worcestershire

Opportunities & challenges: raising our sights, raising our ambitions

Table discussion:

1. What are three biggest challenges & opportunities for the West Midlands in the current climate ?

2. What are your top three ambitions for what you want to achieve in the West Midlands ?

Coffee11.15-11.30am

Building relationships, changing behaviours

Integrated commissioning in Staffordshire

New ways of working for public health in Coventry

Integrated dementia care in Dudley

New approaches to Troubled Families in Wolverhampton

Integrated commissioning & partnerships

Eric RobinsonStaffordshire County Council

New ways of working for public health

Jane MooreCoventry City Council

Dr Jane Moore

Director of Public Health - Coventry

Coventry: “New Ways of Working for Public Health”

Variation in life expectancy across Coventry

How do we Maximise the Life Opportunities of People in

Coventry?

What has this led to?

• Heath and Wellbeing Strategy – People, Place, Outcomes

• Lead responsibilities for delivering strategy shared between partners

• CCG Plan • Developing a shared commitment to asset based

approaches to community engagement• All council directorates and portfolio holders committed

to demonstrating how their areas maximise peoples life opportunities

How do we Maximise the Life Opportunities of People in

Coventry?

Top Tips

• Don’t say it is a health issue• Start with a co-design model for working

with communities and interest groups• Role of Public Health is to act as a catalyst

– delivery needs to be owned by everyone

Background to Dementia Gateways in Dudley

Dr David Hegarty & Andrea Pope-SmithDudley Metropolitan Borough Council

New approaches to Troubled Families

Sarah NormanWolverhampton City Council

Building Relationships &

Changing BehaviourTroubled Families

Sarah Norman – Chair Regional Troubled Families Network

"If you always do what you've always done, you'll always

get what you've always got."

Henry Ford?

Information Sharing Whole family working Difficult conversations Intensive

What we need to do differently

“Dedicated workers dedicated to families” Family Intervention Programme Model Key worker model Are “stand alone models” a lost opportunity

to change the way all agencies work with Troubled Families? Vz

Will key workers working in existing agencies be able to work sufficiently differently?

Stand Alone vz integrated models

“These workers have a distinct working style seen as the key to success consisting of dogged persistence, the ability to challenge values and behaviour, clear honest, authoritative and assertive working styles and a real understanding of the family”

Practical “hands on” support, modelling behaviour, teaching “on the job”

What is the best way to build a family intervention workforce?

Is this a new profession?

New breed of worker?

Most LAs in the West Midlands have located Troubled Families in Children’s Services

Many of the Parents have mental health, substance misuse or learning disabilities.

Contributions also possible from YOTs, Family Nurse Partnerships, Tenancy Sustainment

Aspects of the approach may be relevant to working with adults without children

Is Troubled Families a Children’s service?

Funding only available for three years What is the legacy strategy?

◦ Demonstrate savings achieved?◦ Embedding in the way existing services work?

Evidence Base How does your legacy strategy impact on

what you need to do now?

Legacy

Lunch & networking12.30-1.30pm

Peter HayWest Midlands ADASS

Wendy SaviourNHS Commissioning Board

Making it work in the West Midlands

Sue IbbotsonPublic Health England

The role of the NHS Commissioning Board

in the West Midlands

Wendy Saviour,Director,

NHS Commissioning Board Birmingham, Solihull and the

Black Country Area Team

14 March 2013

The NHS Commissioning Board• NHS CB combines a single national operating

model with local focus and implementation

• Mandate and Constitution drive our agenda

• Improving outcomes for patients at the heart of everything we do

• Partnerships essential – within and outside the NHS

• We will support and develop CCGs so that they can be the best they possibly can be

Nationwide Organisation, Local Presence NHS Commissioning Board

• Central team – main base Leeds, small presence in London

• Four Regional Teams (part of the Operations Directorate) – we are part of Midlands and the East

• 27 Area Teams (ATs) – commissioning high quality primary care services, supporting and developing CCGs, assessing and assuring performance, direct and specialised commissioning, managing and cultivating local partnerships and stakeholder relationships, inc representation on health and wellbeing boards

• Three Area Teams in the West Midlandso Birmingham, Solihull and the Black Countryo Arden, Herefordshire and Worcestershireo Shropshire and Staffordshire40

Local Area Team (LAT)Common LAT functions:

• CCG development and assurance

• Emergency planning

• Resilience and response

• Quality and Safety

• Partnerships

• Reconfiguration

• System Oversight

• Key local partner of Health and Wellbeing Boards

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Our purpose

• Improve health outcomes and quality

• Clinical leadership and engagement

• Patients and the public to have more choice and control over their care and services

• Innovation and transformation

• Equality and the reduction of inequality in access to healthcare

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Our role• Allocate resources to CCGs

• Support and hold to account CCGs

• Direct commissioning responsibility for:

oPrimary care

oSpecialised services

oPublic Health, Military and Offender health services

• Strategic, clinical and professional leadership across Local Area

• Clinical Networks and Senate43

Clinical Networks and SenateNHS Outcomes Framework

Senates [12]

Strategic Clinical

Networks

Local Professional

Networks

Operational Delivery Networks

Other Local

Networks

“The conscious and guiding intelligence”

“Engines for change and improvement across complex care systems”

“Gathering frontline knowledge and expertise”

“Mapping patient pathways to ensure access to specialist support”

“15 AHSNs: Masters of science and evidence based practice”

Multi-professional

i.e. Cancer; CVD; Maternity and Children’s; Mental Health / Dementia / Neurological Conditions

i.e. Pharmacy; Eye health; Dental

e.g. Adult Critical Care; Neonatal Intensive Care; Trauma; Burns; Paediatric NM; Paediatric IC

e.g. Academic Health Science Networks, Research Networks

Annual national priorities from the NHSCB Medical and Nursing DirectoratesAll supported by Improvement Body and Leadership Academy

NHSCB Network Support Teams (AT-based)

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The West Midlands Clinical Senate

NHS Outcomes Framework

Senates [12]

“The conscious and guiding intelligence”

Multi-professional

“The Senate, an assembly of some three hundred of Rome’s great and good, generally acknowledged - even by those not in it - to be both the conscience and the guiding intelligence of the Republic. Membership of this elite was determined not automatically by birth but by achievement and reputation…..

“This gave to the Senate’s deliberations immense moral weight, and even though its decrees never had the technical force of law, it was a brave or foolish magistrate who chose to ignore them”

Holland; Rubicon (London, 2003) p37.

The West Midlands Clinical Senate: Key Relationships

The West Midlands Clinical Senate: Council and Assembly

The Senate Council :• Experienced and credible clinical chair - Dr David Hegarty • Core multi-disciplinary ‘steering’ group of between 20–30• Responsible for the formulation and provision of independent strategic clinical

advice to CCGs, the NHS CB and HWBs• Considers objective data and information, views and opinions from a broad

range of experts and others invited through the ‘Assembly’

The Senate Assembly:• Diverse multi-professional forum providing the Council with ready

access to experts from a broad range of health and care professions, invited through the Chair, as required

• Membership to encompass a wide range of clinical professions, the ‘birth to death’ spectrum of NHS care, and the five domains of the NHS Outcomes Framework.

The West Midlands Strategic Clinical Networks

Strategic Clinical Networks

“Engines for change and improvement across complex care systems”

i.e. Cancer; CVD; Maternity and Children’s; Mental Health / Dementia / Neurological Conditions

SCNs will operate for cancer; cardiovascular; maternity and children; mental health, dementia and neurological conditions from April 2013.

A model through which professionals and organisations will come together, working across boundaries to:

deliver programmes of continuous quality improvement

contribute to the achievement of outcome ambitions for patients, and benefit population health, where there is a need for whole system or collective improvement endeavour.

SCN Oversight Group

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West Midlands SCN Oversight Group

Cancer SCN Steering Group

Cardiovascular SCN Steering

Group

Maternity & Children SCN

Steering Group

Mental H, Dementia & Neuro Conditions SCN

Steering Group

SCN sub-groups / task and finish groups together with

county specific groups / local implementation teams

Core Membership of SCN Oversight Group

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Acute CEO Representative

Area Team Medical Directors

Mental Health CEO representative

Specialised Commissioning Director

Commissioning COO representatives for each

county

Patient Representation

Thank You

Table discussion:

1. What do we need to do at which level – locally, sub-regionally & across West Midlands ?

2. What have we got to build on ? What have we got to share ?

Action Planning & Next Steps

R.Humphries@kingsfund.org.ukTwitter @richardatkf

Slides, videos and other materials from the day will be available at www.iewm.net/making-it-work