Working Together

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Working Together

• Tim Crayford
• Maggie Atkinson
• John Dixon

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Dr. Tim Crayford

• President, ADPH
• Director of Public Health Medical Director,
  Croydon NHS Primary Care Trust

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Central Government

• Our Health, Our Care, Our Say DH 2006
• To ensure there is more visible local leadership
  on health and wellbeing, particularly on public
  health issues such as childhood obesity, smoking
  rates and health inequalities. It is important
  that the local authority lead member for adult
  social services is able to influence the
  commissioning decisions of health and social care
  bodies, and drive action to reduce health
  inequalities
• by engendering systematic partnership working
  between NHS bodies, local authorities and other
  partners, for example through greater use of
  joint appointments, pooled budgets and joint
  commissioning. We want to see health and social
  care services delivered seamlessly around the
  needs of patients, families and carers, and local
  partners able to work together in tackling the
  wider causes of social exclusion, worklessness,
  and vulnerability

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Our Health, Our Care, Our Say

• New powers for Scrutiny (APHR)
• Jointly appointed DsPH
• LDPs to become more aligned with LAAs

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NHS view on commissioning
PPI
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Strong and prosperous communities

• by engendering systematic partnership working
  between NHS bodies, local authorities and other
  partners, for example through greater use of
  joint appointments, pooled budgets and joint
  commissioning. We want to see health and social
  care services delivered seamlessly around the
  needs of patients, families and carers, and local
  partners able to work together in tackling the
  wider causes of social exclusion, worklessness,
  and vulnerability
• local authorities will now be under a statutory
  duty to (establish) Local Involvement Networks
  (LINks)
• formal arrangements for Directors of Public
  Health to be jointly appointed and held jointly
  accountable by the chief executives of local
  authorities and PCTs

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Strong and prosperous communities

• statutory partnership for health and well-being
  under the LSP
• Strengthened role for LA Scrutiny esp. in
  relation to the DPH and the APHR
• A new Lead Member at local authority executive
  level, whom we will expect to play a leading role
  on local health and well-being partnerships
• LAAs strengthened

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Pulling it all together
Annual Public Health Report (HEAs)
LSP LAA
6 Domains of Choosing Health
JSNA
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JSNA
DPH
JSNA
DASS
DCSS
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Care Services Ideal
Need
Demand
Want
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Efficient delivery
Need
Demand
Want
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Current Care Services
Need
Demand
Want
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Wellness needs?
Need
Demand
Want
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Challenges Joint DPH Appointments

• Variable interpretation
• Clearly the right direction
• Need to remain NHS-based
• ?account via the LSP

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Challenges JSNA Information

• Accessing it
• Pooling it
• Analysing it mapping it
• Presenting it in a JSNA
• Sharing our experiences with it

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Dr. Maggie Atkinson

• President, ADCS
• Director of childrens services, Gateshead
  Metropolitan Borough Council

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Childrens Services integrated!

• We are charged with being outcome focused ......
• not process obsessed or stuck in old models
  ......
• Which means a focus on addressing and narrowing
  gaps and taking out inequalities
• We are REQUIRED to work together Health's NSFs,
  Every Child Matters, Our Health Our Care Our Say
• ...And my friend, Mrs Cannybody.

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Whos she?

• She lives on Ubiquity Street, Anytown,
  Everyshire, in social housing, on the minimum
  wage
• She's a single parent and a busy woman
• She wants to ask one person for help, guidance,
  advice on public services and get a straight
  answer
• where to go
• what to do
• how to get support
• She wants her family to be healthier and better
  placed than she is
• She is not interested in who pays your wage, or
  mine
• She's interested in ......

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• Good ante-natal, maternity and post-natal care
  for herself
• Advice on her baby, her older child, her teenage
  stepchild's smoking, drinking and risk taking
  lifechoices
• Advice on lifestyles, when  finances are tight
  and diet, fitness, exercise
• Advice on stress  hers and others'...  and on
  stopping smoking
• She wants us to .....

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• see the person, not the episode or the casework
• ask her to tell her story once,
• safely share and use what she tells us
• keep our promises that we can help
• think wellbeing and wellness, and
• plan services around helping her attain them
• join up to support her and her family, and MEAN
  IT!
• not make her second guess or be clever or
  articulate to get what's needed

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Circle of exchange
Lead Practitioner(s)
Nurses
Advisers, mentors
Circle of participation
Teachers, tutors
Outreach workers
Places of worship
scouts brownies guides Cadets etc
Dinner supervisor
Circle of friendship
Police And support officers
grand father
grand mother
Social worker
People next door
Circle of intimacy
Fire fighters
Football or other sports clubs
best friend
Mum, Dad, carer, brothers sisters others at home
Aunt or uncle
Lollipop person
Nanny or childminder
People in the park
Godparent
Doctors, health workers
cousin
Community wardens
Class mates
Step sibling
Parents friends
Education Welfare Service
Community of neighbours
Learning support assistant
Other children in school
Shopkeepers
Librarian
Therapy services
Baby sitter, Child minder
Educational Psychologist
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John Dixon

• President, ADAS
• Director of Social Caring Services,West Sussex
  County Council

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Inequalities and Well-being Working
TogetherJohn DixonExecutive Director of
Adults and Children, West Sussex County
Counciland President, ADASS
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Adults Services A Changing Role

• Life Chances of Disabled People Opportunity
  Age
• Independence, well-being and Choice Our
  Health, Our Care, Our Say
• Safe and Prosperous Communities
• Place Shaping and The rise of well-being
• Shift in relationship between state and
  citizens
• 100 of population and personalisation
• DASSs huge assimilation of roles

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DASS Joined Responsibilities

• 50 - Housing
• 40 - Crime Prevention
• Regeneration
• Safer Communities
• Neighbourhood Services
• 25 - Culture, Leisure, adult learning
• Most - Health
• 10 - Childrens as DCS

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All our Tomorrows - Revisited
Professional gift relationship
Specialised interventions
Resource Intensive
Targeted help to individuals
Support to Communities
Infrastructure for Community development and
self-help
Sustainability
Customer in control
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Infrastructure for citizens to support informed
safe choices to help providers

• Housing/Accommodation/Supporting People
• Public Health
• Community Health
• Transport
• Access to Employment/Workforce
• Social Inclusion
• Lifelong Learning
• Community Safety
• Regeneration
• Leisure Recreation opportunity

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Effective Joint Commissioning

• All about patient/care pathways
• Best mix for patients of health/social care/3rd
  sector input
• From self-care to tertiary care
• Choice and control from professionals to
  users/patients
• Transferring activity finance within care
  pathways the 5 plus test
• Joining the two commissioning frameworks
• Achieving - user satisfaction
• - clinical outcomes
• - reconfiguration
• - financial sustainability

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Personalisation, Eligibility The Green Paper
on Care Support

• Its about Social Justice as much as funding
• Need to agree principles of new settlement first
• Rethink dependency and contribution
• The two groups those currently eligible for
  state funding
• those outside of the state net
• Those currently funded not much longer
  affordable
• to be
  given control
• Those not now funded more than half the
  population
• Transparency and eligibility
• Some help for everyone, and more for those who
  need it most
• Public knowledge and affection NHS vs. social
  care
• The weakest link in the welfare state assurance
  for old age and disability?
• Affordability and 1.1trillion insurance risk
  capping?

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World Class Commissioning and Putting People First

• Comprehensive understanding of the needs of
  everyone in the community
• Planning in partnership with users and carers for
  services to meet agreed outcomes through improved
  choice and control
• Work with providers and Third Sector to develop
  services for independence and well-being
• More intelligent and responsive procurement of
  services to improve outcomes.
• Ensure individual purchasing is as near to the
  person as possible
• Improving evaluation of service provision as a
  return on investment
• Need to join up governance, leadership, basic
  skills and knowledge
• Need for workforce development
• Practice based commissioning focus on needs of
  communities
• links with local government social care and
  childrens services
• with acknowledgements to Mark Britnell

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