Young people and the health reforms: update, challenges and opportunities

Alison HadleyDepartment for Education

Zoe RentonNational Children’s Bureau

The case for change Recent improvements in some health outcomes for young people –

declining rates of teenage pregnancy and STIs and drug and alcohol use, but outcomes lag behind young people in western European countries and significant inequalities persist

Increasing pressures on the NHS demand a greater emphasis on long term investment in preventing both physical and mental ill health

The importance of healthy behaviours and health services in childhood and the teenage years in setting patterns for later life.

Sir Ian Kennedy’s review of children’s health services identified aspects of the previous system, that were not well designed to meet the needs of children and young people

Despite real progress in partnership working, many areas still feel a disconnect between local joint strategic planning and commissioning for children and young people and those for health

A DfE-DH joint priority

“Nothing can be more important than getting it right for children and young people.”

“…we are determined to design children and young people into our proposals (health reforms) from the outset”

“The Department of Health will continue to work closely with the Department for Education on services for children, to ensure that NHS and public health reform supports the ability of local health, education and social care services to work together for children young people and families”

Achieving equity and excellence for children. How liberating the NHS will help us meet the needs of children and young people. DH 2010

Maintaining the focus on children and young people

Children and Young People’s Health Outcomes Strategy

Health Secretary Andrew Lansley said:

‘Our ambition for the Children’s and Young People’s Health Outcomes Strategy is a simple one – to improve outcomes for children and young people’s health.

‘We will bring together people and resources from across the NHS, social care and wider children’s services to develop a clear set of goals to give all children the right start in life.

‘By intervening early we will be to able to influence patterns of behaviour and can ensure that children and young people get the quality of care, services and support that they deserve.’

The health reforms

▪ NHS Commissioning Board (NHSCB): independent statutory authority with responsibility for allocating £80b of health funds to Clinical Commissioning Groups. Accountable to Secretary of State through Mandate to the NHS CB setting out: objectives, requirements to meet objectives and financial settlement. First mandate to set objectives for April 2013-March 2015. C&YP outcomes strategy will inform C&YP objectives in Mandate.

▪ Clinical Commissioning Groups (CCG): one or more group of GP practices in each LA, receiving 80% of NHS budgets. Responsible for commissioning healthcare services for the whole population, against the Health and Wellbeing Strategy – contributing to NHS and Public Health outcomes. Accountable to NHS Commissioning Board

The health reforms

▪ Health and Wellbeing Boards (HWB): HWB in each top tier Local Authority. Statutory requirement on core membership: DCS, Director of Adult Services, Director of Public Health, elected member, representative of CCG, representative of HealthWatch

▪ Statutory requirement on HWB to produce: a Joint Strategic Needs Assessment of current and future needs – and a Health and Wellbeing Strategy, which informs all commissioning. HWBs can challenge CCGs if out of line with HWB Strategy.

▪ Public Health England (PHE): part of DH and responsible for improvements in public health outcomes. PHE and LAs to jointly appoint a Director of Public Health, responsible for public health of their local populations, through a ring fenced grant. Shadow allocations to be published today. Grant determination to be published in next few weeks.

The health reforms

▪ Local HealthWatch: local consumer voice for health and social care, to shape planning of services, provide help for local people on choices and advocate for individuals making complaints.

▪ HealthWatch England: independent consumer champion, statutory committee within Care Quality Commission

▪ Monitor: sector regulator for health, reporting directly to Parliament, working with CQC to protect patients’ interests. CQC inspects and licence all health and adult social care providers

▪ Ofsted: continues to inspect and regulate children’s services and education

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Opportunities and Challenges

Health and Wellbeing Boards and CCGsChallenges:

▪ Young people need an explicit focus, separate from children

▪ Decision makers in HWBs and CCGs may lack knowledge and expertise on young people’s health to secure their interests in the JSNA, HWB Strategy and subsequent commissioning plans

Opportunities

▪ Life course approach of NHS and Public Health outcomes frameworks puts young people on the map

▪ HWBs statutory membership and duties offer potential for a more integrated, horizontal approach to assessing and meeting the health needs of young people across NHS and public health

▪ Learning set on children and young people as part of National Learning Network for Early Implementers

▪ Children and Young People’s Health Outcomes Strategy

HealthWatchChallenges

▪ Making the engagement meaningful, sufficient capacity and expertise to engage with CYP, inclusive of marginalised groups, with impact and outcome of participation work measured

▪ Ensuring engagement of young people and influence of their views is not lost through limited statutory HealthWatch representation on HWB

▪ Ensuring existing effective practice is shared and used

Opportunities

▪ Potential to engage young people systematically in scrutinising, shaping and improving local services

▪ Local HealthWatch can act as ‘local network of networks’ to draw in effective engagement already established by local areas, professional organisations (e.g. RCPCH) and VCS organisations

▪ HealthWatch England regulations out for consultation to 2 March▪ Local HealthWatch. FAQs by end of Feb. LAs setting up steering groups;

shadow HW in place by October. Service spec on LGA CoP. ▪ CQC online community for development of HealthWatch

Joint Strategic Needs Assessment

Challenges▪ Increasing awareness of interdependencies among decision makers,

including elected members▪ Increasing knowledge and expertise among DPHs and HWB members▪ Making the JSNA more than a data pack

Opportunities▪ Opportunity to reposition the JSNA away from an adult focus to include

children and young people at the heart ▪ Children and young people’s indicators included in the NHS and Public

Health Outcomes Frameworks – with 18 out of 63 indicators in the PHOF (with more work to come on mental health and young people’s perception of services)

▪ Wide scope of PHOF highlights the interdependencies between health and other outcomes – e.g. child poverty, teenage pregnancy, NEETs and adult unemployment. Strengthens the case for involvement of all agencies (including schools) to ensure commissioning of early help for young people needing extra support

▪ Statutory guidance and wider resources to support HWBs – guidance out for ‘engagement’ with short public consultation in Spring

CYP sector lobbying group: shared concerns

Lack of coherent strategy for ensuring the reforms deliver for children and young people

Need for a clear message that HealthWatch is for children, and action to ensure it works

Securing joint planning, commissioning and delivery beyond health and social care

CYP sector lobbying group: what we achieved Children and young people’s issues getting a hearing! Children and Young People’s Health Outcomes Forum and

forthcoming strategy - NCB/CDC engagement event on 9th March Commitment to use guidance to promote Health and Well-being

Board’s role in securing joint working across health and social care and health-related services (including youth, education and young offender services)

Confirmation that children and young people are central to HealthWatch remit and considering extending to child social care

CYP sector representation on HealthWatch Programme Board.

Key Timings (subject to legislation)

NHS Commissioning Board established in shadow form from October 2011 as a special health authority

NHS Commissioning Board established as independent statutory body by October 2012 to authorise CCGs and carry out preparatory functions; will take on full responsibilities from April 2013.

SHA and PCT clusters in place until April 2013.

Phased introduction of CCGs: by April 2013, all GP practices will be members of an authorised or shadow CCG

Health and wellbeing boards take on full responsibilities April 2013

… but strongly encouraged to operate in non-statutory form by April 2012 ready for developing JSNA and joint health and wellbeing strategy to inform commissioning for 2013-14

Making the system work: Children and Young People’s Health Outcomes Strategy

▪ Forum membership announced. Joint chairs: Christine Lenehan CE Council for Disabled Children and Ian Lewis, Medical Director at Alder Hey NHS Foundation Trust

▪ Forum focusing on four themes: Public Health Acutely ill children Mental health services for children and young people Children with disabilities and long term conditions

▪ Stakeholder engagement: online feedback http://healthandcare.dh.gov.uk/category/children/

▪ NCB involvement▪ Strategy to be published before summer recess

Positive for Youth: other health issues

▪ PSHE review: focusing on defining outcomes, improving quality and disseminating effective practice. Consultation closed 30 November.

▪ School health service – a new vision for school nursing, to support schools in managing pupils’ wellbeing, medical and long term conditions and developing health promoting school environments. Developed with young people – further BYC event on 26 November to test model with additional consultation with young people and parents

▪ Young people friendly services – making asking for advice normal and reducing the stigma around sexual and mental health advice. You’re Welcome criteria = commissioning framework for young people’s services – with flexibility for local areas to involve young people in developing own service brand

▪ Integrating health advice into services young people trust – making advice and support hard to miss, not difficult to find

▪ Using new media to improve young people’s easy access to trusted information and advice when they need it. New DH social marketing campaign for young people in 2012

Next steps

Development of Children and Young People’s Health Outcomes Strategy – to inform all NHS CB Mandate and all further policy

Health and wellbeing boards take on full responsibilities April 2013

… but need to developing JSNA and joint health and wellbeing strategy in autumn 2012 to inform commissioning for 2013-14

▪ Positive for Youth: on-going collaboration across government and with stakeholders and commitment to review progress one year on

Questions for discussion

1. What opportunities and challenges do the reforms present for your organisation and the young people you work with?

2. How can local youth charities be supported to navigate the changes in their area, and to engage with the Health and Well-being Board and new health commissioners?

1. How can the voluntary youth sector help to ensure HealthWatch gives a real voice to young people – in decisions about health services and their own care?