Working Together

Tim Crayford Maggie Atkinson

John Dixon

Dr. Tim Crayford

President, ADPH

Director of Public Health & Medical Director, Croydon NHS Primary Care Trust

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

Our Health, Our Care, Our Say

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

with LAAs

NHS view on commissioning

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

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

Pulling it all together

Annual Public Health Report(HEAs)

6 Domains of Choosing

Health

JSNA

LSPLAA

JSNA

DPH

DCSS DASS

JSNA

Care Services Ideal

Need Demand

Want

Efficient delivery

Need Demand

Want

Current Care Services

NeedDemand

Want

Wellness needs?

NeedDemand

Want

Challenges: Joint DPH Appointments

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

Challenges: JSNA Information

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

Dr. Maggie Atkinson

President, ADCS

Director of children’s services, Gateshead Metropolitan Borough Council

Children’s 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.

Who’s 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 ......

• 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 .....

• 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

Circle ofintimacy

Mum, Dad, carer,brothers & sisters

others at home

Circle ofexchange

Circle ofparticipation

Circle offriendship

Aunt oruncle

Godparent

grandfather

bestfriend

cousin

grand mother

Placesof

worship

People in

the park

Parents’friends

Other children in school

Communityof

neighbours

Classmates

Footballor other sportsclubs

scouts browniesguidesCadetsetc

Nurses

PoliceAnd support

officers

Firefighters

Nannyor

childminder

Shopkeepers

Community wardens

Therapy servicesBaby sitter,

Child minder

Librarian

Educational Psychologist

Learningsupportassistant

Dinnersupervisor

Lollipopperson

Doctors, health workers

Teachers,tutors

LeadPractitioner(s)

Outreach workers

Advisers, mentors

EducationWelfareService

Social worker

Step sibling

People nextdoor

John Dixon

President, ADAS

Director of Social & Caring Services,West Sussex County Council

Inequalities and Well-being –Working Together

John DixonExecutive Director of Adults and Children, West Sussex County

Counciland President, ADASS

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

• DASS’s huge assimilation of roles

DASS: Joined Responsibilities

50% - Housing40% - Crime Prevention

RegenerationSafer CommunitiesNeighbourhood Services

25% - Culture, Leisure, adult learningMost - Health10% - Children’s as DCS

Targeted help to individuals

Support to Communities

Infrastructure for Community development and self-help

Professional gift relationshipSpecialised

interventionsResource Intensive

SustainabilityCustomer in

control

All our Tomorrows - Revisited

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

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

Personalisation, Eligibility & The Green Paper on Care & Support• It’s 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?

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 children’s services with acknowledgements to Mark Britnell

ADASS Business Unit

Local Government House

Smith Square

London SW1P 3HZ

Tel: 020 7072 7433

Fax: 020 7863 9133EMAIL: team@adass.org.uk WEB:

www.adass.org.uk