Rewiring local health services

1. Rewiring local health services Abigail Gallop Senior Adviser (Health) 26 September 2013 www.local.gov.uk

2. Summary • Where we are – public health transition • Public health funding • Health and Wellbeing Boards • Integration • Rewiring health services • Available support • Questions www.local.gov.uk

3. National structure • DH – overall policy direction of the system • NHS England • Operation and delivery of NHS – CCG commissioning plans • Commissions some PH and community health services under Mandate with DH • Local Area Teams – key contact for HWBs • Public Health England • Health protection • Provision of information and support to public health sector • Healthwatch England • Supports local Healthwatch

4. Public Health England Infectious diseases Immunisation Standardisation and bio medicines Environmental hazards Emergency preparedness Health intelligence Nutrition NHS Commissioning Board Screening Children’s public health (0 – 5) Public health of prisoners PHE/NHSE responsibilities

5. Weighing and measuring children Dental public health Fluoridation Medical inspection of school children Sexual health Seasonal mortality Accidental injury Physical activity Drug, alcohol and tobacco misuse Obesity NHS health check programme PH information to NHS Health at work Reducing and preventing health defects Prevention and early intervention Children’s public health (5 – 19) Social exclusion LA Public health responsibilities – 2013

6. Public health support • Timetable of events run by the LGA “Changing behaviours in public health – to nudge or to shove?” 15 October • Publications – latest September publication “NHS Health Check – frequently-asked questions” • Health and Wellbeing System Improvement Programme

7. Health and Wellbeing Boards • Local decisions and priorities • Leadership • Membership and structure • Important role of district councils • Emerging themes • Alignment with CCGs • Integration

8. Health and Wellbeing Boards Support • Health and Wellbeing System Improvement Programme: • Healthwatch Implementation Team • Healthwatch Impacts and Outcomes Toolkit • Health and Wellbeing Peer Challenge • Self-Assessment Toolkit • Systems Leadership • LG Inform • Events, information, knowledge hub, learning, publications

9. Integration • £3.8 Billion Integrated Care Fund: “a single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities” – “Integration Transformation Fund” • Not until 2015/16 but need to build momentum now, using the additional £200 million due to be transferred to local government from the NHS. Two-year plan needed by March 2014. • Pioneers • Role of HWBs

10. Support on Integration • LGA Whole System Integrated Care and Support project • Knowledge hub community • Integrated Care Toolkit • An overarching ‘Value Case' for integrated care • ‘Value case' summaries from 8-12 local areas demonstrating whole system integrated care • An evidence journey through the system at a local level • A searchable database of integrated care initiatives throughout the country • A signposting tool • A model showing the impact of different interventions or whole system models of integrated care on outcomes, cost, activity and individual • The toolkit is designed to be useful for all partners at a Health and Wellbeing Board level, particularly in the context of supporting joint business planning for the £3.8bn Integration Transformation Fund and a desire locally to drive more integrated health and care.

11. Rewiring health services • All health and social care consistently coordinated around the needs and wishes of the individual: • Focus on what people can do rather than what they can’t do • Personal wellbeing budgets • Recognising and supporting the crucial role of family, carers and neighbours

12. Rewiring health services • Place-based public service budgets • Local commissioners to direct resources • Ring-fenced budgets irrelevant as unnecessarily restrictive • Savings in acute services from more effective prevention reinvested in supporting the local community • Consumer Champions not inspections

13. Rewiring health services • Health and wellbeing boards strengthened to extend their leadership across local services • Involving the full range of health services including community, mental health and acute trusts • Signing off health and care commissioning plans to ensure alignment with democratically-mandated local services • Extending joint commissioning across core social care and health budgets

14. Summary • More public health functions moving into the local authority • Increasing leadership role for the Health and Wellbeing Board • Increasing focus on integration of services and budgets • Person-focused, not service or condition • ‘Local champions’ not inspections

15. More information • LGA website: www.local.gov.uk/health-wellbeing-and-adult-social-care • LGA Knowledge Hub – https://knowledgehub.local.gov.uk • LGA Events - http://www.local.gov.uk/events • Direct contact: • Alyson Morley – alyson.morley@local.gov.uk • Paul Ogden – paul.ogden@local.gov.uk • Abigail Gallop – abigail.gallop@local.gov.uk