Master Presentation - Health & Wellbeing event 14.03.13
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Master Presentation - Health & Wellbeing event 14.03.13

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This is a master presentation comprising of slides by Richard Humphries (the King's Fund), Jane Moore (Coventry City Council), Andrea Pope-Smith (Dudley MBC), Sarah Norman (Wolverhampton City ...

This is a master presentation comprising of slides by Richard Humphries (the King's Fund), Jane Moore (Coventry City Council), Andrea Pope-Smith (Dudley MBC), Sarah Norman (Wolverhampton City Council), Peter Hay (Birmingham CIty Council) and Wendy Saviour ( NHSCB)

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  • Adult social care budget areas: Care and Independence / Community Safety / Business Partner / Health Development / Community ServiceChildren’s Service budget areas: Children, Young People and Families / Education and Skills Place budget areas: Built County / Rural County / Tourism and Cultural County / Business and Enterprise County / Sustainable County / Transport and Connected County / Economic Planning and Future Prosperity / Strategic Management Overheads / Transformation and Property Consultancy Corporate/Support Services: Audit / Procurement / Treasury Management / Pension Services / Precepts / Corporate Budget Items / Central Financial ServicesICT / Schools ICT / Broadband / HR / Property Consultancy / Schools Property UnitFinance & Resources: Members & Member Support / Information Governance Unit / Legal Services / Elections / Emergency Planning / Trading ServicesLaw & Democracy: Strategy and Transformation / Chief Execs Office / Organisational Development Strategy & Transformation: Communications / Customer Service / KnowledgeCustomer Services and CommunicationsService Total 418.938 Then there is also revenue: Capital Financing: £46.541 millionCentrally Controlled: £9.925 millionContingency: £2.000 millionNet Revenue Budget: £477.404 million (including the service budgets)
  • Most data was pulled from the PCT budget breakdown provided by Kim Curry.The learning disability / mental health and ambulance service data is from the PCT Cluster legacy document.
  • The timetable for the new enhanced JSNA required the 2012 JSNA to be produced around 6 months after the previous JSNAAs agreed through the Health and Wellbeing Board, the JSNA 2012 was developed rapidly, largely using the information gained from the last year. A Task and Finish Group was established to guide the JSNA development, and key priorities were selected in line with these principles(In future years we will be increasing the range and breadth of inputs into the process, and increasing involvement in the process itself)
  • Share with you is not just from our experience of Troubled Families in Wolverhampton, but from some of the discussions we have been having in the Regional Network and nationally. Not answers but things to think about
  • All agree that if Troubled Families is to succeed it will require us all to work differently – but what does this mean in practice?
  • Information Sharing to identify families and then to work successfully with them. Proved bureaucratic and time consuming. Involve Police, Job Centre Plus, EOS, Health etc. Cracking this could have learning for other areas where we need to share information better to target support e.g. long term conditionsWhole Family working fundamental to the Programme DCLG in their 5 Family Intervention factors talk about “A dedicated worker, dedicated to a family” and “Considering the family as a whole- gathering the intelligence”They also talk about “A persistent, assertive and challenging approach”. Louise Casey would say Why called Troubled Families, we need to be honest with families about the label, not all LAS in the West Midlands have subscribed to this with some including my own calling the programme something else. But most agree more honest and intrusive conversations than have been had before.More intensive than most agencies have had time to be involved before, Caseloads of only 5 for the most challenging families, key worker visiting several times a day, early in the morning, or in the evening to establish routines with the family
  • As I said One of the 5 Family Intervention Factors promoted by DCLG is
  • DCLG Working with Troubled Families – A Guide to the evidence and good practiceCertainly need to train recruited or identified workers?NVQ 4 “Working with Families with Multiple and Complex Needs” which some las are using, some adapting adding modules they think are missing and DCLG / DfE are reviewing this qualificationBut is this a new profession?
  • Either way need to be developing the Evidence base of impactCurrent evidence base for Troubled Families comes mainly from what is known as the Dundee model – a project in Dundee that started in 1995 – and from the subsequent development of Family Intervention Projects. However there are limitations to this evidence – lack of control groups, dependency on project or worker assessment of outcomes, limited information on whether improvements sustainedThe payment mechanism for Troubled Families will require all of us to provide very clear evidence of outcomes against the three national criteria but this may not capture other outcomes achieved, anything about sustainment or provide the evidence in such a way that provides a clear business case for continuation funding.
  • The SCN oversight group is the decision making body for the SCNs ;maintains authoritative power on matters relating to network activity. Whilst it is the overarching body for the individual SCNs, day-to-day strategic and operational decision making responsibilities are devolved to the individual SCN steering groups.
  • Membership as above. ToR in draft – group now needs to be formed and start to meetOur “plans on a page for the SCNs have been submitted to Stephen Cartwright and David Levy and favourable feedback received, now need to develop these high level priorities into PIDs for submission March 31st – on track and raring to go

Master Presentation - Health & Wellbeing event 14.03.13 Master Presentation - Health & Wellbeing event 14.03.13 Presentation Transcript

  • Health & Wellbeing in the West Midlands:Making it work across the NHS & LocalGovernment14th March 2013
  • LogisticsMobiles to silent pleaseNo scheduled fire alarmWiFi password is…Refreshments and lunch will be served next doorLinks to slides and outputs from the day will be available oniewm blog: www.iewm.net/making-it-work
  • Welcome & introduction to day Richard Humphries The 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
  • 8
  • NHS structures have become more complex...and new roles forlocal government-
  • ....in the West Midlands
  • Austerity - economic & fiscal prospects are dismal Source: NIESR
  • Quality & safety
  • West Midlands spend on health, care & wellbeing Housing Children’s Adult Education Local authority total social care Social Care £0.2b £0.7b £1.5b £4.5b £6.9 billion Public health £0.3b CCG allocations £6.6 billion Other health commissioning (NHSCB/CSU)
  • The total resource Total £13.8b billion 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
  • What’s it like for you ?Nick Bell, CEO, David Hegarty,Staffordshire County Council CCG Lead, DudleyJo Davidson, DASS/DCS, Dr Richard Harling, DPH,Herefordshire Council 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 New ways of working for Integrated commissioning public health in Coventry in Staffordshire New approaches to Troubled Families in Integrated dementia care Wolverhampton in Dudley
  • Integrated commissioning & partnerships Eric Robinson Staffordshire County Council
  • New ways of working for public health Jane Moore Coventry City Council
  • Coventry:“New Ways of Working for Public Health” Dr Jane Moore Director of Public Health - Coventry
  • 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-Smith Dudley Metropolitan Borough Council
  • New approaches to Troubled Families Sarah Norman Wolverhampton City Council
  • Troubled FamiliesSarah Norman – Chair Regional Troubled Families Network
  • Henry Ford?
  •  Information Sharing Whole family working Difficult conversations Intensive
  •  “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?
  •  “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?
  •  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
  •  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?
  • Lunch & networking 12.30-1.30pm
  • Making it work in the West MidlandsPeter Hay Sue Ibbotson Wendy SaviourWest Midlands ADASS Public Health England NHS Commissioning Board
  • The role of the NHS Commissioning Board in the West Midlands Wendy Saviour, Director,NHS Commissioning BoardBirmingham, 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 PresenceNHS 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 Midlands o Birmingham, Solihull and the Black Country o Arden, Herefordshire and Worcestershire40 o Shropshire and Staffordshire
  • 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 Boards41
  • 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 healthcare42
  • Our role• Allocate resources to CCGs• Support and hold to account CCGs• Direct commissioning responsibility for: o Primary care o Specialised services o Public Health, Military and Offender health services• Strategic, clinical and professional leadership across Local Area• Clinical Networks and Senate43
  • Clinical Networks and Senate NHS Outcomes Framework Strategic Local Operational Other Senates Clinical Professional Delivery Local [12] Networks Networks Networks Networks“The “Engines for “Gathering “Mapping patient “15 AHSNs: Mastersconscious change and frontline pathways to ensure of science andand guiding improvement knowledge and access to specialist evidence basedintelligence” across complex expertise” support” practice” care systems”Multi- i.e. Cancer; CVD; i.e. Pharmacy; Eye e.g. Adult Critical e.g. Academic Healthprofessional Maternity and health; Dental Care; Neonatal Science Networks, Children’s; Mental Intensive Care; Research Networks Health / Dementia / Trauma; Burns; Neurological Paediatric NM; Conditions Paediatric IC NHSCB Network Support Teams (AT-based) Annual national priorities from the NHSCB Medical and Nursing Directorates All supported by Improvement Body and Leadership Academy
  • 45
  • The West Midlands Clinical Senate NHS “The Senate, an assembly of some three hundred of Outcomes Rome’s great and good, generally acknowledged - Framework even by those not in it - to be both the conscience and the guiding intelligence of the Republic. Senates [12] Membership of this elite was determined not“The consciousand guiding automatically by birth but by achievement andintelligence” reputation…..Multi-professional “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 AssemblyThe 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 SCNs will operate for cancer; cardiovascular; maternity Strategic and children; mental health, dementia and neurologicalClinical Networks conditions from April 2013.“Engines for change A model through which professionals and organisationsand improvement will come together, working across boundaries to:across complex caresystems”  deliver programmes of continuous quality improvementi.e. Cancer; CVD;  contribute to the achievement of outcomeMaternity and ambitions for patients, and benefit populationChildren’s; MentalHealth / Dementia / health, where there is a need for whole system orNeurological Conditions collective improvement endeavour.
  • SCN Oversight Group West Midlands SCN Oversight Group Cancer SCN Cardiovascular Maternity & Mental H, Dementia & Steering Group SCN Steering Children SCN Neuro Conditions SCN Group Steering Group Steering Group SCN sub-groups / task and finish groups together with county specific groups / local implementation teams50
  • Core Membership of SCN Oversight Group Acute CEO Representative Area Team Patient Representation Medical Directors SCN/Senate Associate Director, SCN Clinical Directors, SCN Network Managers Commissioning Mental Health COO CEO representatives representative for each county Specialised Commissioning Director51
  • 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
  • Slides, videos and other materials from the daywill be available at www.iewm.net/making-it-work R.Humphries@kingsfund.org.uk Twitter @richardatkf